We developed a protocol to assess well-being in mice during procedures using general anesthesia. A series of behavioral parameters indicating levels of well-being as well as glucocorticoid metabolites were analyzed. The protocol can serve as a general aid to estimate the degree of severity in a scientific, animal-centered manner.
In keeping with the 3R Principle (Replacement, Reduction, Refinement) developed by Russel and Burch, scientific research should use alternatives to animal experimentation whenever possible. When there is no alternative to animal experimentation, the total number of laboratory animals used should be the minimum needed to obtain valuable data. Moreover, appropriate refinement measures should be applied to minimize pain, suffering, and distress accompanying the experimental procedure. The categories used to classify the degree of pain, suffering, and distress are non-recovery, mild, moderate, or severe (EU Directive 2010/63). To determine which categories apply in individual cases, it is crucial to use scientifically sound tools.
The well-being-assessment protocol presented here is designed for procedures during which general anesthesia is used. The protocol focuses on home cage activity, the Mouse Grimace Scale, and luxury behaviors such as burrowing and nest building behavior as indicators of well-being. It also uses the free exploratory paradigm for trait anxiety-related behavior. Fecal corticosterone metabolites as indicators of acute stress are measured over the 24-h post-anesthetic period.
The protocol provides scientifically solid information on the well-being of mice following general anesthesia. Due to its simplicity, the protocol can easily be adapted and integrated in a planned study. Although it does not provide a scale to classify distress in categories according to the EU Directive 2010/63, it can help researchers estimate the degree of severity of a procedure using scientifically sound data. It provides a way to improve the assessment of well-being in a scientific, animal-centered manner.
EU Directive 2010/631 stipulates that the 3R Principle (Replacement, Reduction, Refinement) developed by Russel and Burch2 is to be applied whenever animal experimentation is necessary. The ultimate goal of the EU Directive is to phase out all animal testing, but the Directive acknowledges that, for the time being, some animal experiments are still needed to conduct research that will protect human and animal health. Thus, if an animal experiment cannot be replaced by any alternative method, only the minimum number of laboratory animals is to be used to obtain reliable results. In addition, the amount of pain, suffering, and distress accompanying experimental procedures should be minimized using appropriate refinement measures. EU Directive 2010/63 stipulates that the severity of a procedure must be prospectively classified as non-recovery, mild, moderate, or severe1. As severity classification is decided on a case-by-case basis, it is important to have scientifically sound tools to estimate the severity of a given procedure.
Score sheets as proposed by Morton and Griffith3 are an essential tool in detecting any deviations from normal status, including negative effects on well-being4. Score sheets are used to retrospectively determine pain, suffering, and distress caused by an experiment and focus on visible changes in the physical state of the individual animal (e.g., body weight, fur, gait). Although, Annex VIII of EU Directive 2010/63 provides examples of each severity category, researchers still lack tools to estimate the degree of severity of a given procedure using scientifically based data.
The absence of indicators showing negative well-being is not the only way to determine the state of the animal; the presence of indicators pointing to positive well-being is also important5,6,7,8. For example, animals display luxury behaviors like burrowing and nest building behavior only when all their essential needs are met. If well-being is reduced, luxury behaviors are the first to decline5,7. Protocols to be used in assessing well-being should include indicators pointing to the physical, physiological/biochemical, and psychological states of animals in order to evaluate their well-being in a detailed and comprehensive manner9.
Within the context of refinement, a protocol was developed to meet these requirements and to assess the effects of a procedure involving general anesthesia on well-being of mice10. At the same time, the goal was to minimize any additional stress to enable the easy integration of the protocol into a given experiment. The protocol considers burrowing behavior, home cage behavior such as activity, food intake, and nesting, and trait anxiety-related behavior. In addition, it includes the Mouse Grimace Scale (MGS), and the non-invasive analysis of corticosterone metabolites in feces. The protocol is designed to facilitate the assessment of well-being in a scientific and animal-centered manner and to provide information on well-being that supports the classification of the degree of severity. In addition to score sheets, it can provide useful information for the severity classification of a procedure. As the protocol is easy to carry out and does not require extensive equipment, it can be integrated into an ongoing experiment without influencing the results of a study. It should be noted that the Animal Research: Reporting of In Vivo Experiments (ARRIVE) guideline11 is to be observed in all studies involving animal experiments, with the goal of improving design, analysis, and reporting.
