C. charlier, cirm 01 07 2013

Clinical, Forensic, Environmental and
Industrial Toxicology Service
PERSONNEL
Prof. Dr Corinne CHARLIER, Head of Service Dr Raphaël DENOOZ, Responsible for clinical and forensic toxicology Nathalie DUBOIS, Responsible for industrial toxicology (Industrial engineer) Catherine PIRARD, Responsible for environmental toxicology (Master of Chemical Sciences) 1 Pharmacist (temporary assistant) 1 or 2 clinical biologists (temporary assistants) Resmi AGIRMAN Alexandra CORDONNIER Jessica DELEERSNYDER Nicolas DIET Laurence GEROMBOUS Patricia LANTEIR Viviane MALHERBE Isabelle MONET Chantal RIVIERE ACTIVITIES OF THE SERVICE

The Toxicology Service is part of Clinical Biology Department, in the University Hospital in
Liege. It can be presented divided in 4 sections: clinical toxicology, forensic toxicology,
industrial toxicology and environmental toxicology.
The activity of the CLINICAL TOXICOLOGY Unit can be summarized in two major
missions: the Therapeutic Drug Monitoring (TDM) and the diagnosis of acute or chronic
intoxications
.
Therapeutic Drug Monitoring consists in measuring ex vivo blood concentration of the
drugs. This parameter, correctly interpreted, allows to confirm that the administered dose
to each patient is sufficient and not responsible for undesirable effects. TDM constitutes
an interesting tool to adapt optimally the therapy, and sometimes also, to reduce
significantly the cost of the medication.
The identification and quantification in biological samples of drugs, narcotics, or
potentially toxic products of another nature, constitute an invaluable help for diagnosis of
acute or chronic intoxications
. In the framework of acute intoxications, anamnesis and
clinical examination are not suffisant. A targeted research and specific methods are
undertaken when the poison is known or strongly suspected, whereas research is more general, calling upon “general unknown screening”, in the event of intoxications of unspecified origin. The laboratory has developed varied techniques, immunological and chromatographic methods, allowing a fast description of the principal poisons responsible for acute pathologies at the origin of hospitalizations. The activity of FORENSIC TOXICOLOGY accounts for approximately 15% of the activity
of the laboratory. It consists of analyzing biological samplings (blood, urine, hair, internal organs) or not biological (powders, tablets, seedlings) at the request of magistrates or medical examiners, in order to find the reason of death or to determine if author of some facts was under influence, etc … The ENVIRONMENTAL TOXICOLOGY is a field rapidly on the rise. Man is exposed to
toxic agents via various aspects of the environment: air, earth and water. For the last few years, an environmental awakening has resulted in a growing interest in this field of valuation and research. For example, we carry out files at the request of public institutions or private individuals. For a given situation, we evaluate the impact of the exposure to the pollutants on Man’s health. According to the level of concentration of these pollutants, we calculate the risks of systemic effects as well as an increased risk of cancers associated with the presence of the chemical toxics. We also collaborate in the REACH program by the evaluation (on file) of the biocide toxicity put on sale in the European Market. In our activity dedicated to INDUSTRIAL TOXICOLOGY, we can propose human
biomonitoring in order to verify workers’ exposure, but we have also participated to many workplace risk analysis. RESEARCH PROJET
CLINICAL TOXICOLOGY
In this sector, the major areas of research are the following: 1. The Therapeutic drug monitoring
Interest of therapeutic drug monitoring of not conventionally measured drugs
Various researches have been conducted in recent years in order to demonstrate the
interest of therapeutic drug monitoring of drugs usually uncontrolled. The drugs
concerned by this work are as follows: β-lactams, oral anticoagulants, sulfonylureas,
methadone, bupropion and GHB. Different reasons can justify the use of therapeutic
monitoring for these drugs, such as the diagnosis of resistance or hypersensitivity, the
checking of compliance, the reduction of toxicity and treatment cost.
