The Song of the Cell: An Exploration of Medicine and the New Human

by Siddhartha Mukherjee

Cell therapy for blood diseases had a terrifying birth.

Would the skin cell now turn into a stem cell—capable of making not just skin, but bone, cartilage, heart, muscle, and brain cells—i.e., every cell in the body?

Tenderness and rot share a border. And rot is an aggressive neighbor whose iridescence keeps creeping over.

it potentially even synthesizes its own hormones.I

Bone is not just an organ with a single supply of rejuvenating cells; it is a chimera of rejuvenation. It has at least two sources for two sites.

the Gremlin-marked stem cells (or OCHRE cells) would act as a regenerative reservoir.

Osteoarthritis was the forme fruste—the frustrated form—of a tissue trying to repair itself, but failing.

What the injury had thrown off was the capacity of cartilage at the joint to maintain its internal balance—between

It is, first, an imbalance caused by the death of Gremlin-marked cartilage progenitor cells that cannot generate adequate bone and cartilage to keep up with the demands of the joint.

Because the repairing cells die during the injury.

It is a flaw in rejuvenative homeostasis.

the maintenance and repair of tissues in adulthood seems idiosyncratic and peculiar to the tissue itself.

It’s as if every organ, and every cell system, has chosen its own kind of Band-Aid for repair and regeneration.

Death—the most absolute of absolutes—is, in fact, a relative balance between forces of decay and rejuvenation.

It is almost—not quite, but almost—as hard as finding some agent that will dissolve away the left ear, say, and leave the right ear unharmed.

cell capable of infinite rebirth: the cancer cell.I

The genes that control these accelerators and brakes are broken—i.e., mutated—such that proteins that they encode, the regulators of cell division, no longer function in their appropriate contexts. The accelerators are permanently jammed, or the brakes fail permanently.

they recruit other proteins that further recruit others, until a malignant cascade of protein signals within a cell ultimately whips the cell into a kind of mitotic frenzy—to keep dividing without control.

heterogeneity of “mutational fingerprints”—the

reaches down to the individual cell level.

an assemblage of nonidentical diseases.

One rule of cancer that I’ve learned is that it is like a fixated interrogator: it does not allow you to change subjects—even when you think you can.

The cancer cell, in contrast, is trapped—imprisoned in a program of perpetual rebirth. It is the ultimate selfish cell.

Sequencing is seduction. It is data, not knowledge. So where is the “really clinically useful information” sitting? Somewhere, I believe, in an intersection between the mutations that the cancer cell carries and the identity of the cell itself.

many cancer cells use a fast and cheap method of glucose consumption to generate energy.

we’ve discovered that some (but not all) cancers use insulin—whose release is prompted by glucose—as a mechanism of resistance to an otherwise potent anticancer drug.

Uncloak cancer’s cloak, and you have a therapy that doesn’t seem to depend on the immune system.

Part of the answer may lie in the fact that the use of oxygen-dependent reactions to generate energy create toxic by-products—highly reactive chemicals that are harmful to cells that then need to be dispensed and cleansed.

“Atomism” argues that material, informational, and biological objects are built out of unitary substances.

cells, by themselves, are incomplete explanations for organismal complexities.

“cooperative” and “unitary”—selfless and self-regarding—are not mutually exclusive ideas. They exist in parallel.

But I too made things That may one day be Better versions of me.

Augmentation has become the new emancipation. And the more the borderlands between ailment and enhancement blur, the more easily the “raw” material that Saletan describes is perceived as precisely that: “raw,” and therefore awaiting to be molded into something else—a new kind of human, built anew. “Cooked,”

the birth of cell theory is not the story of mistaken origins but of origins mistaken.