2019.10.25
Progressing Along the Long Road in the Study of Treatment of Infectious Diseases
Disaster Medical Science Division
Professor Eiichi N. Kodama
Infectious diseases as a disaster
Most people probably think of earthquakes and tsunamis when they hear the word “disaster.” However, “infectious diseases” wherein viruses and germs that enter the human body multiply and cause sickness can also be viewed as a disaster. For example, some infectious diseases are highly lethal, such as the Ebola virus disease that caused enormous damage in Africa and other places, and some types of bird flu. Depending on the scale of the outbreak, as with earthquakes and tsunamis, people may need to take refuge across a wide area. In the case wherein it is impossible to return until the end of decontamination, the situation is akin to that of a nuclear crisis.
Infectious diseases research by Prof. Kodama and his engagement in the development of therapeutics for the leukemia virus
IRIDeS’s Prof. Eiichi N. Kodama has been engaged in the research of various infectious diseases until now, including tuberculosis, HIV, measles, and the Epstein–Barr (EB) virus; however, among these, with respect to leukemia caused by the EB virus, Prof. Kodama has taken the lead in developing therapeutics for approximately 20 years. Prof. Kodama explains, “viral carcinogenesis is not dramatic like Ebola, but rather it is a silent outbreak that causes cancer while the infected person does not notice.” Patients suffering from leukemia caused by the EB virus exist not only in Japan but also throughout East Asia and Africa. The treatment of cancer caused by this virus is of great importance, and hence, Prof. Kodama has been engaged in the development of therapeutics for the EB virus. However, the road has not been smooth.
Prof. Kodama says, “In modern medicine, it is really, really difficult to design even one new drug.” The development of new medicines requires a huge number of personnel, countless trial and error, and massive research costs. It is not surprising that even pharmaceutical companies with hundreds of researchers cannot produce even a single new medicine per year. It is hard to imagine the difficulties of new drug development for a single researcher at a university who also has to undertake teaching, medical treatments as a doctor, and administrative duties. “You may imagine a situation that an individual researcher makes a proposal, ‘Listen, why don’t we develop this type of new drug?’ and he or she meets with a favorable reaction from others, ‘That is a great idea. You can, and we will support you.’ But the reality is different. As to whether the research would produce results, and whether those results would lead to a treatment, in fact, the researcher himself or herself does not know the answer unless the research has been actually done.” However, this is true for all research. “Even in the case of iPS cells discovery by Prof. Shinya Yamanaka at Kyoto University, he was told at first that it would be impossible. Researchers need put aside the issue of whether the challenge actually leads to success. It will never be possible if you don’t try.” Prof. Kodama began the development of EB virus-related leukemia therapeutics initially by acquiring small-scale research expenses.
Even at the initial phase of research, Prof. Kodama already felt a good response. When compounds that could control leukemia cells were actually discovered, he became convinced that the research would become successful. “But I was an unknown researcher at that time and had not built credibility yet,” Prof. Kodama says. As he gradually became known through academic societies and publications, however, requests for collaborative research began to come in from medical departments, pharmaceutical companies and other universities. “As I was offered various compounds from colaborators, the probability of finding a prospective treatment in line with my objectives increased exponentially. More researchers also declared their interest in joint research.” Prof. Kodama, in a joint research with Japan Tobacco, discovered an anti-HIV drug that can actually be administered to patients, leading to a second over-the-counter drug, which led to his greater achievements and trust. He finally acquired a major research grant from Japan Agency for Medical Research and Development (AMED) in 2016. Today, with a team of people, he is drawing close to the final stage of research.
Today, human safety from EB virus-related leukemia therapeutics is being confirmed in animal experiments. However, Prof. Kodama points out that “there are many drugs that are terminated the development at this final stage since their unexpected adverse effects are found.” If the hurdle of animal experiments is overcome, and there are no issues in the clinical studies conducted thereafter, it will finally be approved as a new drug and will be put to actual use for treatment. Prof. Kodama is cautious until the end and states, “Even in that case, it is difficult to bring an end to cancer with just one new drug, and it will probably be used in combination with other drugs.”
From what Prof. Kodama says, current medical research is composed of huge, long-term projects, requiring teams with a large number of people, and with roles distributed between members that are highly specialized so that medical research is cautiously moved forward while building up expertise. In this situation, the development of the study of leukemia therapeutics by Prof. Kodama is an incredibly rare case in which he began on his own and gradually won over trust and cooperation from others while taking the lead in the same study until the very end.
The significance of infectious disease treatment in affected areas
Prof. Kodama’s specialization is basic research; however, at the time of the 2011 Great East Japan Earthquake and the 2016 Kumamoto Earthquake, he went to the affected areas as an emergency medicine support doctor. Through those experiences, Prof. Kodama realized that the treatment of various infectious diseases is significant in terms of being a countermeasure for post-disaster infectious diseases among victims. At evacuation points wherein many people gather, the importance of infectious disease prevention is now being emphasized. Prof. Kodama, while working at disaster sites, has recognized that “it is not realistic to deal with infectious diseases only through preventative measures.” In affected areas, it is not easy to take sufficient preventative measures such as wearing masks and ensuring water for handwashing, and, at evacuation points where there are no healthcare providers, it is not easy to newly prescribe vaccines that require careful temperature control. On the contrary, if infectious diseases are treated, it is possible to limit them at an early stage by easily prescribing such therapeutics when people become infected in affected areas. Infectious diseases require both prevention and treatment, and Prof. Kodama believes that the therapeutics of infectious diseases is, in fact, the key after the occurrence of a disaster.
For the future
Smiling, Prof. Kodama says, “Originally, I was neither majoring in disasters nor infectious diseases. But while I was dealing with them as the need arose, they became my areas of expertise.” Currently, Prof. Kodama is also the Head of the IRIDeS Disaster Medical Science Division and has a coordinating role to facilitate collaboration between disaster medical research and other IRIDeS research. He would like to commit himself to train younger researchers in infectious diseases and to assist with the research on bacterial infectious diseases in the future.
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