The study was performed according to the guidelines laid down by the German Animal Welfare Act and was approved by the Berlin State Authority ("Landesamt für Gesundheit und Soziales", permit number: G0053/15).
NOTE: The main objective of this protocol was to investigate the effect of repeated anesthesia on glucocorticoid metabolites. A sample size calculation was performed to determine the number of animals to be used: n ≥ 2 × (s/µ1– µ2)2 × (zα + zβ)2. µ1– µ2 is the difference between population means at which power and sample size calculations are made (α = 5%, β = 80%); zα = 1.96 and zβ = 0.84 are the quantiles of the standard normal distribution. Figure 1 illustrates the time line of this protocol. If a parameter of the protocol shows a difference with the control level, the animal should be closely monitored, and the parameter should be measured again after a suitable period. For example, if trait anxiety-related behavior is increased, this behavior should be tested again a week later, in order to help determine the period until full recovery. Time points and periods defined in this protocol can be adapted for use with other procedures. When changing time points, habituation periods should be kept as described in the protocol. In order to reduce factors that might influence the mice's behavior, tests requiring more manipulation should be conducted after tests that do not disturb the normal behavior of mice. Figure 2 summarizes all tests of the protocol using a summary scoring sheet. Figure 3 provides simplified scales of the grade of well-being, which give an overview of how to interpret the test results.
1. Habituating mice to handling by experimenter
2. Preparing the behavioral testing room and apparatuses
NOTE: Provide a separate room for testing, ideally near the room where the animals are kept. Transport the mice in their home cages to the testing room at least 60 min before the procedure is conducted. If possible, conduct all tests of this protocol in the same testing room where the procedure is carried out.
3. Mouse Grimace Scale
NOTE: Photographs for the MGS are taken in the observation cage at three time points: (i) 2 days prior to the procedure to record baseline MGS levels, (ii) 30 min after the procedure, and (iii) 150 min after the procedure. When well-being is impaired, scores on the MGS increase. If increased MGS scores are still observed after 150 min, take additional photographs at a later stage.
4. Burrowing behavior8,15,16
5. 24-h observation period
NOTE: Mice are housed individually, as described in 2.2. (Figure 5), for a period of 24 h, in order to measure food intake, home cage activity, nest building behavior, and FCM levels. The 24-h observation takes place twice: (i) 2 days prior to the procedure for baseline levels, (ii) on the day of the procedure.
6. Free exploratory paradigm
This protocol was originally developed to assess well-being of C57BL/6JRj mice following a single experience of isoflurane anesthesia (one 45-min anesthesia session, n = 13 females) or repeated isoflurane anesthesia (six 45-min anesthesia sessions with 3 – 4 days between the anesthesia sessions, n = 13 females) compared with the well-being of control mice (n = 6 females)10, which received no anesthesia but were tested according to the same measures. We assessed the impact of a single experience of isoflurane anesthesia and repeated isoflurane anesthesia on the well-being of C57BL/6JRj mice compared with untreated control mice. Here, representative results of female C57BL/6JRj mice, including some data previously published in Hohlbaum et al.10, as well as previously unpublished results, are shown.
Statistical analysis
Explorative data analysis and tests for normality were performed for each parameter. Differences between the study groups (i.e. control, single isoflurane anesthesia, repeated isoflurane anesthesia were analyzed using the respective test, as stated in the figure legends. When data met normal distribution assumptions, 1-way ANOVA was performed. Non-normally distributed data were analyzed using the Kruskal-Wallis-Test. Differences were considered significant at p < 0.05.
