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Nicole Gunawansa | November 18th, 2015
This interview was held on May 25th, 2015 in the Tohoku Medical Megabank Building

Part 2- Conception and the Global Vision of ToMMo

Question 4: Please discuss the creation of ToMMo. What was the motivation and thought process behind this organization?

Dr. Yamamoto: The notion of the Tohoku Medical Megabank Organization (ToMMo) originated due to 3/11. In the time after a debilitating disaster, the best hope for a brighter future for Tohoku was a project that embodied creative regeneration. The Tohoku region is heavily based in agriculture and fishery. It was imperative that the situation be improved by going above and beyond in customary rebuilding efforts: Tohoku needed to be built back better.

Dr. Yamamoto meeting ToMMo Clinical Fellow working at Ongawa Community Medical Center.

In order to achieve this goal, we needed to establish an innovative research center, bringing good scientists together for effective collaboration and regional revival. The aspiring objectives of this innovative institute were (and continue to be) noble: 1) improve the physical and mental welfare of the disaster affected populations with genomic based medicine, 2) create a new, community wide medical record system heavily based on ICT (to replace the paper system that dreadfully failed when the tsunami washed away thousands of records), and 3) alleviate the doctor shortage in the devastated coastal area by establishing a fellowship rotation program geared towards capable physicians. ToMMo was proposed to meet all of these goals while integrating genome cohort science, including an affiliation with a bio-bank. Our genome project is primarily focused on disaster-affected people, and we hope to recruit 150,000 participants for a robust genomic analysis of the impact of natural disasters on the human body. The young physicians in the ToMMo Clinical Fellowship (TCF) program also experiences the ever-advancing world of genomics as their specialty training in Sendai includes clinical genetics, in the hopes that these doctors can contribute to promote patient health through genetic research. Overall, ToMMo is an organization created to remember the poignant past and move towards the healthier future.

Question 5: What has your position as Executive Director of ToMMo taught you about disaster medicine and organizing disaster relief efforts?

Dr. Yamamoto: As Executive Director, my job is to navigate and realistically organize ideas from the community and administration. I also am expected to be ToMMo’s spokesman to the Japanese government and society. Having such great responsibilities is a tough business, but definitely worthwhile. As a molecular biologist, I still want to work on basic science, but now my primary duty is to help this society recover. I speak to people who question our project by advancing the comprehension of our project, conveying the present and future benefits of ToMMo. When I think about the geological situation in Japan, I recognize that the people of Japan cannot control or predict the next natural disaster; however, we can prepare, protect, and recover from future disaster situations. Japan must conduct itself in the best way, ensuring good preparedness and prompt recovery; I am happy to be a part of this progressive, meaningful endeavor.

Question 6: What is the global vision of ToMMo? Do you hope to expand the participants to include people from other places like Fukushima or to "export" this scheme or to collaborate with other cohort studies?

Dr. Yamamoto: ToMMo is Japan’s forerunner in the ever developing world of bio-banks and genome cohort based research. Bio-banks always need genome cohort as a fundamental, but our bio-bank has a new approach: an integrated bio-bank. Normally if you donate samples (blood, urine, etc.) it is a limited resource, but we hope for a longer term use of these samples to limit the number of biological samples taken from participants. In order to do this, ToMMo staffs carry out the data analysis by themselves to mitigate superfluous analysis and waste of resources, providing the information rather than the sample. The bio-bank plus information storage plus analytical center amalgamate to make ToMMo. Essentially, our analytical center does the initial analysis of various types of samples, and provides the information (rather than the real samples) to other areas of the organization for further research. This concept originated from the UK Biobank style. UK biobank is the storage bank, and nearby is the affiliated Sanger Institute where analysis is done. ToMMo has integrated these two primary aspects of genome medicine into one advanced organization, promoting higher standards of data management, distribution, and exploration.

Opening remarks by Dr. Yamamoto at the Karolinska-Tohoku Joint Symposium on Medical Sciences.

ToMMo has been working on the genome analysis, proteome analysis, and metabolome analysis. Our collaborator, Iwate Medical University, have been performing an epigenome analysis and transcriptome analysis. These analyses are conducted in a combined effort, between these two universities. If our collective data is of interest to others in this field and these outside (domestic and international) researchers want to contribute to our analysis, then we will only provide a small amount of samples for their separate research projects. This is how ToMMo functions, in this integrated manner, and I believe that our bio-bank model will soon develop all over the world. As of now, Karolinska Institute Biobank in Sweden and the Taiwan Biobank are going in the same direction. I believe that we (ToMMo) are leading the way for better genomic research, with these other international bio-banks, and that is our broad global impact.

As for Fukushima, I really wanted to help people there, and when we planned this Tohoku Medical Megabank Project we discussed collaboration with Fukushima Prefecture. However, Fukushima wanted to develop by itself, utilizing the support they have received from all over the world, and they would rather take on a similar endeavor geared towards the people of Fukushima. It is important to understand that the small cohort business is distributed all over Japan, and most of these institutes have a classical cohort approach: focused on associations (e.g. interpreting the relationship between increased sodium and increased hypertension). Yet, in order to find cause and effect, a classical cohort much be transformed into a genome cohort — evaluating genetic and environmental interactions. ToMMo hopes to exemplify a high standard of research and encourage the transition towards genome-based analysis in Japan.

Go to the next part.

Related Link

To Place Seeds of "Hope" in Tohoku Now (Interview from ToMMo's public magazine "phrase" Vol.1)
Iwate Tohoku Medical Megabank Organization