Complex Oscillatory Waves Emerging From Cortical Organoids Model Early Human Brain Network Development
Complex Oscillatory Waves Emerging From Cortical Organoids Model Early Human Brain Network Development
Complex Oscillatory Waves Emerging From Cortical Organoids Model Early Human Brain Network Development
Correspondence
[email protected]
In Brief
Oscillatory activity is a candidate
mechanism for how neural populations
are temporally organized. Cortical
organoids exhibit periodic and highly
regular nested oscillatory network events
that are dependent on glutamatergic and
GABAergic signaling. The emerging
development of network activity
transitions to more spatiotemporally
complex activity, capturing features of
preterm infant electroencephalography.
Highlights
d Long-term, single-cell transcriptomics reveals cortical
organoid developmental dynamics
Short Article
92093, USA
2Department of Cellular & Molecular Medicine, School of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
3Neurosciences Graduate Program, Institute for Neural Computation, Department of Cognitive Science, University of California, San Diego,
lu Data Science Institute, University of California, San Diego, La Jolla, CA 92093, USA
8Kavli Institute for Brain and Mind and Halıcıog
9Center for Academic Research and Training in Anthropogeny (CARTA), La Jolla, CA 92093, USA
10These authors contributed equally
11Senior author
12Lead Contact
*Correspondence: [email protected]
https://doi.org/10.1016/j.stem.2019.08.002
558 Cell Stem Cell 25, 558–569, October 3, 2019 ª 2019 Elsevier Inc.
Figure 1. Cellular and Molecular Development of Human Cortical Organoids
(A) Overview of human neural network formation and dynamics evaluation using cortical organoids.
(B) Schematic of the protocol used to generate cortical organoids. Scale bar, 200 mm.
(legend continued on next page)
Cell Stem Cell 25, 558–569, October 3, 2019 559
researchers have not yet clearly determined whether brain orga- Figures 1D and S1). Although the initial fraction of GFAP-positive
noids are a suitable model for neural network dynamics (Kelava cells was less than 5%, this population increased to about 30%–
and Lancaster, 2016; Paşca, 2018). 40% after 6 months of differentiation (Figures 1D and 1E).
Here, we use human iPSCs to generate cortical organoids that To characterize the cellular diversity of cortical organoids dur-
exhibit evolving cellular transcriptional profile and nested oscilla- ing development, we performed single-cell RNA-seq on 1-, 3-,
tory network dynamics over the span of several months. We 6-, and 10-month organoids (Figures 1H–1M and S1; Table
subsequently investigated the molecular basis of oscillatory ac- S1). We used unsupervised clustering on the combined dataset
tivity formation, maintenance, and temporal control. Finally, we of 15,990 cells to identify clusters and their relative abundance at
applied supervised machine learning with cross-validation to distinct time points. Based on the expression gene markers, we
evaluate the similarity between electrophysiological network ac- combined smaller subclusters into five major cell classes:
tivity patterns of the in vitro model and human preterm neonatal progenitors; intermediate progenitors; glial cells; glutamatergic
electroencephalogram (EEG). Our findings suggest that orga- neurons; and GABAergic neurons. Based on this annotation,
noid models are suitable for the investigation of the physiological 1-month organoids consisted of >70% progenitor cells (express-
basis of network formation at early and late stages of the human ing SOX2 and PAX6; Figures 1J and 1M). At the 3- and 6-month
brain development. This prolonged evaluation of cortical orga- stage, cortical organoids comprised mainly glia (SLC1A3) and
noid activity expands our understanding of the emergence of glutamatergic neurons (GRIA2 and SNAP25; Figures 1J and
network-level neurodynamics in humans. 1M). The glial cells started with a small population and increased
to around 40% of cells present in the cortical organoids. Remain-
RESULTS ing populations of progenitors (around 5%) and intermediate
progenitors (around 10%) were present throughout the matura-
Generation of Functional Cortical Organoids tion. A fraction of glutamatergic neurons at the 3- and 6-month
Despite the structural and transcriptional similarities between time point expressed subunits of GABAergic receptors, such
brain organoids and the developing nervous system, the emer- as GABRB3 (Figure S1C). This expression of GABAergic recep-
gence of higher level complex network activity comparable to tors predates the appearance of interneurons.
