Matrix-free human pluripotent stem cell manufacturing by seed train approach and intermediate cryopreservation.

Aggregate dissociation GMP Intermediate cryopreservation STBR Seed train Suspension culture hPSC

Journal

Stem cell research & therapy
ISSN: 1757-6512
Titre abrégé: Stem Cell Res Ther
Pays: England
ID NLM: 101527581

Informations de publication

Date de publication:
25 Mar 2024
Historique:
received: 10 01 2024
accepted: 17 03 2024
medline: 26 3 2024
pubmed: 26 3 2024
entrez: 26 3 2024
Statut: epublish

Résumé

Human pluripotent stem cells (hPSCs) have an enormous therapeutic potential, but large quantities of cells will need to be supplied by reliable, economically viable production processes. The suspension culture (three-dimensional; 3D) of hPSCs in stirred tank bioreactors (STBRs) has enormous potential for fuelling these cell demands. In this study, the efficient long-term matrix-free suspension culture of hPSC aggregates is shown. STBR-controlled, chemical aggregate dissociation and optimized passage duration of 3 or 4 days promotes exponential hPSC proliferation, process efficiency and upscaling by a seed train approach. Intermediate high-density cryopreservation of suspension-derived hPSCs followed by direct STBR inoculation enabled complete omission of matrix-dependent 2D (two-dimensional) culture. Optimized 3D cultivation over 8 passages (32 days) cumulatively yielded ≈4.7 × 10 Together, an entirely matrix-free, highly efficient, flexible and automation-friendly hPSC expansion strategy is demonstrated, facilitating the development of good manufacturing practice-compliant closed-system manufacturing in large scale.

Sections du résumé

BACKGROUND BACKGROUND
Human pluripotent stem cells (hPSCs) have an enormous therapeutic potential, but large quantities of cells will need to be supplied by reliable, economically viable production processes. The suspension culture (three-dimensional; 3D) of hPSCs in stirred tank bioreactors (STBRs) has enormous potential for fuelling these cell demands. In this study, the efficient long-term matrix-free suspension culture of hPSC aggregates is shown.
METHODS AND RESULTS RESULTS
STBR-controlled, chemical aggregate dissociation and optimized passage duration of 3 or 4 days promotes exponential hPSC proliferation, process efficiency and upscaling by a seed train approach. Intermediate high-density cryopreservation of suspension-derived hPSCs followed by direct STBR inoculation enabled complete omission of matrix-dependent 2D (two-dimensional) culture. Optimized 3D cultivation over 8 passages (32 days) cumulatively yielded ≈4.7 × 10
CONCLUSIONS CONCLUSIONS
Together, an entirely matrix-free, highly efficient, flexible and automation-friendly hPSC expansion strategy is demonstrated, facilitating the development of good manufacturing practice-compliant closed-system manufacturing in large scale.

Identifiants

pubmed: 38528578
doi: 10.1186/s13287-024-03699-z
pii: 10.1186/s13287-024-03699-z
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

89

Subventions

Organisme : Deutsche Forschungsgemeinschaft
ID : EXC 62/2
Organisme : Deutsche Forschungsgemeinschaft
ID : ZW64/4-2
Organisme : Deutsche Forschungsgemeinschaft
ID : KFO311 / ZW64/7-1
Organisme : Bundesministerium für Bildung und Forschung
ID : 01EK1601A
Organisme : Bundesministerium für Bildung und Forschung
ID : 13XP5092B
Organisme : Bundesministerium für Bildung und Forschung
ID : 031L0249
Organisme : Bundesministerium für Bildung und Forschung
ID : 01EK2108A
Organisme : Förderung aus Mitteln des Niedersächsischen Vorab
ID : ZN3340
Organisme : HORIZON EUROPE Health
ID : 101056712

Informations de copyright

© 2024. The Author(s).

