685 West Baltimore St. HSF I 580A
Education and Training
Short Bio: Made in Britain. Favorites: tea, sushi, good Italian and Indian food, motorcycles, wine, music, guitars, Caribbean, friendly folks, etc. Collaborates freely.
Real Bio: I received my Ph.D. in Biochemistry in 1979 from the Glasgow Caledonia University. From 1979-1981, I was a postdoctoral fellow in Alan Senior's laboratory in the Department of Biochemistry at the University of Rochester, NY. There, I worked on the biochemistry of pancreatic bicarbonate secretion. I decided to switch from biochemistry to physiology because I had developed an interest in the mechanisms underlying high blood pressure. Hence, I came to the Department of Physiology at the University of Maryland to work on that problem. My work led to the discovery of endogenous ouabain. In the years that followed, I was fortunate to be involved with work going from molecules through to clinical studies. My lab is now focused primarily on ouabain, aldosterone and opiates in the brain.
Currently, I am a Professor, a full member of the Graduate School, and a faculty member of the NIH training program in Integrative Membrane Biology.
Ouabain, Calcium Metabolism, Vascular Function, Brain, Hypertension, Heart Failure, Kidney Failure
Hamlyn JM, Manunta P. (2015) Endogenous cardiotonic steroids in kidney failure: a review and an hypothesis. Adv Chronic Kidney Dis. 2015 May;22(3):232-44. PMCID: PMC4410676.
Gatti G, Lanzani C, Citterio L, Messaggio E, Carpini SD, Simonini M, Pozzoli S, Casamassima N, Zagato L, Rampoldi L, Hamlyn JM, Manunta P. (2015) 6C.06: Genes involves in blood pressure response to acute and chronic salt modifications: identification of a new pathway. J Hypertens. 2015 Jun;33 Suppl 1:e80-1. PMID: 26102939
Lanzani C, Gatti G, Citterio L, Messaggio E, Delli Carpini S, Simonini M, Casamassima N, Zagato L, Brioni E, Hamlyn JM, Manunta P. (2016) Lanosterol Synthase Gene Polymorphisms and Changes in Endogenous Ouabain in the Response to Low Sodium Intake. Hypertension. 2016 Feb;67(2):342-8. PMCID: PMC4713326
Blaustein MP, Chen L, Hamlyn JM, Leenen FH, Lingrel JB, Wier WG, Zhang J. (2016) Pivotal role of α2 Na+ pumps and their high affinity ouabain binding site in cardiovascular health and disease. J Physiol. 2016 Jun 28. PMCID: PMC5088234
Hamlyn JM and Blaustein MP. (2016) Endogenous Ouabain: Recent Advances and Controversies. Hypertension, 2016 Sep;68(3):526-32. PMCID: PMC4982830
Tentori S, Messaggio E, Brioni E, Casamassima N, Simonini M, Zagato L, Hamlyn JM, Manunta P, and Lanzani C. (2016) Endogenous Ouabain and Aldosterone are Co-elevated in the Circulation of Patients with Essential Hypertension. Journal of Hypertension, 2016 Oct;34(10):2074-80. PMID: 27457665
Leenen FHH, Blaustein MP, Hamlyn JM. (2017) Update on angiotensin II: new endocrine connections between the brain, adrenal glands and the cardiovascular system. Endocr Connect. 2017;6(7):R131-R145. PMCID: PMC5613704
Lu J, Wang HW, Ahmad M, Keshtkar-Jahromi M, Blaustein MP, Hamlyn JM, Leenen FHH. (2018) Central and peripheral slow-pressor mechanisms contributing to Angiotensin II-salt hypertension in rats. Cardiovasc Res. 2018;114(2):233-246. PMCID: PMC5852508
Iatrino R, Lanzani C, Bignami E, Casamassima N, Citterio L, Meroni R, Zagato L, Zangrillo A, Alfieri O, Fontana S, Macrina L, Delli Carpini S, Messaggio E, Brioni E, Dell'Antonio G, Manunta P, Hamlyn JM, Simonini M. (2019) Lanosterol Synthase Genetic Variants, Endogenous Ouabain, and Both Acute and Chronic Kidney Injury. Am J Kidney Dis. 2019 Apr;73(4):504-512. Epub 2019 Jan 16. PMID: 30660405
Leenen FHH, Wang HW, Hamlyn JM. Sodium pumps, ouabain and aldosterone in the brain: A neuromodulatory pathway underlying salt-sensitive hypertension and heart failure. Cell Calcium. 2020 Mar;86:102151. Epub 2019 Dec 17. PMID: 31954234.
