Boron Neutron Capture Synovectomy
Use of the boron neutron capture reaction is a potential means of treating the symptoms of rheumatoid arthritis and related diseases. For this approach, termed boron neutron capture synovectomy (BNCS), the goal is cellular ablation within the inflamed syn
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Jacquelyn C. Yanch
Contents 31.1
Introduction................................................................................................................ 521
31.2
Boron Neutron Capture Synovectomy (BNCS)....................................................... 522
31.3
Development of BNCS ............................................................................................... 31.3.1 Preliminary Compound Investigation .............................................................. 31.3.2 Neutron Beam Design ...................................................................................... 31.3.3 Whole Body Patient Dose in BNCS ................................................................ 31.3.4 Potential of Gadolinium Neutron Capture Synovectomy ................................ 31.3.5 Efficacy of BNCS in an Animal Model ...........................................................
31.4
Further Development of BNCS ................................................................................ 528
523 523 524 525 526 526
References ................................................................................................................................. 529
31.1
Introduction
Rheumatoid arthritis (RA) is a chronic, autoimmune disease affecting roughly 1–2 % of the adult population [1]. Although it is a systemic disease with the potential to affect many organs, the prevailing feature is a progressive, deforming arthritis characterized by an inflammatory reaction in the synovium. The synovial membrane is the inner layer of the joint capsule and lines the joint everywhere except over the articular cartilages which cover the ends of the bones. In a patient with RA, the synovium becomes grossly edematous and inflamed resulting in considerable
J.C. Yanch Departments of Nuclear Science and Engineering and Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA e-mail: [email protected] W.A.G. Sauerwein et al. (eds.), Neutron Capture Therapy, DOI 10.1007/978-3-642-31334-9_31, © Springer-Verlag Berlin Heidelberg 2012
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pain and reduced range of motion. If left untreated, the inflammation usually results in progressive joint destruction and deformity leading ultimately to varying degrees of incapacitation [1]. Treatment for RA involves various drugs administered to reduce synovial inflammation, and, for the majority of patients, this approach is effective in providing relief of symptoms. For a significant number of patients, however, one or more joints remain unresponsive, and other means of addressing the inflamed synovium are sought. Surgical removal of the synovium (“synovectomy”) is performed via open surgery or arthroscopically via multiple small entries. Both procedures result in removal of up to 80 % of the synovial membrane and alleviation of symptoms in 70–80 % of cases [2–4]. While the synovial membrane will regrow within 6 months of surgery, benefits persist for approximately 5 years. Inflammation, however, eventually returns. Alternat
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