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Campus Now

July

SPECIAL REPORT

The possibility of medicine is expanded through an encounter of medicine, science, and engineering.

Challenge of the Institution for Advanced Biomedical Sciences

Waseda University and Tokyo Women's Medical University have cooperated and exchanged ideas in research for 40 years, with the goal of combining science, engineering, and medicine. Now, the two universities have begun operations at the Joint Institution for Advanced Biomedical Sciences, and a full-fledged partnership system has been started. In order give a better understanding of the current situation, leading professor from both universities discussed the increasing expectations and future issues. Also, the voices of corporations are represented.

Dialogue

A discussion was held regarding the path to the establishment of the Tokyo Women's Medical University / Waseda University Joint Institution for Advanced Biomedical Sciences in March 15, 2008. Also discussed where the goals and future expectations for the institution.

A ray of light to advanced medicine through the combination of medicine, science, and engineering

The starting point was joint research for artificial hearts.

--- In 2000, Tokyo Women's Medical University (hereafter referred to as Women's Medical University) and Waseda University (hereafter referred to as Waseda) conducted an agreement for scholastic exchange. Since that time, the two universities have work for scholastic exchange. I believe that there was exchange even before 2000. How have the two of you exchanged to each other's university?

Umezu: If you trace back the first contact between Waseda and Women's Medical University, it seems that Shigenobu Okuma attended Women's Medical University's first graduation ceremony as a guest. At the time, gender-based discrimination was still common. When one of the guests questioned whether women were capable of becoming doctors, Okuma is said to have reprimanded the guest. Then, in 1965, Professor Shigeru Sakakibara, who was a prominent person in the field of cardiac surgery, proposed joint research in artificial hearts to Professor Kiichi Tsuchiya, a mentor of mine who was involved in fluid control engineering. This was the start of exchange between the two universities.

By the way, the reason that I enrolled in Professor Tsuchiya's seminar was that he was involved in research and development for railroads. I am a huge fan of railroads. But, Professor Tsuchiya recommended that I pursue research related to medicine. When I replied, somewhat unthinkingly, that "the fields of fluid control engineering and medicine are unrelated", the Professor made a disappointed face and said the following.

"The point isn't whether there is a relationship or not. What is important is how much of a relationship you can create. Blood flows in our bodies. Isn't this flow of blood controlled by our nervous system, like a flow control? How can you say that there is no relationship?"

At the time, I thought "there is absolutely no relationship". However, from the following day, I began going to the Women's Medical University and conducting animal experiments together with a cardiac surgeon. Over 100 dogs were used in a year of experiments. But, I really like dogs, so it was a very difficult experience for me and somewhat traumatic. So, I decided to research a method that could be used to reduce the number of animal experiments. I spent 30 hard years using modeling and simulation of the blood circulatory system in order to perform research that would be beneficial to medicine.

Okano: I was also a student of applied chemistry at Waseda, but I came to the Women's Medical University to perform experiments when I was pursuing my doctorate. This was a period of development for medical devices which were inserted into the human body, such as artificial hearts and artificial kidneys. At the time, Professor Yasuhisa Sakurai of the Women's Medical University was implementing outstanding Japanese technology into the School of Medicine in a timely fashion. Professor Sakurai spoke about wanting to create a facility for the development of new medical treatments. So, the Institution for Medical Engineering was established at the Women's Medical University and research was continued persistently. I entered the Women's Medical University and researched medical material for use in devices for medical treatment.

In order to heal a patient who doesn't heal by himself or herself, it isn't necessary for the doctor to try to solve every problem alone. If a variety of technology is implemented, then it is only natural that a good solution will be found. However, until now, doctors in Japan were trying to do everything themselves and having a difficult time. As a result of the establishment of this kind of institution, there is the joining together of medicine, science, and engineering. I believe that this will create new methods of treatment unavailable until now.

---I' m sure that a lot of difficulties were encountered up until the establishment of the joint institution. What kind of debates did you have?