Blaustein MP, Hamlyn JM. Ouabain, endogenous ouabain and ouabain-like factors: The Na+ pump/ouabain receptor, its linkage to NCX, and its myriad functions. Cell Calcium. 2020 Mar;86:102159. Epub 2020 Jan 9. PMID: 31986323.
Salimi S, Hamlyn JM. (2020) COVID-19 and Crosstalk With the Hallmarks of Aging. J Gerontol A Biol Sci Med Sci. 2020 Sep 16;75(9):e34-e41. PMCID: PMC7337690.
Guo Y, Mehrabian Z, Johnson MA, Neil R Miller NR, Henderson AD, Hamlyn JM, Bernstein SL.L. (2021) Biomarkers of lesion severity in a rodent model of nonarteritic anterior ischemic optic neuropathy (rNAION). eCollection 2021. PMCID: PMC7993789.
Hamlyn, J.M., Blaustein, M.P., Bova, S., DuCharme, D.W., Harris, D.W., Mandel, F., Mathews, W.R. and Ludens, J.H. (1991) Identification and Characterization of a Ouabain-like Compound From Human Plasma. Proc. Natl. Acad. Sci. (USA). 88:6259-6263.
Gottlieb, S.S., Rogowski, A.C., Weinberg, M., Krichten, C.M., Hamilton, B.P. and Hamlyn, J.M. (1992) Elevated concentrations of endogenous ouabain in patients with congestive heart failure. Circulation. 86:420-425.
Manunta, P., Rogowski, A.C., Hamilton, B.P., Hamlyn, J.M. (1992) Ouabain-induced hypertension in the rat: relationships among circulating and tissue ouabain and blood pressure. J. Hypertension. 12:549-560.
Rossi, G.P., Manunta, P., Hamlyn, J.M., Pavan, E., De Toni, R., Semplicini, A., Pessina, A.C. (1995) Endogenous ouabain in primary aldosteronism and essential hypertension: relationship with plasma renin, aldosterone and blood pressure levels. J. Hypertension.13:1181-1191.
Laredo, J., Shah, J.R., Lu, Z-R., Hamilton, B.P., Hamlyn, J.M. (1997) Angiotensin II stimulates secretion of endogenous ouabain from bovine adrenocortical cells via angiotensin type-2 (AT2) ptors. Hypertension. 29 (2):401-407.34.
Shah, J.R., Laredo, J., Hamilton, B.P., Hamlyn, J.M. (1999) Effects of Angiotensin II on Sodium Potassium Pumps, Endogenous Ouabain and Aldosterone in Bovine Zona Glomerulosa Cells. Hypertension. 33 (pt2):373-377.
Manunta, P., Stella, P., Rivera, R., Ciurlino, D., Cusi, D., Ferrandi, M., Hamlyn, J.M., Bianchi, G. (1999) Increased Left Ventricular Mass, Stroke Volume and Ouabain-like Factor in Essential Hypertension. Hypertension. 34:450-456.
Arnon, A., Hamlyn, J.M., Blaustein, M.P. (2000) Sodium entry via Store Operated Channels Modulates Ca2+ Signalling in Arterial Myocytes. Am J Physiol Cell Physiol. 278(1):C163-C173.
Templeton, J.T., Hamlyn, J.M., Hamilton, B.P., Ayotte, J., Majgier-Baranowska, H., Lester, A., Perrealt, H., Marat, K. (2000) Regioselective derivatization of ouabain with trialkylsilyl reagents and selective oxidation of the unprotected alcohols. Steroids. 65:379-386.
Arnon, A., Hamlyn, J.M., Blaustein, M.P. (2000) Ouabain Augments Ca2+ transients in Arterial Smooth Muscle Without Raising Cellular Sodium. Am. J. Physiol. 279:H679-691.
Manunta, P., Hamilton, J., Rogowski, A.C., Hamilton, B.P., Hamlyn, J.M. (2000) Chronic Hypertension Induced by Ouabain but not Digoxin in the Rat: Antihypertensive Effect of Digoxin and Digitoxin. Hypertension Research. 23:S77-85.
