as used herein , the term “ snac ” means sodium - n - salicyloyl - 8 - aminocaprylate , monosodium 8 -( n - salicyloylamino ) octanoate , n -( salicyloyl )- 8 - aminooctanoic acid monosodium salt , monosodium n -{ 8 -( 2 phenoxybenzoyl ) amino } octanoate , e414 monosodium salt or sodium 8 -[( 2 - hydroxybenzoyl ) amino ] octanoate . it has the structure “ n -[ 8 -( 2 - hydroxybenzoyl ) amino ] caprylic acid ” has an empirical formula c 15 h 21 no 4 . the term “ vitamin b 12 ” means any member of a group of cobalt - containing compounds known as cobalamins which include , but is not limited to cyanocobalamin , hydroxocobalamin , methylcobalamin , and 5 - deoxyadenosylcobalamin . the term “ treatment ” or “ treating ” means any treatment of a disease or disorder in a mammal , including : preventing or protecting against the disease or disorder , that is , causing the clinical symptoms not to develop ; inhibiting the disease or disorder , that is , arresting or suppressing the development of clinical symptoms ; and / or relieving the disease or disorder , that is , causing the regression of clinical symptoms . the term “ mammal ” include human subjects . the terms “ carrier , excipient , emulsifier , stabilizer , sweetener , flavoring agent , diluent , coloring agent , solubilizing agent ” are as defined in the handbook of pharmaceutical excipients ( fourth edition ) by raymond c . rowe , paul j . sheskey and paul j . weller , the content of which is herein incorporated by reference . the term “ intrinsic factor protein ” means is a glycoprotein produced by the parietal cells of the stomach . it is necessary for the absorption of vitamin b 12 later on in the terminal ileum . in a preferred embodiment , the treatment is directed to subjects that had failed to respond to existing oral vitamin b 12 treatment . preferably , tablets are used for the treatment . such tablets contain from about 0 . 01 mg to about 25 mg of vitamin b 12 and from about 1 mg to about 600 mg of snac each , preferably from about 0 . 02 mg to about 25 mg of vitamin b 12 and more preferably from about 0 . 1 mg to about 20 mg of vitamin b 12 and the most preferably from about 0 . 5 mg to 10 mg of vitamin b 12 and from about 10 mg to about 200 mg of snac in each tablet . the preferred weight ratio of vitamin b 12 and snac in the tablet is from about 2 : 1 to about 1 : 700 , more preferably from about 1 : 2 to about 1 : 600 or from about 1 : 3 to about 1 : 20 and the most preferably from about 1 : 4 to about 1 : 10 . in a preferred embodiment , the pharmaceutical composition is in the form of tablets . preferably , each tablet contains from about 0 . 01 mg to about 25 mg of vitamin b 12 and from about 50 mg to about 600 mg of snac . more preferably , each tablet contains from about 0 . 02 mg to about 20 mg of vitamin b 12 . more preferably , each tablet contains from about 0 . 1 mg to about 10 mg of vitamin b 12 . the most preferably , each tablet contains about 15 to 20 mg of vitamin b 12 and about 50 to 100 mg of snac , or about 0 . 1 to 1 . 5 mg of vitamin b 12 and about 25 to 150 mg of snac . in another preferred embodiment , the tablet further contains at least one of a carrier , excipient , emulsifier , stabilizer , sweetener , flavoring agent , diluent , coloring agent , solubilizing agent or combinations thereof . in another preferred embodiment , the tablet optionally contains from about 1 to 25 mg of capmul pg - 8 and optionally contains from about 0 . 5 to 10 mg of providone . preferably , capmul pg - 8 is in an amount from about 2 to 20 mg and providone is in an amount from about 1 to 8 mg . preferably , capmul pg - 8 is in an amount from about 5 to 15 mg and the providone is in an amount from about 1 . 5 to 5 mg . more preferably , capmul pg - 8 is in an amount from about 5 to 10 mg and providone is in an amount from about 1 . 5 to 5 mg . without intending to be bound by any particular theory of operation , it is believed that gastrointestinal absorption of vitamin b 12 depends on the presence of sufficient intrinsic factor protein , secreted from gastric parietal cells . the average diet supplies about 10 mcg / day of vitamin b 12 in a protein - bound form that is available for absorption after normal digestion . vitamin b 12 is bound to intrinsic factor during transit through the stomach ; separation occurs in the terminal ileum , and vitamin b 12 enters the mucosal cell for absorption via a receptor mediated process . it is then transported by the transcobalamin binding proteins . a small amount ( approximately 1 % of the total amount ingested ) is absorbed by simple diffusion , but this mechanism is adequate only