STV Animal Ethics Committee (AEC)
Application to Generate and Breed a New Mouse Line
(GBNML)
Office use only:
Date received
Office use only:
GBNML number:
Tierbase number:
NOTES:
1. This form is to be used for approval to either generate or breed a new genetically
modified strain of mice.
2. This form can be submitted only when it is either accompanied by a new protocol
application or when an approved protocol exists
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
4. An original, plus 18 double-sided copies of this form, should be submitted to the AEC
Administrative Officer by the relevant AEC deadline day.
Please note:
If you are creating a new line of GM mice by crossing two lines, please complete the
following parts:
- Part A
- Part B
- Part C
If you are creating a new line of GM mice by DNA or ES cell line techniques or
importing a new GM line from an external source, please complete the following
parts:
- Part A
- Part C
GBNML – Application to Generate and Breed a New Mouse Line
Dated: June 2010
Part A – Project Details
1.1
Strain nomenclature and People Responsible
GBNML strain name (e.g. H-2Kb/hTFPI)
Mutation Name Use correct nomenclature (see www.jax.org, Transgenic Res 6(5):
309-19 1997, or Genomics 45(2): 471-6 (1997) (eg B6-TgN(HUTFPIMUSMH2KB)XXXdAp)
1.2
Principal Researcher
Title and Name
Appointment
Department
Institution
Mailing address
Include a brief
summary of relevant
experience for this
project
Phone
Fax
Mobile/pager
email
1.3
Additional contact person
Title and Name
Appointment
Department
Institution
Mailing address
Phone
Fax
Mobile/pager
email
Animal Tech 1:
Animal Tech 2:
1.4
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 to the back of
this form.
Please note: You may not produce a new line of GM mice without IBC approval. This application will not
be approved until IBC approval has been granted.
GBNML – Application to Generate and Breed a New Mouse Line
Dated: June 2010
1.5
BIOLOGICAL CHARACTERISTICS OF THE FOUNDERS
Are the biological characteristics:
Well characterised?
Partially characterised?
Unknown?
1.6
Yes
Yes
Yes
No
No
No
GENETIC ALTERATION ANTICIPATED IN THE NEW HYBRID
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 AEC must be notified immediately.
1.7
HUSBANDRY & CARE
Describe any special husbandry or animal care requirements:
1.8
NUMBERS REQUESTED
SVH AEC No:
Number of mice of required genotype needed for AEC protocol:
Estimated total number of mice to be generated to produce the above:
1.9
HEALTH MONITORING
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):
Part B- Generating a new strain by crossing two strains
Strain name 1
Source of strain 1:
Complete Part C
X
Strain name 2
Source of strain 2:
Part C- Creating a new strain using DNA or ES cell techniques or importing a
new GM line from external source.
Made in house? (in the case of 2 loci, give info. for 1st locus)
Yes
No
Constructor/Owner:
Institute name (internal/external):
Date of construction or arrival at the institute:
Attach recent serology report for imported GM line:
GBNML – Application to Generate and Breed a New Mouse Line
Dated: June 2010
Knock Out Information
Blastocyst injection: Yes
Name of ES line used:
Literature reference:
No
Transgenic Information
DNA injection: Yes
No
Strain background of the fertilized egg:
Literature reference:
Characteristics of the Strain
Genetic background:
Construct description:
Comments:
Phenotype:
Breeding at the Facility
Phenotype visible: Yes
No
Tissue sample for screening: Ear Biopsy
Blood
Heparin Blood
Other
Genotyping method (Use approved SOPs where possible)
Breed room:
Cryoconservation:
Restrictions on use of strain:
Tail
Animal details
Modified Gene Locus (include all mutations as loci 1,2,3 etc)
Locus Number
Mutation Type
Gene Name
Chromosome
Background strain (e.g. C57Bl/6):
I allow / do not allow strain information to be uploaded to the APN database;
Name: ________________________
Signed:_______________________
Date:
/
/
If you do not allow upload please justify:
GBNML – Application to Generate and Breed a New Mouse Line
Dated: June 2010