AU763251B2

AU763251B2 - Mixed micellar pharmaceutical delivery system and method for preparation

Info

Publication number: AU763251B2
Application number: AU68143/00A
Authority: AU
Inventors: Pankaj Modi
Original assignee: Generex Pharmaceuticals Inc
Current assignee: Generex Pharmaceuticals Inc
Priority date: 1998-02-10
Filing date: 2000-08-25
Publication date: 2003-07-17
Anticipated expiration: 2019-02-05
Also published as: AU6814300A

Description

J. .1 WO 01/15666 PCT/CA00/01019 Title of Invention FtoI MIXED MICELLAR PHARMACEUTICAL DELIVERY SYSTEM AND METHOD Of PREPARATION Technical Field The present invention relates to an improved delivery system for the administration of large-molecule pharmaceuticals, e.g. peptidic drugs, vaccines and honrmones. In particular it relates to pharmaceuticals which may be administered through the oral and nasal membranes.

Background Art In spite of significant efforts in academic and commercial laboratories, major breakthroughs in oral peptide and protein formulation have not been achieved.

Relatively little progress has been made in reaching the target of safe and effective oral formulations for peptides and proteins. The major barriers to developing oral formulations for proteins and peptides include poor intrinsic permeability, lumenal and cellular enzymatic degradation, rapid clearance, and chemical stability in the gastrointestinal (GI) tract. Pharmaceutical approaches to address these barriers, which have been successful with traditional small, organic drug molecules, have not readily translated into effective peptide and protein formulations. Although the challenges are significant, the potential therapeutic benefits remain high especially in the field of diabetes treatment using insulin.

Scientists have explored various administration routes other than the injection for proteins and peptides. These routes include oral, intranasal, rectal, vaginal cavities for the effective delivery of large molecules. Out of the above four mentioned routes oral and nasal cavities have been of greatest interest to scientists. Both the oral and nasal membranes offer advantages over other routes of administration. For example, drugs administered through these membranes have a rapid onset of action, provide therapeutic plasma levels, avoid first pass effect of hepatic metabolism, and avoid exposure of the drug to hostile GI environment. Additional advantages include easy access to the membrane sites so that the drug can be applied, localized and removed WO 01/15666 PCT/CA00/01019 2 -2easily. Further, there is a good potential for prolonged delivery of large molecules through these membranes.

The oral routes have received far more attention than has the other routes. The sublingual mucosa includes the membrane of ventral surface of the tongue and the floor of the mouth whereas the buccal mucosa constitutes the lining of the cheek. The sublingual mucosa is relatively permeable thus giving rapid absorption and'acceptable bioavailability of many drugs. Further, the sublingual mucosa is convenient, acceptable and easily accessible. This route has been investigated clinically for the delivery of a substantial number of drugs.

The ability of molecules to permeate through the oral mucosa appears to be related to molecular size, lipid solubility and peptide proten ionization. Small molecules, less than 1000 daltons appear to cross mucosa rapidly. As molecular size increases, the permeability decreases rapidly. Lipid soluble compounds are more permeable than non-lipid soluble molecules. Maximum absorption occurs when molecules are un-ionized or neutral in electrical charges. Therefore charged molecules present the biggest challenges to absorption through the oral mucosae.

Most proteinic drug molecules are extremely large molecules with molecular weight exceeding 6000 daltons. These large molecules have very poor lipid solubility and are practically impermeable. Substances that facilitate the absorption or transport of large molecules (>2000 daltons) across biological membranes are known as the enhancers, (Lee et al., Critical Reviews in Therapeutic drug Carrier Systems, 8, 91, 1991; Lee et al., Critical Reviews in Therapeutic drug Carrier Systems, 8, 115, 1991, 1992). Enhancers may be characterized as chelators, bile salts, fatty acids, synthetic hydrophillic and hydrophobic compounds, and biodegradable polymeric compounds.