Références

Inoue H, Nagata N, Kurokawa H, Yamanaka S. iPS cells: a game changer for future medicine. EMBO J. 2014;33:409–17.
pubmed: 24500035 pmcid: 3989624 doi: 10.1002/embj.201387098
Ilic D, Ogilvie C. Pluripotent stem cells in clinical setting–new developments and overview of current status. Stem Cells, XX (2022) 1–11.
Ackermann M, Kempf H, Hetzel M, Hesse C, Hashtchin AR, Brinkert K, Schott JW, Haake K, Kühnel MP, Glage S. Bioreactor-based mass production of human iPSC-derived macrophages enables immunotherapies against bacterial airway infections, Nature. Communications. 2018;9:1–13.
Zweigerdt R. Large scale production of stem cells and their derivatives. Adv Biochem Eng / Biotechnol. 2009;114:201–35.
pubmed: 19513633
Ilic D, Devito L, Miere C, Codognotto S. Human embryonic and induced pluripotent stem cells in clinical trials. Br Med Bull. 2015;116:19–27.
pubmed: 26582538
Kropp C, Massai D, Zweigerdt R. Progress and challenges in large-scale expansion of human pluripotent stem cells. Process Biochem. 2017;59:244–54.
doi: 10.1016/j.procbio.2016.09.032
Tannenbaum SE, Reubinoff BE. Advances in hPSC expansion towards therapeutic entities: A review. Cell Prolif. 2022;55:e13247.
pubmed: 35638399 pmcid: 9357360 doi: 10.1111/cpr.13247
Platas Barradas O, Jandt U, Minh Phan LD, Villanueva ME, Schaletzky M, Rath A, Freund S, Reichl U, Skerhutt E, Scholz S, Noll T, Sandig V, Pörtner R, Zeng A-P. Evaluation of criteria for bioreactor comparison and operation standardization for mammalian cell culture. Eng Life Sci. 2012;12:518–28.
Elanzew A, Sommer A, Pusch-Klein A, Brüstle O, Haupt S. A reproducible and versatile system for the dynamic expansion of human pluripotent stem cells in suspension. Biotechnol J. 2015;10:1589–99.
pubmed: 26110829 doi: 10.1002/biot.201400757
Kropp C, Kempf H, Halloin C, Robles-Diaz D, Franke A, Scheper T, Kinast K, Knorpp T, Joos TO, Haverich A. Impact of feeding strategies on the scalable expansion of human pluripotent stem cells in single-use stirred tank bioreactors. Stem Cells Transl Med. 2016;5:1289–301.
pubmed: 27369897 pmcid: 5031176 doi: 10.5966/sctm.2015-0253
Olmer R, Lange A, Selzer S, Kasper C, Haverich A, Martin U, Zweigerdt R. Suspension culture of human pluripotent stem cells in controlled, stirred bioreactors. Tissue Eng Part C Methods. 2012;18:772–84.
pubmed: 22519745 pmcid: 3460618 doi: 10.1089/ten.tec.2011.0717
Zweigerdt R, Olmer R, Singh H, Haverich A, Martin U. Scalable expansion of human pluripotent stem cells in suspension culture. Nat Protoc. 2011;6:689–700.
pubmed: 21527925 doi: 10.1038/nprot.2011.318
Manstein F, Ullmann K, Kropp C, Halloin C, Triebert W, Franke A, Farr C-M, Sahabian A, Haase A, Breitkreuz Y, Peitz M, Brüstle O, Kalies S, Martin U, Olmer R, Zweigerdt R. High density bioprocessing of human pluripotent stem cells by metabolic control and in silico modeling. Stem Cells Transl Med. 2021;10:1063–80.
pubmed: 33660952 pmcid: 8235132 doi: 10.1002/sctm.20-0453
Manstein F, Ullmann K, Triebert W, Zweigerdt R. Process control and in silico modeling strategies for enabling high density culture of human pluripotent stem cells in stirred tank bioreactors. STAR Protocols. 2021;2:100988.
pubmed: 34917976 pmcid: 8666714 doi: 10.1016/j.xpro.2021.100988
Abecasis B, Aguiar T, Arnault É, Costa R, Gomes-Alves P, Aspegren A, Serra M, Alves PM. Expansion of 3D human induced pluripotent stem cell aggregates in bioreactors: bioprocess intensification and scaling-up approaches. J Biotechnol. 2017;246:81–93.
pubmed: 28131858 doi: 10.1016/j.jbiotec.2017.01.004
Huang S, Razvi A, Anderson-Jenkins Z, Sirskyj D, Gong M, Lavoie A-M, Pigeau G. Process development and scale-up of pluripotent stem cell manufacturing. Cell Gene Therapy Insights. 2020;6:1277–98.
doi: 10.18609/cgti.2020.141
