IBC # 00-000 Recombinant DNA in Animals SECTION 1: GENERAL INFORMATION Protocol Title: Principal Investigator: SECTION 2: RECIPIENTS OF RECOMBINANT DNA This program involves: Y N The use of recombinant DNA-containing pathogens in unmodified animals or invertebrate organisms. The introduction of recombinant DNA directly into animals or invertebrate organisms (i.e., creating transgenic animals). The purchase of recombinant DNA-containing animals or invertebrate organisms (i.e., purchase of transgenic animals). The use of recombinant DNA-containing pathogens in recombinant DNA-containing animals or invertebrate organisms. The organism can be found: Organism (animal) name (Genus, species) Common name and strain Normal (WT) Containment Level for this Organism Within the state of VA (yes or no) Within the U.S. (yes or no) Country of Origin (if not the U.S.) Is the organism already modified (i.e. purchased transgenic)? (Yes or No) Will naturally occurring (WT) pathogens be introduced to this organism? Will recombinant pathogens be introduced to this organism? (Yes or No) (Yes or No) *Note: An existing spreadsheet including the specific information requested above may be inserted or submitted with your application -as APPENDIX F- in place of the above table. Recombinant DNA in Plants 1 of 6 Rev. 8/1/14 IBC # 00-000 SECTION 3: MODIFIED DNA DIRECTLY INTRODUCED INTO ANIMALS/INVERTEBRATE ORGANISMS *Note: The following questions apply to recombinant DNA introduced directly into an animal or invertebrate organism. If you are introducing modified organism(s) to the animals/invertebrate organisms, please skip to Section 4. Recombinant DNA categories to be transferred to this organism (Check all that apply): Protein-coding (marker/reporter) Protein-coding (other) Non-coding miRNA Catalytic RNA Double-stranded RNA/siRNA Epitope tag Antisense RNA Complex sample (genomic library, etc) Other Method of recombinant DNA transfer into the target organism (Check all that apply) Germline Somatic Virus Biolistics Transplantation (nuclei) Transposon Recombination Transplantation (organs/tissues/cells) Nanoparticles Injection Other Briefly describe how recombinant DNA molecules will be introduced into the target organism: Note: An existing spreadsheet including the specific information requested below may be inserted or submitted with your registration -as APPENDIX G- to satisfy the information required in the following 3 tables. For each protein-coding gene (except marker/reporter genes) or catalytic RNA, provide: Name Source of gene or catalytic RNA (e.g., name of native organism or “synthetic”) Known or suspected function(s) Organism DNA is being inserted into (if more than 1 organism is listed in Section 2) For non-coding segments, miRNA/dsRNA/siRNA/asRNA or complex samples, provide the source organism: Recombinant DNA in Plants 2 of 6 Rev. 8/1/14 IBC # 00-000 Type Source Organism Organism DNA is being inserted into (if more than 1 organism is listed in Section 2) If "Other", please explain the type and source of recombinant DNA: Type Source Organism Organism DNA is being inserted into (if more than 1 organism is listed in Section 2) SECTION 4: ADDITONAL INFORMATION Y N Does this program involve the generation of transgenic rodents? Does this program involve the purchase or transfer of transgenic rodents? The spatial expression of recombinant DNA molecules will be ubiquitous in the target organism? If no, list specific tissues/organs where expression will occur: The temporal expression of recombinant DNA molecules will be ubiquitous in the target organism? If no, list times during development or life stages when expression will occur: Y N Is the organism(s) to be modified a known invertebrate pest of plants or animals? Recombinant DNA in Plants 3 of 6 Rev. 8/1/14 IBC # 00-000 If yes, briefly describe the nature and importance of this pest species (include information as to whether any of the pest species to be modified as: Is the organism(s) to be modified an invertebrate vector of plant disease agents? If yes, briefly describe the nature and importance of this vector species: Is the organism(s) to be modified an invertebrate vector of animal (including human) disease agents? If yes, briefly describe the nature and importance of this vector species: SECTION 5: MODIFIED VIRAL DNA Y N Is this the deliberate transfer of recombinant DNA derived from a eukaryotic viral genome into an animal and/or invertebrate organism? If yes, please list all sources of viral-derived recombinant DNA in the table below: Viral genome (Source of recombinant DNA) Is the viralderived recombinant DNA to be transferred replication competent itself? % of viralderived recombinant DNA to be transferred into the target pathogen (*Note: all members of the same family are considered identical) If <66% of a viral genome will be introduced, will a Helper be used to restore infectivity of the source virus following introduction into the target pathogen? Is there a reasonable expectation that complementation or recombination could restore infectivity of the source virus once introduced into the target pathogen? Organism DNA is being inserted into (if more than 1 organism is listed in Section 2) For each recombinant viral pathogen to be transferred, if less than 100% of the genome is used, provide a brief summary as to the potential for the fraction of the viral genome being utilized to lead to a productive infection: SECTION 6: MODIFIED PATHOGENS INTRODUCED INTO ANIMALS/INVERTEBRATE ORGANISMS In the table below, please list the pathogens that will be introduced to animals Recombinant DNA in Plants 4 of 6 Rev. 8/1/14 IBC # 00-000 Name of pathogen Animal it will be introduced (if more than 1 animal is listed in Section 2) SECTION 7: EFFECT OF MODIFICATION(S) ON THE ANIMAL/INVERTEBRATE ORGANISM(S) For the following questions, consider the effect of the recombinant DNA modification(s) on the target organism(s) either through direct introduction or in the context of a recombinant DNA-containing pathogen. Y N Modifications include the introduction of recombinant DNA with the intent of reducing a specific biological activity within the target organism. Y N Are any of the targeted biological activities known or suspected components of the target organism's immune system? Could the loss any of the proposed biological activities lead to the production of undesirable traits in the target organism? For each Yes, briefly describe all biological activities whose reduction or loss may lead to immunosuppression, increased transmission of pathogens, or the development of any undesirable traits: Y N Modifications include the introduction of recombinant DNA with the intent of adding a specific biological activity to the target organism. The specific biological activities to be added to or augmented in the target organism are known or suspected to be: Y N Immunomodulatory Pathogen Receptor or other Critical Host Factor Drug/Antibiotic Resistance Recombinant DNA in Plants 5 of 6 Rev. 8/1/14 IBC # 00-000 Could the addition of the biological activity lead to the production of undesirable traits in the target organism? For each Yes, briefly describe all biological activities to be added / augmented: Y N Is there an intentional release of the target animal organism(s) (either recombinant DNA-modified, or those introduced to recombinant pathogens) into the environment planned for this program? If yes, briefly describe how these experiments will be conducted; and describe the anticipated effect on human or animal health, as well as the environment: *Note: The process and act of releasing genetically-modified non-human vertebrates or invertebrates into the environment may be regulated by USDA-APHIS and/or the FDA. If you have answered "Yes" to this question, your application will not be considered complete unless this application is accompanied by the appropriate permit application and a copy of the approved permit. See http://www.aphis.usda.gov/biotechnology/index.shtml for more information. Recombinant DNA in Plants 6 of 6 Rev. 8/1/14