Marthe Gautier

Marthe Gautier (born 10 September 1925) is a French medical doctor and researcher, best known for her role in discovering the link of diseases to chromosome abnormalities.

Marthe Gautier
Born	(1925-09-10) 10 September 1925
Nationality	French
Alma mater	Hôpitaux de Paris
Known for	Role in the discovery of Down syndrome
Scientific career
Fields	pediatric cardiology
Institutions	Hôpitaux de Paris, Harvard, Hôpital Trousseau
Thesis	(1955)
Doctoral advisor	Robert Debré

Education

Marthe Gautier discovered a vocation for pediatrics at an early age. In 1942 she joined her sister Paulette who was about to complete her medical studies in Paris intending to become a pediatrician. She passed the entrance exam of the "Internat des hôpitaux de Paris" and spent the next four years as an intern gaining clinical experience in pediatrics.

In 1955 she submitted and defended her thesis in pediatric cardiology under the direction of Robert Debré. Her thesis focused on the study of clinical and anatomical pathology of fatal forms of rheumatic fever (rheumatic endocarditis) due to streptococcus infection.

Robert Debré, in charge of pediatrics in France at the time, offered Gautier a scholarship for one year at Harvard University in order to acquire knowledge in pediatric cardiology with two main objectives. The first was to eradicate rheumatic fever, using penicillin and the treatment of sometimes life-threatening cardiovascular disease with cortisone; the second was to create a department for diagnosis and surgery of congenital heart diseases for newborns and young children.

In September 1955, Gautier left for Boston. She was accompanied by Jean Alcardi and Jacques Couvreur, both Fulbright scholars, and the three became the first interns of the Hôpitaux de Paris to be awarded scholarships for the US.[1] At Harvard, one of the tasks of her internship was to be trained as a laboratory technician working on cell culture. Besides the two objectives that had been set initially, Gautier was also working half-time as a technician in a laboratory for cell culture to obtain in-vitro cultures of fibroblast starting from aorta fragments.

After a year in Boston, Gautier returned to Paris. Meanwhile, her job in the pediatric cardiology service at the Bicêtre Hospital in Paris had been given to a colleague during her absence. However, she learned that there was a position available at the Trousseau Hospital, in Raymond Turpin's team.

Turpin's research was focused on polymalformative syndromes, of which the most common is trisomy, characterized by intellectual disability and morphological abnormalities. At the time, Turpin favored the hypothesis of a chromosomal origin of trisomy but there was no laboratory for cell culture in France and the number of human chromosomes was estimated at 48, but without any certainty.

Down syndrome

Laboratory cell culture

In 1956, biologists from Lund University in Sweden announced that humans have exactly 46 chromosomes. Turpin had many years earlier proposed the idea of culturing cells to count the number of chromosomes in trisomy. Gautier had recently joined the pediatrics group he headed at the Armand-Trousseau Hospital, and she offered to attempt this, since she had been trained in both cell culture and tissue staining techniques in the United States.[2] Turpin agreed to provide her with tissue samples from patients with Down syndrome. With very limited resources Gautier set up the first in vitro cell culture laboratory in France.[3]

In order to count the chromosomes, Gautier worked on fibroblasts derived from connective tissue, which were easier to obtain under local anesthesia. Although the principle of cell culture is simple, there were many practical obstacles to getting it to work under the primitive conditions available to Gautier, who was forced to use a personal loan to purchase laboratory glassware and, at times, her own blood as a source of human serum. She eventually confirmed that the protocol worked, using connective tissue from a neighbouring surgeon, taken during planned interventions in children. She used the "hypotonic shock" method[4] followed by drying the slide after attachment in order to disperse the chromosomes of dividing cells and make them easier to count.

Using this protocol, Gautier found that the cells of normal children have 46 chromosomes. In May 1958, she observed an additional chromosome in the cells of a trisomic boy,[5] the first evidence of chromosomal abnormalities in individuals with Down syndrome.

Announcement of results

At the time, the laboratories at the Armand-Trousseau hospital did not have a microscope capable of capturing images of the slides. Gautier entrusted her slides to Jérôme Lejeune, an intern at CNRS, who offered to take pictures in another laboratory better equipped for this task.[5] In August 1958 the photographs identified the supernumerary chromosome in Down syndrome patients.[6] However Lejeune did not return the slides, but instead reported the discovery as his own.