Various mechanisms of action of enhancers have been proposed. These mechanisms of action, at least for protein and peptidic drugs include reducing viscosity and/or elasticity of mucous layer, facilitating transcellular transport by increasing the fluidity of the lipid bilayer of membranes, and increasing the thermodynamic activity of drugs (Critical Rev, 117-125, 1991, 1992).

Many enhancers have been tested so far and some have found to be effective in facilitating mucosal administration of large molecule drugs. However, hardly any ''WO 01/15666 PCT/CA00/01019 3 penetration enhancing products have reached the market place. Reasons for this include lack of a satisfactory safety profile respecting irritation, lowering o the barrier function, and impairment of the mucocilliary clearance protective mechanism. The main factor to be considered in the use of enhancers especially related to bile salts, and some protein solubilizing agents is extremely bitter and,unpleasant taste. This makes their use almost impossible for human consumption on a daily basis. Several approaches were utilized to improve the taste of the bile salts based delivery systems, but none one of them are commercially acceptable for human consumption to date.

Among the approaches utilized includes patch for buccal mucosa, bilayer tablets, controlled release tablets, use of protease inhibitors, buccally administered film patch devices, and various polymer matrices.

The basic problem associated with the above technologies is the use of large quantities of bile acids and theirjsalts to promote the transport of the large molecules through membranes in the form of localized delivery system using patches or tablets.

In spite of using protease inhibitors and polymer coatings the technologies failed to deliver proteinic drugs in the required therapeutic concentrations. Further, the problem is compounded because of the localized site effect of the patch which resulted in severe tissue damage in the mouth. Most attempts were made to deliver large molecules via the oral, nasal, rectal, and vaginal routes using single bile acids or enhancing agents in combination with protease inhibitors and biodegradable polymeric materials. However, it is extremely difficult to achieve therapeutic levels ofproteinic drugs using these formulations. As single enhancing agents fails to loosen tight cellular junctions in the oral, nasal, rectal and vaginal cavities for a required period of time to allow passage of large molecules through the mucosal membranes without further degradation. This problem makes it impractical to use the above mentioned systems for a commercial purpose.

In order to overcome the above mentioned problem of the bitter taste, irritation and the penetration of large molecules through the sublingual, buccal and GI tract mucosal lining, a system has now been designed where protein drug was encapsulated in mixed micelles made up of combination of enhancers, e.g. yolk proteins (lecithins).

This system allows opening of the paracellular junctions (tight junctions) in oral as well 1, WO 01/15666 PCT/CAOO/01019 4 as in GI tract by gl motility movement with high degree of protease activity preserved and protecting molecules from premature degradation in the hostile acidic and proteolytic GI environment.

It is believed that the mixed micelles encapsulate molecules with high degree of efficiency encapsulation). These mixed micelles are extremely small in the size (1 nm to 10 nm), and are smaller than the pores of the membranes in the oral cavity or the GI tract. It is therefore believed that the extremely small size of mixed micelles helps encapsulated molecules penetrate efficiently through the mucosal membranes of the oral cavity.

The absorption of proteins and peptides is believed to be enhanced by the diffusion of large molecules entrapped in the mixed micellar form through the aqueous pores and the cell structure perturbation of the fight paracellular junctions.

The amount of physiologically peptide or protein in the compositions of this invention is typically a quantity that provides an effective amount of the drug to produce the physiological activity (therapeutic plasma level) for which peptide or protein is being administered. In consideration of the fact that the bioavailability of any active substance can never be 1000/o, that is to say the administered dose of the active drug is not completely absorbed/it is preferable to incorporate slightly larger amount than the desired dosage. Where the dosage form is a spray (aerosol) or the like which is repeatedly dispensed from the same container, it is recommendably so arranged that the unit dose will be slightly greater than the desired dose. It should be understood that dosage should vary with species of warm blood animals such as man, domestic animals, and their body weights.'Although the composition of this invention is prepared as the microfine droplets (1 to 10 nm or less) by the virtue of its preparation methods used and suitable combinations of enhancer compound characteristics. The utilization of atomizer or aerosol spray devices (metered dose inhalers or nebulizers) may be useful to further a sufficient reduction of particle size for effective inhalation from the nasal or oral cavity so the drug may successfully absorbed or reach to the specific site.