Further work is underway in the field of infectious diseases, such as development of
techniques for the determination of antiretroviral and antifungal drugs.
Persons in charge of the project: Raphaël DENOOZ, Virginie MISTRETTA
Improvement treatment of nosocomial pneumonia in intensive care units by
determination of antibiotic concentrations in blood samples and bronchoalveolar
washings

The main objective of this work is the study of the distribution of antibacterial agents in
the respiratory tract, according to the different dosing schedules. This study aims to
optimize the antibacterial treatment in intensive care units.
Person in charge of the project: Raphael DENOOZ
2. The diagnosis of acute intoxication
Various analytical techniques are being evaluated to improve the drug screening. The main objectives of this research are to increase the number of molecules found, to improve the sensitivity of the method (limits of detection, limits of quantification), and to reduce analysis run time. Analyses are carried out using a liquid chromatograph coupled to a diode array detector (HPLC-DAD, UPLC-DAD) and a gas chromatograph coupled to a mass spectrometer (GC-MS-MS). Persons in charge of the project: Raphaël DENOOZ, Marine DEVILLE FORENSIC TOXICOLOGY
Projects conducted in the field of forensic toxicology are the following : 1. Study of the opiates pharmacokinetic within the framework of drug withdrawal
This work led to obtaining a doctoral thesis aims to study the pharmacokinetics of various opiates (heroin, morphine, methadone and codeine) with the objective of improving the withdrawal treatment management. These researches will also address key issues for magistrates, such as determining if the quantity of narcotics found in the biological samples can confirm a death or an abnormal behaviour, or to determine the moment of consumption compared to the facts (deaths, aggressions or crimes). Person in charge of the project: Nathalie DUBOIS 2. Belac accreditation for unconventional matrix (different from blood or urine)

We developed different analytical methods to confirm drugs consumption with unconventional matrix such as scalp hair or saliva. Hair is a very useful sample to appreciate drug consumption during several months, whereas saliva samples is used to evaluate the influence of drug consumption without invasive blood sampling. We obtained the Belac accreditation for the analytical procedures developed for these matrix. Analytical methods developed to research drugs in postmortem samples such as liver and kidney will be also be proposed to the Belac accreditation in the next months. Persons in charge of the project: Raphaël DENOOZ, Nathalie DUBOIS ENVIRONMENTAL TOXICOLOGY
Research projects in environmental toxicology are as follows: 1. A field of research of prime interest is the evaluation of toxic risks for humans exposed
to various endocrine disturbers, in particular pesticides and drugs such as hormones
(estradiol, desogestrel, levonorgestrel, ethinylestradiol), plastifyers or conservants
(phtalates, parabens, …).
Techniques for detection of these compounds in various biological matrices, such as
blood or mother's milk, are developed in the laboratory. Some groups of patients are
particularly targeted: women of age to procreate, cancer patients (breast, thyroid…),
children developing a precocious puberty…
Persons in charge of the project: Lucas DEWALQUE, Corinne CHARLIER
2. Study of the influence of the oxydative stress on the metabolism and the transport of
folates in autistic patients

Recent studies showed the presence of plasmatic and urinary markers of the oxydative
stress among autistic patients. A biomarker of effect, the oxidized DNA, can be
highlighted in the blood cells of the patients by the Comet Assay method. This technique
which measures deteriorations of the DNA of cells insulated from electrophoresis in gel
is developed in the laboratory. The method developed will be applied to the evaluation of
the impact on humans of other potentially mutagen pollutants, and research projects in
industrial toxicology will then be carried out.
