C P Case

University of Bristol, Bristol, England, United Kingdom

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Publications (41)262.64 Total impact

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    ABSTRACT: Some psychiatric diseases in children and young adults are thought to originate from adverse exposures during fetal life, including hypoxia and hypoxia/reoxygenation. The mechanism is not understood. Several authors have emphasised that the placenta is likely to play an important role as the key interface between mother and fetus. Here we have explored whether a first trimester human placenta or model barrier of primary human cytototrophoblasts might secrete factors, in response to hypoxia or hypoxia/reoxygenation, that could damage neurones. We find that the secretions in conditioned media caused an increase of [Ca(2+)]i and mitochondrial free radicals and a decrease of dendritic lengths, branching complexity, spine density and synaptic activity in dissociated neurones from embryonic rat cerebral cortex. There was altered staining of glutamate and GABA receptors. We identify glutamate as an active factor within the conditioned media and demonstrate a specific release of glutamate from the placenta/cytotrophoblast barriers in vitro after hypoxia or hypoxia/reoxygenation. Injection of conditioned media into developing brains of P4 rats reduced the numerical density of parvalbumin-containing neurones in cortex, hippocampus and reticular nucleus, reduced immunostaining of glutamate receptors and altered cellular turnover. These results show that the placenta is able to release factors, in response to altered oxygen, that can damage developing neurones under experimental conditions.
    Experimental Neurology 05/2014; DOI:10.1016/j.expneurol.2014.05.003 · 4.62 Impact Factor
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    ABSTRACT: The histological specimens from 29 failed metal-on-metal (MoM) hip arthroplasties treated at our institution were reviewed. Five patients had a failed MoM total hip arthroplasty (THA), and 24 patients a failed hip resurfacing. Clinical and radiographic features of each hip were correlated with the histological findings. We report three major histological subtypes. Patients either have a macrophage response to metal debris, a lymphocytic response (ALVAL) or a mixed picture of both. In addition we observe that the ALVAL response is located deep within tissue specimens, and can occur in environments of low wear debris. The macrophage response is limited to the surface of tissue specimens, with normal underlying tissue. Patients with subsequently confirmed ALVAL underwent revision surgery sooner than patients whose histology confirms a macrophage response (3.8 vs. 6.9 years p<0.05). Both histological subtypes (ALVAL and macrophage dominant) are responsible for abnormal soft tissue swellings.
    Hip International 02/2014; DOI:10.5301/hipint.5000117 · 0.76 Impact Factor
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    Michiya Matsusaki, Charles Patrick Case, Mitsuru Akashi
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    ABSTRACT: Three-dimensional (3D) tissue constructs consisting of human cells have opened a new avenue for tissue engineering, pharmaceutical and pathophysiological applications, and have great potential to estimate the dynamic pharmacological effects of drug candidates, metastasis processes of cancer cells, and toxicity expression of nano-materials, as a 3D-human tissue model instead of in vivo animal experiments. However, most 3D-cellular constructs are a cell spheroid, which is a heterogeneous aggregation, and thus the reconstruction of the delicate and precise 3D-location of multiple types of cells is almost impossible. In recent years, various novel technologies to develop complex 3D-human tissues including blood and lymph capillary networks have demonstrated that physiological human tissue responses can be replicated in the nano/micro-meter ranges. Here, we provide a brief overview on current 3D-tissue fabrication technologies and their biomedical applications. 3D-human tissue models will be a powerful technique for pathophysiological applications.
