Institutional Animal Care and

Use Committee IACUC

An-Najah National University

For Committee use

Protocol number Year/ month/serial number per year

Received on (dd/mm/yy)

Statistical Reviewer Name

Safety Reviewer Name

Veterinarian Name

Approved on (dd/mm/yy)

Request modification on (dd/mm/yy)

Resubmitted on (dd/mm/yy)

Disapproved on (dd/mm/yy)

Filled by the applicant

)Principal investigator or principal supervisor for student projects(

Protocol Title
(List the animal
in the title)
Principal investigators
Details )Should be a university member (
Other investigators
Name Dr. Hiba Natsheh
Mustafa idais
Dr. Naim Kittana
e-mail Hiba.natsheh@najah.edu Mustafa-
naim.kittana@najah.edu id@outlook.com
Mobile 0505418904
0569076468
number 0599840556
Animals
BALB/C mice Rabbit Hamster Rat White mice
Requested
Female Male Female Male Female Male Female Male Female Male
Age in days 8-9
weeks
Number 15
Total number 15
Indicate details .If female mice are not available, males can be used as well

Animal Use Starting date should be equal to the Date of request plus (age of animals + 20 days)
Starting Date 15.12.2023

Animal Use 30.12.2023

Ending Date
Faculty Faculty of
Medicine and
Health Sciences
Department Pharmacy
department
Status Researchers
(Researcher or
student)
(if student
determine the
study level)
Background on the research We have designed and characterized a novel formulation
proposal which is composed of polylysine blended with chitosan as a
words List at least 3 important 200( form of gel,studies on polylysine in the field of skin
)references regeneration and wound healing which is a polycationic
polymer have shown its ability to enhance cell adhesion
through the interaction with the negatively charged cell
components which is important for cell migration,
proliferation, and protein production, this is crucial for
diabetic wound
Justification for the research and
animal type use

Specific aims and objectives for

the research
Experimental design-Materials
and Methods List in steps
(what will be done, time, tools,
treatment applied, Animal Care
Consideration, Veterinary Care
Provision, Animal welfare (Rs3)
If surgery: Blood or body fluid
withdrawal/tissue,
collection/injections…etc.
Restraint with mechanical devices
If dietary/ water/ fluid manipulation)
Euthanasia / Disposition of Yes□ No□
Animals
If yes
□ Cervical dislocation
□ Ketamine injections
□ Cardio blood withdrawal
If no:
What will be done with the animal? (Write about status of the animal and
disposal at the end of research)

Biohazard/ Safety to Protect □Yes □No

Investigators
If yes please indicate

Study end points The study will be stopped if any abnormal clinical signs are observed.
(When the research will be stopped, This includes injury, strange movements, or voices.
specify)

Further Notes

I approve reading the Guideline □Yes □No

of Animal Use in Teaching and
Research (‫دليل أخالقيات رعاية واستخدام‬
‫حيوانات التجارب في التعليم والبحث العلمي‬
‫ )في جامعة النجاح الوطنية‬prior to the
application