Kimura, K., Manunta, P., Hamilton, B.P., Hamlyn, J.M. (2000) Different Effects of In Vivo Ouabain and Digoxin on Renal Artery Function and Blood Pressure in the Rat. Hypertension Arch. 23:S67-76.
Manunta, P., Hamilton, B.P., Hamlyn, J.M. (2001) Structure-activity relationships for the hypertensinogenic activity of ouabain: role of the sugar and lactone ring. Hypertension. 37(2):472-477.
Kawamura, A., Abrell, L., Maggiali, F., Berova, N., Nakanishi, K., Labutti, J., Magil, S., Haupert, G.T., Jr., Hamlyn, J.M. (2001) Conformational Flexibility of Ouabain and its Biological Implication: Observations with Ouabain 1,5,19- and 1,11,19- Phosphates.Biochemistry. 40(19): 5835-5844.
Manunta, P., Messaggio, E., Ballabeni, C., Sciarrone, M.T., Lanzani, C., Ferrandi, M., Hamlyn, J.M., Cusi, D., Galletti, F., Bianchi, G. (2001) Plasma Ouabain-Like Factor During Acute and Chronic Changes in Sodium Balance in Essential Hypertensive Patients.Hypertension. 38:198-203.
Aileru, A.A., deAlbuquerque, A., Hamlyn, J.M., Manunta, P., Shah, J.R., Hamilton, M.J., Weinreich, D. (2001) Altered Use-Dependent Synaptic Plasticity in the Sympathetic Ganglia from Acquired and Inherited Forms of Ouabain-Dependent Hypertension. American Journal of Physiology. 281(2):R635-44.
Ward, S.C., Hamilton, B.P., Hamlyn, J.M. (2002) Novel receptors for ouabain in bovine adrenocortical cells and membranes.Hypertension. 39(2):536-542.
Hamlyn, J.M., Laredo, J., Shah, J.R., Lu, Z-R., Hamilton, B.P. (2003) 11-Hydroxylation in the Biosynthesis of Endogenous Ouabain: Multiple Implications. Annals of the New York of Sciences Academy. 986: 685-693.
Wang, J-G., Staessen, J.A., Messaggio, E., Nawrot, T., Fagard, R., Hamlyn, J.M., Bianchi, G., Manunta, P. (2003) Salt, Endogenous Ouabain and Blood Pressure Interactions in the General Population. Journal of Hypertension. 21(8):1475-1481.
Blaustein, M.P., Robinson, S., Gottlieb, S.S., Balke, C.W., Hamlyn, J.M. (2003) Sex, Digitalis, and the Sodium Pump.Molecular Interventions. 3:68-72.
Lighthall, G., Hamilton, B.P., Hamlyn, J.M. (2004) Identification of salt-sensitive genes in the kidneys of Dahl Rats.Journal of Hypertension. 22(8):1487-94.
Lanzani, C., Citterio, L., Jankaricova, M., Sciarrone, M.T., Barlassina, C., Fattori, S., Messaggio, E., Serio, C.D., Zagato, L., Cusi, D.,Hamlyn, J.M., Stella, A., Bianchi, G., Manunta, P. (2005) Role of the adducin family genes in human essential hypertension. Journal of Hypertension. 23(3):543-9.
Manunta, P., Iacoviello, M., Forleo, C., Messaggio, E., Hamlyn, J.M., Lucarelli, K., Bianchi, G., Rizzon, P. and Pitzalis, M.V. (2005) High Circulating Levels of Endogenous Ouabain in the Offspring of Hypertensive and Normotensive Individuals. Journal of Hypertension. 23(9):1677-81.
Zhang, J., Lee, M-Y., Cavalli, M., Chen, L., Berra-Romani, R., Balke, C.W., Bianchi, G., Ferrari, P., Hamlyn, J.M., Iwamoto, T., Lingrel, J.B., Matteson, D.R., Wier, W.G. and Blaustein, M.P. (2005) Sodium pump a2 subunits control myogenic tone and blood pressure in mice. J. Physiol. 569:243-56. PMCID: PMC1464198
Pitzalis, M.V., Hamlyn, J.M., Messaggio, E., Iacoviello, M., Bianchi, G., Rizzon, P., and Manunta, P. (2006) Independent and incremental prognostic value of endogenous ouabain in idiopathic dilated cardiomyopathy. Eur J Heart Fail. 8(2):179-86.