the living human brain remains largely untested (Figure 1A). To GABAergic neurons were mainly restricted to 6- to 10-month
investigate the formation of a functional network, we promoted organoids, as indicated by expression of GAD2 (also known as
cortical specification by previously described protocols (Paşca GAD65), DLX1, and DLX5 (Figures 1J–1M, S1C, and S1D),
et al., 2015; Thomas et al., 2017; Yoon et al., 2019; Figure 1B; reaching around 15% of the total neuronal population after
see STAR Methods for details). At the beginning of differentia- 10 months of maturation, consistent with its presence later in
tion, an abundance of proliferative neural progenitor cells the in vivo development (Uylings et al., 2002). The molecular pro-
(NPCs) (expressing Ki67, SOX2, and Nestin) that self-organized file of GABAergic neurons was further evaluated by single-cell
into a polarized neuroepithelium-like structure was observed. transcriptomics (Figure S1E) and by the presence of protein
Similar to human cortical development in vivo, the proliferative markers (Figure S1F). To demonstrate the biosynthesis of
zone around a lumen delimited by b-catenin+ cells was sur- GABA during the maturation process, we employed metabolo-
rounded by progenitor cells. Progressively, the organoids mics liquid chromatography coupled to mass spectrometry
increased in size and in the proportion of mature neurons (ex- (Gertsman et al., 2014). The neurotransmitter GABA was de-
pressing NeuN and MAP2) to ultimately develop into concentric tected in the culture media of cortical organoids after 6 months
multilayer structures composed of NPCs, intermediate progeni- of maturation (Figure S1G) in a physiologically relevant concen-
tors (TBR2; also known as EOMES), and lower (CTIP2; also tration (Van Hove and Thomas, 2014). These results suggest the
known as BCL11B) and upper (SATB2) cortical layer neurons presence of the basic components for the generation of a neural
(Figures 1C–1E and S1). The neurons exhibit dendritic protru- network in a developing human cortical in vitro model.
sions and synaptic ultrastructure (Figures 1F and 1G). After
6 months, inhibitory neurons can also be observed (calretinin Emergence of Nested Oscillatory Network Activity
[CR], also known as CALB2; GABAB; NKX2.1, also known as In addition to the observed cellular diversity and expression of
TTF1; GABA; LHX6; somatostatin [SST]; and parvalbumin [PV]; synaptic markers, we interrogated the presence of functional
(H) 1- to 4-Hz oscillatory power in the LFP increases up to the 25th week in culture and plateaus at 30 weeks. Inset: oscillatory power is calculated by fitting a
straight line (dashed) over the aperiodic portion of the PSD and taken as the height of narrow peaks rising above the linear fit.
(I) Pairwise correlation of LFP across all electrodes (coherence) within a well during network events initially increases and then decreases after 30 weeks.
(J) An example of sequential frames during a network event shows the spatial propagation of wave spreading and then disappearing again after 100 ms.
The data shown in (C), (D), (F), (G), (H), and (I) are presented as mean ± SEM. *p < 0.05; **p < 0.01; ***p < 0.001; unpaired Student’s t test (C), quadratic (F, H, and I)
and linear (G) regression.
AMPA/kainate, respectively) and GABA receptor agonists discontinu (Tolonen et al., 2007), quiescent periods are
(muscimol, GABAA; baclofen, GABAB) by significantly reducing punctuated by high-amplitude oscillations (spontaneous activity
the number of spike events and bursts, with a subsequent transients [SATs]) lasting a few seconds. Intervals of complete
extinction of synchronous activity. The electrical activity was quiescence disappear as infants become of term, and the EEG
abolished in the presence of TTX (Figures 3D and 3E). Blockade is dominated by continuous and low-amplitude desynchronized
of GABAergic transmission by bicuculline increased the number activity in adult brains (Figures 4A, S4A, and S4B).
of network-synchronized events and did not affect peak popula- Due to the inability to interrogate the electrophysiology of
tion firing rates but abolished nested 2-Hz oscillatory activity by intact human embryonic brains, we attempted to quantitatively
erasing subsequent reverberant peaks (Figure 3F). compare network activity in cortical organoids to preterm human
EEG. We analyzed a publicly available dataset of 101 serial EEG
Cortical Organoid Network Development Resembles recordings from 39 preterm infants ranging from 24 to 38 weeks
Some Preterm EEG Features post-menstrual age (PMA): 567 data points total (Stevenson
Despite emergence of complex oscillatory network activity in et al., 2017). The dataset contains 23 precomputed features for
organoids, it is unclear whether the spontaneous developmental each EEG record, ranging from timing, rate, and variability of
trajectory observed is representative of programmed early SATs (or bursts), as well as spectral power in canonical oscilla-
neurodevelopment. Although network activity from cortical orga- tory bands (delta, theta, etc.; see Table S2 for full list of features).