In January 1959, by studying new cases[6] and to forestall similar research by the English,[2] the Trousseau laboratory announced the results of the analysis of the slides in the Proceedings of the Academy of Sciences through a paper published with Lejeune as first author, Gautier second (her surname misspelled) and Turpin last author.[7]

The Turpin team identified the first translocation and the first chromosomal deletion, resulting in publications Gautier co-signed.[8]

Attribution of the discovery

In April 1960, the condition was named trisomy 21. As of 1970 the Lejeune foundation started to promote the discovery as sole work of Lejeune – omitting the co-authors.[9] Gautier has told how she was put to one side by Turpin and by Lejeune who claimed responsibility for the discovery, even though it relied on the work that she had initiated and directed technically.[10] Aware of having been manipulated Gautier decided to abandon trisomy 21 and to return to caring for children affected by cardiopathy.[11][12]

On 31 January 2014, Gautier was due to speak about her role in the discovery at the seventh biennial congress on human and medical genetics in Bordeaux, and to receive the grand prize of the French Federation of Human Genetics. The Jérôme Lejeune Foundation obtained authorisation from the Bordeaux Tribunal de Grande Instance for bailiffs to be sent to film this session. At the last minute, concerned that the recording might be used in legal proceedings it could not afford to defend, the congress organisers decided to cancel her presentation and she received her award privately instead.[13] [14]

The ethics committee of the INSERM has issued a note in July 2014, reminding the decisive role of Marthe Gautier, and has built upon this case to remind the international rules currently in vigor for scientific publications and authors list. The note precises that "history of discovery is not identical to the history of science, and the process of validating knowledge remains very different«. The technical approach is a necessary condition for discovery- key role of Marthe Gautier : but quite often it must be extended pour make recognition emerge – priori contribution of Raymond Turpin and thereafter Jérôme Lejeune. As the discovery of trisomy would have been impossible without the mandatory contributions of Raymond Turpin and Marthe Gautier, it is regrettable that their names were not sustematically associated with this discovery, as much in terms of communication but also in the assignement of various awards and distinctions."[15]

Marthe Gautier was directly appointed to the rank of Officer of the French Legion of Honor[16] and was decorated on September 16th, 2014. Marthe Gautier has, in the past, declined this distinction twice before consenting to it "by indignation towards the impudence of the Lejeune Foundation".

She was promoted Commander of the National Order of Merit on 15 November 2018.[17]

Medical career

After the trisomy discovery Gautier left Turpin's team and applied for a position in public health care to dedicate herself to cardio-pediatrics. She was hired by Professor Nouaille in a newly opened service at the Hospital Kremlin Biccetre. Subsequently, she became Master of Research at the INSERM.[2] Gautier is currently in retirement.

References

1. "Harvard Medical School and School of Dental Medicine, 1956-57". Harvard University. Retrieved 1 March 2014.
2. Gautier, Marthe; Harper, Peter S. (2009). "Fiftieth anniversary of trisomy 21: returning to a discovery". Human Genetics. 126 (2): 317–324. doi:10.1007/s00439-009-0690-1. ISSN 0340-6717.
3. "The history of cytogenetics Portraits of some pioneers" S. Gilgenkrantz & E.M. Rivera, 2003 in "Annales de génétique"
4. J.-H. Tjio et A. Levan, Hereditas, 42, 1, 1956.
5. Pain, Elisabeth (11 February 2014). "After More Than 50 Years, a Dispute Over Down Syndrome Discovery". Science Now.
6. Le Méné, Jean-Marie (2009). "La découverte de la trisomie 21". Retrieved 9 February 2014.
7. Lejeune, Jérôme; Gauthier, Marthe; Turpin, Raymond (1959). "Les chromosomes humains en culture de tissus". Comptes Rendus Hebdomadaires des Séances de l'Académie des Sciences. 248 (1): 602–603.
8. Gautier, Marthe (30 September 2009). "La découvreuse oubliée de la trisomie 21". La Recherche (434): 57. Archived from the original on 2 February 2014.
9. "Archived copy". Archived from the original on 2014-09-06. Retrieved 2014-09-06.CS1 maint: archived copy as title (link)
10. "Trisomie 21 : la Fondation Lejeune menace par huissiers". Libération. 3 February 2014.
11. "Fiftieth anniversary of the trisomy 21: return on a discovery". Med Sci (Paris) Volume 25, Numéro 3, Mars 2009. Retrieved 17 May 2014.
12. 'The history of cytogenetics – Portraits of some pioneers' S. Gilgenkrantz, E.M. Rivera, University of Nancy (France) & Michigan State University (USA) ,
13. Casassus, Barbara (11 February 2014). "Down's syndrome discovery dispute resurfaces in France". Nature. doi:10.1038/nature.2014.14690.
14. "Who really decoded Down's syndrome?". New Scientist. 5 April 2014.
15. http://presse.inserm.fr/jeudi-25-septembre-2014/15704/
16. http://www.legiondhonneur.fr/sites/default/files/promotion/lh_20140420_1.pdf
17. https://www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000037615089&dateTexte=&categorieLien=id