Umezu: First of all, what everyone was thinking when they saw 6,600 square meters of land was for Waseda and the Women's Medical University to construct separate buildings and then join them with a connecting passage. But, we didn't share that idea. We wanted to create one building and get rid of the walls. Sure, there were some opposite opinions, people saying that operation would become difficult when two universities entered the same building. But, we recognized the importance of undertaking a new challenge that was unprecedented in the world. Everything started from that flow of ideas.

Okano: That's right. I believe that this joint institution became possible because everyone, including the directors and presidents of the universities, shares the same desire to take on a new challenge. Even if everyone understands the importance of joining medicine, science, and engineering, both the School of Medicine and the School of Science & Engineering have their own traditions and culture. Failure will occur if the unique elements of each school cannot be joined together. However, Waseda and the Women's Medical University have been cooperating since 40 years ago, which was a big factor in the success of this project./p>

Striving to develop personnel who will become global leaders.

---In my understanding, the objective of the joint institution is not just to contribute to medicine, but to develop personnel who support improvements in medicine. Specifically, what kind of personnel do you envision?

Umezu: From the perspective of the School of Science and Engineering, I think that almost none of the students have an interest in the field of medicine. I was also that way at first. However, I entered the research facilities of the National Cardiovascular Center, a facility where there were researchers with backgrounds in medicine as well as science and engineering. I learned a great deal through my encounters with people of different fields. There was an atmosphere where we would be discussing each other's research over a cup of coffee and suddenly decide to work together on our next project. I would like this joint institution to become that kind of place. I think that personnel required in the future will be researchers with a wide point of view. I believe that the joint institution is the ideal place to study such a wide perspective.

Okano: Exactly. Just like Professor Umezu says, we want to develop personnel who can incorporate new concepts into their own research, taking one project to completion while keeping the bigger picture in mind.

From the perspective of doctors, we need doctors who not only treat illnesses which are treatable, but also take on new challenges to treat illnesses which cannot be treated with existing medicine. Even for doctors who possess such dexterity that they are known as the "hand of God", they can do even greater things if they use technology. For example, if we can use robots to create a hand that is smaller than the human hand, they we can enter anywhere, even deep into the human body. Two human hands can be replaced by 100 smaller hands. Professor Umezu has a lot of this kind of technology available for use. I think that a new type of doctor will be born, one who uses technology to advance the field of medicine.

Umezu: There are already Waseda students who have encountered Professor Okano's new research, and written their doctoral theses on topics related to the content of that research. I feel that this is another thing that will lead to the birth of more and more new medicine and technology.

Okano: Well said. In the laboratory, students are performing experiments together without really knowing who is in the School of Medicine and who is in the School of Science & Engineering. Furthermore, on the topic of personnel development, I want to say that I would like to create an age in which Japan leads the world from now on. For that purpose, I want to give young people the kind of education that will enable them to become global leaders.

---Compared to movements overseas, how late is the Japanese movement for joining medicine, science, and engineering?

Okano: It's a completely different level. For example, all pacemakers are imported. Japan is this advanced when it comes to electronics, yet we can't make pacemakers in our own country. In America, they have implemented the latest technology in medical areas since long ago, striving to develop medicine. In university research, Harvard and MIT have an outstanding partnership.

However, our joint institution is holding its own. Even from a global perspective, our facility is extremely unique in that it has absolutely no walls and research is always performed closely together. People from the School of Science and Engineering can perform research while using the techniques of the School of Medicine. Doctors can bring more and more advanced devices into the sites of medicine. I want to make sure that we keep producing this kind of success.

Umezu: At the same time, we want to honestly evaluate new technology and create a system in which such new technology can be quickly used in clinical practice. In Japan, the process required until new technology can be used in clinical practice is extremely conservative. I don't want to sit around and wait for devices created by America. I want Japan to take the initiative in sending new technology out to the world.

