The virus is rampant, a covert cellular battle for the survival of humanity | An exclusive interview with the author of "The Emperor of All Maladies"

When the waves of genetic technology and artificial intelligence sweep through the scientific community, the cell, an ancient and mysterious unit of life, a life carrier that is more fundamental than genes and more microscopic than organs, is becoming the key code for us to understand health, diseases, and even the future of humanity.

Siddhartha Mukherjee, a writer, doctor, and scholar who is skilled at combining medical popular science with literature. His first book, "The Emperor of All Maladies: A Biography of Cancer" (2010), is regarded as a milestone in modern scientific writing, winning the Pulitzer Prize, and was named by Time Magazine as "one of the best non-fiction works of the past 100 years". Subsequently, his "The Gene: An Intimate History" published in 2016 continued to explore the far-reaching impact of genetics.

Now, his new work "The Song of the Cell" (Chinese translation version) has been released. What drives him to focus on cells this time?

When the COVID-19 pandemic swept the world, humanity faced the power and vulnerability of cells with an unprecedented urgency for the first time. How do viruses invade cells? How do cells respond to infections? What is the key to treatment? It is in the face of these sharp questions that he realizes that studying genes alone is not enough. Genes are the sheet music, and cells are the instruments; only by deeply understanding cells can we truly understand the operating rules of life.

"Although genes are the pillars of life, they do not possess life themselves. Cells are the more core units of life." The author said this in an interview. Cells are the movement that builds life and the stage for all diseases, helping to better understand health, diseases, and human destiny. From CAR-T cell therapy to in vitro fertilization (IVF), from gene editing technology to stem cell regeneration, these scientific breakthroughs also point to a fact: We are not only understanding the units of life but also rewriting the possibilities of life.

But the road of science has never been smooth. Behind the breakthroughs is the reality where challenges and controversies coexist. CAR-T cell therapy is hailed as a revolutionary technology in cancer treatment, but some patients also suffer from new diseases due to the therapy itself. And the in vitro fertilization technology, although it has brought hope to countless infertile families, has also sparked widespread debates due to ethical issues such as gender selection. "The progress of science is always accompanied by moral considerations," Siddhartha Mukherjee said, "We cannot only talk about the success of technology but also must face the challenges of fairness, ethics, and cost."

Today, the application of AI technology in the medical field has become impossible to ignore: from predicting protein structures to designing new drug molecules, from interpreting clinical data to optimizing laboratory work, AI has become a powerful assistant for scientists. But Siddhartha Mukherjee also calmly pointed out that The true potential of AI has not yet been fully released and is still in the exploration stage.

"The New Human" - In his new book, he put forward this thought-provoking concept. Humans once thought that the birth of life is the irreversible natural law, but the birth of the first in vitro fertilized baby broke this concept. When cells are re-edited, organs are regenerated, and genes are precisely repaired, humans themselves have become the objects of scientific remodeling. This is not the imagination of science fiction but the reality that is happening. "We must face such a future: Humans reshaped through cell technology are emerging with a brand-new appearance."

Driven by science, cell research is bringing new possibilities for disease treatment and the understanding of life. "The Song of the Cell" combs the development context of this field and also discusses the balance between technological progress and ethical considerations. This book is a profound dialogue about the fate of humanity, and it vindicates cells: Cells are not cold life units but the microscopic movement that constitutes life and the future.

In this symphony of science and humanity, each of us is both a listener and a participant. Then where will the future "New Human" go? Can science and ethics resonate in harmony? Siddhartha Mukherjee had a chat with "The Next Wave Institute".

The following conversation has been edited.

The Next Wave Institute:

You have written two books, "The Emperor of All Maladies: A Biography of Cancer" and "The Gene: An Intimate History", and the focus of this new book is "cells".

What inspired you to write this book, and what connections does it have with your previous works?

Siddhartha Mukherjee: 

The birth of this book comes from several opportunities. First, when I finished writing "The Gene: An Intimate History", a thought emerged in my mind: Although "genes" are the building blocks of life, they do not possess life themselves; genes are the cornerstone that makes life possible, but "cells" are the real units of life. Therefore, I wanted to capture the mystery of this basic unit of life and explore how it builds us and how we are woven from them.

Second, We are not only understanding cells but also manipulating them and even creating new cell forms. For example, CAR-T cell therapy (Chimeric Antigen Receptor T-cell) and cells that use genetic engineering to produce insulin. This raises a new proposition: How do we understand the potential and consequences of this "cell modification"?

Third, I hope that through this book, I can re-examine the root causes of diseases - Many diseases are actually "dysfunctions or disorders of cell functions". For a long time, we have been trapped in a "gene-centered" framework, accustomed to blaming diseases on genes, the environment, behavior, exposure, or chance. In my previous works, I summarized these factors as the five dimensions of a "pentagon". But for each factor of this "pentagon", without the "change of cells" as the basis, it is impossible to cause diseases. Therefore, To truly understand the nature of diseases, we must return to the "cell" as the unit of life.