noids does not exhibit the full temporal complexity seen in We computed analogous features from each organoid LFP
adults, the pattern of alternating periods of quiescence and recording when appropriate. It is important to note that the
network-synchronized events resembles electrophysiological biophysics of scalp EEG is drastically different from extracellular
signatures present in preterm human infant EEG. During trace field potential in the organoid, due to factors such as spatial
Comparing to the Early Developing Brain: Insights and Detailed methods are provided in the online version of this paper
Limitations and include the following:
Some features of early network dynamics in humans (e.g., SATs)
can be recapitulated by the in vitro model, with no additional d KEY RESOURCES TABLE
constraints other than structural and genetic similarities. The d LEAD CONTACT AND MATERIALS AVAILABILITY
regularized regression model presented here was built on d EXPERIMENTAL MODEL AND SUBJECT DETAILS
preterm EEG data only, following an internal cross-validation B Human cell source
procedure to estimate the hyperparameters. It was then directly B Rodent cell source
applied to organoid LFP data—previously unseen by the classi- d METHOD DETAILS
fier—to produce a ‘‘predicted developmental time,’’ in addition B Generation of cortical organoids
to data from several other cellular models for validation. Simulta- B Neurosphere generation
neous MEA and EEG seizure recordings, in human subjects, B Mycoplasma testing
share common features in the EEG frequency range (Schevon B Immunofluorescence staining
et al., 2012). However, when comparing the in vitro MEA and B Electron microscopy (EM)
neonatal EEG features, it is crucial to remove any comparison B 10X genomics single-cell and analysis
of features affected by the spatial filtering properties of the skull. B Mass spectrometry
Moreover, there are a few factors that might challenge the inter- B Whole-cell patch-clamp
pretation of the regression model results. First, it is difficult to B Multi-electrode array (MEA) recording
control external variation in infant EEG due to differences that B Custom MEA analysis
B Statistical analysis Ben-Ari, Y. (2001). Developing networks play a similar melody. Trends
Neurosci. 24, 353–360.
B Statistics and Regression for custom MEA analysis
d DATA AND CODE AVAILABILITY Birey, F., Andersen, J., Makinson, C.D., Islam, S., Wei, W., Huber, N., Fan,
H.C., Metzler, K.R.C., Panagiotakos, G., Thom, N., et al. (2017). Assembly of
B Single-cell RNA sequencing data
functionally integrated human forebrain spheroids. Nature 545, 54–59.
B The unnormalized feature weights
Blankenship, A.G., and Feller, M.B. (2010). Mechanisms underlying sponta-
neous patterned activity in developing neural circuits. Nat. Rev. Neurosci.
SUPPLEMENTAL INFORMATION 11, 18–29.
Butler, A., Hoffman, P., Smibert, P., Papalexi, E., and Satija, R. (2018).
Supplemental Information can be found online at https://doi.org/10.1016/j. Integrating single-cell transcriptomic data across different conditions, technol-
stem.2019.08.002. ogies, and species. Nat. Biotechnol. 36, 411–420.
Buzsáki, G. (2004). Large-scale recording of neuronal ensembles. Nat.
Neurosci. 7, 446–451.
ACKNOWLEDGMENTS
Buzsáki, G., and Draguhn, A. (2004). Neuronal oscillations in cortical networks.
This work was supported by grants from the California Institute for Science 304, 1926–1929.
Regenerative Medicine (CIRM) DISC1-08825 and DISC2-09649; the NIH Buzsáki, G., Anastassiou, C.A., and Koch, C. (2012). The origin of extracellular
through R01MH108528, R01MH094753, R01MH109885, R01MH100175, fields and currents–EEG, ECoG, LFP and spikes. Nat. Rev. Neurosci. 13,
and R56MH109587; a SFARI grant no. 345469; and a NARSAD Independent 407–420.
