Drawing on interviews with knowledge workers in regenerative medicine projects, we explore the role of trust in the creation of intellectual capital in research and development intensive environments. Through a textual-coding analysis of these interviews, we typify four patterns of hierarchical relationships between senior and junior workers. These typologies remarkably differ because of dissimilar levels of cognitive and affective trust. In this paper, we explain how these two forms of trust interact, in both concordant and discordant ways, in solving projects’ challenges, agency issues emerging in knowledge-intensive hierarchical work relationships and, ultimately, in shaping the creation of intellectual capital.