with very large doses . it is also believed that snac will allow b 12 to bypass its usual receptor mediated process . the following examples are given as specific illustrations of the invention . it should be understood , however , that the invention is not limited to the specific details set forth in the examples . all parts and percentages in the examples , as well as in the remainder of the specification , are by weight unless otherwise specified . further , any range of numbers recited in the specification or paragraphs hereinafter describing or claiming various aspects of the invention , such as that representing a particular set of properties , units of measure , conditions , physical states or percentages , is intended to literally incorporate expressly herein by reference or otherwise , any number falling within such range , including any subset of numbers or ranges subsumed within any range so recited . the term “ about ” when used as a modifier for , or in conjunction with , a variable , is intended to convey that the numbers and ranges disclosed herein are flexible and that practice of the present invention by those skilled in the art using concentrations , amounts , contents , carbon numbers , and properties that are outside of the range or different from a single value , will achieve the desired result , namely , effective treatment of a subject with vitamin b 12 deficiency which failed to respond to existing oral vitamin b 12 tablets as well as pharmaceutical compositions for such treatment . the preparation method for n -[ 8 -( 2 - hydroxybenzoyl ) amino ] caprylic acid and snac involves the following steps : the starting material is salicylamide , which is converted to form carsalam . the second step involves the alkylation of carsalam . the penultimate step is a hydrolysis to cleave the ethyl protection group at the end of the alkyl chain and spring open the heterocyclic ring forming the free acid of snac . in the final step , the sodium salt of the snac free acid is formed by reaction with a 1 % excess stoichiometric amount of sodium hydroxide base . upon cooling the precipitated product is isolated by centrifugation and vacuum dried prior to packaging . the in - process controls for the synthetic scheme are given in table i . the tablet die and punches are checked to ensure that they are clean and that their surfaces are dusted with magnesium stearate powder . vitamin b 12 , snac , carrier , excipient , emulsifier , stabilizer , sweetener , flavoring agent , diluent , coloring agent , solubilizing agent are screened through a # 35 sieve and transferred into a sealed containers . 50 mg of vitamin b 12 is weighed and mixed thoroughly with 11 grams of a carrier , excipient , emulsifier , stabilizer , sweetener , flavoring agent , diluent , coloring agent and / or solubilizing agent . 100 vitamin b 12 tablets are made , with each tablet containing 0 . 5 mg of vitamin b 12 and 110 mg of a carrier , excipient , emulsifier , stabilizer , sweetener , flavoring agent , diluent , coloring agent and / or solubilizing agent . these tablets are used as a control . 50 mg of vitamin b 12 , 1 gram of snac are weighed and thoroughly mixed with 10 grams of a carrier , excipient , emulsifier , stabilizer , sweetener , flavoring agent , diluent , coloring agent and / or solubilizing agent . 100 vitamin b 12 tablets are made , with each tablet containing 0 . 5 mg of vitamin b 12 . 10 mg of snac and 100 mg of a carrier , excipient , emulsifier , stabilizer , sweetener , flavoring agent , diluent , coloring agent and / or solubilizing agent . the process is repeated to make tablet batches containing 1 . 0 mg , 0 . 8 mg , 0 . 6 mg , 0 . 4 mg and 0 . 2 of vitamin b 12 , respectively . these tablets have the following specifications for release of snac component : tablets with four types of different ingredients were made as follows : ( 1 ) 8 . 8 mg of vitamin b 12 , 35 mg of snac were weighed , thoroughly mixed and made into a tablet for dosing on rat ; ( 2 ) 8 . 8 mg of vitamin b 12 , 35 mg of snac and 5 mg of capmul pg - 8 were weighed , thoroughly mixed and made into a tablet ; ( 3 ) 8 . 8 mg of vitamin b 12 , 35 mg of snac and 0 . 9 mg of providone were weighed , thoroughly mixed and made into a tablet . each of the four processes was repeated to produce more tablets . male sprague - dawley rats ( 325 - 350 g ) were dosed with vitamin b 12 intravenously ( 0 . 