Blood Cells in Crosstalk

REVIEW

Blood Cells in Crosstalk:
Cells at Work! and
Cells at Work! Code Black

by Mallika Sekhar

No cell is an island, just as no body is an island. Crosstalk between cells can be tender and nurturing; noisy, rude and commanding; hierarchic and orderly; anarchic and disruptive. Cells transgress territory using their bodies. These matters represent a cellular ecology where cells exist in their ecospheres while interacting with other ecospheres. The term ‘ecology’ has come to mean something beyond its original nineteenth century remit: namely, the relationship of living things to their environment. Its use in social and mental spheres in the twentieth century goes beyond metaphor as our understanding of the connectedness between these spheres grows. Cellular ecology is a twenty-first century addition to this lexicon. When futures consider languages, this relational ecological framework might serve as a useful apparatus to interrogate communication, enabling a more iterative discourse and opening new ways of relating across structures, species, and worlds.

Unlike the ecological crisis afflicting the earth, the internal milieu of the human body is relatively stable. The pH of human blood, for example, is a tight figure: a number that – unlike the pH of oceans – has not changed over time. Yet, there are similarities between systems of the earth and those of the body. As with the environment, there is a rich mutuality between cells within the body. Like in the biosphere, these interdependent processes respond to challenges posed by villains from within and without, to vanquish, adapt, or succumb. And, in a similar vein to environmental threats, the villainy is shaped by social forces. How does the body get it right so often? How do blood cells live, work and relate in the service of the body and how do they relate with the body they serve? Furthermore, how do they relate with social forces that shape and distort the body – fumes, frets, forces majeure and others? Could a visual exposition of this provide an opportunity to reimagine our relationships with ourselves, with others, with the earth?

Consider the red blood cell. Born of a decent mitosis, it must lose its nucleus before release from marrow to the circulating blood. This extrusion of its nucleus gives it a functionary status, like Kazuo Ishiguro’s beings grown for their organs in Never Let Me Go (2005). What ignominy, I always think, to spend three months in the service of the body and all that time, anucleate, possessing no control. Something similar occurs with platelet cells in the blood. Some people call platelets “particles,” as if they were matter without life. Is Pluto not a planet? These matters have a resonance that extends beyond taxonomy. The matter of enucleation, an active step that removes control, is the defining ritual that propels the red blood cell into maturity. It haunts me, partly because of the wonder of its anaerobic metabolism and partly because of the importance afforded to ‘agency’ in present times.

Cue Netflix, where I chanced upon the series Cells at Work! and Cells at Work!, Code Black. As I am both a blood doctor and a fan of Japanese anime, I watched them. In doing so, I was cajoled into questioning myself about the notion of ‘agency’. Based on a successful manga comic, this anime anthropomorphises blood cells and, over 21 episodes, describes their adventures upon encountering villains inside a body that is a metropolis. Our hero red cell, AE3803, finds herself in the bone marrow, where all blood cells start out. The graduating class is lined up to leave home, sniffing into their hankies for the ceremonial yanking of the nucleus pom-pom on their cap. Their nucleus extruded, they are congratulated by another cell, a macrophage: “From now on you will be an independent red cell”. AE3803 remembers her birth, remembers the shaping of her fate when the nurse holding her baby self, proclaimed, “This baby would be a good red blood cell”. The adventures of AE3803, a shy and scared red cell prone to getting lost while making her oxygen deliveries, kickstart the series.

With each episode we are introduced to new threats that showcase different blood cells. We see cells experiencing uncertainty and fear, shame and guilt and how they abide by their code of duty to the body. We cheer hero neutrophil U-1146, a handsome youth wearing a blood splattered uniform with strands of hair covering his right eye. We admire how he stands ready to kill a villain at a moment’s notice, yet is thoughtful of demeanour and softly spoken; how he befriends AE3803 and watches out for her, and we marvel at how the little platelet cells go about repairing and scaffolding while there is mayhem around them. To describe the depiction as anthropomorphising somehow seems inadequate. True, there is speech – voice, language, subtitles. Then there is language – looks, nudges, shoves. These are the feeders for the main deal, the message – run, hide, fight, kill. The animes use these strategies as proxy for the crosstalk that occurs in our bodies through chemicals and through physical movements by which they engage with co-workers, push out or trap enemies, through movement from cell membrane to membrane.

The vanities, the valour, the wit, the web of causality, the hope and pathos of cells that fail, the existential dilemmas and the dialogues speaking of them are grandly inventive and huge fun – there are many epic moments. When large quantities of bacteria from raw fish (what else in a manga?) invade the gut, the phone rings non-stop at Mission HQ. A signal flashes: Status Queasy. While neutrophil U-1146 and his friends rush in to fight, a parasite escapes them and starts chewing through the wall of the stomach. Neutrophils are helpless against parasites; the eosinophil saves the situation and gets her ‘Because I’m Worth It’ moment, but she gets into trouble and the basophil, a dark hooded woman in a moody trench coat, moves in to the rescue. The basophil’s exit line? “An uninvited guest chomps a big hole and rays of light shine through upon the hearts of the masses. How ironic. Such is the fate of cells”. Such moments of grandeur enticed me, drew me in and I was hooked.