Manunta, P., Hamilton, B.P. and Hamlyn, J.M. (2006) Salt intake and depletion increase circulating levels of endogenous ouabain in normal men. Am J Physiol Regul Integr Comp Physiol. 290(3):R553-9.
Blaustein, M.P., Hamlyn, J.M. and Pallone, T.L. (2007) Sodium pumps: ouabain, ion transport, and signaling in hypertension. Am J Physiol Renal Physiol. 293(1):F438; author reply F439.
Stella P, Manunta P, Mallamaci F, Melandri M, Spotti D, Tripepi G, Hamlyn JM, Malatino LS, Bianchi G, Zoccali C. (2008) Endogenous ouabain and cardiomyopathy in dialysis patients. J Intern Med. Mar;263(3):274-80. PMCID: PMC3518455
Manunta P, Maillard M, Tantardini C, Simonini M, Lanzani C, Citterio L, Stella P, Casamassima N, Burnier M, Hamlyn JM, Bianchi G. (2008) Relationships among endogenous ouabain, alpha-adducin polymorphisms and renal sodium handling in primary hypertension. J Hypertens. 26(5):914-20.
Cao C, Payne K, Lee-Kwon W, Zhang Z, Lim SW, Hamlyn JM, Blaustein MP, Kwon HM, Pallone TL. (2009) Chronic ouabain treatment induces vasa recta endothelial dysfunction in the rat. Am J Physiol Renal Physiol. 296(1):F98-F106. PMCID: PMC2636913
Manunta P, Ferrandi M, Bianchi G, Hamlyn JM. (2009) Endogenous ouabain in cardiovascular function and disease. J Hypertens.27(1):9-18. PMCID: PMC3518455
Blaustein MP, Zhang J, Chen L, Song H, Raina H, Kinsey SP, Izuka M, Iwamoto T, Kotlikoff MI, Lingrel JB, Philipson KD, Wier WG,Hamlyn JM. (2009) The pump, the exchanger, and endogenous ouabain: signaling mechanisms that link salt retention to hypertension. Hypertension. 53(2):291-8. Epub 2008 Dec 22. Review. No abstract available. PMCID: PMC2727927
Tripodi G, Citterio L, Kouznetsova T, Lanzani C, Florio M, Modica R, Messaggio E, Hamlyn JM, Zagato L, Bianchi G, Staessen JA, Manunta P. (2009) Steroid biosynthesis and renal excretion in human essential hypertension: association with blood pressure and endogenous ouabain. Am J Hypertens. 22(4):357-63. PMCID: PMC3518306
Zhang J, Hamlyn JM, Karashima E, Raina H, Mauban JR, Izuka M, Berra-Romani R, Zulian A, Wier WG, Blaustein MP. (2009) Low-dose ouabain constricts small arteries from ouabain-hypertensive rats: implications for sustained elevation of vascular resistance. Am J Physiol Heart Circ Physiol. 297(3):H1140-50. PMCID: PMC2755988
Pulina MV, Zulian A, Berra-Romani R, Beskina O, Mazzocco-Spezzia A, Baryshnikov SG, Papparella I, Hamlyn JM, Blaustein MP, Golovina VA. (2010) Upregulation of Na+ and Ca2+ transporters in arterial smooth muscle from ouabain-induced hypertensive rats. Am J Physiol Heart Circ Physiol. 298(1):H263-74. PMCID: PMC2806143
Blaustein MP, Hamlyn JM. (2010) Signaling mechanisms that link salt retention to hypertension: Endogenous ouabain, the Na(+) pump, the Na(+)/Ca(2+) exchanger and TRPC proteins. Biochim Biophys Acta. 2010 Dec;1802(12):1219-29. PMCID: PMC2909369
Manunta P, Messaggio E, Casamassima N, Gatti G, Carpini SD, Zagato L, Hamlyn JM. (2010) Endogenous ouabain in renal Na(+) handling and related diseases. Biochim Biophys Acta. 2010 Dec;1802(12):1214-8. PMCID: PMC3517663
Bignami E, Casamassima N, Frati E, Lanzani C, Corno L, Alfieri O, Gottlieb S, Simonini M, Shah KB, Mizzi A, Messaggio E, Zangrillo A, Ferrandi M, Ferrari P, Bianchi G, Hamlyn JM, Manunta P. (2013) Preoperative endogenous ouabain predicts acute kidney injury in cardiac surgery patients. Crit Care Med. Mar;41(3):744-55. PMCID: PMC3763989
Song H, Karashima E, Hamlyn JM, Blaustein MP. (2014) Ouabain-digoxin antagonism in rat arteries and neurones. J Physiol. Mar 1;592(Pt 5):941-69. Epub 2013 Dec 16. PMCID: PMC3948557
Simonini M, Lanzani C, Bignami E, Casamassima N, Frati E, Meroni R, Messaggio E, Alfieri O, Hamlyn JM, Body SC, Collard CD; the CABG Genomics Investigators, Zangrillo A, Manunta P. (2014) A new clinical multivariable model that predicts postoperative acute kidney injury: impact of endogenous ouabain. Nephrol Dial Transplant. 2014 Jun 11. 2014 Sep;29(9):1696-701. PMCID: PMC4200038