    Advanced drug delivery reviews 01/2014; 74. DOI:10.1016/j.addr.2014.01.003 · 12.71 Impact Factor
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    ABSTRACT: Metal hip replacements generate both metal particles and ions. The biological effects of peri-articular exposure to nanometre and micron sized cobalt chrome (CoCr) wear particles were investigated in a mouse model. Mice received injections of two clinically relevant doses of nanoparticles (32 nm), one of micron sized (2.9 μm) CoCr particles or vehicle alone into the right knee joint at 0, 6, 12 and 18 weeks. Mice were analysed for genotoxic and immunological effects 1, 4 and 40 weeks post exposure. Nanoparticles but not micron particles progressively corroded at the injection site. Micron sized particles were physically removed. No increase of Co or Cr was seen in peripheral blood between 1 and 40 weeks post exposure to particles. No significant inflammatory changes were observed in the knee tissues including ALVAL or necrosis. DNA damage was increased in bone marrow at one and forty weeks and in cells isolated from frontal cortex at 40 weeks after injection with nanoparticles. Mice exposed to the micron sized, but not nanoparticles became immunologically sensitized to Cr(III), Cr (VI) and Ni(II) over the 40 week period as determined by lymphocyte transformation and ELISpot (IFN-γ and IL-2) assays. The data indicated that the response to the micron sized particles was Th1 driven, indicative of type IV hypersensitivity. This study adds to understanding of the potential adverse biological reactions to metal wear products.
    Biomaterials 08/2013; 34(34). DOI:10.1016/j.biomaterials.2013.07.073 · 8.31 Impact Factor
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    ABSTRACT: Resurfacing arthroplasty has fallen out of favour in recent years due to unfavourable survivorship in joint registries and alarming reports of soft tissue reactions around metal on metal prostheses. Our aim was to assess the effect of head size, implant design and component positioning on metal production by resurfacing arthroplasties. We measured whole blood cobalt and chromium and component position in matched populations implanted with two designs of resurfacing arthroplasty over a two-year period. Both implants resulted in a significant increase in blood metal levels (p<0.001) though the ASR design generated significantly higher metal levels (p = 0.041). A significant inverse correlation was seen between component size and blood cobalt levels (p = 0.032) and blood chromium levels (p<0.001). No correlation was identified between component position and blood metal levels. Small diameter metal resurfacing components result in increased metal generation compared with larger components. As increased metal generation has been correlated to wear and therefore failure, caution must be used on implantation of smaller components and indeed, in those who require smaller components, alternative bearing materials should be considered. These results contrast with recent findings which have demonstrated early failure for larger diameter stemmed metal-on-metal prostheses.
    Hip international: the journal of clinical and experimental research on hip pathology and therapy 06/2013; 23(6). DOI:10.5301/hipint.5000057 · 0.76 Impact Factor
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    ABSTRACT: Patients with cobalt chrome (CoCr) metal-on-metal (MOM) implants may be exposed to a wide size range of metallic nanoparticles as a result of wear. In this study we have characterised the biological responses of human fibroblasts to two types of synthetically derived CoCr particles [(a) from a tribometer (30 nm) and (b) thermal plasma technology (20, 35, and 80 nm)] in vitro, testing their dependence on nanoparticle size or the generation of oxygen free radicals, or both. Metal ions were released from the surface of nanoparticles, particularly from larger (80 nm) particles generated by thermal plasma technology. Exposure of fibroblasts to these nanoparticles triggered rapid (2 h) generation of reactive oxygen species (ROS) that could be eliminated by inhibition of NADPH oxidase, suggesting that it was mediated by phagocytosis of the particles. The exposure also caused a more prolonged, MitoQ sensitive production of ROS (24 h), suggesting involvement of mitochondria. Consequently, we recorded elevated levels of aneuploidy, chromosome clumping, fragmentation of mitochondria and damage to the cytoskeleton particularly to the microtubule network. Exposure to the nanoparticles resulted in misshapen nuclei, disruption of mature lamin B1 and increased nucleoplasmic bridges, which could be prevented by MitoQ. In addition, increased numbers of micronuclei were observed and these were only partly prevented by MitoQ, and the incidence of micronuclei and ion release from the nanoparticles were positively correlated with nanoparticle size, although the cytogenetic changes, modifications in nuclear shape and the amount of ROS were not. These results suggest that cells exhibit diverse mitochondrial ROS-dependent and independent responses to CoCr particles, and that nanoparticle size and the amount of metal ion released are influential.