Okano: It's true that Japan is conservative. When you count the number of the world's 100 most commonly used medicines that have not yet been approved by different countries, you see that the number for America is 0. England and France are both 5 or less. China is 20. But Japan tops the list at about 28. I believe that it is absolutely necessary for researchers and patients to work together in the future in order to create new methods of medical treatment. Here, I want to create a cycle in which world first technology is developed, doctors and patients join together to create new systems of treatment, and patients all over the world are treated.

The market for medical devices in Japan is one of excess imports. Within medical cost, the rate of acquisition of foreign currency is only 6 to 7 percent. Compared with other fields, there is no power to compete internationally as an industry. If new methods of medical treatment are created through a partnership of medicine, science, and engineering, and if these new methods can be sent out to the world, then industry will also grow.

Delivering new treatment to patients even one day faster

---Could you give me a couple of specific examples regarding the success of a partnership in medicine, science, and engineering?

Umezu: For example, the first thing that Waseda and the Women's Medical University created together was the artificial heart. 15 years ago, Mr. Kenji Yamazaki, a Professor at the Women's Medical University, proposed joint research with Waseda in order to create what he considered to be the ideal artificial heart. When professors in fields such as high-speed turbines, lubrication, and bio-engineering gathered together, they first consulted with each other and assumed the stance that "we won't become handymen for doctors". They decided to have serious discussions with each other, so that doctors would understand the important areas of our technology and so that we could understand what is important at clinical practice. They also decided to participate in animal experiments. An artificial heart known as Ever Heart was completed with the cooperation of 30 corporations. This artificial heart is used as an assist pump in patients with dilated cardiomyopathy. The first patient in whom this artificial heart was used went shopping at the hospital store only a short time after the operation. The patient left the hospital one year after the operation, and was working 8 hours a day only half a year later. This is one example of using a completely new approach to change the conventional wisdom of medicine.

Okano: Professor Tatsuya Shimizu, a specialist in cardiovascular internal medicine, was responsible for actually joining my development of cell sheet engineering (*) with medical treatment. Professor Shimizu had succeeded in creating technology in which cells taken from a newly born rate are moved inside of a culture dish. Last year, Professor Shimizu worked together with Professor Sawa of Osaka University to create cell sheets by cultivating cells taken from the muscle of a patient who had been fitted with an artificial heart and was awaiting a heart transplant. The professors then successfully completed an operation to attach the cell sheets to the patient's heart. 3 months later, the patient had recovered heart functions and the artificial heart was removed. Recently, the patient has recovered to the point where he is consulting with Professor Sawa about the possibility of working.

Students working under Professor Umezu are also interested in cell sheets, and research is being performed regarding muscle training for cells. This idea calls for the cultivated muscle cells to be made stronger before attachment to the heart.

Umezu: Through an idea of mechanical engineering, research has begun for the strengthening of cells themselves, something that was unimaginable in the past. This theme was born because we removed each other's barriers and held discussions.

Okano: My dream is to create a cell factory. In one room, cell sheets can only be made for one person. However, if we make it possible for robots to operate within a small box, then it would be possible to simultaneously produce cell sheets for many people by preparing multiple boxes. For this purpose, it is necessary for researchers to assemble from many different fields such as mechanical engineering, materials, and electricity. If there are encounters between a variety of fields, than a lot of new themes will be created. Also, there is the possibility of solving important issues contained in each of the different fields. This kind of thing will become possible at the new joint institution.

---What is a good image for future development of the joint institution? What are some issues pertaining to this development?

Umezu: In the future, we want to create an institution which joins together the world, not just two universities. We already have many visitors from overseas. In the future, it would be great if young people from all over the world have the goal of coming to our institution and if we can collaborate with each country. Fortunately, both Professor Okano and I have a good amount of experience working overseas, and we have experience in dealing with both different fields and different cultures simultaneously. So, I think we are capable of considering a system for receiving foreign exchange students.

