CAC #
UL Lafayette New Iberia Research Center
Chimpanzee Advisory Committee Research Approval Request
Section 1: Research Project Overview
Title:
Study Director:
Requested Start Date:
Anticipated Completion Date:
If approval for accessing NIH supported chimpanzees and/or NIH funding is approved
for chimpanzee biomedical research
proceed to section 7 below after completing section 1.
Status of UL Lafayette Institutional Animal Care and Use Committee (IACUC) approval:
Current IACUC approval number
Approval Expiration date:
Pending;
Does this research include use of biological and/or recombinant DNA?
no.
yes. Provide status of UL Lafayette Institutional Biosafety Committee (IBC)
application
Current IBC approval number
Approval Expiration date:
Pending
Section 2: Application
This is a new application
This is a major revision; prior CAC approval No.
This application is a blanket approval (multiple studies may be performed under this
approval).
Include all classes* of compounds in this application.
This application is for a single research project. List class* of compound:
Biomedical Research Application (Proceed to Section 3 Below)
Comparative Genomics and Behavioral Research (Proceed to Section 6 Below)
*Examples of compound classes: monoclonal, anti-viral, novel compound
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Chimpanzee Advisory Committee Research Approval Request
Section 3: Biomedical Research Overview (De-selection of In-vitro and/or In-vivo Nonhuman models):
1. State objective of the proposed research project:
2. Intended beneficiary of proposed therapeutic (check all that apply).
Human
Chimpanzee
(Note: Research intended solely for preservation and welfare of chimpanzees is exempt
from these criteria. However, preliminary testing in lower species and/or preliminary
safety testing is still required.)
3. Is this an established animal model? Provide literature references and/or list prior
chimpanzee in life studies (including untoward and/or adverse effect)
4. Consideration of in vitro and/or in vivo non-human models. Denote all that have been
considered and/or utilized (explaining use, inability to use and/or detailed exclusion criteria
for non-use to meet study objectives):
A. In vitro methods
i. Mathematical models/Computer Simulation
Can be used to meet study objectives.
Cannot be used to meet study objectives.
Include detailed exclusion criteria:
B.
In vitro culture systems:
Can be utilized to meet study objectives.
Cannot be utilized to meet study objectives.
Include detailed exclusion criteria:
C.
In vivo animal models considered and/or utilized for this research.
Monkeys
Dogs
Mini pigs
Rodents
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Chimpanzee Advisory Committee Research Approval Request
Transgenic animals
Chimeric animals
Other (list)
Cannot be utilized to meet specific study objectives. Include detailed exclusion
criteria:
Section 4: Research Overview (Human Subject consideration)
Research can ethically be performed in humans
Yes
Yes: Application is complete, chimpanzee animal model should not be utilized.
No
Research cannot ethically be performed in humans.
a)
Include detailed exclusion criteria for use of humans:
b)
Justification for use of chimpanzees:
Section 5: Research Justification in Chimpanzees; check all that apply
Foregoing the use of chimpanzees will significantly slow or prevent advancement of
therapeutic treatment against
(insert disease) detailed in this application.
This research is proposed for developing treatments or therapies against
disease or condition.)
This research is proposed for biodefense related condition of
(Insert
.
Section 6: Comparative Genomics and Behavioral Research
A.
Does this research provide otherwise unattainable insight into comparative genomics,
normal and abnormal behavior, mental health, emotion, or cognition?
Yes
No (If no, research is not justified for chimpanzee use).
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Chimpanzee Advisory Committee Research Approval Request
B.
Will research be performed in a manner designed to minimize pain and distress to the
animals using only minimally invasive protocols?
Yes
No (describe efforts to minimize pain and distress)
Section 7: Signatures
Please submit both a (signed) hardcopy and an electronic copy (e-mailed to
NIRCcac@louisiana.edu).
By my dated signature, I confirm the information included in this application is accurate and
complete to the best of my knowledge.
NIRC Study Director Signature
Date
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