The therapeutic composition of the present invention can be stored at room temperature or at cold temperature. Storage ofproteinic drugs is preferable at the cold temperature to prevent the degradation of the drugs and to extend their shelf life. While 1, W 01/15666 PCT/CA00/01019 5 the mixed micellar therapeutic composition of the invention is applied to the mucosal membranes, the sites of administration may the same as those used for the usual mucosal therapeutic preparation. Generally, oral, transdermal and nasal are the favourite sites of the administration but the composition can be applied to the rectal and vaginal mucosa. According to the physiologically active peptide or protein used, the dosage form and the site of administration, a specific administration method can be selected.

As used herein, the term "edetate" is used herein to refer to pharmaceutically acceptable salts of ethylenediaminetetraacetic acid.

It has also been found that improvements/in penetration and absorption of mixed micellar formulations can be achieved by mixing the mixed micellar formulation with propellants such as tetrafluoroethane, heptafluoroethane, dimethylfluoropropane, tetrafluoropropane, butane, isobutane, dimethyl ether and other non-CFC and CFC propellants. Preferably they are delivered through metered dose spray devices.

Metered dose inhalers are known and are a popular pulmonary drug delivery form for some drugs. The present formulation, including the propellant is intended to improve the quality of absorption, stability and performance of many formulations. The compositions have been selected to give enhancement in the penetration through pores, and facilitate absorption ofthe drugs to reach therapeutic levels in the plasma. The 2 0 present formulation may be absorbed buccally, by ensuring that the person does not inhale the formulation as it is sprayed. One of the other benefits of using an atomizer or inhaler is that the potential for contamination is minimized because the devices are self contained.

Disclosure of Invention Accordingly the present invention provides a mixed micellar pharmaceutical formulation comprising a proteinic pharmaceutical agent in micellar form, water, an alkali metal lauryl sulphate in a concentration of from 1 to 10 wt./wt.% of the total formulation, a pharmaceutically acceptable edetate in a concentration of from 1 to wt./wt.% of the total formulation, at least one alkali metal salicylate in a concentration of from 1 to 10 wt./wt.% of the total formulation, and at least one micelle forming ''WO 01/15666 PCT/CA0/01019 6 -6compound selected from the group consisting of lecithin, hyaluronic acid, pharmaceutically acceptable salts of hyaluronic acid, octylphenoxypolyethoxyethanol, glycolic acid, lactic acid, chamomile extract, cucumber extract, oleic acid, linolenic acid, borage oil, evening of primrose oil, trihydroxy oxo cholanylglycine, glycerin, polyglycerin, lysine, polylysine, triolein, chenodeoxycholate, deoxycholate and mixtures thereof, wherein the amount of each absorption enhancing compound is present in a concentration of from 1 to 10 wt./wt.% of the total formulation, and the total concentration of absorption enhancing compounds are less than 50 wt./wt.% of the formulation.

Preferably, the mixed micellar pharmaceutical formulation has a pH of between and In an embodiment, the alkali metal lauryl sulphate, the edetate and the alkali metal salicylate are each in a concentration of from 2 to 5 wt./wt.% of the total formulation.

In one embodiment, the edetate is an alkali metal edetate. Preferably the alkali metal edetate is be selected from the group consisting ofdisodium edetate, dipotassium edetate, and combinations thereof.

In another embodiment, the alkali metal lauryl sulphate is sodium lauryl sulphate.

In a further embodiment, the alkali metal salicylate is sodium salicylate.

