call 2013: mouse models and rare diseases

application form

Submission deadline for proposals: February 28, 2013, midnight

This file must be sent:

by email to:

by post mail, two signed versions of the document (corresponding to the document sent by e-mail) to:

Fondation maladies rares

Appel à projets ‘Modèles murins et maladies rares’

Plateforme Maladies Rares

96 rue Didot

75014 Paris

Instructions for sending documents:

- The application must be written in English.

- Annexes should be included in the research project and not on separate documents.

- The Word file must not exceed 2 Mo (compress any figures).

- Document title: Name of applicant-mousemodel-RD

- Do not send pdf documents, or scanned documents.

1. Identification of the project

Project title (in lowercase letters):

Research area:

- main:
- secondary:

Keywords (maximum 4):

Targeted gene:

Request (tick the appropriate boxes):

Targeted mutagenesis

Conditional KO (cKO)

Please indicate the MGI ID number of the mouse gene ( :……………

Knock-Out (KO) (total deletion of the gene)

Please indicate the KOMP clone reference number: …………………………………

Knock-In (KI)

Genetic background : o 129 Sv/Pas o C57BL/6N o BALB/cN

Point Mutation (PM) :

Please indicate the MGI ID number of the mouse gene ( : ……………

Point mutation to generate:

  • mRNA reference sequence: …………………………………
  • mutation: …………………………………
  • position of the mutation in the reference sequence: …………………………………

Humanization

  • Please indicate the MGI ID number of the mouse gene ( to target: …………………………………
  • Reference sequence of the human cDNA: …………………………………

Reporter gene

  • Please indicate the MGI ID number of the mouse gene ( to target: …………………………………
  • Transgene reporter requested: …………………………………

Targeted transgenesis (ROSA26)

  • Promoter to be used: …………………………………
  • Transgene reporter requested: …………………………………
  • Sequence of the transgene: …………………………………

Random transgenesis (pronuclear injection)

BAC plasmid

  • Promoter to be used: …………………………………
  • Transgene reporter requested: …………………………………
  • Sequence of the transgene: …………………………………

Phenotying following the IMPC standard (see attached diagram)

Principal investigator of the project (from a French team):

Name
First name
Position
Institution / department
Laboratory name
Identification of the laboratory
Name of the team (if relevant)
Name, first name of the lab. director
Full postal address
Email address
Phone number
Fax

Partners involved in the project:

Name, first name / Title / Laboratory / Team / Role and contribution
1
2
3
4

Number of person-months involved in the project:

Administrative description (necessary in case of funding of the project):

Legal entity signing the financial agreement
Name of the main institution and its affiliation
Name of the administration
Juridical status (EPST, EPA, …)
Regional delegated administration / presidency of university / direction of hospital
Name, first name of the legal representative
Title of the legal representative
SIRET number
Address
City
Zip code
Phone number
Fax
Signature of the principal investigator
I, the undersigned, Name and first name, agree to be the principal investigator of the submitted project, as it is described in the present application.
Electronic signature* : Date/Place

* The electronic signature is a scanned signature as a jpeg image.

Signature of the laboratory director
I, the undersigned, Name and first name, director of the laboratory Name of the laboratory
authorize, Name and first name of the principal investigator of the project
to develop this project and agree to allow such realisation in my laboratory.
Electronic signature* : Date/Place

* The electronic signature is a scan of the signature as a jpeg image.

2. description of the project

Abstract (maximum one page): context of the proposal, objectives, rationale of the mouse model, outcomes and impacts, relevance of the project in relation to the state of knowledge, existence of an in vitro proof-of-concept…).

The application, written in a maximum of 5 pages, must clearly describe:

  • The state of knowledge on the pathology
  • The objectives of the project
  • The rationale for the creation of a mouse model
  • The rationale for the mouse model used
  • The rationale for global phenotyping (if requested)
  • The project position in the research program of the applicant
  • Animal facilities (in house, on site)
  • Ethical rules (Animal Ethics Committee)
  • Experience of the team in models exploration
  • Expected results and impacts

Include the list of references used in this document (maximum 10) and a list of the main publications of the applicant during the last five years (maximum 10).

Please specify reviewers names to be excluded (conflict of interest, former or current collaborations):

Appendix

IMPReSS standard phenotyping scheme

‘Mouse models and rare diseases’- Application form

Call 2013 - Fondation maladies rares - Phenomin

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