Baseline values
Baseline values, collected before the procedure is carried out, are crucial to determine whether treatment groups differ in the respective parameter. As demonstrated in Figure 6, Figure 7, Figure 8, Figure 9 and Figure 10, baseline levels of the MGS score (p = 0.762, Kruskal-Wallis-Test), luxury behaviors like burrowing (p = 0.896, Kruskal-Wallis-Test) and nesting (p = 0.723, Kruskal-Wallis-Test), food intake (p = 0.398, 1-way ANOVA), and home cage activity (p = 0.208, Kruskal-Wallis-Test) did not significantly differ between the groups. Moreover, no significant differences in baseline FCM concentrations were found (median, interquartile range in brackets [ng/50 mg]: control:123.01 (82.70 – 193.46); single anesthesia: 118.31 (101.73 – 153.54); repeated anesthesia: 129.55 (92.58 – 139.48)) (p = 0.904, Kruskal-Wallis-Test). If differences in the baseline levels occur, delta values can be calculated.
Mouse Grimace Scale
When the mean MGS scores are compared, significant higher scores versus the control were found after the single experience of anesthesia (p = 0.001) and after the last repeated anesthesia session (p = 0.021) caused at 30 min after last anesthesia (Figure 6A). At 150 min after last anesthesia, there were no longer differences between the groups (p = 0.910).
To take into account the fact that baseline MGS scores are not equal to 0 in all cases, the MGS difference score was calculated, as described in the protocol. Both a single experience of anesthesia (p = 0.002) and repeated anesthesia (p = 0.008) increased the MGS difference scores versus the control at 30 min after anesthesia. At 150 min after the last anesthesia, all mice had returned to control levels (p = 0.617) (Figure 6B)10.
Burrowing behavior
Repeated anesthesia significantly reduced the percentage of weight of food pellets mice removed from the burrow versus the control (p = 0.036, Kruksal-Wallis-Test) (Figure 7)10.
Nest building behavior
There were no significant differences in the nest scores between a single experience of anesthesia, repeated anesthesia, and the control (p = 0.240, Kruksal-Wallis-Test) (Figure 8)10.
Food intake
At 1 day after the last anesthesia, mice that had undergone repeated anesthesia showed significantly reduced food intake compared with mice that had experienced single anesthesia (p = 0.047, 1-way ANOVA). In contrast, a week later, mice that had received repeated anesthesia consumed significantly more food than controls (p = 0.012, 1-way ANOVA) or mice that had received a single anesthesia (p = 0.001, 1-way ANOVA) (Figure 9)10.
Home cage activity
At 1 day after the last anesthesia, home cage activity during the dark period, indicated by the area under the activity curve, did not significantly differ among mice that had received a single anesthesia, repeated anesthesia, or control treatment (p = 0.498, Kruskal-Wallis-Test) (Figure 10)10.
Free exploratory paradigm
All mice explored the cage top, when the test was carried out. However, 1 day after the last anesthesia, mice that had received repeated anesthesia (median, interquartile range in brackets [s]: 78.00 (55.00-89.00)) explored the cage top significantly later in time than did controls (31.00 (18.25-42.75); p = 0.009, Kruskal-Wallis-Test) and mice that had received a single anesthesia (27.00 (21.00-45.50); p = 0.001, Kruskal-Wallis-Test), as previously published10. The parameters total duration of exploration (Figure 11A) and number of explorations (Figure 11B) are analogous to the latency to first exploration. Repeated anesthesia significantly reduced the number of explorations versus control (p = 0.023, Kruskal-Wallis-Test) and the total duration of exploration (p = 0.032, Kruskal-Wallis-Test) versus a single anesthesia at 1 day after the last anesthesia. At 8 days after the last anesthesia, all parameters, i.e. latency to first exploration (control: 27.50 (13.50 – 47.25); single anesthesia: 18.00 (9.50 – 38.50); repeated anesthesia: 20.00 (12.50 – 42.00); p = 0.722, Kruskal-Wallis-Test), number of explorations (p = 0.057), and total duration of exploration (p = 0.579), no longer differed between the study groups (Figure 11).
Fecal corticosterone metabolites
In order to take into account the baseline values obtained, the percentage change relative to baseline was calculated and no significant differences between the groups were found (p = 0.119, Kruskal-Wallis-Test) (Figure 12)10.
Figure 1: Time line of protocol. Gray and white colored fields symbolize the dark and light periods of a day, respectively. Depending on the procedure, this protocol may be adapted. "Habituation to the burrow" means that mice have to be acclimatized to using the plastic water bottle as a burrow in their home cage, before the burrowing test may be conducted. B, baseline value; FCM, fecal corticosterone metabolites. This figure has been modified from Hohlbaum et al.10. Please click here to view a larger version of this figure.
