Boron neutron capture synovectomy (BNCS) as a potential therapy for rheumatoid arthritis: radiobiological studies at RA-1 Nuclear Reactor in a model of antigen-induced arthritis in rabbits

Rheumatoid arthritis is a chronic autoimmune pathology characterized by the proliferation and inflammation of the synovium. Boron neutron capture synovectomy (BNCS), a binary treatment modality that combines the preferential incorporation of boron carriers to target tissue and neutron irradiation, was proposed to treat the pathological synovium in arthritis. In a previous biodistribution study, we showed the incorporation of therapeutically useful boron concentrations to the pathological synovium in a model of antigen-induced arthritis (AIA) in rabbits, employing two boron compounds approved for their use in humans, i.e., decahydrodecaborate (GB-10) and boronophenylalanine (BPA). The aim of the present study was to perform low-dose BNCS studies at the RA-1 Nuclear Reactor in the same model. Neutron irradiation was performed post intra-articular administration of BPA or GB-10 to deliver 2.4 or 3.9 Gy, respectively, to synovium (BNCS-AIA). AIA and healthy animals (no AIA) were used as controls. The animals were followed clinically for 2 months. At that time, biochemical, magnetic resonance imaging (MRI) and histological studies were performed. BNCS-AIA animals did not show any toxic effects, swelling or pain on palpation. In BNCS-AIA, the post-treatment levels of TNF-α decreased in four of six rabbits and IFN-γ levels decreased in five of six rabbits. In all cases, MRI images of the knee joint in BNCS-AIA resembled those of no AIA, with no necrosis or periarticular effusion. Synovial membranes of BNCS-AIA were histologically similar to no AIA. BPA-BNCS and GB-10-BNCS, even at low doses, would be therapeutically useful for the local treatment of rheumatoid arthritis.

Boron neutron capture synovectomy (BNCS) as a potential therapy for rheumatoid arthritis: boron biodistribution study in a model of antigen-induced arthritis in rabbits

Boron neutron capture synovectomy (BNCS) is explored for the treatment of rheumatoid arthritis (RA). The aim of the present study was to perform boron biodistribution studies in a model of antigen-induced arthritis (AIA) in female New Zealand rabbits, with the boron carriers boronophenylalanine (BPA) and sodium decahydrodecaborate (GB-10) to assess the potential feasibility of BNCS for RA. Rabbits in chronic phase of AIA were used for biodistribution studies employing the following protocols: intra-articular (ia) (a) BPA-f 0.14 M (0.7 mg (10)B), (b) GB-10 (5 mg (10)B), (c) GB-10 (50 mg (10)B) and intravenous (iv), (d) BPA-f 0.14 M (15.5 mg (10)B/kg), (e) GB-10 (50 mg (10)B/kg), and (f) BPA-f (15.5 mg (10)B/kg) + GB-10 (50 mg (10)B/kg). At different post-administration times (13-85 min for ia and 3 h for iv), samples of blood, pathological synovium (target tissue), cartilage, tendon, muscle, and skin were taken for boron measurement by inductively coupled plasma mass spectrometry. The intra-articular administration protocols at <40 min post-administration both for BPA-f and GB-10, and intravenous administration protocols for GB-10 and [GB-10 + BPA-f] exhibited therapeutically useful boron concentrations (>20 ppm) in the pathological synovium. Dosimetric estimations suggest that BNCS would be able to achieve a therapeutically useful dose in pathological synovium without exceeding the radiotolerance of normal tissues in the treatment volume, employing boron carriers approved for use in humans. Radiobiological in vivo studies will be necessary to determine the actual therapeutic efficacy of BNCS to treat RA in an experimental model.

New developments in the medicinal chemistry of carboranes

The advancements in the synthetic chemistry of carboranes and metallacarboranes have given rise to diversified uses in medicinal chemistry, resulting in many new medical applications. An overview of the medicinal chemistry of carboranes is presented emphasizing the use of nanoparticles, dendrimers, porphyrins and carbohydrates as boron carriers. A review with 80 references.

Dose calculation from a D-D-reaction-based BSA for boron neutron capture synovectomy

Monte Carlo simulations were carried out to calculate dose in a knee phantom from a D-D-reaction-based Beam Shaping Assembly (BSA) for Boron Neutron Capture Synovectomy (BNCS). The BSA consists of a D(d,n)-reaction-based neutron source enclosed inside a polyethylene moderator and graphite reflector. The polyethylene moderator and graphite reflector sizes were optimized to deliver the highest ratio of thermal to fast neutron yield at the knee phantom. Then neutron dose was calculated at various depths in a knee phantom loaded with boron and therapeutic ratios of synovium dose/skin dose and synovium dose/bone dose were determined. Normalized to same boron loading in synovium, the values of the therapeutic ratios obtained in the present study are 12-30 times higher than the published values.