    Biomaterials 05/2013; 34(14):3559-70. DOI:10.1016/j.biomaterials.2013.01.085 · 8.31 Impact Factor
  • Toxicology 12/2011; 290(s 2–3):115. DOI:10.1016/j.tox.2011.09.026 · 3.75 Impact Factor
  • Toxicology 12/2011; 290(s 2–3):115–116. DOI:10.1016/j.tox.2011.09.027 · 3.75 Impact Factor
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    ABSTRACT: The use of nanoparticles in medicine is ever increasing, and it is important to understand their targeted and non-targeted effects. We have previously shown that nanoparticles can cause DNA damage to cells cultured below a cellular barrier without crossing this barrier. Here, we show that this indirect DNA damage depends on the thickness of the cellular barrier, and it is mediated by signalling through gap junction proteins following the generation of mitochondrial free radicals. Indirect damage was seen across both trophoblast and corneal barriers. Signalling, including cytokine release, occurred only across bilayer and multilayer barriers, but not across monolayer barriers. Indirect toxicity was also observed in mice and using ex vivo explants of the human placenta. If the importance of barrier thickness in signalling is a general feature for all types of barriers, our results may offer a principle with which to limit the adverse effects of nanoparticle exposure and offer new therapeutic approaches.
    Nature Nanotechnology 11/2011; 6(12):824-33. DOI:10.1038/nnano.2011.188 · 33.27 Impact Factor
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    ABSTRACT: Lately, concerns have arisen following the use of large metal-on-metal bearings in hip replacements owing to reports of catastrophic soft-tissue reactions resulting in implant failure and associated complications. This review examines the literature and contemporary presentations on current clinical dilemmas in metal-on-metal hip replacement.
    The Bone & Joint Journal 05/2011; 93(5):572-9. DOI:10.1302/0301-620X.93B4.26429 · 2.80 Impact Factor
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    ABSTRACT: Metal-on-metal total hip replacement has been targeted at younger patients with anticipated long-term survival, but the effect of the production of metal ions is a concern because of their possible toxicity to cells. We have reviewed the results of the use of the Ultima hybrid metal-on-metal total hip replacement, with a cemented polished tapered femoral component with a 28 mm diameter and a cobalt-chrome (CoCr) modular head, articulating with a 28 mm CoCr acetabular bearing surface secured in a titanium alloy uncemented shell. Between 1997 and 2004, 545 patients with 652 affected hips underwent replacement using this system. Up to 31 January 2008, 90 (13.8%) hips in 82 patients had been revised. Pain was the sole reason for revision in 44 hips (48.9%) of which 35 had normal plain radiographs. Peri-prosthetic fractures occurred in 17 hips (18.9%) with early dislocation in three (3.3%) and late dislocation in 16 (17.8%). Infection was found in nine hips (10.0%). At operation, a range of changes was noted including cavities containing cloudy fluid under pressure, necrotic soft tissues with avulsed tendons and denuded osteonecrotic upper femora. Corrosion was frequently observed on the retrieved cemented part of the femoral component. Typically, the peri-operative findings confirmed those found on pre-operative metal artefact reduction sequence MRI and histological examination showed severe necrosis. Metal artefact reduction sequence MRI proved to be useful when investigating these patients with pain in the absence of adverse plain radiological features.
    The Bone & Joint Journal 11/2010; 92(11):1501-8. DOI:10.1302/0301-620X.92B11.24504 · 2.80 Impact Factor
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    ABSTRACT: Humans are exposed to chromium and cobalt in industry, from the environment and after joint replacement surgery from the CoCr alloy in the implant. In this study we have investigated whether Cr(III), Cr(VI), Co(II) and Cr in combination with Co could induce chromosome aberrations in human fibroblasts in vitro at the same concentrations that have been found in the peripheral blood of exposed humans. We used 24 colour M-FISH as a sensitive way to detect translocations and aneuploidy and examined the effects of a 24-h exposure and its consequences up to 30 days after the exposure in order to record genomic instability and/or repair. At these physiological doses the metals induced predominantly numerical rather than structural aberrations. Co was the least reactive and Cr(VI) especially in combination with Co the most. All metals at the highest physiological doses caused simple (gain or loss of 3 or less chromosomes) and complex (more than 49 chromosomes) aneuploidy. All metals at the lowest physiological dose caused a significant increase of total aberrations. Cr(VI) was much more effective than Cr(III) in causing chromosome fragments, which were only induced at the highest doses. There was a slow resolution of aneuploidy with time after exposure. This involved a reduction in the proportion of aneuploid cells and a reduction of the number of chromosomes within cells showing complex aneuploidy. We conclude that these metal ions can cause chromosome aberrations at physiological concentrations and that their main effect is aneugenic.