Figure 2: Summary scoring sheet. This sheet includes all tests and can be filled out for each individual mouse. Date and time should be added when the test is conducted. Please click here to view a larger version of this figure.
Figure 3: Scales of the grade of well-being. The scales range from "well-being unimpaired" (green) to "well-being impaired" (red) and express the meaning of the test results in a simplified way. At this stage of knowledge on indicators for well-being, we cannot make a definite statement on the grade of well-being for each test, only a general statement. MGS, Mouse Grimace Scale. Please click here to view a larger version of this figure.
Figure 4: Observation cage. This cage is used for the test of burrowing behavior and to take photographs to be analyzed according to the Mouse Grimace Scale (MGS). The front of the cage is clear and, depending on the fur colors of the mice, the other three walls should be colored either black or white to contrast with the mice. The floor of the glass box is covered with approximately 0.5 cm of bedding material including used bedding material from the home cage. Standard food and water are provided. If possible, water bottles rather than bowls should be used, because mice may fill bowls with bedding material. After a habituation period of at least 30 min, the burrow is added. Please click here to view a larger version of this figure.
Figure 5: 24-h observation period. To assess nest building behavior, home cage activity, and food intake and to collect fecal samples from which to measure fecal corticosterone metabolites (FCM), mice are housed individually for 24 h (cage type III: 420 mm × 260 mm × 150 mm; bedding material approximately 0.5 cm deep with used bedding material from the home cage scattered on top, a cotton nestlet, tap water and standard food diet ad libitum). An infrared sensor is mounted on the top of the cage. Please click here to view a larger version of this figure.
Figure 6: Mouse Grimace Scale (MGS). The box represents the interquartile range (IQR), box edges are the 25th and 75th quartile. The whiskers represent values which are no greater than 1.5 × IQR. Dots are outliers with values between 1.5 – 3.0 × IQR. Colored asterisks are outliers with values greater than 3.0 × IQR. (A) Mean MGS score. (B) Mean MGS difference score. p values were calculated using Kruskal-Wallis-Test: *p < 0.05; **p < 0.01. Due to a technical malfunction (camera, scale), four mice in the single anesthesia group had to be excluded from the statistics. This figure has been modified from Hohlbaum et al.10. Please click here to view a larger version of this figure.
Figure 7: Burrowing behavior. The box represents the interquartile range (IQR), box edges are the 25th and 75th quartile. The whiskers represent values which are no greater than 1.5 × IQR. Colored asterisks are outliers with values greater than 3.0 × IQR. p values were calculated using Kruskal-Wallis-Test: *p < 0.05. Due to a technical malfunction (camera, scale), four mice in the single anesthesia group had to be excluded from the statistical analysis. This figure has been modified from Hohlbaum et al.10. Please click here to view a larger version of this figure.
Figure 8: Nest building behavior. The box represents the interquartile range (IQR), box edges are the 25th and 75th quartile. The whiskers represent values which are no greater than 1.5 × IQR. Dots are outliers with values between 1.5 – 3.0 × IQR. p values were calculated using Kruskal-Wallis-Test; d, day. Please click here to view a larger version of this figure.
Figure 9: Food intake. Data are mean ± standard deviation. p values were calculated using 1-way ANOVA (post-hoc Tukey-HSD): *p < 0.05; **p < 0.01. Please click here to view a larger version of this figure.
Figure 10: Home cage activity. The box represents the interquartile range (IQR), box edges are the 25th and 75th quartile. The whiskers represent values which are no greater than 1.5 × IQR. Dots are outliers with values between 1.5 – 3.0 × IQR. p values were calculated using Kruskal-Wallis-Test. Please click here to view a larger version of this figure.
Figure 11: Free exploratory paradigm. The box represents the interquartile range (IQR), box edges are the 25th and 75th quartile. The whiskers represent values which are no greater than 1.5 × IQR.Dots are outliers with values between 1.5 – 3.0 × IQR. Colored asterisks are outliers with values greater than 3.0 × IQR. (A) Total duration of exploration. (B) Number of explorations. p values were calculated using Kruskal-Wallis-Test: * p < 0.05. This figure has been modified from Hohlbaum et al.10. Please click here to view a larger version of this figure.