In vivo prompt gamma neutron activation analysis for the screening of boron-10 distribution in a rabbit knee: a simulation study

Boron neutron capture synovectomy (BNCS) is under development as a potential treatment modality for rheumatoid arthritis (RA). RA is characterized by the inflammation of the synovium (the membrane lining articular joints), which leads to pain and a restricted range of motion. BNCS is a two-part procedure involving the injection of a boronated compound directly into the diseased joint followed by irradiation with a low-energy neutron beam. The neutron capture reactions taking place in the synovium deliver a local, high-linear energy transfer (LET) dose aimed at destroying the inflamed synovial membrane. For successful treatment via BNCS, a boron-labeled compound exhibiting both high synovial uptake and long retention time is necessary. Currently, the in vivo uptake behavior of potentially useful boronated compounds is evaluated in the knee joints of rabbits in which arthritis has been induced. This strategy involves the sacrifice and dissection of a large number of animals. An in vivo (10)B screening approach is therefore under investigation with the goal of significantly reducing the number of animals needed for compound evaluation via dissection studies. The 'in vivo prompt gamma neutron activation analysis' (IVPGNAA) approach uses a narrow neutron beam to irradiate the knee from several angular positions following the intra-articular injection of a boronated compound whose uptake characteristics are unknown. A high-purity germanium detector collects the 478 keV gamma photons produced by the (10)B capture reactions. The (10)B distribution in the knee is then reconstructed by solving a system of simultaneous equations using a weighted least squares algorithm. To study the practical feasibility of IVPGNAA, simulation data were generated with the Monte Carlo N-particle transport code. The boron-containing region of a rabbit knee was partitioned into 8 compartments, and the (10)B prompt gamma signals were tallied from 16 angular positions. Results demonstrate that for this level of spatial resolution, an estimate of (10)B distribution inside the joint can be obtained to within 10% uncertainty, under ideal conditions. Variations of the anatomic dimensions among individual rabbit knees and potential knee positioning errors will result in an uncertainty of over 20%. IVPGNAA thus provides sufficient resolution and quantification regarding the in vivo uptake characteristics of boronated pharmaceuticals to serve as a useful means of screening new compounds of potential use in BNCS.

Dose evaluation of boron neutron capture synovectomy using the THOR epithermal neutron beam: a feasibility study

Rheumatoid arthritis is one of the most common epidemic diseases in the world. For some patients, the treatment with steroids or nonsteroidal anti-inflammatory drugs is not effective, thus necessitating physical removal of the inflamed synovium. Alternative approaches other than surgery will provide appropriate disease control and improve the patient's quality of life. In this research, we evaluated the feasibility of conducting boron neutron capture synovectomy (BNCS) with the Tsing Hua open-pool reactor (THOR) as a neutron source. Monte Carlo simulations were performed with arthritic joint models and uncertainties were within 5%. The collimator, reflector and boron concentration were optimized to reduce the treatment time and normal tissue doses. For the knee joint, polyethylene with 40%-enriched Li(2)CO(3) was used as the collimator material, and a rear reflector of 15 cm thick graphite and side reflector of 10 cm thick graphite were chosen. The optimized treatment time was 5.4 min for the parallel-opposed irradiation. For the finger joint, polymethyl methacrylate was used as the reflector material. The treatment time can be reduced to 3.1 min, while skin and bone doses can be effectively reduced by approximately 9% compared with treatment using the graphite reflector. We conclude that using THOR as a treatment modality for BNCS could be a feasible alternative in clinical practice.

Dose response of the AIA rabbit stifle joint to boron neutron capture synovectomy

This study assessed the treatment with boron neutron capture synovectomy of synovitis in the antigen-induced arthritis (AIA) model. A boron compound, potassium dodecahydrododeca-borate (K(2)B(12)H(12)), was injected into stifle joints of 24 AIA and 12 normal rabbits and activated by neutron bombardment of the joint to achieve doses from 800 to 81,000 RBE-cGy. Synovial ablation in the AIA joint was accomplished at doses of 6,000 to 7,000 RBE-cGy with no adverse effects to skin or extracapsular tissues.

Computational dosimetry and treatment planning considerations for neutron capture therapy

Specialized treatment planning software systems are generally required for neutron capture therapy (NCT) research and clinical applications. The standard simplifying approximations that work well for treatment planning computations in the case of many other modalities are usually not appropriate for application to neutron transport. One generally must obtain an explicit three-dimensional numerical solution of the governing transport equation, with energy-dependent neutron scattering completely taken into account. Treatment planning systems that have been successfully introduced for NCT applications over the past 15 years rely on the Monte Carlo stochastic simulation method for the necessary computations, primarily because of the geometric complexity of human anatomy. However, historically, there has also been interest in the application of deterministic methods, and there have been some practical developments in this area. Most recently, interest has turned toward the creation of treatment planning software that is not limited to any specific therapy modality, with NCT as only one of several applications. A key issue with NCT treatment planning has to do with boron quantification, and whether improved information concerning the spatial biodistribution of boron can be effectively used to improve the treatment planning process. Validation and benchmarking of computations for NCT are also of current developmental interest. Various institutions have their own procedures, but standard validation models are not yet in wide use.