Hamlyn JM, Linde CI, Gao J, Huang BS, Golovina VA, Blaustein MP, Leenen FH. Neuroendocrine humoral and vascular components in the pressor pathway for brain angiotensin II: a new axis in long term blood pressure control. PLoS One. 2014 Oct 2;9(9):e108916. doi: 10.1371/journal.pone.0108916. eCollection 2014. PMCID: PMC4183521. **NOTE** This paper was the basis for a joint press announcement from UMB and Univ of Ottawa. In that communication we announced the discovery of a new hormone axis linking the brain with the function of peripheral arteries.
Hamlyn JM. Natriuretic hormones, endogenous ouabain, and related sodium transport inhibitors. Front Endocrinol (Lausanne). 2014 Dec 3;5:199. doi: 10.3389/fendo.2014.00199. eCollection 2014. Review. PMCID: PMC4253959.
In contemporary thinking, our research might be termed; "OUABAINOMICS". The latter term is derived from Ouabain - the name given to an unusual steroid found in certain rare plants primarily of African origin. Ouabain was first used as an arrow poison and is a high affinity reversible inhibitor of the sodium pump that in high doese leads mto cardiac arrest. It has been used therapeutically for the acute treatment of shock, cancer, atrial arrhythmias and heart failure. Its clinical utility typically was limited by poor oral bioavailability (<5% of the ingested dose) so it was usually given in small amounts parenterally. In some European countries, large doses are still given by mouth to patients with cardiac conditions. The existence of endogenous analogues that might interact with and inhibit the sodium pump had been suspected since the 1930s and indeed had been demonstrated by bioassay methods by many groups (e.g., Rein, Kramer, Gonick, Haddy, Pamnani, Jandyhala). However, and despite various attempts at identification, the nature of the materials remained unclear. In 1983, I began to screen small volumes of human plasma for sodium pump inhibitors. This work was later scaled up so that ~ 2 tons of plasma was eventually used to develop the various methods and this led to the detection of four highly biologically active materials. The most active of these materials was isolated and much to everyone’s surprise was identified as ouabain or a closely related isomer. Because the blood donors could not have received ouabain therapeutically - the drug had been withdrawn from clinical use in the USA many years before - the presence of such a compound in the human circulation was most mysterious. Subsequent work showed that most of the circulting material originated from the adrenal cortex with a smaller contribution from a source within the brain. Ouabain was thus the first of the endogenous mammalian sodium pump inhibitors to be identified. Other groups (Goto, Valdes, Haupert, Lichtstein, Bagrov, Takahashi and Schoner) have identified or suggested closely related steroids in mammals. While some work implied the possibility of bioactive isomers of ouabain and especially the 11B epimer, it is clear that the major biologically active compound in humans, cows and rodents is ouabain. At low, physiologically relevant concentrations, like ouabain, the isolated human analog (endogenous "ouabain") affects intracellular ion concentrations in discrete sub plasma membrane microdomains without changing ion concentrations in the bulk cell cytosol. Endogenous ouabain alters the function of neurons, cardiac and vascular smooth muscle cells. The remaining outstanding issues include the elucidation of the distal steps in the biosynthetic pathway, and the role of previously undetected ouabain isomers in the brain and their role in physiology and disease.