    Mutation Research/Fundamental and Molecular Mechanisms of Mutagenesis 03/2010; 688(1-2):53-61. DOI:10.1016/j.mrfmmm.2010.03.008 · 4.44 Impact Factor
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    ABSTRACT: Cobalt-chromium particles and ions can induce indirect DNA damage and chromosome aberrations in human cells on the other side of a cellular barrier in tissue culture. This occurs by intercellular signalling across the barrier. We now show that the threshold for this effect depends on the metal form and the particle composition. Ionic cobalt and chromium induced single strand breaks at concentrations equivalent to those found in the blood of patients with well functioning metal on metal hip prostheses. However, they only caused double strand breaks if the chromium was present as chromium (VI), and did not induce chromosome aberrations. Nanoparticles of cobalt-chromium alloy caused DNA double strand breaks and chromosome aberrations, of which the majority were tetraploidy. Ceramic nanoparticles induced only single strand breaks and/or alkaline labile sites when indirectly exposed to human fibroblasts. The assessment of reproductive risk from maternal exposure to biomaterials is not yet possible with epidemiology. Whilst the barrier model used here differs from the in vivo situation in several respects, it may be useful as a framework to evaluate biomaterial induced damage across physiological barriers.
    Biomaterials 03/2010; 31(16):4477-83. DOI:10.1016/j.biomaterials.2010.02.038 · 8.31 Impact Factor
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    Aikaterini Tsaousi, Eric Jones, Charles P Case
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    ABSTRACT: One of the biggest problems with orthopaedic joint replacements has been the tendency for metal-on-polyethylene implants to produce particulate wear debris. These particles stimulated adjacent macrophage infiltration, which caused destruction of bone and soft tissue, resulting in aseptic loosening of the implant. This problem led to the development of new implants with articulating surfaces that produce less volumetric wear (metal-on-metal, MOM, and ceramic-on-ceramic, COC). To determine whether there could be adverse biological effects from exposure to particulate wear debris after total hip replacement (THR), we investigated the in vitro genotoxic effects of alumina ceramic (Al(2)O(3)) particles in comparison with cobalt-chrome metal (CoCr alloy) particles. Primary human fibroblasts were exposed to Al(2)O(3) nanoparticles or CoCr alloy particles (0.1-10mg/T-75 flask) for 5 days. There were no significant differences in cell viability between control and ceramic-treated cells, at all doses and time-points studied. Cells exposed to CoCr alloy particles showed both dose- and time-dependent cytotoxicity. There was a small but significant increase in micronucleated binucleate cells after 24h of treatment with >1mg/T-75 flask of alumina particulates compared with controls, although no clear dose-response was observed. The induction of micronuclei was unaffected by the size or shape of the ceramic particles. The increase in micronucleated binucleate cells was much greater after exposure to CoCr particles for 24h, showing a clear dose-response curve. No increase in gamma-H2AX foci was noted in cells exposed to ceramic particles, in contrast with a significant increase of these foci in cells exposed to CoCr particles at comparable mass/surface doses. Cytogenetic analysis showed that both types of particle caused mainly numerical rather than structural chromosomal aberrations, with a greater number and variation of lesions induced by CoCr particles. In conclusion, our results show that alumina (Al(2)O(3)) ceramic particles are only weakly genotoxic to human cells in vitro when compared with metal (CoCr alloy) particles.