Fission reactor neutron sources for neutron capture therapy--a critical review

The status of fission reactor-based neutron beams for neutron capture therapy (NCT) is reviewed critically. Epithermal neutron beams, which are favored for treatment of deep-seated tumors, have been constructed or are under construction at a number of reactors worldwide. Some of the most recently constructed epithermal neutron beams approach the theoretical optimum for beam purity. Of these higher quality beams, at least one is suitable for use in high through-put routine therapy. It is concluded that reactor-based epithermal neutron beams with near optimum characteristics are currently available and more can be constructed at existing reactors. Suitable reactors include relatively low power reactors using the core directly as a source of neutrons or a fission converter if core neutrons are difficult to access. Thermal neutron beams for NCT studies with small animals or for shallow tumor treatments, with near optimum properties have been available at reactors for many years. Additional high quality thermal beams can also be constructed at existing reactors or at new, small reactors. Furthermore, it should be possible to design and construct new low power reactors specifically for NCT, which meet all requirements for routine therapy and which are based on proven and highly safe reactor technology.

Unexpected formation of an azetidine-carborane derivative by dehydration of N-(1,12-dicarba-closo-dodecaboran-1-yl)formamide. The first X-ray structure of a 2,3-bis(imino)azetidine

Efforts to dehydrate (1,12-dicarba-closo-dodecaboran(12)-1-yl)formamide (a = 6.685(2) A, b = 12.877(4) A, c = 12.547(4) A, alpha = gamma = 90 degrees, beta = 90.724(11) degrees, V = 1080.8(6) A(3), Z = 4) resulted in the formation of a series of unexpected products. Addition of the Burgess reagent to the formamide, for example, led to the isolation of the corresponding methyl carbamate (a = 11.529(8) A, b = 11.529(8) A, c = 11.402(12) A, alpha = beta = gamma = 90 degrees, V = 1516(2) A(3), Z = 4), while treatment with triphosgene, a well-known dehydrating agent, resulted in the formation of a highly unusual 2,3-bis(p-carboranylimino)azetidine derivative. This particular compound, in the presence of Re(I), was hydrolyzed to give the corresponding amide, which is the first example of a 2,3-bis(imino)azetidine that has been characterized crystallographically (a = 38.496(13) A, b = 11.920(4) A, c = 27.523(10) A, beta = 127.050(5) degrees, V = 10079(6) A(3), Z = 8).

Synthesis, NMR, and X-ray crystallographic analysis of C-hydrazino-C-carboxycarboranes: versatile ligands for the preparation of BNCT and BNCS agents and (99m)Tc radiopharmaceuticals

Protected hydrazine derivatives of ortho-, meta-, and para-carboranes were synthesized in good to excellent yields by reacting the mono-lithio salts of the respective carboranes with di-tert-butyl azodicarboxylate (DBAD). Subsequent deprotonation of the remaining carborane CH group, followed by the addition of CO(2)(g), resulted in the formation of bifunctional C-hydrazino-C-carboxycarboranes in good to excellent overall yields. Crystal structures of the monosubstituted ortho-carborane, 1-[(N,N'((tert-butyloxy)carbonyl)hydrazino)]-1,2-dicarba-closo-dodecaborane (8) [a = 21.213(6) A, b = 10.498(3) A, c = 9.866(2) A, alpha = gamma = 90 degrees, beta = 90.529(4) degrees ] and the bifunctional para-carborane 1-[(N,N'((tert-butyloxy)carbonyl)hydrazino)]-1,12-dicarba-closo-dodecaborane-12-carboxylic acid (3) [a = 12.744(10) A, b = 12.875(9) A, c = 14.767(9) A, alpha = beta = gamma = 90 degrees ] were obtained. Intermolecular hydrogen bonding was a dominant packing feature in both structures. The reported compounds represent a unique class of bifunctional carboranes that can be used in peptidomimetic research and as synthons to prepare novel radiopharmaceuticals and boron neutron capture therapy/boron neutron capture synovectomy (BNCT/BNCS) agents.