In another embddiment, the lecithin is selected from the group consisting of saturated phospholipi, e.g. Phospholipon-H (trade mark) saturated phospholipid, unsaturated phospholipid, e.g. Phospholipon-G (trade mark) unsaturated phospholipid, phosphatidylcholine, phosphatidyl serine, sphingomyelin, phosphatidylethanolamine, cephalin, and lysolecithin.

In one embodiment, one of the absorption enhancing compounds is selected from the group consisting of hyaluronic acid, pharmaceutically acceptable salts of hyaluronic acid and mixtures thereof, the concentration such micelle forming compound being from about 1 to about 5 wt./wt.%.

In another embodiment, suitable for delivery through nasal passages, mixed micellar pharmaceutical formulation is suitably diluted to avoid irritation of the nasal WO 01/15666 PCT/CA00/01019 -7passages.

Another aspect of the present invention provides a mixed micellar pharmaceutical formulation, comprising a pharmaceutical agent in micellar form, water, an alkali metal C8 to C22 alkyl sulphate in a concentration of from I to 10 wt./wt.% of the total formulation, a pharmaceutically acceptable edetate in a concentration of from 1 to 10 wt./wt.% of the total formulation, at least one alkali metal salicylate in a concentration of from 1 to 10 wt./wt.% of thetotal formulation, and at least one micelle forming compound selected from the group consisting of lecithin, hyaluronic acid, pharmaceutically acceptable salts of hyaluronic acid, octylphenoxypolyethoxyethanol, glycolic acid, lactic acid, chamomile extract, cucumber extract, oleic acid, linolenic acid, borage oil, evening of primrose oil, menthol, trihydroxy oxo cholanylglycine andpharmaceutically acceptable salts thereof, glycerin, polyglycerin, lysine, polylysine, polidocanol alkyl ethers and analogues thereof, triolein, chenodeoxycholate, deoxycholate and mixtures thereof, wherein the amount of each absorption enhancing compound is present in a concentration of from 1 to 10 wt./wt.% of the total formulation, and the total concentration of absorption enhancing compounds are less than 50 wt./wt.% of the formulation.

Yet another aspect of the present invention provides that the mixed micellar aerosol pharmaceutical formulation additionally comprises i) a phenol selected from the group consisting of phenol and methyl phenol in a concentration of from 1 to wt./wt.% of the total formulation, and i) a propellant selected from the group consisting of Cl-C2 dialkyl ether, butanes, fluorocarbon propellant, hydrogen-containing fluorocarbon propellant, chlorofluorocarbon propellant, hydrogen-containing chlorofluorocarbon propellant, and mixtures thereof.

In one embodiment, the alkali metal C8 to C22 alkyl sulphate is in a concentration of from 2 to 5 wt./wt.% of the total formulation.

In another embodiment, the alkali metal C8 to C22 alkyl sulphate is sodium lauryl sulphate.

In another embodiment, the lecithin is saturated or unsaturated, preferably selected from the group consisting of phosphatidylcholine, phosphatidyl serine, sphingomyelin, phosphatidylethanolamine, cephalin, and lysolecithin.

WO 01/15666 PCT/CAOO/01019 8 In yet another embodiment, one of the micelle forming compounds is selected from the group consisting of hyaluronic acid, pharmaceutically acceptable salts of hyaluronic acid, polidocanol alkyl ethers, trihydroxy oxo cholanyl glycine, polyoxyethylene ethers and mixtures thereof, the concentration such absorption enhancing compound being from about 1 to about 5 wt./wt.%.

Preferably, the ratio of pharmaceutical agent, e.g. insulin, to propellant is from 5:95 to 25:75.

In another embodiment, the propellant is selected from the group consisting of tetrafluoroethane, tetrafluoropropane, dimethylfluoropropane, heptafluoropropane, dimethyl ether, n-butane and isobutane.

In yet another embodiment, the mixed micelar pharmaceutical formulation is contained in an aerosol dispenser.