Persons in charge of the project: Corinne CHARLIER, Vincent RAMAEKERS (Pediatric
Service), Jean-Olivier DEFRAIGNE (Cardiovascular Surgery Service), Etienne
CAVALIER (Medical Chemistry)

3. Determination of threshold values for pollutants in air (Contract with the Walloon
Region)
Threshold values are of prime importance in providing a basis for public health decisions. This project consists to determine threshold values for pollutants in air, determine which analytical techniques are available to perform analysis, and also compare these threshold values with the available data (results of air analysis realized in Wallonia or elsewhere). Persons in charge of the project: Corinne CHARLIER, Catherine PIRARD 4. Determination of acute toxicity threshold levels to be used in case of major accidents
(Contract with the Walloon Region)
To calculate the limits of vigilance, risk and imminent hazard areas around Seveso facilities, acute toxic threshold values are established for each toxic chemical with consideration of the more recent knowledges in terms of toxicity. Persons in charge of the project: Corinne CHARLIER, Catherine PIRARD INDUSTRIAL TOXICOLOGY
Research projects in industrial toxicology are as follows: 1. Comet assay to evaluate DNA damages
The Comet assay (or single cell gel electrophoresis assay) is a rapid and sensitive method for the detection of DNA damage. The test is used as early genotoxicity screening of chemical entities in industrial toxicology. It involves the encapsulation of cells in a low-melting point agarose suspension, lysis of the cell and electrophoresis of the suspended lysed cells. This is followed by visual analysis with staining of DNA and calculating fluorescence to determine the extent of DNA damage. It can be used as an early genotoxicity marker for the monitoring of industrial workers. Person in charge of the project: Nathalie Dubois 2. Markers of genetic susceptibility in industrial toxicology
Polymorphism of relevant xenobiotic metabolising enzyme may be used as toxicological susceptibility markers. A growing number of genes encoding enzymes involved in biotransformation of toxicants are known, leading to increased knowledge of individual responses to environmental and industrial chemical toxic. Several collaborations with different human genetic services are involved to appreciate individual susceptibility of industrial workers. The combination of genotyping and phenotyping is the most appropriate way to determine workers susceptibility to chemicals to which they are exposed. Person in charge of the project: Corinne CHARLIER LABORATORY PUBLICATIONS (2008-2013)
BOOKS
Toxicologie clinique et médico-légale, A. RENAUX, A. HASSOUN, C. CHARLIER, P. KINTZ, P.MANGIN, I. RENAUX, J.P. BEAUTHIER, in "Traité de Médecine Légale", J.P. Beauthier, De Boeck, Bruxelles, 2008, pp 603-639. Le cannabis : historique, culture et modes d’utilisation, In « Regards croisés sur le cannabis », S. Mangoubi, Eds. Mardage, Wavre, Belgium, 2010. Toxicologie clinique et médico-légale, A. RENAUX, I. RENAUX-MUYLKENS, C. CHARLIER, P. KINTZ, A. HASSOUN, P. MANGIN, M. BOLLMANN, M. SAUGY, J.P. BEAUTHIER, in « Traité de Médecine Légale », J.P. BEAUTHIER, De Boeck, Bruxelles, 2011, pp 767-820. INTERNATIONAL PUBLICATIONS
A fatal case of bupropion (Zyban®) overdose, M. MERCEROLLE, R. DENOOZ, G. LACHATRE, C. CHARLIER, Journal of Analytical Toxicology, 2008, 32, 192-196. Simultaneous determination of 5β-lactam antibiotics in human plasma by high performance liquid chromatography with ultraviolet detection, Journal of Chromatography B, 2008, 864, 161-167. Mechanisms of interaction of endocrine-disrupting chemicals with glutamate-evoked secretion of gonadotropin-releasing hormone, G. RASIER, A.S. PARENT, A. GERARD, R. DENOOZ, M.C. LEBRETHON, C. CHARLIER, J.P. BOURGUIGNON, Toxicological Sciences, 2008, 102, 33-41. Performance of iohexol determination in serum and urine by HPLC : validation, risk and uncertainty assessment. E. CAVALIER, E. ROZET, N. DUBOIS, C. CHARLIER, P. HUBERT, J-P. CHAPELLE, J-M. KRZESINSKI, P. DELANAYE, Skin protection creams in medical settings : successful or evil ? E. XHAUFLAIRE-UHODA, E. MACARENKO, R. DENOOZ, C. CHARLIER, G. PIERARD, Journal of Occupational Medicine and Toxicology, 2008, 3, 15-21. Cocaïne and metabolites in waste and surface water across Belgium, A. VAN NUIJS, B. PECCEU, L. THEUNIS, N. DUBOIS, C. CHARLIER, Ph. JORENS, L. BERVOETS, R. BLUST, H. NEELS, A. COVACI, Environmental Pollution, 2009, 157, 123-129. Spatial and temporal variations in the occurrence of cocaine and benzoylecgonine in waste- and surface water from Belgium and removal during wastewater treatment, A.L. VAN NUIJS, B. PECCEU, L. THEUNIS, N. DUBOIS, C. CHARLIER, Ph. JORENS, L. BERVOETS, R. BLUST, H. NEELS, A. COVACI, Water Research, 2009, 43, 1341-1349.
