J. Terry Ernest, pioneer of cell transplantation for eye diseases, 1935-2013
January 8, 2014
A physician-scientist who broke new ground in cell transplantation for eye diseases, J. Terry Ernest, MD, PhD, the Cynthia Chow Professor Emeritus and former chairman of Ophthalmology and Visual Science at the University of Chicago, died on Dec. 26, 2013, in Chicago after a long illness. He was 78.
Ernest's seminal work on ocular blood flow influenced a generation of researchers studying the retina and glaucoma. Late in his career, Ernest turned to the study of macular degeneration and its potential treatment by cell transplantation. His work in this area helped establish underlying concepts for stem cell therapy and has had an impact on numerous other fields of medicine.
In 1997, Ernest led a team that performed the world's first fetal retinal pigment epithelial cell transplantation, an experimental procedure that aimed to treat age-related macular degeneration. His efforts to develop innovative therapies for the disease, which affects millions around the world and is the major cause of blindness in the elderly, led Time magazine to declare him a "Hero of Medicine" in the fall of that year. Although the procedure did not become a standard therapy, it greatly influenced future treatments for macular degeneration.
"Dr. Ernest was a remarkably versatile and visionary ophthalmologist who impacted a broad range of ophthalmologic subspecialties," said Mark Greenwald, MD, professor and interim section chief of Ophthalmology and Visual Science at the University of Chicago. "His work on macular degeneration provided one of the sparks that set off a true therapeutic revolution, inspiring his co-investigators to play a pioneering role in the development of a new class of drugs that inhibit abnormal blood vessel growth in the eye, which now provide enormous benefit."
The first commercially available drug of this class (anti-VEGF), pegaptanib (Macugen), was developed in large part by Terry's colleague and collaborator Samir Patel, MD, co-founder and president of Ophthotech Corporation and a former associate professor of ophthalmology and director of the retina service at the University of Chicago.
"Terry was a role model, mentor and a great friend. He influenced so many of us by his enthusiastic spirit, love for science and patients and a genuine passion for teaching," Patel said. "His unwavering support was instrumental and the main reason behind my decision to take a leave of absence and move into industry. It allowed me to become the co-founder of the company that developed the first anti-VEGF and FDA-approved therapy for wet age-related macular degeneration (AMD).
"Today, millions of patients globally use the second-generation drugs from innovative companies targeting VEGF and hence prevent blindness in the elderly citizens of the western world. My role with the team that was responsible for introducing the era of pharmacotherapy for wet AMD would not have been possible without Terry. I am forever indebted and grateful".
In addition to Patel, Ernest collaborated with or nurtured nearly all of the prominent eye and vision researchers who were associated with the University of Chicago in the late 20th century, including Albert Potts, MD, PhD; Alex Krill, MD; Ramesh Tripathi, MD, PhD; Joel Pokorny, PhD; and Vivianne Smith, PhD, as well as two who remain active at the University of Chicago, Steven Shevell, PhD, and Rima McLeod, MD.
"It is hard to think of a contemporary who had impact in a broader range of ophthalmologic subspecialties," Greenwald said. "It is an interesting twist of fate that Terry's groundbreaking research on stem cell transplantation impacted other areas in medicine more than our own, while Judah Folkman's contemporaneous work on angiogenesis at Harvard has benefited patients with eye disease, including macular degeneration, much more than the cancer patients who inspired it. I believe Terry's stature and legacy will only grow over time."
J. Terry Ernest was born on June 26, 1935, in Sycamore, Ill., the younger of two sons, to Abigail and Edward Terry. His father was a farmer and raised sheep; he also moonlighted as the local mailman. His mother, a homemaker who was Swedish, encouraged her children to learn only English. Ernest's elder brother, Thomas, remained in the Sycamore area his entire life and passed away 14 years ago.
Ernest was a basketball star in high school and was known for his love of horses and motorcycles. When he left home at age 17 to pursue a bachelor's degree in biology at Northwestern University, he rode his motorcycle to the dorms.
He was a member of the University of Chicago community for the majority of his life, earning his MD in 1961 and his PhD in visual science in 1967. He trained with Frank Newell, MD, the first chairman of the Department of Ophthalmology and Visual Science, as a resident, and with Albert Potts, MD, PhD, an internationally respected pioneer in ophthalmic research, as a PhD student.