In addition, this book was born in a special period - when the world was experiencing the baptism of the "COVID-19 pandemic". The pandemic made me deeply realize once again: No matter from which angle to analyze the pathology, the understanding of cells is ultimately unavoidable. Cells are the core of life, and it is the key to the occurrence and treatment of diseases. Surprisingly, up to now, No one has written a book that systematically explores "the history and future of cell biology".

The Next Wave Institute:

I can feel that you pay great attention to the literary beauty in your writing. You often use exquisite metaphors to explain those difficult medical terms to readers. In the title of this new work, "The Song of the Cell", one can feel this implication. What prompted you to connect cells with music?

Siddhartha Mukherjee: 

The title of the book does not come at the beginning. Only when the writing is nearly completed will it naturally emerge in a certain moment. When I finished writing this book, I fell into deep thought: The interdependence between cells and the way they build life is very much like the harmonious resonance between notes. A single note cannot play music. Only a group of notes can converge into a melody, and the interweaving of all notes can interpret a movement.

This is very similar to cells - Each cell is an independent unit of life, just like the pixels in a painting, delicate and tiny. But an isolated cell cannot shape an organ or constitute life. Only the collaboration of numerous cells can compose a vibrant chapter of life. Therefore, comparing the beauty of cells to the rhythm of music became the origin of the book title.

The Next Wave Institute:

When it comes to the core theories of biological research, the cell theory was the earliest to emerge. About 200 years ago, German biologists identified cells as the basic units of life structure and function. About 70 years ago, with the revelation of the DNA molecular structure, the gene theory began to rise, and biology began to shift to the molecular level.

Siddhartha Mukherjee: 

It is very interesting that pathologists like Rudolf Virchow have long understood that although genes are important, the status of cells is equally important. Cells are visible, and we need the invention of a series of new technologies to understand cells and the cell theory more deeply.

If there are "laws" in biology, they should be: The universality of the genetic code, the universality of evolution, and the universality of the cell theory. For a long time, the first two of these three have been widely explored and understood, while the understanding and popularization of the cell theory are relatively insufficient. This is one of the reasons why I wrote this book. There is a "yin-yang relationship" between cells and genes, and they are interdependent: Without genes, cells cannot form; but without cells, genes cannot function.

The Next Wave Institute:

This new book mainly focuses on three core themes: "The history of cell discovery", "The scientific understanding of cell functions", and "The consequences of cell dysfunction and our responses today". First, in the development process of the cell theory, which discoveries impressed you deeply?

Siddhartha Mukherjee: 

When we deeply understand how cells and cell systems collaborate with each other, our understanding of the essence of life becomes more profound. For example, immunology is an excellent case. It represents the height we have reached in understanding the mutual communication between cells and the "collapse" of this communication in the disease state.

Another example is type 1 diabetes. We have clearly determined that the root of the disease is the loss of insulin-secreting cells, and this loss is mainly due to the wrong attack of the immune system. This type of disease makes us understand that Only by truly understanding the physiological functions of cells can we master the pathology of diseases and find the treatment methods.

The Next Wave Institute:

In your new book, you discuss the theme of technology in detail, especially the application in clinical treatment, including cutting-edge medical methods such as stem cell technology, gene editing, and immunotherapy. Then, what breakthroughs have these technologies achieved?

Siddhartha Mukherjee: 

There is no doubt that CAR-T cell therapy is a revolutionary breakthrough in the field of cancer treatment. I myself am also actively involved in this field and have jointly established the first batch of CAR-T therapy centers in India with my partners, which is a first in India. And in China, the promotion of CAR-T therapy has also achieved remarkable results, which is exciting.

Another example is gene editing technology (Gene Editing), which is used to repair specific cells to treat rare diseases, such as using bone marrow transplantation therapy to deal with some hereditary blood diseases. This is also one of the directions we are focusing on in cancer treatment research.

In addition, in vitro fertilization (IVF) is also worth mentioning. It is essentially a breakthrough method relying on cell technology. In addition, we are exploring more new fields, such as treating blood diseases such as sickle cell anemia and thalassemia through gene editing. These technologies have been approved by the US FDA and are gradually changing the lives of patients. In addition, Scientists are trying to use stem cells to regenerate pancreatic cells, rebuild skin cells, and even reshape other functional cells, all of which mark that cell therapy is developing at an unprecedented speed.

The Next Wave Institute:

What challenges do these technologies still face?

Siddhartha Mukherjee: 

First is the technical challenge. As an extremely complex life system, any tiny alteration in cells may bring unexpected chain reactions. For example, although CAR-T cell therapy has shown great potential in treating cancer, a very small number of patients have developed other types of cancers due to CAR-T cells. This is a difficult problem that we need to overcome.

Another example is IVF. As an extremely successful cell therapy, IVF undoubtedly brings hope to countless families, but at the same time, it also triggers ethical controversies. For example, IVF technology makes gender selection possible, and in some countries and regions, gender selection may cause serious social problems.

The Next Wave Institute:

There is also the problem of high treatment costs.

Siddhartha Mukherjee: 

Yes, The complexity of cell therapy brings high costs: Cells must be cultured in a sterile environment, be able to grow and survive in vitro, and finally be successfully transplanted into the human body.