For insulin-containing and some other/compositions, the composition may also contains at least one inorganic salt which op'ens channels in the gastrointestinal tract and may provide additional stimulation to release insulin. Non-limiting examples of inorganic salts are sodium, potassium,,calcium and zinc salts, especially sodium chloride, potassium chloride, calcium chloride, zinc chloride and sodium bicarbonate.

It will be recognized by those skilled in the art that for many pharmaceutical compositions it is usual to add at'least one antioxidant to prevent degradation and 2 0 oxidation of the pharmaceutically active ingredients. It will also be understood by those skilled in the art that colorants, flavouring agents and non-therapeutic amounts of other compounds may be included in the formulation. Typical flavouring agents are menthol and sorbitol.

In one embodiment the antioxidant is selected from the group consisting of tocopherol, deteroxime mesylate, methyl paraben, ethyl paraben and ascorbic acid and mixtures thereof. A preferred antioxidant is tocopherol.

In a preferred embodiment at least one protease inhibitor is added to the formulation to inhibit degradation of the pharmaceutical agent by the action of proteolytic enzymes. Of the known protease inhibitors, most are effective at 3 0 concentrations of from 1 to 3 wt./wt.% of the formulation.

Non-limiting examples of effective protease inhibitors are bacitracin, soyabean WO 01/15666 PCT/CA00/01019 "9 trypsin, aprotinin and bacitracin derivatives, e.g. bacitracin methylene disalicylate.

Bacitracin is the most effective of those named when used in concentrations of from to 2 Soyabean trypsin and aprotinin two may be used in concentrations of about 1 to 2 wt./wt.% of the formulation.

The formulation suitable for delivery through oral mucosal membranes may be in chewable form, in which case it will be necessary to add ingredients suitable for such form. Such ingredients include guar gum, powdered acacia, carrageenin, beeswax and xanthan gum.

The pharmaceutical agent may be selected from a wide variety of macromolecular agents, depending on the disorder being treated, generally with molecular weights greater than about 1000 and especially between about 1000 and 2 000 000. Preferred pharmaceutical agents are selected from the group consisting of insulin, heparin, low molecular weight heparin, hirulog, hirugen, huridine, interferons, interleukins, cytokins, mono and polyclonal antibodies, immunoglobins, chemotherapeutic agents, vaccines, glycoproteins, bacterial toxoids, hormones, calcitonins, insulin like growth factors (IGF), glucagon like peptides (GLP-1), large molecule antibiotics, protein based thrombolytic compounds, platelet inhibitors, DNA, RNA, gene therapeutics and antisense oligonucleotides, and small molecule drugs, e.g.

opioids, narcotics, analgesics, NSAIDS, steroids, hypnotics, pain killers, morphine and the like.

The present invention also provides a process for making a pharmaceutical composition suitable for delivery through transdermal membranes comprising: a) preparing a proteinic pharmaceutical agent composition in micellar form in an aqueous medium which has an alkali metal salicylate in a concentration of from 1 to 10 wt./wt.% of the aqueous micellar pharmaceutical agent composition, an alkali metal lauryl sulphate in a concentration of from 1 to 10 wt./wt.% of the aqueous micellar pharmaceutical agent composition and a pharmaceutically acceptable edetate in a concentration of from 1 to 10 wt./wt.% of the aqueous micellar pharmaceutical agent composition; b) slowly adding the micellar proteinic pharmaceutical agent composition to at least one of the absorption enhancing compounds selected from the group consisting of lecithin, WO 01/15666 PCT/CA00/01019 10 hyaluronic acid, pharmaceutically acceptable salts ofhyaluronic acid, octylphenoxypolyethoxyethanol, glycolic acid, lactic acid, chamomile extract,.* cucumber extract, oleic acid, linolenic acid, borage oil, evening of primrose oil, trihydroxy oxo cholanylglycine, glycerin, polyglycerin, lysine, polylysine, triolein, chenodeoxycholate, deoxycholate and mixtures thereof, whilenixing vigorously, to form a mixed micellar composition; wherein the amount of the absorption enhancing compounds are each present in a concentration of from 1 to 10 wt./wt.% of the total formulation, and the total concentration of alkali metal salicylate, alkalimetal lauryl sulphate, edetate and absorption enhancing compounds is less than 50 wt./wt.% of the formulation.

