Milestones in European Thyroidology (MET)
André Ermans (1923-2008)
André-Marie Ermans was born in Brussels in 1923, son of a manufacturer of marble mantelpieces for chimneys. André’s father had married an Italian girl from Carrara (Tuscany), which in a sense made combining marital happiness and professional well-doing much easier, as the Ermans, through his mother’s family, owned marble quarries in Italy. After the death of André’s mother – at a late age of 86 years –, and later the death of his elderly brother who was the manager of the family business, André took over its management. We remember André’s personal interest and knowledge in everything related to marble. During the 11th ETA meeting in Pisa (September 1991), Aldo Pinchera organized an excursion to Carrara. André showed us the quarries of white marble belonging to his family and – to our astonishment – gave us better explanations on the exploitation and multiple usages of marble than the official tour guide.
In 1941, at the age of 18, André undertook medical studies although, with his family background, nothing really destined him to medicine. In May 1940, Brussels had been invaded by the armies of the Third Reich. The military occupants and the collaborating civil administration decided to impose two new rules on the Free University of Brussels (ULB). The first was that all Jewish faculty members were no longer allowed to teach, and the second was the imposition of a commissar to lead over the destiny of the ULB, instead of its normal board of administrators. These were the reasons for our ‘alma mater’ to courageously decide to close its doors and officially stop all teaching in October 1941 (until the liberation of Brussels in October 1944). In this difficult context, André participated as a young medical student in the clandestine teaching that continued underground during WWII. For his first years of university studies, André passed his exams in front of a clandestine ‘Jury Central’.
André graduated in 1949 and his medical career in internal medicine started at the university hospital Brugmann, under Prof. Paul Bastenie who had become Chief of Medicine in 1946. Because of the long standing interest of Bastenie in endocrinology, a small research facility was established in an adjoining building “la Fondation Boël”, where three young collaborators of Bastenie started experimental work on steroids & diabetes (M. Franckson & V. Conard) and on the entirely novel medical use of radioisotopes (André Ermans). The 3 ‘young Turks’ developed a close collaboration in this lab between 1953 & 1955. André’s main research topic was the metabolism of red cells using the incorporation of P32. In 1955, he spent time training in the department of Biochemistry (Prof. Bigwood) to become acquainted with the use of radiolabeled tracers. This technical expertise eventually led André Ermans to present his Ph.D. thesis in 1958 on “the influence of thyroid activity on the metabolism of P32 in red cells”. Although the mechanisms involved would only be understood forty years later, this was, at the time, the most reliable test of the action of thyroid hormones (better than BMR).
Another big step occurred in 1955. The founder of internal medicine, Prof. Paul Govaerts, was due to retire that year, hence opening the position of Chief of Medicine in the University Hospital Saint Pierre. Bastenie was nominated to chair the department and, as a prerequisite to accept his new position, he requested to take with him his 3 scientific collaborators who, therefore moved to hospital Saint Pierre together that same year. This was a big step forward because there was a large facility devoted to medical research adjoining the hospital, the “Laboratory of Experimental Medicine”. There, this group of extremely active young scientists became rapidly well known in Europe, with pioneering studies on diabetes led by Victor Conard and on metabolism of steroids led by Marcel Franckson. With Bastenie’s particular interest in the thyroid gland (he had written his Ph.D. thesis in 1937 on chronic asymptomatic autoimmune – though the term did not yet exist at that time – thyroiditis), and with his expertise in the use of tracer elements, André Ermans was soon to become the ‘thyroid man’ in the team. In 1956-1957, André asked his new collaborator, Jacques Dumont, to set up radio-chromatography techniques to separate and measure the labelling of the various iodinated amino-acids. One year later, André discovered that thyroid residues from iodine-deficient subjects exhibited a marked elevation in the MIT/DIT ratio, and he was the first to hypothesize that iodine deficiency induced an abnormal iodination of Tg. This discovery was one of the bases for what would become the three classical expeditions of Belgian doctors to the Congo, respectively in 1959, 1960, and 1963. The scientific harvest from these expeditions proved to be tremendous for thyroid research: the iodine lack in goiters with abnormal Tg iodination pattern in iodine-deficient populations; first description of myxedematous cretins; goitrogenic role of cassava; etc. From there on, André pursued the study of iodine deficiency during the rest of his career, mainly with François Delange and Claude Thilly.
In 1960, Jacques Dumont returned to Brussels from John Stanbury’s lab and continued his in vitro work on thyroid cell signal transduction. André, who was more clinically oriented, helped him and never interfered directly with his work. Together, Jacques Dumont & André Ermans collaborated on the studies on endemic cretinism in the Congo and on iodine metabolism in goiter. In 1963, Jacques Dumont (with Henri Vis, a pediatrician) made the first exploratory mission on the island of Idjwi, which initiated new studies of goiter that André took over completely from there onwards. In 1963, Ermans & Dumont applied for research contracts with the Atomic International Agency and Euratom. Both grant applications were approved, and the Euratom contract led to the creation of the “Laboratoire de Médecine Nucléaire” (LMN) as an interdisciplinary, fundamental science lab closely linked with clinical investigation. André was the leader of the network and Jacques the head of the lab. In 1967, André Ermans wanted the lab to be the fundamental arm of his newly created hospital department of nuclear medicine, while Jacques wanted the lab to keep close ties with more basic science. This difference in opinion and strategy between them led to an amicable split between André Ermans & Jacques Dumont, who developed the LMN into what was to become today’s Institute of Interdisciplinary Research (IRIBHN).