Biosynthesis and Adrenocortical Secretion of Endogenous Ouabain
Endogenous ouabain is actively secreted by the adrenal gland and to some extent by the brain. Nevertheless, the mechanisms of the synthesis and secretion of endogenous ouabain remain unexplored. The early portion of the biosynthetic pathway is similar to that for aldosterone and occurs primarily in the zona glomerulosa cell layer of the adrenal gland. The distal events and intermediates in the biosynthesis remain to be determined. Once the endogenous ouabain has been synthesized, it is actively transported out of the cell by an unknown mechanism. The combinination of laboratory studies with clinical studies (Collaborator Dr. Bruce Hamilton) in humans has led to several insgihts into the regulation and significance of endogenous ouabain.
Proteomics and the Biosynthesis of Endogenous Ouabain
In working on the biosynthetic pathway for endogenous ouabain, we developed a series of photo affinity probes, some of which specifically label a number of proteins. Most of these proteins have been identifed by mass spectrometry and some appear to be directly associated with specific reactions in the biosynthetic pathway.
Genetics of Hypertension
The Milan Group at the Ospedale San Raffaele led by Paolo Manunta has shown that one third to one half of patients with common high blood pressure have elevated endogenous ouabain in the circulation. In paralell with the clinical observations, we developed two new strains of rats in which one strain was hypersensitive to endogenous ouabain and in the later generations spontaneously developed high blood pressure. The counterpart strain was resistant to both endogenous and exogenous ouabain and maintained blood pressures that were lower than normal and, most interstingly, that did not rise with age. By combining the phenotypes of every animal arising from sib mating for ten generations with information from liver biopsies, we hope to locate key genes that underlie the blood pressure phenotypes.
Mechanisms of Ouabain-Induced Hypertension: Is the Brain or the Artery More Important?
The prolonged administraion of ouabain to outbred rats evokes a sustained hypertension that is due to elevatyed total peripheral vascular resistance. But what is mechanism of the elevated resistance? There are three hypotheses. The first is that endogenous ouabain raises blood pressure because it directly affects calcium handling mechanisms in the vascular wall (including the Na/Ca exchanger, the Na/K pump and store operated channels). Very substantial evidence from transgenic animals and an array of pharmacological studies supports that hypothesis. The second hypotheis is that the interaction of ouabain with sodium pumps activates signaling cascades and these are critical for the ability of ouabain to raise blood pressure. The third hypothesis, advocated by the Leenen group in Ottawa, is that the circulating endogenous ouabain enters the CNS and raises blood pressure via mechanisms that involve aldosterone and angiotensin II in the brain. The brain pathway allows increased amounts of sympathetic nerve activity to reach the peripheral vasculature. Recent work shows that small amounts of endogenous ouabain are synthesized within the CNS and might regulate sympathetic outflow and blood pressure independent of the blood levels. In recent years my lab has beome increasingly more enamoured with the role of the brain and we are actively working in that area. It should be mentioned that in addition to sodium pumps, long believed to be the exclusive target of the cardiac glycosides, there are high affinity specific binding sites for ouabain in the adrenal cortex (Ward et al 2002) and we have found similar sites in the brain. The identity and function of these sites is also being worked out.
We use any method that can answer our questions. Chromatography, Hormone Radioimmunoassays, Tracer methods, Steroid Biosynthesis, Radioreceptor Binding, Cell Culture, Ion Transport, Whole animal hemodynamics, PCR, Photoaffinity labeling, Animal Genetics, as well as NMR and Mass Spectrometry.
- Kirk Marat
- Helene Perreault
- John Templeton
- Koji Nakanishi - Columbia Univeristy, New York
- Paolo Manunta - University of Milan, Ospedale San Raffaele
- Stephen Ward, MD/PhD
- Chris Baba, BS, MS
- Mandi Stevens (Summer fellow)
- Robert Rogowski, BS
- Yasmin Khan, MD
- Gerti Tasko, MD (Visiting Fellow)
- Pratik Dash (Summer student)
- Junjie Gao, Ph.D.
- Andy Yong Liu, PhD
- Brandiese Jacobs, BS. PhD
- Varun Tilva (Summer Student)
- Ian Whitaker, BS, MS
- Loren Gorelick, BS, MS
- Marzieh Keshtkarjahromi, MD
- Pooja Vajpaye BS
- Mitchell Kelly BS