The feasibility of accelerator-based in vivo neutron activation analysis of nitrogen

The feasibility of accelerator-based in vivo neutron activation analysis of nitrogen has been investigated. It was found that a moderated neutron flux from approximately 10 microA of 2.5 MeV protons on a 9Be target performed as well as, and possibly slightly better than the existing isotope-based approach in terms of net counts per unit subject dose. Such a system may be an attractive alternative to the widespread use of (238,239)Pu/Be or 252Cf neutron sources, since there is more flexibility in the energy spectrum generated by accelerator-based neutron sources. From a radiation safety standpoint, accelerators have the advantage in that they only produce radiation when in operation. Furthermore, an accelerator beam can be pulsed, to reduce background detected in the prompt-gamma measurement, and such a device has a wide range of additional biological and medical applications.

A new approach for the synthesis of isonitrile carborane derivatives

A new approach for the synthesis of carborane isonitrile derivatives was developed. This approach involved the dehydration of both boron and carbon derived formamides using the Burgess reagent. The products, some of which were characterized by X-ray crystallography, can now be used as ligands for the synthesis of transition metal based boron neutron capture therapy and synovectomy agents and targeted radiopharmaceuticals.

An investigation of the feasibility of gadolinium for neutron capture synovectomy

Neutron capture synovectomy (NCS) has been proposed as a possible treatment modality for rheumatoid arthritis. Neutron capture synovectomy is a two-part modality, in which a compound containing an isotope with an appreciable thermal neutron capture cross section is injected directly into the joint, followed by irradiation with a neutron beam. Investigations to date for NCS have focused on boron neutron capture synovectomy (BNCS), which utilizes the 10B(n,alpha)7Li nuclear reaction to deliver a highly localized dose to the synovium. This paper examines the feasibility of gadolinium, specifically 157Gd, as an alternative to boron as a neutron capture agent for NCS. This alternative modality is termed Gadolinium Neutron Capture Synovectomy, or GNCS. Monte Carlo simulations have been used to compare 10B and 157Gd as isotopes for accelerator-based NCS. The neutron source used in these calculations was a moderated spectrum from the 9Be(p,n) reaction at a proton energy of 4 MeV. The therapy time to deliver the NCS therapeutic dose of 10000 RBE-cGy, is 27 times longer when 157Gd is used instead of 10B. The skin dose to the treated joint is 33 times larger when 157Gd is used instead of 10B. Furthermore, the impact of using 157Gd instead of 10B was examined in terms of shielded whole-body dose to the patient. The effective dose is 202 mSv for GNCS, compared to 7.6 mSv for BNCS. This is shown to be a result of the longer treatment times required for GNCS; the contribution of the high-energy photons emitted from neutron capture in gadolinium is minimal. Possible explanations as to the relative performance of 157Gd and 10B are discussed, including differences in the RBE and range of boron and gadolinium neutron capture reaction products, and the relative values of the 10B and 157Gd thermal neutron capture cross section as a function of neutron energy.

Development and construction of a neutron beam line for accelerator-based boron neutron capture synovectomy

A potential application of the 10B(n, alpha)7Li nuclear reaction for the treatment of rheumatoid arthritis, termed Boron Neutron Capture Synovectomy (BNCS), is under investigation. In an arthritic joint, the synovial lining becomes inflamed and is a source of great pain and discomfort for the afflicted patient. The goal of BNCS is to ablate the synovium, thereby eliminating the symptoms of the arthritis. A BNCS treatment would consist of an intra-articular injection of boron followed by neutron irradiation of the joint. Monte Carlo radiation transport calculations have been used to develop an accelerator-based epithermal neutron beam line for BNCS treatments. The model includes a moderator/reflector assembly, neutron producing target, target cooling system, and arthritic joint phantom. Single and parallel opposed beam irradiations have been modeled for the human knee, human finger, and rabbit knee joints. Additional reflectors, placed to the side and back of the joint, have been added to the model and have been shown to improve treatment times and skin doses by about a factor of 2. Several neutron-producing charged particle reactions have been examined for BNCS, including the 9Be(p,n) reaction at proton energies of 4 and 3.7 MeV, the 9Be(d,n) reaction at deuteron energies of 1.5 and 2.6 MeV, and the 7Li(p,n) reaction at a proton energy of 2.5 MeV. For an accelerator beam current of 1 mA and synovial boron uptake of 1000 ppm, the time to deliver a therapy dose of 10,000 RBEcGy ranges from 3 to 48 min, depending on the treated joint and the neutron producing charged particle reaction. The whole-body effective dose that a human would incur during a knee treatment has been estimated to be 3.6 rem or 0.75 rem, for 1000 ppm or 19,000 ppm synovial boron uptake, respectively, although the shielding configuration has not yet been optimized. The Monte Carlo design process culminated in the construction, installation, and testing of a dedicated BNCS beam line on the high-current tandem electrostatic accelerator at the Laboratory for Accelerator Beam Applications at the Massachusetts Institute of Technology.