SPECIAL TO THE JAPAN TIMES
Yusuke Nakamura could easily have had a long, successful career as a surgeon in Japan, but he isn’t the kind of person who is satisfied with unanswered questions.
A three-month-long hospital stay after a skiing accident in junior high school initially stoked his interest in medicine and hospital life, but he went on to encounter several big questions during his medical training.
Memories of two patients in particular have stayed with him over the past 40 years. One was a young woman with gastric cancer. “We were the same age,” Nakamura recalls. “She was 27, I was 27. I couldn’t respond. I just tried to avoid crying myself. It was a very hard time for me.”
Another was a 36-year-old colon cancer patient. Nakamura operated on him to relieve his symptoms, but the cancer had metastasized to his liver and he passed away after spending a few final months with his family.
Nakamura wasn’t able to shake the experience. Why had these patients contracted cancer at such a young age? Why did it spread quickly in some but more slowly in others? And what could be done about it? This was the 1970s, and no one had the answers; at the time, Japanese doctors weren’t even notifying patients that they had cancer.
As Nakamura followed these questions into medical literature and the research on hereditary cancer, it led him to a Ph.D. in molecular genetics at Osaka University and then abroad to Salt Lake City, Utah, the home of Howard Hughes Medical Institute. He lived there from 1984 to 1989, working as a research fellow and an assistant professor in the laboratory of professor Ray White.
Nakamura found a large Mormon family in Utah that suffered from familial adenomatous polyposis, a disease that produces thousands of polyps in the colon and causes cancer.
“For a genetic approach, we need a big family,” Nakamura says. “Breast cancer syndrome was also found through a Mormon family. The Mormon church keeps a kind of family chart and they are very cooperative to medical science.”
Nakamura helped uncover the hereditary connection of the disease by pioneering research on variable number of tandem repeats, markers that repeat within a genome and allow for the identification of the sites of genetic diseases.
Later when he returned to Japan, Nakamura served on budgeting committees and encountered a Japanese tendency to reduce funding for individual applications so that a higher overall percentage of projects could be accepted. In effect, this often leaves Japanese researchers with 70 percent of the funding they need.
In Utah, on the other hand, Howard Hughes doubled the budget and encouraged Nakamura to accelerate his research so he could provide the markers he was discovering to other researchers. Nakamura’s network expanded internationally, and the frequent phone calls in English were challenging. People spoke very quickly and he was forced to decipher a wide range of accents.
But his work paid off: By the late ’80s, around 70 percent of known DNA markers were White-Nakamura markers.
“This type of work is basically a contribution to the scientific community,” Nakamura notes. “In Japan, good science means you should insist on one pathway or one molecule and study deep, deep, deep.”
Nakamura found work in the U.S. rewarding. “This kind of idea is very fresh to me, and I learned that contribution to the scientific community is very important,” he says. “That is one of the standards to evaluate the science in the United States. It’s quite different.”
At age 36, Nakamura returned to Japan and spent the next two decades developing genomic medicine in a variety of roles, all aiming to answer the same questions he had as a doctor in his 20s. He worked at the Cancer Institute in Tokyo and then helped direct the Human Genome Center at the University of Tokyo. He also ventured into the pharmaceutical industry by starting the company OncoTherapy in 2001 to develop new drugs that target cancer stem cells and immunotherapy.
He nearly decided to venture abroad again in 1994, this time to Oxford. “But my son said no,” Nakamura says. He has a son and daughter, and his son had struggled with English while living in Utah as a sixth grader, the delicate age just before entering junior high school in Japan.
Nakamura eventually returned to the U.S. in 2012 and opened a laboratory at the University of Chicago after spending 2011 as special adviser to the Cabinet and secretary-general of the Office of Medical Innovation. His year there was interrupted by the Great East Japan Earthquake, which shifted attention from innovation to disaster recovery.
Nakamura chose Chicago because he had many contacts there. When he visited the city, the late Janet Rowley, internationally renowned for her work on cancer genetics, told him, “I’m waiting for you in Chicago.”
He runs a lab of 13 people whose nationalities span the globe from China and Ethiopia to India and Turkey.
“I don’t feel there are any barriers in science,” Nakamura says. “And actually, it’s good. Everybody should learn about different cultures. This is important for our future. If we stay in Japan, maybe we would never learn how we have different cultures.”
His lab is currently working on experiments that include new immuno-therapy treatments and a clinical trial for targeted leukemia and breast cancer drugs.
“When I was in Utah, I only did basic science,” Nakamura says. “But here I have interactions with clinicians. And also I could find the difference between the United States and Japan.”
The United States develops drugs much faster. “One reason,” he says, “is patient-doctor interactions and also balance between the benefit and risk. This is very important. The benefit-risk balance is also very influenced by social media, particularly TV or newspapers.”
Nakamura encountered criticism when he began Bio Bank Japan, a project aimed to gather the DNA of 200,000 Japanese with cancer and other diseases in an effort to provide researchers with materials. The media played up privacy concerns. He also encountered committees within the health ministry hesitant to move forward on human trials. In Chicago, he is able to work directly with the doctors who will be administering the new cancer medicines.
In 2014, Nakamura began a blog titled “Nakamura Yusuke no Chicago Tayori” (Yusuke Nakamura’s Chicago Dispatches). He is a prolific writer, posting every few days on topics ranging from life in Chicago to thoughts on science and politics.
“The simplest reason (I started it) is to not forget Japanese,” he says. “But I learned many things. I want to send some messages how medicine is progressing every day. I want to give hope to Japanese cancer patients.”
Nakamura is tenured at Chicago and can comfortably continue his research, but just as when he was a surgeon, he always aims to help as much as he can.
“My concern is how to contribute to cancer patients. If staying here is better, I will stay,” he says. “If I can contribute more to Japanese cancer patients, I may go back.”
All the while, he is driven by thoughts of his old patients and the more recent loss of his mother to colon cancer in 1999.
“My mother apologized to me the day before her operation,” he recalls. “She felt her having colon cancer may embarrass me. I was so emotional. I couldn’t say anything. That is a very strong motivation to want to develop anti-cancer drugs.”
Name: Yusuke Nakamura
Key moments in career:
1977 — Completes medical degree
1984 — Moves to Utah to work at Howard Hughes Medical Institute
1987 — Presents findings on VNTR
1995 — Becomes director of newly created Human Genome Center at the University of Tokyo
2012 — Opens lab at University of Chicago
Life philosophy: “Possibility is endless.”
Things I miss about Japan: “My friends and old colleagues, Japanese food.”
● 中村 祐輔
1984年 ユタ大学ハワード・ヒューズ医学 研究所研究員に就任
1995年 東京大学医科学研究所附属ヒト ゲノム解析センター長に就任