In one embodiment, the process provides an additional step of adding, while continuing vigorous mixing, at least.dne absorption enhancing compound different from that added in step selected from the group consisting of lecithin, hyaluronic acid, pharmaceutically acceptable salts of hyaluronic acid, octylphenoxypolyethoxyethanol, glycolic acid, lactic acid, chamomile extract, cucumber extract, oleic acid, linolenic acid, borage oil, evening of primrose oil, trihydroxy oxo cholanylglycine, glycerin, polyglycerin, lysine, polylysine, triolein, chenodeoxycholate, deoxycholate and mixtures thereof.

In one embodiment the alkali metal lauryl sulphate is sodium lauryl sulphate.

In another embodiment the alkali metal salicylate is sodium salicylate.

In a further embodiment the alkali metal edetate may be selected from the group consisting of disodium edetate and dipotassium edetate.

In yet another embodiment, the formulation has a combinations selected from the group consisting of sodium hyaluronate and unsaturated phospholipid, ii) Phospholipon-H and glycolic acid, and iii) sodium hyaluronate and lecithin.

The present invention also provides a process for making a pharmaceutical composition suitable for delivery by means of an aerosol comprising: a) preparing a pharmaceutical agent composition in micellar form in an aqueous medium which has an alkali metal C8 to C22 alkyl sulphate in a concentration of from 1 to 10 wt./wt.% of the aqueous micellar pharmaceutical agent composition, a pharmaceutically acceptable edetate in a concentration of from 1 to 10 wt./wt.% of the WO 01/15666 PCT/CA00/01019 11 aqueous micellar pharmaceutical agent composition, at least one alkali metal salicylate in a concentration of from I to 10 wt./wt.% of the aqueous micellar pharmaceutical agent composition; b) slowly adding the micellar proteinic pharmaceutical agent composition to at least one of the absorption enhancing compounds selected from the group consisting of lecithin, hyaluronic acid, pharmaceutically acceptable salts of hyaluronic acid, octylphenoxypolyethoxyethanol, glycolic acid, lactic acid,,6hamomile extract, cucumber extract, oleic acid, linolenic acid, borage oil, evening of primrose oil, menthol, trihydroxy oxo cholanylglycine and pharmaceutically acceptable salts thereof, glycerin, polyglycerin, lysine, polylysine, polidocanol alkyl ethers and analogues thereof, triolein, chenodeoxycholate, deoxycholate and mixtures thereof, while mixing vigorously, to form a mixed micellar composition; and optionally c) an additional step of adding, while continuing vigorous mixing, at least one micelle forming compound different from that added in step selected from the group consisting of lecithin, hyaluronic acid, pharmaceutically acceptable salts of hyaluronic acid, glycolic acid, lactic acid, chamomile extract, cucumber extract, oleic acid, linoleic acid, linolenic acid, monoolein, borage oil, evening of primrose oil, glycerin, polyglycerin, lysine, polylysine, triolein, polyoxyethylene ethers and analogues thereof, polidocanol alkyl ethers and analogues thereof, and mixtures thereof; d) mixing the mixed micellar composition resulting from steps a) to c) with a phenol selected from the group consisting of phenol, m-cresol and mixtures thereof; and subsequently e) placing the formulation into an aerosol dispenser and charging the dispenser a propellant; wherein each of the absorption enhancing compounds are present in a concentration of from 1 to 10 wt./wt.% of the total formulation, and the total concentration of alkali metal salicylate, alkali metal C8 to C22 alkyl sulphate, edetate and absorption enhancing compounds is less than 50 wt./wt.% of the formulation.

