Japanese researchers at Kyoto University have ignited global excitement in the field of regenerative dentistry with their pioneering work on a drug that could enable humans to regrow lost teeth. This breakthrough centers on an anti-USAG-1 antibody, known as TRG035, developed through years of basic research at the university and now advancing through human clinical trials. Led by Dr. Katsu Takahashi, the project represents a landmark achievement for higher education institutions in Japan, showcasing how academic innovation can translate into transformative medical solutions.

Tooth loss affects millions worldwide, with congenital conditions like oligodontia—where individuals are born missing multiple permanent teeth—impacting quality of life from childhood. Traditional treatments such as dentures, bridges, or implants offer functional relief but fall short of restoring natural dentition. The Kyoto University team's approach targets the biological root cause, potentially revolutionizing oral health by harnessing the body's own regenerative potential. This development underscores Japan's strength in biomedical research, driven by collaborative efforts between universities, hospitals, and startups like Toregem BioPharma, spun out from Kyoto University in 2020.

The Science Behind Tooth Development and Suppression

Teeth develop from tooth buds during embryonic stages, forming a primary set (baby teeth) and secondary set (permanent teeth). In most mammals, including humans, a third set remains suppressed. The key player is the USAG-1 protein (Uterine Sensitization-Associated Gene-1), which binds to BMP (Bone Morphogenetic Protein), a signaling molecule essential for tooth formation. USAG-1 acts as a brake, preventing supernumerary teeth.

Researchers discovered this through mouse models deficient in Runx2, a transcription factor critical for tooth development. These mice exhibited congenital tooth agenesis, mimicking human oligodontia. By administering anti-USAG-1 antibodies, the team relieved BMP suppression, allowing dormant tooth buds to activate and grow full teeth. This step-by-step process—antibody binding to USAG-1, freeing BMP, initiating epithelial-mesenchymal interactions—marks a precise molecular intervention, avoiding broad disruptions to Wnt signaling pathways that could cause tumors.

In ferrets, whose dental patterns closer resemble humans, the antibody successfully induced new tooth growth, validating the approach across species. These preclinical successes paved the way for human application, highlighting the rigorous translational research conducted at Kyoto University Graduate School of Medicine.

From Lab Bench to Clinical Trials: Kyoto University's Role

Dr. Katsu Takahashi's journey began in 2007 at Kyoto University, identifying USAG-1's role via 'supernumerary teeth' mice. Over 14 years, the team refined monoclonal antibodies, culminating in a 2021 Science Advances paper demonstrating tooth regeneration in agenesis models. Kyoto University Hospital hosted the world's first Phase 1 investigator-initiated trial starting October 18, 2024, enrolling 30 healthy adult males aged 30-64 with congenital partial edentulism (missing at least four molars).

As of April 2026, the trial—focused on safety and pharmacokinetics—has progressed past its initial phase, with no major adverse events reported in early data. Participants receive a single intravenous dose, monitored for immune responses and tooth bud activation via imaging. This university-led effort exemplifies Japan's integrated model of academic research, where public funding from AMED (Japan Agency for Medical Research and Development) supports startup commercialization via Toregem BioPharma.

The trial's design prioritizes those with genetic tooth deficiencies, where dormant buds exist, ensuring ethical targeting before broader applications.

Key Players and Collaborative Ecosystem in Japanese Academia

Dr. Takahashi, now Chief Surgeon at Kitano Hospital (affiliated with Medical Research Institute), collaborates with Kyoto University colleagues like Honoka Kiso (Toregem CEO, Kyoto U alumna). The startup, incubated at Kyoto University, bridges academia and industry, securing orphan drug status from Japan's MHLW in September 2025 for severe oligodontia.

This model reflects Japan's higher education strengths: Kyoto University ranks among Asia's top for life sciences, fostering spinouts (over 100 since 2010). Partners include Fukui University for initial BMP-USAG-1 studies. Funding from AMED's Stage Gate (passed Feb 2026) accelerates Phase 2 planning, potentially starting late 2026 for efficacy in children/teens with oligodontia.

Stakeholders praise the work: dental associations highlight reduced implant needs (global market $15B+), while ethicists note focus on congenital cases minimizes off-target growth risks.

Photo by Markus Winkler on Unsplash

Challenges in Translating University Research to Clinic

Despite promise, hurdles remain. Safety concerns include potential supernumerary teeth or BMP overactivation causing cysts/jaw issues, addressed by antibody specificity. Efficacy in humans varies; animal models don't perfectly replicate human dentition. Regulatory paths differ: Japan's fast-track for orphans contrasts FDA's Pre-IND (Nov 2025 response received).

• Phase 1: Safety confirmed, no dose-limiting toxicities.
• Phase 2/3: Needed for efficacy in 100s of patients, targeting 2027-2028.
• Cost: Single injection ~$10K initially, scaling via biosimilars.

Japanese universities like Kyoto excel in such trials via hospital integration, but global scaling requires multi-center studies.

Broader Implications for Dental Research in Japanese Higher Education

This project elevates regenerative medicine at Kyoto University, aligning with Japan's Moonshot R&D for organ regeneration. It inspires programs like iPS cell therapies (Nobel laureate Yamanaka at Kyoto). For higher ed, it boosts research jobs, attracting talent amid Japan's aging population (tooth loss peaks 60+).

Statistics: 1% global population has oligodontia; Japan invests ¥100B+ annually in regen med. Success could spawn uni spinouts, enhancing Japan's QS rankings (Kyoto #46 globally 2026).

Global Context and Comparative Research Efforts

Japan leads, but US (Harvard stem cells), UK (King's College Tideglusib), China (Shanghai Jiao Tong hydrogels) pursue alternatives. USAG-1's specificity gives edge; no equivalents match Phase 1 status. Collaborations eyed with EU/US for Phase 3.Key paper on USAG-1 antibody

By 2030, if successful, market $50B+, prioritizing congenital then age-related loss.

Expert Perspectives and Stakeholder Views

"A paradigm shift," says ADA spokesperson, predicting fewer implants. Japanese Dental Association supports expansion. Critics caution overhyping; Phase 1 is safety-only. Kyoto dean: "Embodies uni mission—basic science to bedside."

Patients with oligodontia hopeful; trials recruit via Toregem site.

Photo by Karl Solano on Unsplash

Future Outlook: Commercialization and Higher Ed Impact

Toregem aims 2030 launch, post-Phase 3. Kyoto U expands regen dent programs, offering PhDs/postdocs. Implications: Reduced edentulism burden (Japan 20% elderly toothless), boosting economy ¥1T via healthy lifespans. Unis worldwide watch, spurring investments.Toregem Biopharma updates

For Japanese higher ed, validates startup ecosystem, drawing global talent to /jp research jobs.

Actionable Insights for Researchers and Students

• Follow Kyoto U trials for collab opportunities.
• Explore BMP/USAG-1 in theses; grants via AMED.
• Dental students: Regen med electives rising.
• Track via ClinicalTrials.jp equivalents.

This breakthrough positions Japanese universities at regen med forefront, promising natural smiles restored.