Kwok CK, Ueda Y, Kadari A, Günther K, Ergün S, Heron A, Schnitzler AC, Rook M, Edenhofer F. Scalable stirred suspension culture for the generation of billions of human induced pluripotent stem cells using single-use bioreactors. J Tissue Eng Regen Med. 2018;12:1076–87.
doi: 10.1002/term.2435
Vallabhaneni H, Shah T, Shah P, Hursh DA. Suspension culture on microcarriers and as aggregates enables expansion and differentiation of pluripotent stem cells (PSCs). Cytotherapy. 2023;25:993–1005.
pubmed: 37256241 doi: 10.1016/j.jcyt.2023.05.002
Pohlscheidt M, Jacobs M, Wolf S, Thiele J, Jockwer A, Gabelsberger J, Jenzsch M, Tebbe H, Burg J. Optimizing capacity utilization by large scale 3000 L perfusion in seed train bioreactors. Biotechnol Prog. 2013;29:222–9.
pubmed: 23225663 doi: 10.1002/btpr.1672
Seth G, Hamilton RW, Stapp TR, Zheng L, Meier A, Petty K, Leung S, Chary S. Development of a new bioprocess scheme using frozen seed train intermediates to initiate CHO cell culture manufacturing campaigns. Biotechnol Bioeng. 2013;110:1376–85.
pubmed: 23242970 doi: 10.1002/bit.24808
Hartung S, Schwanke K, Haase A, David R, Franz W-M, Martin U, Zweigerdt R. Directing cardiomyogenic differentiation of human pluripotent stem cells by plasmid-based transient overexpression of cardiac transcription factors. Stem Cells Dev. 2013;22:1112–25.
pubmed: 23157212 doi: 10.1089/scd.2012.0351
Haase A, Glienke W, Engels L, Göhring G, Esser R, Arseniev L, Martin U. GMP-compatible manufacturing of three iPS cell lines from human peripheral blood. Stem Cell Res. 2019;35:101394.
pubmed: 30772682 doi: 10.1016/j.scr.2019.101394
Weegman BP, Nash P, Carlson AL, Voltzke KJ, Geng Z, Jahani M, Becker BB, Papas KK, Firpo MT. Nutrient regulation by continuous feeding removes limitations on cell yield in the large-scale expansion of mammalian cell spheroids. PLoS ONE. 2013;8:e76611.
pubmed: 24204645 pmcid: 3799778 doi: 10.1371/journal.pone.0076611
Halloin C, Schwanke K, Löbel W, Franke A, Szepes M, Biswanath S, Wunderlich S, Merkert S, Weber N, Osten F. Continuous WNT control enables advanced hPSC cardiac processing and prognostic surface marker identification in chemically defined suspension culture. Stem Cell Rep. 2019;13:366–79.
doi: 10.1016/j.stemcr.2019.06.004
Chen EY, Tan CM, Kou Y, Duan Q, Wang Z, Meirelles GV, Clark NR, Ma’ayan A. Enrichr: interactive and collaborative HTML5 gene list enrichment analysis tool. BMC Bioinform. 2013;14:128.
doi: 10.1186/1471-2105-14-128
Kuleshov MV, Jones MR, Rouillard AD, Fernandez NF, Duan Q, Wang Z, Koplev S, Jenkins SL, Jagodnik KM, Lachmann A, McDermott MG, Monteiro CD, Gundersen GW, Ma’ayan A. Enrichr: a comprehensive gene set enrichment analysis web server 2016 update. Nucleic Acids Res. 2016;44:W90–7.
pubmed: 27141961 pmcid: 4987924 doi: 10.1093/nar/gkw377
Kempf H, Kropp C, Olmer R, Martin U, Zweigerdt R. Cardiac differentiation of human pluripotent stem cells in scalable suspension culture. Nat Protoc. 2015;10:1345–61.
pubmed: 26270394 doi: 10.1038/nprot.2015.089
Burridge PW, Holmström A, Wu JC. Chemically defined culture and cardiomyocyte differentiation of human pluripotent stem cells. Curr Protocols Hum Genet. 2015;87:21–3.
Haase A, Olmer R, Schwanke K, Wunderlich S, Merkert S, Hess C, Zweigerdt R, Gruh I, Meyer J, Wagner S. Generation of induced pluripotent stem cells from human cord blood. Cell Stem Cell. 2009;5:434–41.
pubmed: 19796623 doi: 10.1016/j.stem.2009.08.021
Sen A, Kallos MS, Behie LA. Effects of hydrodynamics on cultures of mammalian neural stem cell aggregates in suspension bioreactors. Ind Eng Chem Res. 2001;40:5350–7.
doi: 10.1021/ie001107y
Azarin SM, Lian X, Larson EA, Popelka HM, de Pablo JJ, Palecek SP. Modulation of Wnt/β-catenin signaling in human embryonic stem cells using a 3-D microwell array. Biomaterials. 2012;33:2041–9.
pubmed: 22177620 doi: 10.1016/j.biomaterials.2011.11.070