Figure 12: Fecal corticosterone metabolites (FCM). The box represents the interquartile range (IQR), box edges are the 25th and 75th quartile. The whiskers represent values which are no greater than 1.5 × IQR. Colored asterisks are outliers with values greater than 3.0 × IQR. FCM levels were measured 2 days prior to and 1 day post procedure. The percentage change [%] of FCM concentrations relative to respective baseline value were calculated. Data were analyzed using Kruskal-Wallis-Test. Please click here to view a larger version of this figure.
The protocol was originally developed to assess well-being of C57BL/6JRj mice that received either a single anesthesia or repeated isoflurane anesthesia. The results confirm that tests of luxury behaviors, as well as other measures (e.g. the free exploratory paradigm, the MGS, burrowing food intake) were sensitive methods for assessing well-being. Repeated isoflurane anesthesia caused short-term effects on trait anxiety-related behavior, the MGS, and burrowing behavior. Moreover, repeated isoflurane anesthesia appeared to influence food intake10.
The free exploratory paradigm indicated reduced exploratory behavior and, consequently, higher trait anxiety levels in mice that were repeatedly anesthetized compared with mice anesthetized only once, and the controls. However, mice of all groups explored the gridded cage top10,20. When investigating anxiety-related behavior, it is important to distinguish between trait and state anxiety21,22. Placing the mouse in an unfamiliar environment induces state anxiety. In contrast, the free exploratory paradigm allows the animals to stay in their home cages and, thus, investigates trait anxiety.
The reduction in exploratory behavior among mice after repeated anesthesia cannot be explained by decreased motor activity. Home cage activity during the dark period did not significantly differ between the study groups. This indicates that mice had already physically recovered from the anesthesia when the free exploratory paradigm test was performed.
The MGS was actually developed to assess pain, but there is evidence that the facial expressions are also altered by stress and positive emotions13,23. The photographs of the mouse faces indicated that both single and repeated isoflurane anesthesia increased scores on the MGS over the short-term in the immediate post-anesthetic period. As the MGS difference score remained below 1, the level of stress appeared to be mild10. The results agree with recent observations of Miller et al.24,25 and showed that mice returned to control level 150 min post anesthesia10.
Luxury behaviors like burrowing and nest building behavior are species-specific and can serve as indicators for well-being7 and good general health in mice26. Mice only show luxury behaviors when all their essential needs are met. If well-being is reduced, luxury behaviors are the first to be impaired5,7. Previous studies have shown that both burrowing and nest building can be impaired by pain and distress6,8, but there is also evidence that hippocampal lesions can affect these two behaviors15,27,28,29,30,31.
Luxury behaviors were investigated in the early post-anesthetic period (burrowing behavior) and by the morning of the following day (nest building behavior). The test for burrowing behavior developed by Deacon et al. and adopted by Jirkof et al. was modified with regard to acclimatization (group housing instead of individual housing) and duration of behavioral measurement (only 2 h instead of 24 h)8,15,16.
It is notable that repeated anesthesia reduced burrowing behavior, suggesting that there was an impairment of well-being immediately post anesthesia10, which was also reported by Jirkof et al.8. But in the morning of the following day, when mice had had more time to recover from anesthesia, the high and complex nests they had built indicated that they were experiencing well-being10. These findings differ from previous reports that scored nests at an earlier time32. Therefore, it may be useful to adapt the protocol and score nests earlier in time. However, the circadian rhythm of nest building behavior must still be considered, as mice tend to prepare their nests at the end of the dark phase32.
Food intake was marginally decreased 1 day after repeated anesthesia, but it was increased one week later. As mice did not lose body weight (see Hohlbaum et al.10) some kind of compensation mechanism may be occurring, and impairment of well-being with regard to food intake should be classified as mild10. Food intake provides insight into postoperative distress, well-being and appetite in mice, which can be impaired by postoperative nausea26 and postoperative stress27.