Can cocaine use be evaluated through analysis of waste water ? A nationwide approach conducted in Belgium, A.L. VAN NUIJS, B. PECCEU, L. THEUNIS, N. DUBOIS, C. CHARLIER, Ph. JORENS, L. BERVOETS, R. BLUST, H. MEULEMANS, H. NEELS, A. COVACI, Fatal intoxication by acenocoumarol, phenprocoumon and warfarin : method validation in blood using the total error approach, Journal of Chromatography B, 2009, 877(23), 2344-2348. Pathologies endocriniennes observées chez l'Homme en rapport avec l'exposition aux pesticides organochlorés, Annales de Toxicologie Analytique, 2009, 21, 113-117. Innovative development and validation of an HPLC/DAD method for the qualitative and quantitative determination of major cannabinoïds in cannabis plant material, B. DE BACKER, B. DEBRUS, P. LEBRUN, L. THEUNIS, N. DUBOIS, L. DECOCK, A. VERSTRAETE, Ph. HUBERT, C. CHARLIER, Journal of Chromatography B, 2009, 877, 4115-4124. Quantification in post-mortem blood, and identification in urine, of tramadol and its two main metabolites in two cases of lethal tramadol intoxication : case report and review of literature, B. DE BACKER, F. RENARDY, R. DENOOZ, C. CHARLIER, Journal of Analytical Toxicology, 2010, 34, 599-604. Ultra - Performance Liquid Chromatography - Tandem Mass Spectrometry Method for the determination of bupropion and its main metabolites in human whole blood, R. DENOOZ, M. MERCEROLLE, G. LACHATRE, C. CHARLIER, Journal of Analytical Toxicology, 2010, 34, 280-286. Blood, urine and hair kinetic analysis following a lead acute intoxication, H. GIANG, A. KEUTGENS, R. SCHOOFS, S. KOTOLENKO, R. DENOOZ, C. CHARLIER, Journal of Analytical Toxicology, 2011, 35, 60-64. Determinants of serum concentrations of 1,1 dichloro 2,2 bis (p-chlorophenyl)ethylene and polychlorinated biphenyls among French women in the CECILE study, D. BACHELET, T. TRUONG, M-A VERNER, P. ARVEUX, P. KERBRAT, C. CHARLIER, C. GUILHENNEUC-JOUYAUX, P. GUENEL, Environmental Research, 2011, 111, 861-870. Lifestyle behaviours and plasma vitamin C and beta-carotene levels from the ELAN J. PINCEMAIL, S. VANBELLE, F. DEGRUNE, J.P. CHERAMY-BIEN, C. CHARLIER, J.O. DEFRAIGNE, Journal of Nutrition and Metabolism, 2011, art. ID 494370, doi : 10.1155/2011/494370. Validation of the quantitative determination of tetrahydrocannabinol and its two major metabolites in plasma by UHPLC/MS-MS according to the total error approach, N. DUBOIS, A. PACCOU, B. DE BACKER, C. CHARLIER, Journal of Analytical Toxicology, 2012, 36, 25-29. Apport des troponines T et I ultrasensibles dans le diabète, C. LE GOFF, T. LAURENT, C. GARWEG, J-F KAUX, J. HALENG, C. CHARLIER, J-P CHAPELLE, Immuno-Analyse et Biologie spécialisée, 2012, 27, 1, 40. Differential Effects of Cocaine on Dopamine Neuron Firing in Awake and Anesthetized Rats, S. KOULCHITSKY, B. DE BACKER, E. QUERTEMONT, C. CHARLIER, , V. SEUTIN, Neuropsychopharmacology, 2012, 37, 1559-1571. Evolution