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Adding to the concern was the knowledge that the contaminated water would be discharged to the citys beleaguered Back River Wastewater Treatment Plant, which is located in Baltimore County on the shores of the Back River

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Vitamin B12 deficiency and metabolism-mediated thrombotic microangiopathy (MM-TMA)

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This triggers g-protein coupled activation of calcium-inhibitable adenylyl cyclase 6 (AC-VI) and inhibition of calcium/calmodulin-dependent phosphodiesterase (PDE), causing enhanced accumulation of cyclic AMP (cAMP) and activation of protein kinase A (PKA) [81]