Some of the most memorable lines go to a morphing cancer cell; tension rises when a cancer cell holds its own against a deadly trio of cells protecting the body. It ignores the other two as stupid louts but talks to U-1146, now imprisoned:

“I like you, neutrophil. I could sit and chat with you about all kind of things.
But the thing is I’ve changed my mind. Lives that are necessary and lives that are not… Why does such a distinction have to be made at all?”

“It’s for the sake of this body!” U-1146 shouts, his voice now hoarse, as if from a Kurosawa film. “Because it’s necessary. That’s why we die and kill!”

There follows a conversation – as war rages around them – that is poignant, philosophical and plausible. Such scenes are reminiscent of the Indian epic Mahabharata (3rd-4th Century CE), in which a philosophical discourse occurs at the height of the battle, and the value of one life against another is a recurring theme. The cancer cell poses the question to the neutrophil: “How about a world where we cells don’t have to kill or be killed at all? Even if it’s a world gone mad, approaching death…If it’s possible to make that world real, even for a split second…don’t you think we’d be justified in sacrificing the life of this body? ”

U-1146, a defender, will not let the body down. A pragmatic neutrophil that does not rely on complex memories, U-1146 points out that, should the body die, all of its cells, including the cancer cell, must die with it. The cancer cell, mutated and disfigured, is unmoved and retorts, “But we’ll die after we’ve been liberated.” This scene is a revelatory one: a conceptual leap from the Nixon era of war on cancer to the era of ‘live and let live’ cancer therapy that we adopted during the pandemic, when killing the cancer would have killed its host.

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In The Three Ecologies (1989), Félix Guattari describes a mental and a social ecology in addition to an environmental ecology. He describes stressors – e.g. post-industrial capitalism, homogenisation by mass media – and the need for these additional ecologies to retain singularity, the possibilities of how to move towards achieving them. The blood cells and the pathogens, as conceptualised by this anime series, convey a subjectivity; a singularity of each in the midst of mass homogeneity; a fine sense of social codes and bonds; an intrinsic sense of their limits and untapped potential. These resonate with Guattari’s suggestion and discussion of a mental ecology, in which he proposes a need for a resistance to mass-media homogenisation that endangers the uniqueness of human subjectivity – a uniqueness that operates at a pre-personal, pre-individual level. “Every existence above a certain rank has its singular points, the higher the rank, the more of them. At these points, influences whose physical magnitude is too small to be taken account of by a finite being may produce results of the greatest importance”. The lives of the blood cells seem to exemplify this idea, and their collective lives resonate with Guattari’s thesis on social ecology, in which he posits a need to experiment with new ideas of group living.

Theories of Gaia, the recent microbiomania and the epigenetics boom show us how biological theories can, and should, be interpreted through different vocabularies. Guattari instructs us to abandon scientific or pseudo-scientific paradigms and return to ethical/aesthetic ones that underpin others (an arguable point, according to his critics). Books such as Gut Anthro: An Experiment in Thinking with Microbes (2023) by Amber Benezra and The Hidden Half of Nature: The Microbial Roots of Life and Health (2015) by David R. Montgomery and Anne Biklé go a long way towards bridging the scientific and the aesthetic. The Cells anime, while serving as a (mostly) scientifically accurate rendering of events in the body, also allow a space for imagining some of these notions as operating within the milieu of the human body. The cancer cell, its grand dialogue notwithstanding, eventually exits when neutrophil U-1146 gets the upper hand:

“…Even so, I still have to kill you. Because that’s my job.”

“That’s fine, I’ve lost this time.”

One of the virtues of this series is that it affords space to conceptualise the body in this philosophical mode. For kids wanting to watch 12+ or 16+ rated films, it offers a lot more than the facts and visuals (there are virtual games available that offer these). For kids of any age struggling to understand our place in this world, the films allow us space for reflection that uses science while at the same time transcending science. As the cancer cell says, “have you ever thought like that?”

Cells at Work! and Cells at Work! Code Black are available to watch on streaming platform Netflix .

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MALLIKA SEKHAR is a Consultant Haematologist and Honorary Associate Professor at Royal Free Hospital and UCL Medical School. She is a current fellow at the Institute of Advanced Studies, working on aspects of medical harm (https://thebitterpillpodcasts.libsyn.com/). She is a fellow at the Arvon Advanced Writing Programme, where she is working on a novel.

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Edited by JOSH WEEKS
Proofreading by FLORA SAGERS

Lead image by National Cancer Institute.