IBC Transgenics Registration Form

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SEATTLE CHILDREN’S RESEARCH INSTITUTE
ETIOLOGICAL MEMORANDUM OF UNDERSTANDING AND AGREEMENT (EMUA)
APPENDIX D
TRANSGENIC ANIMALS
PLEASE TYPE. Return to ibc2@seattlechilrens.org or CW8-5A (attn: Jean Troxel, IBC Administrator) when
completed. If you have any questions, please email ibc2@seattlechildrens.org or call (206) 884-4894.
DATE SUBMITTED:
EMUA #:
______________________________________________________________________
1) TITLE OF THE GRANT(S) / PROJECT(S) INVOLVING THE TRANSGENICS
______________________________________________________________________
2) PRINCIPAL INVESTIGATOR
NAME OF PL:
OFFICE ROOM NUMBER:
OFFICE PHONE NUMBER:
Purpose of project:
Animal type:
Housing building & room #s:
IACUC approval #:
Use of Purchased transgenic rodents or use of transgenic rodents made/obtained elsewhere if used at
BL1 containment does not require registration. Creation of new transgenic lines through breeding, in
producing a new strain, will require registration with the IBC (e.g., Cre mice obtained from Jackson
Laboratories crossed to a floxed mice from Researcher Y will result in a new line aka Cre-floxed). For
more information, see NIH OBA FAQs on transgenic animals and the use of recombinant DNA.
Making your transgenics:
A) What method will be used to make the transgenics?
Microinjection of gene construct into pronuclear fertilized oocytes
Insertion of gene construct into embryonic stem cells that are microinjected into oocytes
B) We will make our transgenic animals within our own research group
What method will be used to make the transgenics?
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Microinjection of gene construct into pronuclear fertilized oocytes
Insertion of gene construct into embryonic stem cells that are microinjected into oocytes
Vector-mediated transfer of construct to embryonic stem cells for microinjection into oocytes
What vector?
What titer (particles/ml) of vector used?
Other method (explain)
C) We will construct transgenic animals but none of the above categories are applicable
Explain
About your transgenics:
Knock-outs
Yes
No
Name(s) of KO gene
Function(s) of KO’d gene(s)
“Knock-ins” (gene inserted)
Yes
No
Gene name(s)
Gene(s) function(s)
Gene(s) source(s) (i.e. human, mouse, etc)
Is/are the gene(s) an oncogene?
Yes
Does/do the gene(s) encode a toxin?
No
Yes
No
Does/do the gene(s) encode any other hazardous agent?
Yes (What ?
)
No
Tell us about the gene construct(s):
In what building & room #s will the rDNA/gene construct(s) be made?
Vector(s) used to create gene construct(s)
Cell type(s) used to create and/or package gene construct(s)
Discuss the safety precautions that will be used when handling the vector(s), cells, and constructs:
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What hazards exist in terms of an accidental injection of the construct(s)to one of your staff members?
Discuss both vector and gene hazards.
Please attach a map of the construct(s) showing (as applicable) promoter, enhancer, gene to be
expressed, splice donor and acceptor, intron sequences, and termination/polyadenylation sequences.
The undersigned individual(s) will be involved in the experimentation described above. They are familiar
with and agree to abide by the current NIH Guidelines.
Name (Please Type or Print)
Signatures
Date
I attest to the fact that these individuals are properly trained in the area of recombinant DNA
experimentation. Furthermore, I agree to comply with the NIH requirements pertaining to shipment
and transfer of recombinant DNA materials. I am familiar with and agree to abide by the provisions of
the current NIH Guidelines and other specific NIH instructions pertaining to the proposed project. The
information above is accurate and complete.
Principal Investigator
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Date
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