PGTC TOXICOLOGY CORE -
Research Request Form
(Complete form and submit. Send form attachments in
separate email to conlon@gtc.ufl.edu)
The center will contact you for follow up and pricing. |
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| 1) Principal
Investigator |
First:
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Last:
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| 2) Researcher: |
First: |
Last: |
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3)
Institution: |
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College: |
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Department: |
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6)
Study title: |
7)
Source of funding: |
8) Study ID # |
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9)
Primary contact
(where data is sent): |
First:
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Last:
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Address: |
Phone:
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Email: |
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10)
Test Article:
Name, Lot # or #’s if known, source
(who made it) |
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11)
Promoter in construct
(will be contacted if promoter not in our catalog): |
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Projected tissue/DNA availability dates
(if known): |
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13)
List of subject species, IDs, doses
(attached as MS Excel file): |
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ASSAYS |
14)
List organs to be tested for viral genomes
(quick
frozen in liquid nitrogen): |
15)
Blood PCRs
(frozen in EDTA blood collection tubes).
If so, what time points: |
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Note:
The Principal Investigator or Primary Contact MUST provide an
annotated Genbank sequence of their vector for primer design (filename.gb.
If intellectual property is a factor, contact the Toxicology Core to
discuss the minimal sequence to submit. In addition, an
aliquot of plasmid DNA used in vector preparation may be requested
and provided by the investigator for use in the standard. |
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16)
Serum chemistries and time points(
Standard panel includes: AST, ALP, ALT, CK, BUN, CREAT):
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17) CBC tests (typical panel includes WBC, NE, LY, MO, EO,
BA, RBC Hb, HCT, MCV, MCH, MCHC, RDW, PLT, MPV) and time points.
Note: CBCs must be run within 5 hours of collection: Requests
must be made 10 working days prior to sample receipt. |
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18)
Transgene expression and antibodies.
Currently available:
alpha-1 antitrypsin (AAT) ELISA, anti-AAV2 and AAV1 antibodies).
Contact the Toxicology Core if additional assays desired.
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