FCM reliably indicate stress in mice33,34,35. The peak FCM concentrations typically occur 8-10 h after a stressor but depend on the intestinal transit time18. Therefore, it is crucial to also monitor home cage activity, as included in this protocol. Due to the circadian rhythm effect on excreted FCM18, it is advisable to collect fecal samples over a period of 24 h. FCM concentrations reflected acute stress over the 24-h post-anesthetic period. As FCM levels vary from individual to individual, the percentage change of FCM levels relative to baseline was calculated. The FCM results of the present investigation indicated that neither one experience of anesthesia nor repeated anesthesia significantly increased hypothalamic-pituitary-adrenal (HPA) axis activity10.
All in all, the findings revealed that repeated isoflurane anesthesia caused short-term mild distress and impaired well-being in the early postanesthetic period slightly more than did a single experience of isoflurane anesthesia10.
A protocol to assess well-being should not impose additional distress on the animals. A limitation of the present protocol is that it includes individual housing during the 24-h observation period, which is known to increase plasma corticosterone levels36. However, individual housing is necessary to collect valid data for individuals with respect to home cage activity, food intake, nest building behavior, and FCM levels. The duration of individual housing was minimized by investigating those four parameters at the same time (i.e. during the 24-h observation period). To prevent the results from being biased by individual housing, control mice underwent the same tests and their results were taken into account. If methods are available to measure those parameters in a group-housing environment, they should be used (e.g.an automated home-cage analysis system for home cage activity37 and for food intake). However, automated home cage analysis systems require additional equipment, which may not be available. In studies focusing on groups of animals instead of individuals, home cage activity, food intake, nest building behavior, and FCM levels may also be evaluated for a group of mice. The same applies to the free exploratory paradigm, which only requires the mice to be visibly marked so that they may be distinguished. If well-being is reduced in a group, all mice in the group should be checked carefully (using the score sheet and clinical examination) to identify the mouse or mice concerned. Further observations at the group level are needed to determine the sensitivity of group values.
With regard to refinement, this protocol can be adapted to and integrated into ongoing studies to assess the impact of a particular procedure on the well-being of mice. Depending on the particular procedure and study design, the most suitable tests from this protocol should be chosen. Here, the burrowing and nest building test, MGS, free exploratory paradigm and measurement of food intake appeared to be particularly beneficial.As behavior of mice follows circadian rhythms38, it is advisable to perform behavioral tests in mice of all groups at a defined time point. Mice are more active in the morning than in the afternoon38. However, if the study design does not allow for testing in the morning, the test may be done at another time. It is also important to ensure that each single test is conducted at the same time points for all groups. Otherwise, the impact of the circadian rhythm of the parameters can result in intra- or intergroup differences. Moreover, control mice should be included in the study, so that the results from treated mice and control mice may be compared. Control mice must be tested at the same time point as treated mice. If the protocol shows that well-being is impaired, the procedure should be refined, and the protocol repeated. This approach can show whether the efforts to refine the procedure were effective.
The present protocol can serve as a general aid to estimate the degree of severity caused by a procedure. Therefore, it helps to classify the severity of a procedure on a scientific- and animal-centered level. However, the protocol does not provide a scale for classifying a procedure as mild, moderate, or severe. To classify the severity of a procedure, it is necessary to refer to the examples in Annex VIII of EU Directive 2010/63.
In conclusion, the present protocol supports a systematic assessment of well-being in mice in a scientific, animal-centered manner following procedures during which general anesthesia is used.
The authors have nothing to disclose.
Thanks to Sabine Jacobs for assisting with the sample collection, Edith Klobetz-Rassam for analysis of FCM, PD Dr. med. vet. habil. Roswitha Merle for assisting with statistical analysis, and Wiebke Gentner for proofreading the manuscript. The study is part of the Berlin-Brandenburg research platform BB3R (www.bb3r.de) and was funded by the German Federal Ministry of Education and Research (grant number: 031A262A) (www.bmbf.de/en/index.html).
Isofluran | CP-Pharma Handelsgesellschaft mbH | 1214 | |
InfraMot – Sensore Units | TSE Systems | 302015-SENS | |
InfraMot – Control Units | TSE Systems | 302015-C/16 | |
InfraMot – Software | TSE Systems | 302015-S | |
Nestlet N | Ancare – Plexx | NES3600 | |
Camera EOS 350D | Canon |