Last updated 12/1/2013 (rev 12/1/2014)

Section 1: General Information

Protocol Information

IACUC Protocol Title:
IACUC Protocol Number:

Directions:

§  Important: Save this form to your computer’s hard drive before completing it, or your responses may not be captured!

§  This form must be completed and submitted (as a Word document) electronically. Retain a copy of your completed form for your records.

§  Please respond to all applicable questions. Type responses in the designated shaded boxes or check the designated check boxes.

§  For questions, contact the IACUC Administrative Office at or 540/231-0931.

Section 2: General Information

1.  In what species of animal will the tumor be placed or studied?

2.  Indicate how the tumors will be produced.

Implanted tumor. Complete section 3, and then go to section 5.
Chemically-induced tumors. Complete section 4, and then go to section 5.
Spontaneous naturally-occurring tumor. Go to section 5.
Section 3: Implanted Tumors

Complete this section if your protocol involves tumors that will be implanted in animals.

1.  Please identify the species in which the tumor cells originated.

Rodent. Respond to question 2, and then go to question 5.
Human. Respond to question 3, and then go to question 5.
Other (list below). Respond to question 4, and then go to question 5.

2.  Indicate if the cells line(s) that will be used have been tested for mouse viral agents.

The cell lines have been tested for mouse viral agents. Respond to a, b, and c, below, and then go to question 5.
The cell lines have not been tested for rodent viral agents. Go to question 5.

a.  Indicate who conducted the viral testing.

b.  What was the date of the viral testing?

c.  What were the results of the murine viral antigen testing?

3.  Indicate if the cells line(s) that will be used have been tested for human pathogens (e.g., HIV, hepatitis).

The cell lines have been tested for human pathogens. Respond to a, b, and c, below, and then go to question 5.
The cell lines have not been tested for human pathogens. Go to question 5.

a.  Indicate who conducted the viral testing.

b.  What was the date of the viral testing?

c.  What were the results of the pathogen testing?

4.  Describe any potential zoonotic pathogens that could be present in the cells that will be used, and if appropriate testing has been conducted to determine if these pathogens are present.

5.  Identify the source of the tumor cells.

Tumor cells maintained by the PI.
Tumor cells obtained from a commercial repository.
Tumor cells obtained from another public or private institution.

6.  What type of cells will be used?

7.  Provide the number of cells or size of tissue to be implanted.

8.  What will be the site of implantation or injection?

Section 4: Chemically-Induced Tumors

Complete this section if your protocol involves tumors that will be chemically induced in animals.

1.  Please identify the promoter and carcinogen used.

Section 5: Animal Monitoring

1.  How frequently will the animals be weighed after tumor development is observed?

2.  How frequently will the animals be observed to assess tumor size and animal well-being?

Section 6: Compliance with Virginia Tech Tumor Policy

All studies involving tumor production in rodents must comply with the Virginia Tech IACUC Policy on Experimental Tumor Production and Treatment in Rodents, unless scientifically justified. PIs conducting tumor studies in other species are encouraged to review this policy, as well.

1.  Please indicate if this study will involve any deviations from the Virginia Tech IACUC Policy on Experimental Tumor Production and Treatment in Rodents.

This course will comply with all aspects of the tumor policy. You have completed this appendix.
This course will involve deviations from the tumor policy. Go to question 2.

2.  Please describe any deviations from the tumor policy (e.g., tumor growth beyond maximum allowable), and provide a scientific justification for the deviation(s).

Last Updated: 12/1/2013 (rev 12/1/2014) E-1