St Vincent’s Hospital (Melbourne)
ANIMAL ETHICS COMMITTEE (AEC)
APPLICATION TO GENERATE AND BREED
A NEW MOUSE LINE (GBNML)
NOTES:
1. Please ensure this form is completed using lay language
2. Please complete all relevant sections, incomplete forms will be returned to the researcher
3. Use AEC approved Standard Operating Procedures (SOPs) where possible. Relevant SOPs include:
SOP.8 Murine Health Monitoring Policy
SOP.6 Generation of transgenic mice
SOP.10 Collection of tissues for DNA analysis
Part A - Applicant Details
1. Principal Researcher
Title and Name:
Department:
Institution:
Mailing address:
Qualifications:
Summary of relevant
experience:
Phone:
Fax:
Mobile/pager:
Email:
2. Associate Researcher
Title and Name:
Appointment:
Department:
Institution:
Mailing address:
Phone:
Fax:
Mobile/pager:
E-mail:
3. Animal Technicians
Animal Tech 1
Name:
Department:
Location:
Animal Tech 2
Name:
Department:
Location:
4. Please state the breeding room in which the line will be bred / housed
GBNML – Application to Generate and Breed a New Mouse Line
Version 6, February 2012
Part B – Project Details
1. Please list all scientific terms and provide a lay explanation
Scientific Term
Lay Explanation
2. Please list the aims of the breeding project
3. Please justify the creation of a new line by providing a brief explanation of
the new line including information on the background of the strain and the
relevance of the new line to your current research (include references where
possible)
4. Please confirm how the new line will be created:
Crossing breeding two existing strains
DNA Technique
Embryonic Stem Cell Technique
Other (please state): __________________________________________________
5. Please state the name of the new strain (e.g. H-2Kb/hTFPI)
6. Please state the full Mutation Name (Use correct nomenclature)
*For assistance, please see www.jax.org, Transgenic Res 6(5): 309-19 1997, or Genomics 45(2): 471-6 (1997) (e.g. B6TgN(HUTFPI-MUSMH2KB)XXXdAp)
GBNML – Application to Generate and Breed a New Mouse Line
Version 6, February 2012
7. Please describe the anticipated phenotype of the new line, including what
organs or tissues will be affected. Please state any expected or anticipated
abnormalities or effects on health, welfare, breeding or lifespan
NOTE: If the clinical status deviates from the predications made in this application, the AEC must be notified
immediately.
8. Please describe any special husbandry or animal care requirements
9. Please provide the Institutional Biosafety Committee (IBC) reference
number
IBC Reference Number:
10. Please state the St Vincent’s Hospital Animal Ethics Reference Number for
the approved project within which this new proposed line will be used
AEC Reference Number:
11. Please state the number of mice required for use in the above approved
project
12. Please estimate the total number of mice that must be produced from this
new line, to achieve the above requirement
13. Please describe the fate of the animals that do not have the appropriate
genotype
14. Please provide the details of the person who will be responsible for
monitoring the health of the line, by completing the “Monitoring Sheets for
GM” mice at:
a) First box change at 5-7 days (litter and mother assessment)
Name:
Qualifications:
Position:
b) Weaning (litter and mother assessment)
Name:
Qualifications:
Position:
c) Post-weaning to 24 weeks (individual animal assessment)
Name:
Qualifications:
Position:
GBNML – Application to Generate and Breed a New Mouse Line
Version 6, February 2012
15. Please explain how the wellbeing of the animals will be monitored (include
what signs will be looked for and how frequently)?
16. If tissue is to be collected for genotyping, please state how tissues will be
collected for screening
Biopsy
Tail
Blood
Heparin Blood
Other: _________________
17. Please describe the locus of the modified gene/s for genotyping purposes
(include all mutations as loci 1, loci 2, loci 3 etc)
Locus Number
Mutation Type
Gene Name
Chromosome
18. Please state the original background strain (e.g. C57Bl/6)
Part C- Generating a new strain by crossing two existing strains
Only complete this section if applicable. If not applicable, progress to Part D.
1. Please detail the two exiting strains which will be crossed
Please ensure a copy of a recent serology report is attached
Strain 1
Name of Strain:
Source of Strain:
(SVHM / Other)
Phenotype status
(please select)
Strain 2
Name of Strain:
Source of Strain:
(SVHM / Other)
Phenotype status
(please select)
Established
Partially characterised
Unknown
Established
Partially characterised
Unknown
Part D - Creating a new strain using DNA or Embryonic Stem Cell
techniques
Only complete this section if applicable. If not applicable, progress to Part E.
Knock Out Information
Blastocyst injection: Yes
No
Name of embryonic stem cell line used:
Literature reference:
Transgenic Information
DNA injection: Yes
No
Strain background of the fertilized egg:
Literature reference:
GBNML – Application to Generate and Breed a New Mouse Line
Version 6, February 2012
1. Please describe the technique by which the new strain will be created:
Part E - Declaration
1. Declaration by Facility Manager:
I hereby confirm we can facilitate the above application to Generate and Breed a
New Mouse Line and adequate housing is available for the proposed number of
animals.
Name:
Position:
Signature:
Date:
2. Declaration by Principal Investigator:
As the Principal Investigator, I hereby confirm that the information provided in this
form is true and correct and that all work will be carried out and managed as per the
Australian Code of Practice for the Care and Use of Animals for Scientific Purposes
(2004).
Name:
Position:
Signature:
Date:
Please note that the approximate number of animals bred must be reported to the
Bureau of Animal Welfare on an annual basis. Therefore, please ensure you keep
accurate records of animal numbers.
GBNML – Application to Generate and Breed a New Mouse Line
Version 6, February 2012