SAN JOSE, Calif.—In the seven years since he left Theranos, Adam Rosendorff had never publicly revealed his role in the blood-testing startup’s downfall. In just four days of testimony, the former lab director has become the most important witness yet in Elizabeth Holmes’s criminal-fraud trial.

Dr. Rosendorff’s testimony has connected Theranos’s problems directly to Ms. Holmes, supporting prosecutors’ contention that the company’s founder intended to defraud patients and investors about Theranos’s technology.

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