Address Line 1 (Street Address)
Address Line 2 (Apt, Ste, Unit)
Additional Contact Email address
Grant Number(s) that supported line development
Note: We request that investigators submit 3 vials per iPSC and fibroblast line. This ensures the lab has extra vials in the event of a QC measure failure. Sending less than 3 vials could result in additional requests for any vials that fail QC.
Note: If you are depositing fibroblast-derived iPSCs, please send original fibroblast lines in the same shipment.
Are you returning samples generated from NCRAD samples?
Yes
No
I would like to deposit (check all that apply):
iPSCs
Fibroblasts
iPSC - Number of iPSC lines you want to deposit
1-5
6-10
11-15
16-20
21-25
26-30
31-35
36-40
41-45
46-50
51+
iPSC - Number of iPSC lines you want to deposit: 51+ (Please specify)
iPSC - Mutation Info
Note: Exact mutation information will be required before depositing.
Please send sequencing data for validation (if available).
Wild Type
Mutation
Sporadic AD
*exact mutation info will be required before depositing, please include sequencing primers for validation
APOE4
APP
c9orf72
MAPT
PGRN
PSEN1
PSEN2
TREM2
Other
iPSC - Mutation Type - APOE4
What genotype?
* must provide value
iPSC - Mutation Type - Other (Please specify)
* must provide value
Patient-derived
Genetically engineered
iPSC - Do you have isogenic lines?
Yes
No
iPSC - Please deposit any isogenic lines, if available.
iPSC - Use of feeders layers?
Yes
No
mTesr1
Tesr2
E8
mTesr E8
mTesr 3D
Nutristem
StemMACS iPS-Brew XF
Unknown
Other
iPSC - Media - Other (Please specify)
Matrigel
Vitronectin
Laminin
None
Unknown
Other
iPSC - Substrate - Other (Please specify)
DMSO
Cryostore
mFreSR
Gibco PSC Cryopreservation
Synth-a-Freeze
Unknown
Other
iPSC - Freezing media - Other (Please specify)
iPSC - Passage number at freeze (range)
1-15
16-20
21-25
26-30
31+
Unknown
Lines with less than 30 passages are preferred. Lines with greater than 30 passages will be moved to the end of the queue and expanded last.
iPSC - Number of cells frozen per vial
< 500,000
500,000-1,000,000
>1,000,000
Unknown
iPSC - Reprogramming method
Episomal
mRNA
Retroviral
Lentiviral
Sendai Virus
Unknown
Other
iPSC - Reprogramming method - Other (Please specify)
Dispase
Collagenase
Accutase
EDTA
Unknown
Other
iPSC - Passaging Method - Other (Please specify)
5% CO2
Unknown
Other
iPSC - CO2 Conditions - Other (Please specify)
Atmospheric
Hypoxic
Unknown
iPSC - O2 Conditions - Hypoxic - What % O2?
iPSC - Do you have Mycoplasma testing for iPSCs?
* must provide value
Mycoplasma free
Not tested/unknown
iPSC - Please upload iPSC mycoplasma testing documentation.
iPSC - How many requests have you received for your iPSC lines in the last 12 months?
1-5
6-10
11-15
16-20
21-25
26-30
31+
iPSC - Number of requests:
iPSC - Please upload relevant iPSC protocol(s).
iPSC - Do you have an additional iPSC protocol to upload?
Yes
No
iPSC - Please upload relevant iPSC protocol(s).
iPSC - Have any of these iPSC lines been published on?
No
Yes
Unknown
iPSC - Please provide the PubMed link(s) to publication(s):
iPSC - Please provide any other relevant information about your iPSCs you would like us to know.
Fibroblast - Number of fibroblast lines you want to deposit
1-5
6-10
11-15
16-20
21-25
26-30
31-35
36-40
41-45
46-50
51+
Fibroblast - Number of fibroblast lines you want to deposit: 51+ (Please specify)
Fibroblast - Mutation Info (Fibroblast)
Note: Exact mutation information will be required before depositing.
Please send sequencing data for validation (if available).
Wild Type
Mutation
*exact mutation info will be required before depositing, please include sequencing primers for validation
Fibroblast - Mutation Type (Fibroblast)
APOE4
APP
c9orf72
MAPT
PGRN
PSEN1
PSEN2
TREM2
Other
Fibroblast - Mutation Type - APOE4
What genotype?
* must provide value
Fibroblast - Mutation Type - Other (Please specify)
* must provide value
RPMI 1640 + FBS
DMEM + FBS
DMEM/F12 + FBS
Unknown
Other
Fibroblast - Media - Other (Please specify)
Fibroblast - Freezing media
growth medium + DMSO
growth medium + glycerol
Unknown
Other
Freezing media - Other (Please specify)
Fibroblast - Passage number at freeze (range)
1-5
6-10
11-15
16-20
21-25
26+
Unknown
Fibroblast - PDL at freeze (range)
1 to 9
10 to 19
20 to 29
30 to 39
40 to 49
50+
Unknown
Fibroblast - Number of cells frozen per vial
< 500,000
500,000-1,000,000
>1,000,000
Unknown
Fibroblast - Passaging Method
Trypsin EDTA
Unknown
Other
Fibroblast - Passaging Method - Other (Please specify)
Fibroblast - CO2 Conditions
5% CO2
Unknown
Other
Fibroblast - CO2 Conditions - Other (Please specify)
Fibroblast - O2 Conditions
Atmospheric
Hypoxic
Unknown
Fibroblast - O2 Conditions - Hypoxic - What % O2?
Fibroblast - Do you have Mycoplasma testing for fibroblasts?
* must provide value
Mycoplasma free
Not tested/unknown
Fibroblast - Please upload Fibroblast mycoplasma testing documentation.
Fibroblast - How many requests have you received for your fibroblast lines over the last 12 months?
1-5
6-10
11-15
16-20
21-25
26-30
31+
Fibroblast - Number of requests:
Fibroblast - Please upload relevant Fibroblast Protocol(s).
Fibroblast - Do you have an additional Fibroblast protocol to upload?
Yes
No
Fibroblast - Please upload relevant Fibroblast protocol(s).
Fibroblast - Have any of these fibroblasts been published on?
Yes
No
Fibroblast - Please provide the PubMed link(s) to publication(s):
Fibroblast - Please provide any other relevant information about your fibroblasts you would like us to know.