    Mutation Research/Fundamental and Molecular Mechanisms of Mutagenesis 02/2010; 697(1-2):1-9. DOI:10.1016/j.mrgentox.2010.01.012 · 4.44 Impact Factor
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    ABSTRACT: The increasing use of nanoparticles in medicine has raised concerns over their ability to gain access to privileged sites in the body. Here, we show that cobalt-chromium nanoparticles (29.5 +/- 6.3 nm in diameter) can damage human fibroblast cells across an intact cellular barrier without having to cross the barrier. The damage is mediated by a novel mechanism involving transmission of purine nucleotides (such as ATP) and intercellular signalling within the barrier through connexin gap junctions or hemichannels and pannexin channels. The outcome, which includes DNA damage without significant cell death, is different from that observed in cells subjected to direct exposure to nanoparticles. Our results suggest the importance of indirect effects when evaluating the safety of nanoparticles. The potential damage to tissues located behind cellular barriers needs to be considered when using nanoparticles for targeting diseased states.
    Nature Nanotechnology 11/2009; 4(12):876-83. DOI:10.1038/nnano.2009.313 · 33.27 Impact Factor
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    ABSTRACT: The bystander effect is a feature of low dose radiation exposure and is characterized by a signaling process from irradiated cells to non irradiated cells, which causes DNA and chromosome damage in these 'nearest neighbour' cells. Here we show that a low and short dose of Cr(VI) can induce stem cells, cancer cells and fibroblasts to chronically secrete bystander signals, which cause DNA damage in neighboring cells. The Cr(VI) induced bystander signaling depended on the telomerase status of either cell. Telomerase negative fibroblasts were able to receive DNA damaging signals from telomerase positive or negative fibroblasts or telomerase positive cancer cells. However telomerase positive fibroblasts were resistant to signals from Cr(VI) exposed telomerase positive fibroblasts or cancer cells. Human embryonic stem cells, with positive Oct4 staining as a marker of pluripotency, showed no significant increase of DNA damage from adjacent Cr and mitomycin C exposed fibroblasts whilst those cells that were negatively stained did. This selectivity of DNA damaging bystander signaling could be an important consideration in developing therapies against cancer and in the safety and effectiveness of tissue engineering and transplantation using stem cells.
    Mutation Research/Fundamental and Molecular Mechanisms of Mutagenesis 10/2009; 683(1-2):1-8. DOI:10.1016/j.mrfmmm.2009.09.012 · 4.44 Impact Factor
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    ABSTRACT: Genomic instability is considered to be an important component in carcinogenesis. It can be caused by low-dose exposure to agents, which appear to act through induction of stress-response pathways related to oxidative stress. These agents have been studied mostly in the radiation field but evidence is accumulating that chemicals, especially heavy metals such as Cr (VI), can also act in the same manner. Previous work showed that metal ions could initiate long-term genomic instability in human primary fibroblasts and this phenomenon was regulated by telomerase. The aim of this study was to examine the difference in clonogenic survival and cytogenetic damage after exposure to Cr (VI) and radiation both singly and in combination in normal human fibroblasts (hTERT- cells) and engineered human fibroblasts, infected with a retrovirus carrying a cDNA encoding hTERT, which rendered these cells telomerase positive and replicatively immortal (hTERT+ cells). Cr (VI) induced genomic instability in hTERT- cells but not in hTERT+ cells, whereas radiation induced genomic instability in hTERT+ cells and to a lesser extent in hTERT- cells. Combined exposure caused genomic instability in both types of cells. However, this genomic instability was more pronounced in hTERT- cells after radiation followed by Cr (VI) and more pronounced in hTERT+ cells after Cr (VI) followed by radiation. Moreover, the biological effects provoked by combined exposure of Cr (VI) and radiation also led to a synergistic action in both types of cells, compared to either Cr (VI) treatment only or radiation exposure only. This study suggests that telomerase can prevent genomic instability caused by Cr (VI), but not by radiation. Furthermore, genomic instability may be prevented by telomerase when cells are exposed to radiation and then Cr (VI) but not after exposure to Cr (VI) and then radiation.
