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Abstract

The Great East Japan Earthquake (GEJE) and resulting tsunami of March 11, 2011 gave rise to devastating damage on the Pacific coast of the Tohoku region. The Tohoku Medical Megabank Project (TMM), which is being conducted by Tohoku University Tohoku Medical Megabank Organization (ToMMo) and Iwate Medical University Iwate Tohoku Medical Megabank Organization (IMM), has been launched to realize creative reconstruction and to solve medical problems in the aftermath of this disaster. We started two prospective cohort studies in Miyagi and Iwate Prefectures: a population-based adult cohort study, the TMM Community-Based Cohort Study (TMM CommCohort Study), which will recruit 80 000 participants, and a birth and three-generation cohort study, the TMM Birth and Three-Generation Cohort Study (TMM BirThree Cohort Study), which will recruit 70 000 participants, including fetuses and their parents, siblings, grandparents, and extended family members. The TMM CommCohort Study will recruit participants from 2013 to 2016 and follow them for at least 5 years. The TMM BirThree Cohort Study will recruit participants from 2013 to 2017 and follow them for at least 4 years. For children, the ToMMo Child Health Study, which adopted a cross-sectional design, was also started in November 2012 in Miyagi Prefecture. An integrated biobank will be constructed based on the two prospective cohort studies, and ToMMo and IMM will investigate the chronic medical impacts of the GEJE. The integrated biobank of TMM consists of health and clinical information, biospecimens, and genome and omics data. The biobank aims to establish a firm basis for personalized healthcare and medicine, mainly for diseases aggravated by the GEJE in the two prefectures. Biospecimens and related information in the biobank will be distributed to the research community. TMM itself will also undertake genomic and omics research. The aims of the genomic studies are: 1) to construct an integrated biobank; 2) to return genomic research results to the participants of the cohort studies, which will lead to the implementation of personalized healthcare and medicine in the affected areas in the near future; and 3) to contribute the development of personalized healthcare and medicine worldwide. Through the activities of TMM, we will clarify how to approach prolonged healthcare problems in areas damaged by large-scale disasters and how useful genomic information is for disease prevention.

2011年3月11日に発生した東日本大震災は、東北地方の太平洋沿岸に甚大な被害をもたらした。震災からの復興を促進し、災害後の医療上の問題を解決するために、東北大学は東北メディカル・メガバンク計画を立案し、岩手医科大学と協働して、宮城県と岩手県において、地域住民コホート調査及び三世代コホート調査と名付けた2つの前向きコホート調査を開始した。地域住民コホート調査では、被災地を中心に80,000人の成人をリクルートする、また、三世代コホート調査では、妊婦と配偶者、出生した子供、その兄姉、祖父母あわせて70,000人をリクルートする予定である。前者では、2013年から2016年まで参加者のリクルートを実施し、その後少なくとも5年間追跡する、また、後者では、2013年から2017年まで参加者をリクルートし、その後少なくとも4年間追跡する予定である。これらに加え、2012年から宮城県で横断調査デザインからなる地域子ども長期健康調査を開始している。東北メディカル・メガバンク計画では、これら2つの前向きコホート調査をもとに、生体試料とゲノム情報を含む関連情報から構成される複合バイオバンクを構築する。本複合バイオバンクには、健康と医療に関する情報、生体試料、ゲノムデータ等が保管され、主として東日本大震災によって増加や症状の悪化等が懸念される疾患について個別化予防・医療を実現するための基盤を確立することを目指している。なお、生体試料や情報は、外部の研究者へも分譲する予定である。本計画では、これらの活動を通して東日本大震災の住民の健康への中長期的な影響を調査する。東北メディカル・メガバンク計画では、コホート調査、バイオバンク形成とともに、ゲノム解析研究を推進する。その目的は、1)複合バイオバンクを構築する、2)コホート調査の参加者へゲノム解析結果を回付し、被災地において個別化予防・医療を推進する、3)人類全体に対して、個別化予防・医療の発展に貢献する、ことである。東北メディカル・メガバンク計画の活動を通して、大規模災害で被害を受けた地域における医療問題の解決方法及び疾病予防のためのゲノム情報の有益さを明らかにすることを目指す。 *東北メディカル・メガバンク計画スタディ・グループの名簿はAppendix を参照

Figures

Figure 1.
Figure 1.. Location of Iwate Prefecture, Miyagi Prefecture, and Fukushima Prefecture and characteristics of the Great East Japan Earthquake
This panel shows a map of Japan highlighting the location of Miyagi and Iwate Prefectures in red. Fukushima Prefecture, shown in light red color, is not included in this project. These three prefectures are areas most affected by the earthquake. Tokyo is shown in yellow color. The letter X indicates the epicenter.
Figure 2.
Figure 2.. Municipalities of Miyagi Prefecture and Iwate Prefecture
This panel shows the municipalities of Miyagi Prefecture and Iwate Prefecture. Green area indicates study area. Red circles indicate the location of the Community Support Centers in Miyagi Prefecture and the Satellites in Iwate Prefecture.
Figure 3.
Figure 3.. Organization of the Tohoku Medical Megabank Project (TMM)
TMM started on February 1, 2012, and is sponsored by the Reconstruction Agency, the Ministry of Education, Culture, Sports, Science and Technology (MEXT), and the Japan Agency for Medical Research and Development (AMED). Panel shows the organization of TMM as of April 1, 2015.
Figure 4.
Figure 4.. System of dispatching physicians on a rotating basis for community medical support and development of young resources
ToMMo, jointly with Tohoku University Hospital and Tohoku University School of Medicine, has created the system of dispatching physicians on a rotating basis, which connects communities with the university. The system is referred to as the “ToMMo Clinical Fellowship (TCF)”. IMM has also adopted the same system, and refers to it as the “IMM Medical Megabank Fellows System”.
Figure 5.
Figure 5.. Roadmap of the TMM cohort studies
This panel shows the roadmap for recruitment and follow-ups of the cohorts towards the realization of personalized healthcare and medicine.
Figure 6.
Figure 6.. Age distribution of the TMM Community-Based Cohort (TMM CommCohort) participants
This panel shows the age-distribution of participants in the TMM CommCohort as of December 28, 2015, recruited in Miyagi and Iwate Prefectures combined.
Figure 7.
Figure 7.. Age distribution of the TMM Birth and Three-Generation Cohort (TMM BirThree Cohort) participants
This panel shows the age distribution of children, mothers, fathers, and grandparents who participated in the TMM BirThree Cohort as of December 28, 2015, recruited in Miyagi Prefecture.
Figure 8.
Figure 8.. Construction of an integrated biobank
We are constructing an integrated biobank, which consists of biospecimens and data of genome and omics linked to de-identified health and clinical information of cohort study participants.
Figure 9.
Figure 9.. Laboratory automation and a laboratory information management system in TMM
This panel shows how TMM handles and stores biospecimens from participants in the TMM BirThree Cohort Study.
Figure 10.
Figure 10.. Genome analysis strategies within TMM
This panel shows the genome analysis strategies within TMM to realize personalized healthcare and medicine.
Figure 11.
Figure 11.. Complementary cooperation of the TMM Community-Based Cohort (TMM CommCohort) and the TMM Birth and Three-Generation Cohort (TMM BirThree Cohort) in genome analyses
This panel shows synergetic effects of the TMM CommCohort and the TMM BirThree Cohort.

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