Use of Human or Rodent Cells or Tissues in Animals
This form may be submitted in support of a protocol application or separately, as an addendum. If this is an addendum,
please also provide a cover letter that includes the following: PI Name/Department; Protocol Number/Title; Contact
Person/Contact Details; and PI Signature (required).
Pathogen Testing: PCR or MAP testing must be arranged and paid by the Principal Investigator at an independent
laboratory. Boston College does not provide this testing.
Objectives: Explain the objectives of the research using human or rodent cells or tissues in animals:
Animal Species to
Receive Cells:
Use of RODENT
Cells or Tissues:
Animal species receiving cells (indicate strain and/or genetic modification) and quantities per year:
TYPE OF SAMPLE
SOURCE OF SAMPLE
(Institution & Tissue Type)
UNIQUE IDENTIFIER*
DATE OF LAST RODENT
PATHOGEN TEST
Rodent cell line(s)
Rodent fresh cells or
tissues
Not necessary if harvested
within same BC
colony and used for a single
passage in rodents.
Not Necessary
* A unique identifier should codify the source and a specific identification number (such as “HMS1259” or “ATCC1234”) to
enable tracking of rodent pathogen testing results.
Rodent cell lines that are being brought in from a different BC colony or from an outside source, or that have been reharvested from rodents for more than five years at BC, require periodic pathogen testing.
Use of HUMAN
Cells or Tissues:
TYPE OF SAMPLE
Human fresh cells or
tissue
SOURCE OF SAMPLE
(Institution & Tissue Type)
UNIQUE IDENTIFIER*
DATE OF LAST RODENT
PATHOGEN TEST
(Not necessary)
(Not necessary)
Human cell line(s)
* A unique identifier should codify the source and a specific identification number (such as “HMS1259” or “ATCC1234”) to
enable tracking of rodent pathogen testing results.
Human cell lines previously passaged in rodents should be periodically screened for murine pathogens. If obtained from a
non-commercial source, testing is required.
Labs must register with the BC Institutional Biosafety Committee (IBC: http://www.bc.edu/offices/facilities/ehs/labs.html)
and notify the BC IACUC of biosafety protocol approval.
BC IRB (Institutional Review Board: http://www.bc.edu/research/oric/human.html) approval is required unless human
samples meet the following criteria:


They were NOT collected specifically for this research.
Researcher is NOT able to obtain the identity of the human donor (excepting common commercial knowledge, as
with HeLa cells).
BC IRB approval is required BEFORE obtaining or using human embryos or oocytes for deriving new cell lines.
List BC IRB Protocol Number here, or indicate why BC IRB approval is not required:
If obtaining human stem cell (hES) lines that have not been federally approved, provide a letter from the source that
confirms the consent, donation, and cell line establishment process was approved by the source’s IRB (the IRB assurance
number should be provided, and that state registration was obtained (if a requirement in the state of origin).
Rev. 3/15/11
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Boston College Institutional Animal Care and Use Committee