Okano: I also want to accept students from Japanese universities through something like a short-term study abroad program. Furthermore, I want to advance partnerships between industry and academia, including overseas corporations. I also feel that it is necessary to hold discussions with governments and create new social systems in order to deliver new treatment to patients even one day faster. I think that it will be easier to advance these objectives now that a center like the joint institution has been established.

Realizing a new educational system to close the gap between medicine and science & engineering.

Okano: Up until now, Waseda has given birth to a variety of new technology. But, in the 21st century, don't you think that this potential can be maximized through a partnership with medicine?

Umezu: That's exactly right. A lot of people are changing their way of thinking, both engineers and doctors. I know a person who left Waseda to become a doctor. Now, that person is enrolling in graduate school while working because he wants to obtain a doctorate in engineering in order to give patients the best treatment possible. At this joint institution, I believe that we can perform outstanding education and research to respond to the needs of that clinician.

Okano: The current system of learning was segmented in the 20th century. However, the interdisciplinary aspect between different types of learning has fallen off and it hasn't been possible to get all the benefits. In particular, even though there is increasing importance of interdisciplinary fields between medicine and engineering, no action has been taken. It is unacceptable to continue using the 20th century system of learning to develop personnel which is the same as the 20th century.

Umezu: Very true. I feel that types of learning must be moved, boundaries must be overcome, and widening must occur. This is something that I want to transmit to the next generation.

Okano: I think that measures to close interdisciplinary gaps are extremely important for creating personnel for the 21st century. This is a type of education which didn't exist until now, with doctors, scientists, and engineers giving instruction from different sides. Also, instructors and students work together when considering themes and solutions.

Umezu: Even us professors are learning new things every day.

Okano: I hope that many doctors, scientists, and engineers will encounter each other at this joint institution, and that the discussion of future dreams will become a commonplace scene.

Umezu: There is no end once we begin discussing dreams with each other. Since we were in our 20s, we always thought about having a huge impact on the world once our time came. Let's leave a legacy of success that will surprise the world!

Cell sheet engineering

One method of regenerative medicine proposed by Professor Okano. Cells can be cultivated, removed from a culture dish, and directly attached to the transplant area. There are many examples of successful world-first regenerative treatments using cell sheets. For example, recovery of vision by regenerating the retina (undergoing clinical trials in France), regenerating the periodontal membrane to prevent teeth from falling out, and preventing strictures and accelerating recovery by attaching cell sheets to areas from which tumors has been removed during endoscope surgery for esophagus cancer.

Professor Teruo Okano
TWIns Tokyo Women's Medical University
Director of the Institution for Advanced Biomedical Sciences

Graduated from the School of Science and Engineering at Waseda University. Completed his doctoral degree in Applied Chemistry at the Waseda University Graduate School of Science and Engineering. Served as a Research Associate and a Faculty Member at Tokyo Women's Medical University, an Assistant Professor at the University of Utah, and an Assistant Professor at Tokyo Women's Medical University. From 1994, served as a Professor at Tokyo Women's Medical University and as a Professor at the University of Utah. In 1999, became Director of the Institution for Medical Engineering at Tokyo Women's Medical University. In 2001, became Director of the Institution for Advanced Biomedical Sciences at Tokyo Women's Medical University.

Professor Mitsuo Umezu
TWIns Waseda University
Director of the Institution for Advanced Biomedical Sciences

Graduated from the School of Science and Engineering at Waseda University. Completed his doctoral degree in Mechanical Engineering at the Waseda University Graduate School of Science and Engineering. Served as a Researcher at the National Cardiovascular Center and Director of Mechanical Engineering (project leader in developing an artificial heart) at St. Vincent's Hospital in Sydney, Australia. In 1992, became a Professor at Waseda University. Also, in 1993, served as a Visiting Professor Emeritus at the University of New South Wales in Australia. In 2001, established a program in Bioscience and Biotechnology at the Graduate School of Science and Engineering. Has served as head of the program in Bioscience and Biotechnology until the present.