Konze SA, van Diepen L, Schröder A, Olmer R, Möller H, Pich A, Weißmann R, Kuss AW, Zweigerdt R, Buettner FF. Cleavage of E-cadherin and β-catenin by calpain affects Wnt signaling and spheroid formation in suspension cultures of human pluripotent stem cells. Mol Cell Proteomics. 2014;13:990–1007.
pubmed: 24482122 pmcid: 3977196 doi: 10.1074/mcp.M113.033423
Sullivan S, Stacey GN, Akazawa C, Aoyama N, Baptista R, Bedford P, Griscelli AB, Chandra A, Elwood N, Girard M, Kawamata S, Hanatani T, Latsis T, Lin S, Ludwig TE, Malygina T, Mack A, Mountford JC, Noggle S, Pereira LV, Price J, Sheldon M, Srivastava A, Stachelscheid H, Velayudhan SR, Ward NJ, Turner ML, Barry J, Song J. Quality control guidelines for clinical-grade human induced pluripotent stem cell lines. Regen Med. 2018;13:859–66.
pubmed: 30205750 doi: 10.2217/rme-2018-0095
Marín Morales JM, Münch N, Peter K, Freund D, Oelschlägel U, Hölig K, Böhm T, Flach A-C, Keßler J, Bonifacio E. Automated clinical grade expansion of regulatory T cells in a fully closed system. Front Immunol. 2019;10:38.
pubmed: 30778344 pmcid: 6369367 doi: 10.3389/fimmu.2019.00038
Spanholtz J, Preijers F, Tordoir M, Trilsbeek C, Paardekooper J, De Witte T, Schaap N, Dolstra H. Clinical-grade generation of active NK cells from cord blood hematopoietic progenitor cells for immunotherapy using a closed-system culture process. PLoS ONE. 2011;6:e20740.
pubmed: 21698239 pmcid: 3116834 doi: 10.1371/journal.pone.0020740
Gao D, Critser J. Mechanisms of cryoinjury in living cells. ILAR J. 2000;41:187–96.
pubmed: 11123179 doi: 10.1093/ilar.41.4.187
Karlsson JO, Toner M. Long-term storage of tissues by cryopreservation: critical issues. Biomaterials. 1996;17:243–56.
pubmed: 8745321 doi: 10.1016/0142-9612(96)85562-1
Heng BC, Ye CP, Liu H, Toh WS, Rufaihah AJ, Yang Z, Bay BH, Ge Z, Ouyang HW, Lee EH. Loss of viability during freeze–thaw of intact and adherent human embryonic stem cells with conventional slow-cooling protocols is predominantly due to apoptosis rather than cellular necrosis. J Biomed Sci. 2006;13:433–45.
pubmed: 16374523 doi: 10.1007/s11373-005-9051-9
Ichikawa H, Nakata N, Abo Y, Shirasawa S, Yokoyama T, Yoshie S, Yue F, Tomotsune D, Sasaki K. Gene pathway analysis of the mechanism by which the Rho-associated kinase inhibitor Y-27632 inhibits apoptosis in isolated thawed human embryonic stem cells. Cryobiology. 2012;64:12–22.
pubmed: 22133891 doi: 10.1016/j.cryobiol.2011.11.005
Li Y, Ma T. Bioprocessing of cryopreservation for large-scale banking of human pluripotent stem cells. BioResearch Open Access. 2012;1:205–14.
pubmed: 23515461 pmcid: 3559214 doi: 10.1089/biores.2012.0224
Wu J, Rostami MR, Cadavid Olaya DP, Tzanakakis ES. Oxygen transport and stem cell aggregation in stirred-suspension bioreactor cultures. PLoS ONE. 2014;9:e102486.
pubmed: 25032842 pmcid: 4102498 doi: 10.1371/journal.pone.0102486
Matson J, Characklis WG. Diffusion into microbial aggregates. Water Res. 1976;10:877–85.
doi: 10.1016/0043-1354(76)90022-1
Laco F, Woo TL, Zhong Q, Szmyd R, Ting S, Khan FJ, Chai CL, Reuveny S, Chen A, Oh S. Unraveling the inconsistencies of cardiac differentiation efficiency induced by the GSK3β inhibitor CHIR99021 in human pluripotent stem cells. Stem Cell Rep. 2018;10:1851–66.
doi: 10.1016/j.stemcr.2018.03.023
Jacobs K, Zambelli F, Mertzanidou A, Smolders I, Geens M, Nguyen HT, Barbé L, Sermon K, Spits C. Higher-density culture in human embryonic stem cells results in DNA damage and genome instability. Stem Cell Rep. 2016;6:330–41.
doi: 10.1016/j.stemcr.2016.01.015
Bazzoni G, Dejana E. Endothelial cell-to-cell junctions: molecular organization and role in vascular homeostasis. Physiol Rev. 2004;84:869–901.
pubmed: 15269339 doi: 10.1152/physrev.00035.2003
Tsukita S, Furuse M. The structure and function of claudins, cell adhesion molecules at tight junctions. Ann N Y Acad Sci. 2000;915:129–35.
pubmed: 11193568 doi: 10.1111/j.1749-6632.2000.tb05235.x