Investigator Grant to A.R.M. B.V. is supported by a Sloan Research Fellow- Buzsáki, G., Logothetis, N., and Singer, W. (2013). Scaling brain size, keeping
ship, the Whitehall Foundation (2017-12-73), and the National Science Foun- timing: evolutionary preservation of brain rhythms. Neuron 80, 751–764.
dation (1736028). I.A.C. is a San Diego IRACDA Fellow supported by National Camp, J.G., Badsha, F., Florio, M., Kanton, S., Gerber, T., Wilsch-Bra €uninger,
Institutes of Health NIH/NIGMS K12 GM068524 Award. A.R.M. is supported M., Lewitus, E., Sykes, A., Hevers, W., Lancaster, M., et al. (2015). Human ce-
by U19MH1073671, part of the National Cooperative Reprogrammed Cell rebral organoids recapitulate gene expression programs of fetal neocortex
Research Groups (NCRCRG) to Study Mental Illness. R.G. is supported by development. Proc. Natl. Acad. Sci. USA 112, 15672–15677.
the Natural Sciences and Engineering Research Council of Canada (NSERC
Cederquist, G.Y., Asciolla, J.J., Tchieu, J., Walsh, R.M., Cornacchia, D., Resh,
PGS-D), UCSD Kavli Innovative Research Grant (IRG), Frontiers for Innovation
M.D., and Studer, L. (2019). Specification of positional identity in forebrain or-
Scholars Program, and Katzin Prize. We thank Patrick S. Cooper for his help on
ganoids. Nat. Biotechnol. 37, 436–444.
the Australian EEG Database. We thank Dr. V. Taupin for her expert assistance
with electron microscopy and Dr. Bruce Barshop and Dr. Jon Gangoiti (UCSD) de Hemptinne, C., Swann, N.C., Ostrem, J.L., Ryapolova-Webb, E.S., San
for their expertise in mass spectrometry. We also thank the Epigenomics Cen- Luciano, M., Galifianakis, N.B., and Starr, P.A. (2015). Therapeutic deep brain
ter (UCSD). This work was supported by the UC San Diego School of Medicine. stimulation reduces cortical phase-amplitude coupling in Parkinson’s disease.
Nat. Neurosci. 18, 779–786.
Farahany, N.A., Greely, H.T., Hyman, S., Koch, C., Grady, C., Pașca, S.P.,
AUTHOR CONTRIBUTIONS Sestan, N., Arlotta, P., Bernat, J.L., Ting, J., et al. (2018). The ethics of exper-
imenting with human brain tissue. Nature 556, 429–432.
C.A.T., R.G., and P.D.N. should be considered co-first authors, as each de-
signed the experiments and conducted the analyses with input from A.R.M. Fries, P. (2005). A mechanism for cognitive dynamics: neuronal communica-
and B.V.; C.A.T. and P.D.N. generated and characterized the cortical organo- tion through neuronal coherence. Trends Cogn. Sci. 9, 474–480.
ids and performed the MEA recordings. C.A.T., J.G., J.B., S.P., A.W., I.A.C., A. Gao, R., Peterson, E.J., and Voytek, B. (2017). Inferring synaptic excitation/in-
Domissy, and G.W.Y. performed and analyzed 103 Genomics single-cell ex- hibition balance from field potentials. Neuroimage 158, 70–78.
periments. C.A.T., M.V., and A. Devor performed functional experiments. W.W. Gertsman, I., Gangoiti, J.A., and Barshop, B.A. (2014). Validation of a dual
and G.G.H. performed whole-cell patch-clamp electrophysiology analysis. LC-HRMS platform for clinical metabolic diagnosis in serum, bridging quanti-
C.A.T. and P.D.N. analyzed the MEA data, and R.G. performed the custom tative analysis and untargeted metabolomics. Metabolomics 10, 312–323.
MEA and EEG analyses. A.R.M. and B.V. should be considered co-senior au-
Giandomenico, S.L., Mierau, S.B., Gibbons, G.M., Wenger, L.M.D., Masullo,
thors, as they contributed equally to directing the overall study design, with
L., Sit, T., Sutcliffe, M., Boulanger, J., Tripodi, M., Derivery, E., et al. (2019).