"He always would joke that he chose the eye during medical school because he thought the eye was so small. How complicated could it be?" recalled Bill McMahon, Ernest's son-in-law. "Of course, little did he know, he would say, how wrong he would be, how the eye is one of the most complex organs and so difficult to perform surgery on. From the beginning he wanted to do research and be a leader. He devoted himself to the field."
After a year as chief resident in ophthalmology at what was then known as the University of Chicago Hospitals and Clinics, Ernest joined the faculty as instructor. He served as a lieutenant colonel in the Army Medical Corps during the Vietnam War and was based at the Walter Reed Army Institute of Research in Maryland from 1967 to 1970.
Ernest returned to the University of Chicago in 1970, first as an assistant professor and then associate professor of Ophthalmology and Visual Science until 1977, when he left to serve on the faculties of the University of Wisconsin, Madison, Indiana University Medical School (where he was the Coleman Professor and chair of ophthalmology) and the University of Illinois at Chicago.
In 1985, he re-joined the University of Chicago for good as professor and Chairman of Ophthalmology and Visual Science, a position he would retain until 2004. Ernest's interest in fetal cell transplantation led him to advanced study of medical ethics, including a sabbatical from 2004 to 2005 devoted to medical ethics and the law at the University of Manchester in England.
"Terry Ernest was one of the first faculty from the Medical Center to join us and work closely with the ethics center," said Mark Siegler, MD, the Lindy Bergman Distinguished Service Professor of Medicine and Surgery at the University of Chicago, founding director of the University of Chicago's MacLean Center for Clinical Medical Ethics, and executive director of the Bucksbaum Institute for Clinical Excellence.
"When Terry began thinking of ways to treat macular degeneration using transplanted cells, he came to the MacLean center and requested a 'Research Ethics Consultation.' This was an approach to new, cutting-edge research ideas that we had launched at the University a few years before and that became a national standard in later years. Terry was a pioneer in using the Research Ethics Consultation and remained involved in the activities of the ethics program until he retired. He was a wonderful, caring physician, a gentleman, and a great colleague," Siegler said.
In 2002, Ernest was appointed the first Cynthia Chow Professor and held that title until 2011. He continued to see patients in clinic until 2007.
McMahon said his father-in-law modeled his career after Newell and Potts. "It was his goal to be chairman of the department, and he lived his dream," he said.
Ernest received numerous awards during his career, including a Research Career Development Award from the National Institutes of Health, a Heed Ophthalmic Foundation Award and an Honor Award from the American Academy of Ophthalmology. He was included in Chicago magazine's "Best Doctors" list in 2001 and was a member of many societies, including the American Association for the Advancement of Science and the American Ophthalmological Society.
Ernest also was a prolific author. With Newell, he co-authored the widely used textbook Ophthalmology: Principles and Concepts, beginning with the third edition (1974). He edited the popular compendium The Year Book of Ophthalmology from 1982 to 1988 and was editor of Investigative Ophthalmology & Visual Science, one of the leading journals for eye and vision research, from 1983 to 1987. He played leadership and oversight roles in the Association for Research in Vision and Ophthalmology and the National Eye Institute. Among the many funders who supported his work were the National Institutes of Health and Research to Prevent Blindness.
Ernest's greatest legacy, however, may be through his teaching.
"As a clinician, he was a true role model for approximately 50 outstanding physicians who trained under his leadership," Patel said. "Terry worked tirelessly with clinical hours every weekend. Never rushed, always focused and ready to sacrifice for the best interest of his patients. His infectious sense of humor has touched all of us who trained under him."
"He was a guiding light for me in entering this amazing field of ophthalmology," said Chris Albanis, MD, clinical associate of Ophthalmology and Visual Science at the University of Chicago, who served as a resident during Ernest's tenure as Chair.
"He not only taught me diagnostic skills, but how to be a good doctor: Sit at eye level, listen to the patient, try to be the last one to leave the room as the patient will always have something to share as they leave. These are some of the many things he taught me, amongst the importance of hard work. Even as chairman, he continued to have clinic every single Saturday of the year," Albanis added.
Ernest is survived by his daughter, Sarah Ernest McMahon, and granddaughters Sadie, Malley and Kimberly. He was preceded in death by another daughter, Kimberly. The memorial service will be held on January 25, 2014 at 3 p.m. at Bond Chapel followed by a reception at 4 p.m. to 7 p.m. at Quadrangle Club.
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