of the content of THC and other major cannabinoïds in drug-type cannabis cuttings and seedlings during growth of plants, B. DE BACKER, K. MAEBE, A. VERSTRAETE, C. CHARLIER, Journal of Forensic Sciences, 2012, 57, 918-922. Urinary levels of bisphenol A, triclosan and 4-nonyphenol in a general Belgian population, C. PIRARD, N. DUBOIS, C. SAGOT, C. CHARLIER, Environment International, 2012, 48, 78-83. Identification and structure elucidation of four cannabimimetic compounds in seized products, R. DENOOZ, J.C. VAN HEUGEN, M. FREDERICH, P. DE TULLIO, C. CHARLIER, Journal of Analytical Toxicology, 2013, 37, 56-63. La surveillance biologique de l’exposition aux produits chimiques en toxicologie industrielle et de l’environnement. Annales de Biologie Clinique, 2013, 71, 257-67. NATIONAL PUBLICATIONS
GHB measurement by GC-MS in blood, urine and gastric contents, following an acute Q. BODSON, R. DENOOZ, P. SERPE, C. CHARLIER, Acta Clinica Belgica, 2008, 63, 200-208. Cocaïne dans nos rivières : une approche méthodologique originale dans le domaine de la toxicologie environnementale, L. THEUNIS, A. VAN NUIJS, B. PECCEU, N. DUBOIS, P.G. JORENS, L. BERVOETS, R. BLUST, H. NEELS, A. COVACI, C. CHARLIER, Revue Médicale de Liège, 2008, 63(S1), 39-43. Le cosméceutique, oxymoron de la quête d'une efficacité cosmétique ?, G. PIERARD, J. MEUNIER, C. PIERARD-FRANCHIMONT, F. HENRY, E. XHAUFLAIRE-UHODA, C. CHARLIER, P. QUATRESOOZ, Dermatologie, Actualité, 2009, 113, 16-19. Comment j'explore…des lésions cutanées chez un toxicomane adepte de la cocaïne ou du Crack, C. DEVILLERS, C. PIERARD-FRANCHIMONT, G. PIERARD, C. CHARLIER, P. QUATRESOOZ, Revue Médicale de Liège, 2009, 64, 3, 158-160. Fondements de la cosmétovigilance sur le mode européen, C. PIERARD-FRANCHIMONT, J. MEUNIER, P. QUATRESOOZ, F. HENRY, C. CHARLIER, A. SCHEEN, G.E. PIERARD, Evaluation biologique du stress oxydant. Application en routine clinique, J. PINCEMAIL, C. LEGOFF, C. CHARLIER, P. GILLION, J.P. CHERAMY-BIEN, E. VAN HANACKER, J.P. CHAPELLE, J.O. DEFRAIGNE, Nutritions et Endocrinologie, 2009, Déc., 16-31. Simultaneous quantification of five-b-lactam antibiotics in human plasma by HPLC-DAD : Clinical application for ceftazidime treatment in intensive care units, Acta Clinica Belgica, 2010, 65, S1, 24-30. Assessment of exposure to persistent organochlorine compounds in epidemiological studies on breast cancer : a literature review and perspectives for the CECILE study, D. BACHELET, M.