A.R.M. leading the cortical organoid development and analyses and B.V. lead-
Cerebral organoids at the air-liquid interface generate diverse nerve tracts
ing the electrophysiological analyses. C.A.T., P.D.N., R.G., B.V., and A.R.M.
with functional output. Nat. Neurosci. 22, 669–679.
wrote the manuscript. All authors reviewed the manuscript for publication.
Haller, M., Donoghue, T., Peterson, E., Varma, P., Sebastian, P., Gao, R., Noto,
T., Knight, R.T., Shestyuk, A., and Voytek, B. (2018). Parameterizing neural po-
DECLARATION OF INTERESTS wer spectra. bioRxiv. https://doi.org/10.1101/299859.
Henriques, J.B., and Davidson, R.J. (1991). Left frontal hypoactivation in
A.R.M. is a co-founder and has equity interest in TISMOO, a company dedi-
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cated to genetic analysis focusing on therapeutic applications customized
for autism spectrum disorder and other neurological disorders with genetic or- Johnson, M.H. (2001). Functional brain development in humans. Nat. Rev.
igins. The terms of this arrangement have been reviewed and approved by the Neurosci. 2, 475–483.
University of California, San Diego in accordance with its conflict of interest Kelava, I., and Lancaster, M.A. (2016). Stem cell models of human brain devel-
policies. opment. Cell Stem Cell 18, 736–748.
METHOD DETAILS
Neurosphere generation
The neurosphere generation protocol was published elsewhere (Nageshappa et al., 2016). Briefly, iPSC were dissociated using
Accutase (Life Technologies), centrifuged and resuspended in medium (IMDM medium, 15% fetal bovine serum, 2 mM L-glutamine,
1% NEAA, 1 mM sodium pyruvate, 100 U PS, 200 mg/mL iron-saturated transferrin, 10 mM b-mercaptoethanol, 50 mg/mL ascorbic
acid; supplemented with 10 mM SB (Stemgent) and 1 mM Dorso (R&D Systems) on a ‘‘low-attachment’’ plate for embryoid body (EB)
formation. After 8 days, the EBs were plated for rosette formation and expansion of neural progenitors in the presence of defined
medium DMEM/F-12 supplemented with Gem21 NeuroPlex (Gemini Bio-Products) and 20 ng/mL of FGF2. For neurosphere
generation, 4,000 neural progenitors were seeded on ‘‘low-attachment’’ plate under rotation with no FGF2. The neurospheres
were developed for around 8 weeks prior to MEA plating.
Mycoplasma testing
All cellular cultures were routinely tested for mycoplasma by PCR. Media supernatants (with no antibiotics) were collected,
centrifuged, and resuspended in saline buffer. Ten microliters of each sample were used for a PCR with the following primers:
Forward: GGCGAATGGGTGAGTAAC; Reverse: CGGATAACGCTTGCGACCT. Only negative samples were used in the study.
Immunofluorescence staining
Cortical organoids were fixed with 4% paraformaldehyde overnight at 4 C and then transferred to 30% sucrose. After the 3D struc-
tures sink, they were embedded in O.C.T. (Sakura, Tokyo, Japan) and sliced in a cryostat (20 mm slices). Following air dry, the slides
containing the sliced samples were permeabilized/blocked with 0.1% Triton X-100 and 3% FBS in PBS for 2 hours at room temper-
ature, and incubated with primary antibodies overnight at 4 C. Primary antibodies used in this study were: mouse anti-Nestin, Abcam
(Cambridge, UK) ab22035, 1:250; rat anti-CTIP2, Abcam ab18465, 1:500; rabbit anti-SATB2, Abcam ab34735, 1:200; chicken anti-
MAP2, Abcam ab5392, 1:2000; rabbit anti-Synapsin1, EMD-Millipore AB1543P, 1:500; mouse anti-NeuN, EMD-Millipore MAB377,
1:500; rabbit anti-Ki67, Abcam ab15580, 1:1000; rabbit anti-SOX2, Cell Signaling Technology 2748, 1:500; rabbit anti-GFAP, DAKO
Z033429, 1:1000; rabbit anti-TBR1, Abcam ab31940, 1:500; rabbit anti-TBR2, Abcam ab23345, 1:500; rabbit anti-beta-catenin,
Abcam E247, 1:200; mouse anti-GABA, Abcam ab86186, 1:200; mouse anti-GABA B Receptor 1, Abcam ab55051, 1:100; mouse
anti-Parvalbumin, Millipore MAB1572, 1:500; rabbit anti-Calretinin, Abcam ab92341, 1:200; rat anti-Somatostatin, Millipore
MAB354, 1:100; rabbit anti-TTF1 (NKX2.1), Abcam ab76013, 1:200. Next, the slices were washed with PBS and incubated with
secondary antibodies (Alexa Fluor 488-, 555- and 647-conjugated antibodies, Life Technologies, 1:1000) for 2 hours at room
temperature. The nuclei were stained using DAPI solution (1 mg/mL). The slides were mounted using ProLong Gold antifade reagent
and analyzed under a fluorescence microscope (Axio Observer Apotome, Zeiss).