The vigorous mixing may be accomplished using high speed stirrers,The vigorous mixing may be accomplished by using high speed stirrers, e.g. magnetic stirrers or propellor stirrers, or by sonication.

WO 01/15666 PCT/CA00/01019 12 In one embodiment, the mixed micellar formulation is formed by sonication of the aqueous micellar pharmaceutical agent composition in the presence of lecithin.

The present invention also provides a metered dose aerosol dispenser with the composition of the present invention therein.

The present invention also provides a method for administering mixed micellar pharmaceutical formulations of the present invention, by spraying the intermixed composition into the mouth with a metered dose spray device.

The present invention also provides a method'for administration of a proteinic pharmaceutical agent in a buccal cavity of a human being by spraying into the cavity, without inhalation, from a metered dose spray dispenser, a mixed micellar pharmaceutical formulation and a propellant comprising: i) a proteinic pharmaceutical agent in micellar form, water, an alkali metal lauryl sulphate in a concentration of from I to 10 wt./wt.% of the total formulation, a pharmaceutically acceptable edetate'in a concentration of from 1 to 10 wt./wt.% of the total formulation, at least one alkali metal salicylate in a concentration of from I to wt./wt.% of the total formulation, and at least one micelle forming compound selected from the group consisting of lecithin, hyaluronic acid, pharmaceutically acceptable salts ofhyaluronic acid, octylphenoxypolyethoxyethanol, glycolic acid, lactic acid, chamomile extract, cucumber extract, oleic acid, linolenic acid, borage oil, evening of primrose oil, trihydroxy oxo cholanylglycine, glycerin, polyglycerin, lysine, polylysine, triolein, chenodeoxycholate, deoxycholate and mixtures thereof, wherein the amount of each absorption enhancing compound is present in a concentration of from 1 to wt./wt.% of the total formulation, and the total concentration of absorption enhancing compounds are less than 50 wt./wt.% of the formulation; ii) a phenol selected from the group consisting of phenol and methyl phenol in a concentration of from 1 to 10 wt./wt.% of the total formulation; and iii) a propellant selected from the group consisting of Cl-C2 dialkyl ether, butanes, fluorocarbon propellant, hydrogen-containing fluorocarbon propellant, chlorofluorocarbon propellant, hydrogen-containing chlorofluorocarbon propellant, and mixtures thereof.

WO 01/15666 PCT/CA00/01019 13 Modes For Carrying Out The Invention The present invention provides an improved method for delivery of macromolecular (high molecular weight) pharmaceutical agents, particularlythrough the membranes in the nose, mouth, vagina or rectum. The preferred delivery is through oral and nasal cavities. The pharmaceutical agents cover a wide spectrum of agents, including proteins, peptides, hormones, vaccines and drugs. The molecular weights of the macromolecular pharmaceutical agents are preferably above 1000, especially between 1000 and 2 000 000.

For example, hormones which may be administered with the present invention include thyroids, androgens, estrogens, prostaglandins, somatotropins, gonadotropins, erythropoetin, interferons, interleukins, steroids and cytokins. Vaccines which may be administered with the present invention include bacterial and viral vaccines such as vaccines for hepatitis, influenza, tuberculosis, canary pox, chicken pox, measles, mumps, rubella, pneumonia, BCG, HIV and AIDS. Bacterial toxoids which may be administered using the present invention include diphtheria, tetanus, pseudonomas and mycobactrium tuberculosis. Examples of specific cardiovascular or thromobolytic agents include heparin, hirugen, hirulos and hirudin. Large molecules usefully administered with the present invention include monoclonal antibodies, polyclonal antibodies and immunoglobins.