Baum B, Georgiou M. Dynamics of adherens junctions in epithelial establishment, maintenance, and remodeling. J Cell Biol. 2011;192:907–17.
pubmed: 21422226 pmcid: 3063136 doi: 10.1083/jcb.201009141
Silva MM, Rodrigues AF, Correia C, Sousa MF, Brito C, Coroadinha AS, Serra M, Alves PM. Robust expansion of human pluripotent stem cells: integration of bioprocess design with transcriptomic and metabolomic characterization. Stem Cells Transl Med. 2015;4:731–42.
pubmed: 25979863 pmcid: 4479622 doi: 10.5966/sctm.2014-0270
Towler MC, Hardie DG. AMP-activated protein kinase in metabolic control and insulin signaling. Circ Res. 2007;100:328–41.
pubmed: 17307971 doi: 10.1161/01.RES.0000256090.42690.05
Chen X, Chen A, Woo TL, Choo AB, Reuveny S, Oh SK. Investigations into the metabolism of two-dimensional colony and suspended microcarrier cultures of human embryonic stem cells in serum-free media. Stem Cells Dev. 2010;19:1781–92.
pubmed: 20380517 doi: 10.1089/scd.2010.0077
Kempf H, Olmer R, Haase A, Franke A, Bolesani E, Schwanke K, Robles-Diaz D, Coffee M, Göhring G, Dräger G, Pötz O, Joos T, Martinez-Hackert E, Haverich A, Buettner FFR, Martin U, Zweigerdt R. Bulk cell density and Wnt/TGFbeta signalling regulate mesendodermal patterning of human pluripotent stem cells. Nat Commun. 2016;7:13602.
pubmed: 27934856 pmcid: 5155150 doi: 10.1038/ncomms13602
Frank PG, Lisanti MP. Role of caveolin-1 in the regulation of the vascular shear stress response. J Clin Investig. 2006;116:1222–5.
pubmed: 16670766 pmcid: 1451214 doi: 10.1172/JCI28509
Li S, Chen Y, Zhang Y, Jiang X, Jiang Y, Qin X, Yang H, Wu C, Liu Y. Shear stress promotes anoikis resistance of cancer cells via caveolin-1-dependent extrinsic and intrinsic apoptotic pathways. J Cell Physiol. 2019;234:3730–43.
pubmed: 30171601 doi: 10.1002/jcp.27149
Conway DE, Lee S, Eskin SG, Shah AK, Jo H, McIntire LV. Endothelial metallothionein expression and intracellular free zinc levels are regulated by shear stress. Am J Physiol-Cell Physiol. 2010;299:C1461–7.
pubmed: 20861469 pmcid: 3006326 doi: 10.1152/ajpcell.00570.2009
Heng BC, Clement MV, Cao T. Caspase inhibitor Z-VAD-FMK enhances the freeze-thaw survival rate of human embryonic stem cells. Biosci Rep. 2007;27:257–64.
pubmed: 17594512 doi: 10.1007/s10540-007-9051-2
Xu X, Cowley S, Flaim CJ, James W, Seymour LW, Cui Z. Enhancement of cell recovery for dissociated human embryonic stem cells after cryopreservation. Biotechnol Prog. 2010;26:781–8.
pubmed: 20014103 doi: 10.1002/btpr.358
Chen Y, Tristan CA, Chen L, Jovanovic VM, Malley C, Chu P-H, Ryu S, Deng T, Ormanoglu P, Tao D. A versatile polypharmacology platform promotes cytoprotection and viability of human pluripotent and differentiated cells. Nat Methods. 2021;18:528–41.
pubmed: 33941937 pmcid: 8314867 doi: 10.1038/s41592-021-01126-2
Laflamme MA, Chen KY, Naumova AV, Muskheli V, Fugate JA, Dupras SK, Reinecke H, Xu C, Hassanipour M, Police S. Cardiomyocytes derived from human embryonic stem cells in pro-survival factors enhance function of infarcted rat hearts. Nat Biotechnol. 2007;25:1015–24.
pubmed: 17721512 doi: 10.1038/nbt1327
P.R. Pandey, A. Tomney, M.T. Woon, N. Uth, F. Shafighi, I. Ngabo, H. Vallabhaneni, Y. Levinson, E. Abraham, I. Friedrich Ben-Nun, End-to-end platform for human pluripotent stem cell manufacturing, Int J Mol Sci. 2019;21:89.
Cuesta-Gomez N, Verhoeff K, Dadheech N, Dang T, Jasra IT, de Leon MB, Pawlick R, Marfil-Garza B, Anwar P, Razavy H, Zapata-Morin PA, Jickling G, Thiesen A, O’Gorman D, Kallos MS, Shapiro AMJ. Suspension culture improves iPSC expansion and pluripotency phenotype. Stem Cell Res Ther. 2023;14:154.
pubmed: 37280707 pmcid: 10245469 doi: 10.1186/s13287-023-03382-9
Pigeau GM, Csaszar E, Dulgar-Tulloch A. Commercial scale manufacturing of allogeneic cell therapy. Front Med. 2018;5:233.
doi: 10.3389/fmed.2018.00233