André Ermans became Head of the Division of Endocrinology (1967) and later Chief of the Service of Nuclear Medicine (1971) where he pursued his numerous studies on the thyroid until his retirement in 1988. He also became Professor at the Faculty of Medicine in ULB (1966). Outstanding awards were bestowed upon him: the “Assubel prize” (1982), the “Honorary membership” of the ETA (1994), and the ETA “Lissitzky career award” (1997).
André Ermans was the mentor and ‘spiritual father’ of several distinguished scientists, many actively involved in ETA’s activities: J. Dumont, F. Delange, C. Thilly, D. Glinoer, & P. Bourdoux. He authored over 300 scientific publications on goitre, origin of endemic cretinism, physio-pathology of iodine deficiency, influence of dietary goitrogens on thyroid function, congenital hypothyroidism, and programmes for iodine prophylaxis. André Ermans was not only the leader of numerous clinical and experimental studies of thyroid disorders, but he also led several scientific missions and campaigns for the eradication of iodine deficiency in Central Africa, Algeria and Vietnam, under the auspices of the Belgian Ministry of Development and Cooperation, the International Development and Research Centre (Canada), and the European Economic Communities.
André was one of the founding fathers of the European Thyroid Association in 1965 during the International Thyroid Congress in Rome. More detail on this story can be found in the vignette written by Christian Beckers and David Evered. Always an active member of our annual ETA meetings, André was always keen to share his vast knowledge with younger members of the association. He presided over the Brussels’ group to organize the 12th ETA meeting in Brussels (1982). During numerous meetings spent abroad in his pleasant company, one of the striking features was that André was particularly cool and relaxed in such circumstances, as if he had this capacity to leave behind the burdens of his professional (and also sometimes personal) life.
André had an amazingly astute vista and understanding of what is undoubtedly ‘excellence in clinical investigation’. As an example, D.G. remembers having an appointment with the boss one day in 1973, to tell the story of a patient with severe De Quervain’s thyroiditis. In two minutes, scribbled on a simple piece of paper, André hypothesized the bases of what was to become the first complete functional investigation of what happens to the thyroid during the acute and recovery phases in this disease. Applied to two similar patients, every prediction made by André became hard “evidence-based” facts. His vista to explain the mechanisms of this disease had been entirely correct. The article published together remained for many years thereafter a ‘classical’ study on the metabolism of thyroid hormones in subacute thyroiditis: “Sequential study of thyroid function impairment in the early stage of subacute thyroiditis” (Acta Endocrinologica 77:26-35, 1974).
In spite of the international stature acquired among his peers, André often felt insecure as to his international leadership. As a consequence, André was known to demand the greatest rigorousness from his collaborators, and at all times. For instance, when it became time for D.G. to begin writing up his Ph.D. thesis, André set the following rules: “Daniel, you will write the first three chapters – the plan comprised nine chapters altogether – and only then give them to me for review”. Three months of hard labour later, having given him the written chapters, André asked to see me. Sucking on his traditional Dunhill pipe, he mumbled: “c’est très-très bien” (it’s very good); je n’ai que quelques remarques à te faire” (I have only a few comments to make). Then started a series of precise criticisms that simply destroyed all the hard work done; and back to the writing bench. Thereafter, the same sequence of discussions and corrections with André went on for one full year and eleven successive versions of the thesis, before André eventually approved the text and considered it to be presentable in front of the jury. Needless to say, twenty years of almost daily collaboration with this exceptional man played a crucial role in my own formation and scientific tenacity. And what André had done with this thesis was nothing remarkable for him. He would do the same for any topic, research project, submission of abstract, publication of article, chapter for textbook, grant application, communication to congress, etc. for each and every one of his many collaborators over all these years, both in the field of thyroid research and all aspects of nuclear medicine.
A still classical thyroid textbook today was published by Bastenie and Ermans on “Thyroiditis and Thyroid Function” (Pergamon Press, 1971). Deborah Doniach wrote the preface and addressed a handwritten letter to the authors before the book’s publication where she graciously mentioned: “I am sure the book will be a tremendous success & will teach people an awful lot”. Facetiously, she added “some Gallicisms may not be obvious to you but I assure you they would strike an English very much” (well, once a subject of the British Empire, always a subject of the Empire; personal note of present writers).
André retired officially in 1988, at the age of 65 years, from his hospital and university positions. Four years before, André was instrumental in establishing the “Fondation de Recherche Médicale André Vésale” in hospital Saint Pierre. André had the vista to predict a long time before anybody else the urgent necessity to protect and defend clinical investigation, because he understood that harder times were on the horizon. The “Vésale Foundation” helped find funds to provide grants to young doctors interested in clinical research and help them develop their project from the onset. André became the president of the foundation where he continued to serve until 2001. It has been a privilege to pursue my friendly collaboration (DG) with André during many years in the foundation, until old age and failing physical energy led him to resign.
André passed away on August 15, 2008 and it is sad that the last years of his life were so difficult. Due to poor health, André decided at the end of 2004 (our last conversation) that he no longer wished to meet his previous collaborators who, in the mean time, had become his close friends. We respected his decision until the end.
Top left: André Ermans with Monique Camus & Daniel Glinoer at ETA meeting in Jerusalem (1973; Top right: André Ermans with Daniel Glinoer and Governor André DeGroeve at gala dinner of Vésale Foundation (1992); Mid page: André Ermans receives the diploma of Honorary ETA Member from Jacques Dumont, then ETA President (1997); Lower left: André Ermans with companion Chantal Woehrlé at his farewell retirement dinner (1988); Lower right: André Ermans with a group of Belgian participants at ETA meeting in Brussels (1982).