According to the book’s capsule, Project Itoh was hospitalized…

One and a half years before Project Itoh’s death, Kojima commissioned Itoh to write the novelization of Metal Gear Solid 4—not to make use of an up-and-coming author, but so that another bearer of his memes would connect the video game’s story to a different medium. Kojima considered that Itoh did not merely trace the game’s plot and scenes: he transformed the material into a work of his own that could convey Kojima’s ideas even to readers unfamiliar with the game; Kojima described it as not novelized but Itoh-ized.

“He's the developer of this Metal Gear REX weapon, and I like Japanese animation so I wanted to include a character who goes to anime conventions like Otakon in America. The image in my head was of a heavier guy, someone who's always eating a chocolate bar, but somewhere along the way he turned out as you see here.”

When Kojima reread Shibumi in 2006 as part of his research for Metal Gear Solid 4, he was startled by parallels with ideas he had already used: a combat discipline similar to CQC, the heightened threat perception he learned in scout/tracking training, and the merciful murder of a parental figure, which he related to Big Boss and The Boss. His reappraisal led him to recommend the novel to the development team.

Kojima described Satoshi Itoh as one of the fans who most deeply understood his works, to the point Itoh became known as a “Kojima fundamentalist.” After Itoh’s literary debut as Project Itoh they became friends and respected each other as creators with similar tastes; Itoh’s death in the spring of 2009 made Kojima feel he had lost both a recipient of his memes and a precious son.

As he approached fifty, Kojima acknowledged that studio work was already physically fatiguing and that he should be preparing a successor and retirement, but the person to whom he had handed the baton had died before him. He said he could only pick up Itoh’s last wishes and continue telling stories; he also began the series My Lovable Memes after Itoh’s death to search for new receivers.