5 mg / kg ) alone , or orally with the tablets made in example 4 at a dose of 50 mg / kg vitamin b 12 alone or in combination with snac at 200 mg / kg . blood samples were collected at 0 , 3 , 10 , 20 , 30 , 60 , 120 , 240 and 360 minutes post dosing . plasma samples were analyzed for b12 by ria . the model independent pk metrics obtained following b12 - snac combination were compared to those obtained following b12 alone . the testing results are shown in table 1 . ( 1 ) treatment b : a single oral dose of cyanocobalamin / snac ( 5 mg cyanocobalamin / 100 mg snac ) administered in the fasted state as a tablet . ( 6 subjects ); ( 2 ) treatment c : a single oral dose of cyanocobalamin alone ( 5 mg cyanocobalamin , vitalabs , commercial ) administered in the fasted state as a tablet . ( 6 subjects ). ( 3 ) treatment d : a single intravenous dose of cyanocobalamin ( 1 mg cyanocobalamin ) administered in the fasted state . ( 4 subjects ). each subject received a 1 ml intravenous injection of a 1 mg / ml ( 1000 μg / ml ) solution resulting in a total dose of 1 mg cyanocobalamin . the subjects were fasted overnight prior to dosing and had no liquids ( including water ) consumption for at least one hour before and after dosing . the oral forms of cyanocobalamin / snac tablets were administered in a single dose as tablets with 50 ml of plain water . twenty - five blood samples were drawn for cyanocobalamin analyses at the following time points : within 30 minutes pre - dose and at minutes 2 , 5 , 10 , 20 , 30 , 40 , 50 , and at hours 1 , 1 . 5 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 14 , 16 , 20 and 24 post - dose . pharmacokinetic metrics was obtained following a model independent pharmacokinetic analysis of individual cyanocobalamin concentrations . descriptive statistics was used to summarize the results . following 1 tablet of 5 mg b12 / 100 mg snac mean b12 peak concentration is 12847 ± 6613 pg / ml and occur within 1 hour post dose ( mean tmax of 0 . 50 ± 0 . 21 hours ). mean auclast ( 0 - 24 ) value is 54618 ± 16392 hr * pg / ml . the percent coefficient of variation (% cv ) is 51 . 5 % for cmax and 30 . 0 % for auc . following a single oral dose of cyanocobalamin alone ( 5 mg cyanocobalamin , vitalabs , commercial ) mean b12 peak concentration is 1239 ± 450 pg / ml and occur between 3 to 10 hours post - dose ( mean tmax of 6 . 8 ± 3 . 2 hours ). mean auclast ( 0 - 24 ) value is 23131 ± 8343 hr * pg / ml . the percent coefficient of variation (% cv ) is 36 . 3 % for cmax and 36 . 1 % for auc . following a single intravenous dose of cyanocobalamin ( 1 mg cyanocobalamin ) administered in the fasted state ( 4 subjects ). mean b12 peak concentration is 221287 ± 80248 pg / ml and mean auclast ( 0 - 24 ) value is 215391 ± 44602 hr * pg / ml . the percent coefficient of variation (% cv ) is 36 . 3 % for cmax and 20 . 7 % for auc . the mean bioavailability of 1 tablet of 5 mg vitamin b12 alone , 1 tablet of 5 mg vitamin b12 / 100 mg snac , and 2 tablets of 5 mg vitamin b12 / 100 mg snac are 2 . 15 ± 0 . 77 %, 5 . 07 ± 1 . 52 , and 5 . 92 ± 3 . 05 %, respectively . ( note : 2 tablets of 5 mg vitamin b12 / 100 mg snac were dosed previously in a pilot arm are designated treatment a ). the mean tmax of 1 tablet of 5 mg vitamin b12 alone , 1 tablet of 5 mg vitamin b12 / 100 mg snac , and 2 tablets of 5 mg vitamin b12 / 100 mg snac are 6 . 8 ± 3 . 2 hours , 0 . 50 ± 0 . 21 hours , and 0 . 54 ± 0 . 32 hours , respectively . no adverse events were observed during the given treatments . all formulations appear to be safe and well tolerated . it was found surprisingly that the extent of b12 absorption , measured as cmax and auc , was significantly enhanced by the administration of the cyanocobalamin / snac combination . vitamin b12 bioavailability was ˜ 240 % greater for the 1 tablet of 5 mg b12 / 100 mg snac compared to 5 mg b12 commercial formulation . mean peak b12 concentrations following b12 commercial oral formulation occurred significantly later compared to that following the b12 / snac combinations likely due to a different site of absorption between the two oral formulations . this is consistent with literature data describing intestinal absorption of b12 occurring in the distal section of the gastrointestinal tract in the absence of the carrier . the principles , preferred embodiments , and modes of operation of the present invention have been described in the foregoing specification . the invention which is intended to be protected herein , however , is not to be construed as limited to the particular forms disclosed , since these are to be regarded as illustrative rather than restrictive . variations and changes may be made by those skilled in the art , without departing from the spirit of the invention .
a novel method and composition for treating vitamin b 12 deficiency mammals that fail to respond to oral vitamin b 12 therapy .