In ‘The Song of Cell’ Author Siddhartha Mukherjee Uses Stories to Decipher and Explain an ‘Unsung Hero’

Siddhartha Mukherjee believes that science is an act of storytelling. “We tell each other stories constantly,” he says. “We are trading narratives.” No wonder storytelling forms a large part of his books, including his latest “The Song of Cell,” about the emerging field of cell therapy and how it is being used to create a breakthrough in the treatment of several deadly diseases like cancer.

The Indian American physician, immunologist, biologist, and an assistant professor of medicine at Columbia University Medical Center, was speaking at a Dec. 7 fireside chat held at the New York City-based Cure Healthcare Innovation Campus. It was hosted by CEO Seema Kumar, founder of the Seema Network, and publisher of Seema magazine.

However, all the data, evidence and jargon of science, can be a challenge, Mukherjee says, at times making one forget that through this all, there’s a through line and a plot. “When you are trying to solve the structure of something or when you are trying to figure out why therapy works or doesn’t, or you are inventing a therapy, there is a through line, a plot, a beginning and an end as if you are telling a story, he says. “The only difference here is that it is a story.” So a lot of Mukherjee’s work involves “taking all that information and stitching it together.”

But he notes that writing “The Song of Cell” wasn’t easy. “When it comes to writing books, it is the invisible parts, the tends and ligaments that hold the book together, that are the most difficult, because they have to be erased,” he explained. “If you get a sense of them, the book is now revealed.”

Another aspect that made this book different from his other two — “The Emperor of All Maladies,” winner of the Pulitzer Prize, and “The Gene” — is the main character of the book; in this case the cell, he describes as “the single least autonomous unit of life.” Here, Mukherjee couldn’t rely on a chronological order. “Generally speaking, in literary nonfiction, chronology is always your friend, so you start a story from the beginning and you end at the end.” But because “cells are so diverse, in their function, structure and also in their discovery and history, that you cannot write a chronological history of cell biology,” he explains. “Because you’d go mad and you’d drive your readers mad.”

Mukherjee has a particular interest in T-cells — a type of white blood cell and part of the immune system activated to fight disease. He’s been treating patients in India who have certain types of cancer with genetically engineered T-cell variants.

He also had a hard time determining the structure of the book. “Here you can think about it as a series of short links, short stories,” he says. The historical prelude and the future of prelude make the two ends of the book, while the chapters are the center of the book. “Each chapter is basically a cell,” he says, which is “not chosen randomly, but because it illustrates something about life, and also about potentially human life.”

Mukherjee talked about the genesis of the book as well and the reasons he wrote it. Describing the cell as an “unsung hero,” Mukherjee says not only did it have a book, but the lack of knowledge on it was frustrating. “Without cells we would be nothing,” he says, adding that he wanted “to correct that missing link.”

Delving into the cell further, Mukherjee calls it “incredibly diverse,” with a diverse purpose. “A neuron doesn’t look anything like a skin cell, which is nothing like a blood cell, and is different from a muscle cell,” he notes. “Yet they are all playing out the geno — just as you play out a musical score.” And hence the title — “The Song of Cell.” He believes that as we move ahead in time, we will understand these songs, and they will help us understand physiology.”

Mukherjee has a particular interest in T-cells — a type of white blood cell and part of the immune system activated to fight disease. He’s been treating patients in India who have certain types of cancer with genetically engineered T-cell variants. Genetically engineered T-cells, known as CAR [chimeric antigen receptor], have become a staple in the treatment of certain kinds of leukemias, lymphomas and blood cancers.

The book includes several revelatory and exhilarating stories of scientists, doctors, and patients. One of them is his friend Sam Dean, a newspaper writer, “who died because his cells had rebelled against his body.” He was suffering from malignant melanoma, which was treated with surgery but it was replaced with metastatic melanoma which spread all over his body. Then he was treated with immunotherapy. “In Sam’s case he was given a drug to basically activate T-cells in his body to kill the melanoma cells,” Mukherjee elaborates. However, every time that is done, “there is a challenge because when you activate the cells, they attack the affected cells but also attack your own body, resulting in an autoimmune disease as in the case of Dean, which he couldn’t find a way through. “It was like threading the proverbial needle,” Mukherjee says, about “the constant battle” between his liver and his cells. “He couldn’t keep up anymore, his liver failed, his cancer came back and unfortunately he died.”

Then we read about Emily Whitehead, a 7-year-old, who had Acute lymphocytic leukemia (ALL), and was treated with CAR T-cell therapy. “Her cancer had relapsed twice, and she was essentially slated to die,” Mukherjee says. “She was the first child treated with CarTcells which were weaponized using gene therapy, to direct themselves against the cells of which cancer is a subpart.” Her response was great, but there was a terrifying side to it. “When the T cells get activated, they release an incredibly inflammatory cascade, sort of like, as I say in the book, it’s sort of like soldiers on a rampage. And you can get so much of a rampage of T cells killing cancer that the body goes berserk, it can’t handle this kind of attack.” But “Emily, fortunately, was treated with a medicine to dampen down that attack so that she ultimately survived. She still is alive today and applying to colleges.” One of those cases, where a cure was available, provided and worked.