OHSU Research Integrity Office, Mailcode L106RI, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098
Phone: 503-494-7887 Fax: 503-346-6808
OREGON HEALTH & SCIENCE UNIVERSITY
Transgenic Rodent IBC Approval Form
For more information on transgenic animal requirements and the policy, please see
http://www.ohsu.edu/xd/about/services/integrity/policies/policy-detail.cfm?policyid=756222
(Please answer questions completely – Use additional space as necessary)
Principal Investigator (Last Name, First Name, Degree)
Telephone Number
Email Address
IACUC Protocol Number and Last IACUC Approval Date
Mail Code
Laboratory Contact
For questions, contact the IBC at (503) 494-7887 (option 1) or the Transgenic Core at (503) 494-4705
1. Please provide overview of rDNA molecules to be used for generation of each transgenic mouse that
will be created.
Vector type
Insert(s)
Host (cell type and/or species)
2. Vectors to be used (plasmids, cosmids, phages, viruses)--specify type and strain, and give description.
Please provide commercial product literature, a web link to specific information, a vector map, or a hard copy of any
journal articles describing construction of vector:
DNA Insert(s) and Expression
3. State DNA Source (species, tissue/cell, or microbiological agents).
4. Genes contained in the inserted DNA sequences:
5. Will the transgene be under the control of a gammaretroviral long terminal repeat (LTR)?
6. What gene products will be expressed and what is their function?
7. Are any of the gene products potentially oncogenic or toxic for vertebrates? If yes, discuss.
8. Will any gene be intentionally mutated? If yes, describe.
Host
9.
Where will the transgenic mice be housed?
Please note that additional experiments with the resulting transgenic/knockout mice may also require IBC
approval (e.g., injecting mice with recombinant DNA or recombinantly modified cells, etc.). Please view the
IBC web page at http://www.ohsu.edu/xd/research/about/integrity/ibc/index.cfm or contact the IBC with
questions.
Principal Investigator Signature
Date
Please return signed original to Transgenic Core at L481 AND submit a copy to the IBC at Mail Code: L106-RI,
fax to 503-346-6808, or email to ibc@ohsu.edu
3/10/11