Mass spectrometry
Samples were assayed using an adaptation of published protocol (Gertsman et al., 2014). Cortical organoid media (100 mL) was
mixed with 2 mM 13C4-4-aminobutyric acid, as internal standard. Metabolites were extracted using 80% ice-cold methanol. After
incubation for 30 minutes at 20 C, samples were deproteinized at 4 C by centrifugation at 17,136 x g for 10 minutes. Supernatants
were evaporated to dryness in a centrifugal evaporator at 36 C (Savant SPD121P Speed-Vac concentrator. Thermo Fisher, Asheville,
NC) and reconstituted in 100 mL of 10% methanol in water + 0.1% formic acid, by means of consecutive vortexing, orbital shaking and
sonication. 5 uL of which were injected into a Sciex 4500 triple quadrupole mass spectrometer (Sciex, Foster City, California, USA) to
determine 4-aminobutyric acid (GABA) concentration. Chromatographic separations were conducted in a 3 mm ACE C18-PFP
reversed-phase HPLC column (Mac-mod analytical, Chadds Ford, PA, USA) using an Acquity binary pump (Waters, Milford, MA,
USA) equipped with an in-line degasser at 0.3 mL/min flow-rate and at 13 C, to enhance the retention of the low-retained com-
pounds, by means of a simple binary gradient of acetonitrile partitioning in 3% acetonitrile in water, both containing 0.1% formic
acid. Compounds were eluted during the first 3 minutes, then it ramped to 100%. Total run time was 45 minutes. Positive electrospray
ionization multiple reaction monitoring transitions were optimized for GABA (and 13C4-GABA), m/z 104.2 > 87 (108.2 > 90.9) and m/z
104.2 > 68.9 (108.2 > 73), using collision energies of 15 and 23, respectively, and unit mass resolution. GABA concentrations were
calculated by interpolation using an 8-point calibration curve, spanning 0.01 to 0.2 mM, constructed by supplementing medium with
the appropriate amounts of GABA. Quantification was conducted using MultiQuant 2.1 software (Sciex, Foster City, CA, USA).
Whole-cell patch-clamp
Whole-cell patch-clamp recordings were performed from cells of cortical organoids in a similar condition as for MEA recordings: 6- to
8-week cortical organoids were plated on 35 mm dishes that were previously coated with 100 mg/mL poly-L-ornithine and 10 mg/ml
laminin. Cells were fed twice a week and were maintained for 24 weeks. The extracellular solution for patch-clamp experiments con-
tained (in mM) the following: 130 NaCl, 3 KCl, 1 CaCl2, 1 MgCl2, 10 HEPES, and 10 glucose; pH 7.4 with 1 M NaOH (4 mM Na+
Pharmacology
The pharmacological manipulation was performed with cortical organoids plated on 4 MEA wells (n = 4, cortical organoid culture)
using the following drugs: 10 mM bicuculline, 100 mM picrotoxin, 50 mM muscimol, 20 mM CNQX, 20 mM AP5, 25 mM baclofen and
1 mM TTX. In this assessment, baseline recordings were obtained immediately before and 15 minutes after the addition of the com-
pound. Three washes with PBS for total removal of the drug were performed in washout experiments; fresh media was added and
another recording was conducted after 2 hours.
Statistical analysis
Data are presented as mean ± s.e.m., unless otherwise indicated, and it was obtained from different samples. No statistical method
was used to predetermine the sample size. The statistical analyses were performed using Prism software (GraphPad, San Diego,
CA, USA). Student’s t test, Mann–Whitney-test, or ANOVA with post hoc tests were used as indicated. Significance was defined
as p < 0.05(*), p < 0.01(**), or p < 0.001(***).