This form is to be used for approval to either generate or breed a new genetically modified strain of mice, including those from an outside source. This form can be submitted only when it is either accompanied by a new protocol application or when an approved protocol exists.
PRINCIPAL
INVESTIGATOR:
PROJECT NO:
PROJECT TITLE:
PHONE:
1. BIOSAFETY COMMITTEE:
The generation and breeding of genetically modified mice including transgenic and knockout mice requires approval from the Institutional Biosafety Committee (IBC).
State the IBC No.: and attach a copy of the IBC approval letter.
2. TECHNIQUES:
If techniques requiring surgical manipulation of the mice are required, name the person/s performing the techniques:
If unknown to the AREC, provide a statement of experience with those technique/s.
3. ANIMAL DETAILS:
Background strain (eg: C57Bl/6):
Genetic Modification (ie: if transgenic – promoter and transgene; if knockout – gene deleted):
New Strain:
Source of Mice:
YES NO
4. MUTATION NAME:
What will the mouse be called?
(Use correct nomenclature (see www.jax.org
), Transgenic Res 6(5): 309-19 1997, or Genomics 45(2): 471-
6 (1997) (eg: B6-TgN(HUTFPI-MUSMH2KB)XXXdAp) and attach references detailing genotype of mice.
5. BIOLOGICAL CHARACTERISTICS:
Are the biological characteristics:
Well characterised? YES NO
Partially characterised? YES NO
Unknown? YES NO
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6. GENETIC ALTERATION:
What organs or tissues are affected?
What abnormalities are expected?
What are the effects on health, welfare, breeding or lifespan?
NOTE: If the clinical status deviates from the predications made in this application, the AREC must be notified immediately.
7. HUSBANDRY & CARE:
Describe any special husbandry or animal care requirements:
8. METHODS:
Describe the methods that will be used in the generation of these mice:
9. GENOTYPING:
Describe the method of genotyping:
(Use approved SOP’s where possible.)
10. NUMBERS REQUESTED:
Number of mice of required genotype needed for AEC protocol:
Estimated total number of mice to be generated to produce the above:
11. HEALTH MONITORING: (for strains with unknown phenotype only)
Name the person(s) who will be responsible for completing the “Monitoring Sheets for GM mice” at:
- first box change at 5-7 days (litter and mother assessment):
- weaning (litter and mother assessment):
- post-weaning to 24 weeks (individual animal assessment):
Principal Investigator ’s Signature: Date:
___________________________________________________________________________
ANIMAL RESEARCH & ETHICS COMMITTEE OFFICE USE ONLY
Breeding approval granted: YES

NO

Comments:
AREC Chairman: _____________________________________ Date: ____________________.
PERSONNEL NOTIFICATION:
Head of Department (Uni of Melb) Principal Investigator Biological Research Centre
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