-A. VERNER, C. GUIHENNEUC-JOUYAUX, C. CHARLIER, M. CHARBONNEAU, S. HADDAD, P. GUENEL, Acta Clinica Belgica, 2010, 65, S1, 49-57. Quantitative determination of eight organochlorine pesticides in serum by GC coupled to tandem mass spectrometry, Acta Clinica Belgica, 2010, 65, S1, 58-64. Validated quantitative simultaneous determination of cocaine, opiates, and amphetamines in serum by U-HPLC coupled to tandem mass spectrometry, N. DUBOIS, B. DEBRUS, Ph. HUBERT, C. CHARLIER, Acta Clinica Belgica, 2010, 65, S1, 75-84. Intérêt du dosage des sulfamidés hypoglycémiants : de la vérification de la compliance au diagnostic différentiel des hyperinsulinismes, Revue Médicale de Liège, 2010, 65, 493-497. Ce que les psychiatres devraient savoir sur… l’intérêt du dosage plasmatique des antidépresseurs dans la pratique clinique, Acta Psychiatrica Belgica, 2012, 112, 45-51. La fertilité masculine menacée par la présence de perturbateurs endocriniens dans l’environnement ? Revue Médicale de Liège, 2012, 67, 243-249. Sevrage rapide aux opiacés sous anesthésie (RODA), N. DUBOIS, C. HALLET, D. LUPPENS, M. ANSSEAU, C. CHARLIER, Revue Médicale de Liège, 2013, 68, (5-6), 298-302. Toxicité induite par les antidépresseurs : état des lieux, Acta Psychiatrica Belgica, 2013, sous presse. CONGRESS and SEMINARS (2008-2013)
CONGRESS
• Organisation of the « 4èmes Journées Internationales de Toxicologie »,
• Organisation of the « 5èmes Journées Internationales de Toxicologie »,
SEMINARS
05/09/2008 Biomarkers in toxicology: Oxidized DNA and DNA adducts Laurence PIRSON 03/10/2008 Heroin: determination of the time between 14/11/2008 Cocaine: determination of the time between 19/12/2008 Lindane in shampoos: What degree of toxicity? 14/01/2009 Interest of sulfonylureas assay 24/04/2009 Endocrine disturbances related to environmental pollutants Corinne CHARLIER 15/05/2009 Interest of antiretroviral drugs therapeutic monitoring 09/10/2009 Alcohol and road safety: exploitation of the data bank 04/12/2009 Methadone: determination of the time between 26/02/2010 Residues of drugs in rivers 23/04/2010 Saliva, a new alternative matrix in Toxicology. 21/05/2010 Effects of cocaine on the activity of the dopaminergic 10/09/2010 Traces of production of synthesis drugs in waste water: 15/10/2010 Drugs screening and analytical strategies in emergency 03/12/2010 What are the values thresholds for the atmospheric pollutants in the surrounding air? 11/02/2011 Evaluation of the pharmacokinetics of opioids in the 06/05/2011 Endocrine disruptors in serum 23/09/2011 Biomarkers in Toxicology. 18/11/2011 Actuality in porphyria 09/03/2012 Therapeutic monitoring of antiepileptic drugs 20/04/2012 Melanoma and chemicals with endocrine disruptive 28/09/2012 Immunoanalysis on ARCHITECT® 17/12/2012 Driving License : from withdrawal to restoration Role of the laboratory of Toxicology 07/02/2013 Estimated time between heroin use and sampling in chronic Nathalie DUBOIS 22/03/2013 Actualities on Hg pollution 19/04/2013 Alcohol and road safety FUNDED RESEARCH PROJECTS (2008-2013)
BELGIAN FEDERAL SCIENCE POLICY
«COcaine and metabolites in waste and surface WATer across Belgium (COWAT)»
Research program to support the federal drug policy note, collaboration with the
«Study of part of locally cultivated cannabis on Belgian market of the drug
(GEOCAN)».