    Mutagenesis 10/2008; 24(1):25-33. DOI:10.1093/mutage/gen048 · 3.50 Impact Factor
  • Gemma M Keegan, Ian D Learmonth, C Patrick Case
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    ABSTRACT: Humans are exposed to cobalt (Co) and chromium (Cr) from industry and surgical devices, most notably orthopedic joint replacements. This review compares the potential health effects of exposure to Co and Cr contaminants from these two different sources, both in the locally exposed tissues and at sites distant to the primary exposure. Surgical implantation results largely in exposures to ions, corrosion products, and particles of Co and Cr. Industrial exposures are predominantly to metal compounds and particles. Although there are large literatures on industrial and surgical exposures to these metals, there has yet to be a systematic comparison of the two to test whether more general lessons might be learned about the human toxicology of Co and Cr. Both industrial and surgical exposures cause inflammatory and other immune reactions in the directly exposed tissues. In the lung there is a well-established risk of cancer following long-term exposures to hexavalent Cr; however, the development of sarcoma in the connective tissues adjacent to implants in response to metal particles is rare. Both types of exposure are associated with changes in the peripheral blood, including evidence of oxidative stress, and altered numbers of circulating immune cells. There is dissemination of Co and Cr to sites distant to the orthopedic implant, but less is known about systemic dissemination of these metals away from the lung. The effects of industrial exposures in the reproductive, renal, and cardiac systems have been investigated, but this has yet to be explored after surgical exposures. The form of the metal (and associated elements) in both instances is key to the toxicological effects arising in the body and further characterization of debris released from devices is certainly recommended, as is the impact of nanotoxicology on the health and safety of workers and patients. Biomonitoring schemes currently used in industry could be translated, if required, into suitable programs for orthopedic out-patients. Cross-communication between experts in industrial and occupational medicine and regulatory agencies may be useful.
    Critical Reviews in Toxicology 10/2008; 38(8):645-74. DOI:10.1080/10408440701845534 · 6.41 Impact Factor
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    ABSTRACT: Particles of surgical cobalt chrome alloy are cytotoxic and genotoxic to human fibroblasts in vitro. In vivo orthopaedic patients are exposed to cobalt chrome particles as a result of wear of a joint replacement. Many of the wear debris particles that are produced are phagocytosed by macrophages that accumulate at the site of the worn implant and are disseminated to local and distant lymph nodes the liver and the spleen. In this study we have tested whether this process of phagocytosis could have altered the cytotoxic and genotoxic properties of the cobalt chrome particles. Quartz particles have been investigated as a control. Micron-sized particles of cobalt chrome alloy were internalised by either white cells of peripheral blood or by THP-1 monocytes for 1 week and 1 day, respectively. The particles were then extracted and presented at different doses to fibroblasts for 1 day. There was a reduction of the cytotoxicity and genotoxicity of the cobalt chrome particles after phagocytosis by white cells or THP-1 cells. Cobalt chrome particles that were internalised by fibroblasts also showed a reduction of their cytotoxicity but not their genotoxicity. In contrast the cytotoxicity and genotoxicity of quartz particles was increased after internalisation by THP-1 cells. The surface morphology of the cobalt chrome particles but not the quartz particles was changed after phagocytosis by THP-1 cells. This study suggests that the genotoxic and cytotoxic properties of particles that fall within the size range for phagocytosis may be highly complex in vivo and depend on the combination of material type and previous phagocytosis. These results may have relevance for particle exposure from orthopaedic implants and from environmental or industrial pollution.
    Mutation Research/Fundamental and Molecular Mechanisms of Mutagenesis 08/2008; 643(1-2):11-9. DOI:10.1016/j.mrfmmm.2008.05.004 · 4.44 Impact Factor
  • Charles Patrick Case
    Toxicology 11/2007; 240(3):138-138. DOI:10.1016/j.tox.2007.06.018 · 3.75 Impact Factor

Publication Stats

2k Citations
262.64 Total Impact Points

Institutions

  • 2005–2014
    • University of Bristol
      • • School of Clinical Sciences
      • • The Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology
      Bristol, England, United Kingdom
  • 2000–2001
    • Bristol Hospital
      Bristol, Connecticut, United States