Auteurs

Kevin Ullmann (K)

Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Department of Cardiothoracic Transplantation and Vascular Surgery (HTTG), Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany. Ullmann.Kevin.HTTG@mh-hannover.de.
REBIRTH Research Center for Translational and Regenerative Medicine, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany. Ullmann.Kevin.HTTG@mh-hannover.de.

Felix Manstein (F)

Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Department of Cardiothoracic Transplantation and Vascular Surgery (HTTG), Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
REBIRTH Research Center for Translational and Regenerative Medicine, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.

Wiebke Triebert (W)

Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Department of Cardiothoracic Transplantation and Vascular Surgery (HTTG), Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
REBIRTH Research Center for Translational and Regenerative Medicine, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.

Nils Kriedemann (N)

Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Department of Cardiothoracic Transplantation and Vascular Surgery (HTTG), Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
REBIRTH Research Center for Translational and Regenerative Medicine, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.

Annika Franke (A)

Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Department of Cardiothoracic Transplantation and Vascular Surgery (HTTG), Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
REBIRTH Research Center for Translational and Regenerative Medicine, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.

Jana Teske (J)

Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Department of Cardiothoracic Transplantation and Vascular Surgery (HTTG), Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
REBIRTH Research Center for Translational and Regenerative Medicine, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.

Mira Mertens (M)

Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Department of Cardiothoracic Transplantation and Vascular Surgery (HTTG), Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
REBIRTH Research Center for Translational and Regenerative Medicine, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.

Victoria Lupanow (V)

Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Department of Cardiothoracic Transplantation and Vascular Surgery (HTTG), Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
REBIRTH Research Center for Translational and Regenerative Medicine, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.

Gudrun Göhring (G)

Department of Human Genetics, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.

Alexandra Haase (A)

Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Department of Cardiothoracic Transplantation and Vascular Surgery (HTTG), Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
REBIRTH Research Center for Translational and Regenerative Medicine, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.

Ulrich Martin (U)

Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Department of Cardiothoracic Transplantation and Vascular Surgery (HTTG), Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
REBIRTH Research Center for Translational and Regenerative Medicine, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.

Robert Zweigerdt (R)

Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Department of Cardiothoracic Transplantation and Vascular Surgery (HTTG), Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany. Zweigerdt.Robert@mh-hannover.de.
REBIRTH Research Center for Translational and Regenerative Medicine, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany. Zweigerdt.Robert@mh-hannover.de.

Classifications MeSH