Research program to support the federal drug policy note, collaboration with the University of Gent, 2007-2009.
«Trace detection of synthetic drugs production in waste waters (GEOAMP)».

Research program to support the federal drug policy note, collaboration with the University of Gent, 2009-2010. CONTRACTS OF RESEARCH FIRS
• Study of the influence of the oxydative stress on the metabolism and on the transport of • Improving the management of nosocomial pneumonia in intensive care for the determination of antibiotics in blood and bronchoalveolar lavage, 2010 • Diagnostic and therapeutic alliance against invasive fungal infections, 2011. Ph D Thesis
«Intérêt clinique et économique du suivi thérapeutique pharmacologique pour des médicaments habituellement non contrôlés», Raphaël DENOOZ. Liège, 29th June 2010. Thesis in progress
• Evaluation de la pharmacocinétique de l’héroïne chez des consommateurs chroniques, • Impact des produits chimiques à effet perturbateur endocrinien sur la santé de l’Homme, • Suivi thérapeutique pharmacologique et dépistage des intoxications pour les médicaments psychotropes utilisés au Rwanda, Innocent HAHIRWA. • Redistribution post-mortem de substances psychoactives, Eric LEMAIRE. COLLABORATIONS

Various collaborations are carried out with:
THE UNIVERSITY OF LIEGE
Pediatric Service (Dr. V Ramaekers) - Project FIRS (oxidized DNA)
Clinical Hematology Service (Pr Y Beguin) – Optimization of antifungal treatment
Infectious Diseases and General Internal Medicine (Pr M. Moutchen) –
Cardiovascular Surgery Service (Pr. JO Defraigne) - FIRS Project (oxidized DNA)
CIRM - Analytical Chemistry Service (Pr Ph Hubert) - Development of Analytical
Gynecology Department (Pr M. Nisolle) - Endocrine disruptors
Dermatopathology Department (Pr Ph. Delvenne) - Endocrine disruptors
Dermatology (Pr A. Nikkels) - Endocrine disruptors
BELGIUM AND FOREIGN UNIVERSITIES
Clinical department of Biology, Microbiology and Immunology (Pr A. Verstraete),
Gent University (GEOCAN and GEOAMP Projects) • Institute for International Research on Criminal Policy (IRCP) (Pr B. De Ruyver),
Gent University (GEOCAN and GEOAMP Projects) • Center Toxicology (Pr H. Neels), Antwerp University (COWAT Project)
Laboratory of Ecophysiologie, Biochemistry and Toxicology (Pr L. Bervoets),
Clinical laboratory of Pharmacology, Pharmacothérapy and Clinical Toxicology
(Pr P Jorens), Antwerp University (COWAT Project) • Department of Bio-engineering (Pr J. Dewulf), Gent University (GEOAMP Project)
CHU Limoges (France) (Pesticides Projects and IBAS – ImmunoSuppressants
CHU Lille (France) (Pesticides Projects - Pharmacogenomic and Toxicogenomic)
NON-UNIVERSITY ORGANIZATIONS
The Belgian Police: Federal and local (GEOCAN and GEOAMP Projects)
Federal Public Service Public Health. Food Chain Safety and Environnement
Walloon Agency for Air and Climate (Standards quality of air)
Liege-Oupeye Purification Station (GEOAMP Project)
Malvoz Provincial Institute (Air analysis)
INSERM (France) (Pesticides project)
ISSeP

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International Journal of Clinical Medicine , 2013, 4, 309-312 doi:10.4236/ijcm.2013.47054 Published Online July 2013 (http://www.scirp.org/journal/ijcm) A Case Study of Gut Fermentation Syndrome (Auto-Brewery) with Saccharomyces cerevisiae as the Causative Organism Barbara Cordell, Justin McCarthy Panola College, Carthage, USA. Email: bcordell@panola.edu Received April 25th

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