As will be understood, the concentration of the pharmaceutical agent is an amount sufficient to be effective in treating or preventing a disorder or to regulate a physiological condition in an animal or human. The concentration or amount of pharmaceutical agent administered will depend on the parameters determined for the agent and the method of administration, e.g. oral, nasal. For example, nasal formulations tend to require much lower concentrations of some ingredients in order to avoid irritation or burning of the nasal passages. It is sometimes desirable to dilute an oral formulation up to 10-100 times in order to provide a suitable nasal formulation.

The mixed micellar formulation is prepared by first preparing a first micellar composition which contains the pharmaceutically active agents, alkali metal C8 to C22 alkyl sulphate, edetate and alkali metal salicylate. For those compositions intended for administration through the nasal, oral, vaginal or rectal cavities, the first micellar WO 01/15666 PCT/CA00/01019 14 composition is then added to at least one of the absorption enhancing compounds to form a mixed micellar composition. At least one other absorption enhancing compound may also be added subsequently. Preferably the first absorption enhancing compound is lecithin.

When making the aerosol formulation, the phenol and/or m-cresol and/or isotonic agent, e.g. glycerin, are then added. The formulation is then put into an aerosol dispenser and the dispenser charged with the propellant/The propellant, which is under pressure, is in liquid form in the dispenser. In/the present invention, when the composition of the present invention is in a dispenser, the aqueous phase may be separated from the propellant phase. Preferably, however, the ratios of the ingredients are adjusted by simple experimentation so that the aqueous and propellant phases become one, i.e. there is one phase. If there are two phases, it is necessary to shake the dispenser prior to dispensing a portion of the contents, e.g. through a metered valve. The dispensed dose of pharmaceutical'agent is propelled from the metered valve in a fine spray.

The preferred propellants are hydrogen-containing chlorofluorocarbons, hydrogen-containing fluorocarbons, dimethyl ether and diethyl ether. Even more preferred is hydrofluoroalkane (HFA) 134a (1,1,1,2 tetrafluoroethane).

Although the present invention has such wide applicability, the invention is described hereinafter with particular reference to insulin and its analogues, which are used for the treatment of diabetes.

As indicated hereinbefore, the compositions of the present invention require that the pharmaceutical formulation be in mixed micellar form.

In the case of insulin, which is intended for administration through nasal or oral cavities, the first micellar solution may be made by adding a buffer solution to powdered insulin, and then stirring until the powder is dissolved and a clear solution is obtained. A typical buffer solution is an aqueous solution of sodium salicylate and sodium lauryl sulphate and disodium edetate. Typical concentration of sodium salicylate and sodium lauryl sulphate in the aqueous solution are about 3 to 20 wt./wt.% of each compound in the solution. Typically, insulin is present in the micellar solution in an amount which will give a concentration of about 2 to 4 wt./wt.% of the final WO 01/15666 PCT/CA00/01019 15 formulation. Typically the concentration may be about 10 wt./wt.% of the first micellar composition.

The micellar solution is then added slowly to the first absorption enhancing compound, e.g. lecithin while mixing vigorously, e.g. sonicating, to orm a mixed micelle liposomal solution. At least one other absorption enhancing compounds selected from the group consisting of lecithin, hyaluronic aci, pharmaceutically acceptable salts of hyaluronic acid, octylphenoxypolyethoxyethanol, glycolic acid, lactic acid, chamomile extract, cucumber extract, oleic'acid, linolenic acid, borage oil, evening of primrose oil, trihydroxy oxo cholanylglycine, glycerin, polyglycerin, lysine, polylysine, triolein, chenodeoxycholate, deoxycholate is then added. The mixing may be done with a high speed mixer or sonicator to ensure uniform micelle particle size distribution within the formulation.

Each of the absorption enhancing compounds, when present, is in a concentration of from 1 to 10 wt./wt.% of the total formulation.

Preferred salts of hyaluronic acid are alkali metal hyaluronates, alkaline earth hyaluronates and aluminium hyaluronate. The preferred salt is sodium hyaluronate.

The preferred concentration of hyaluronic acid or pharmaceutically acceptable salts of hyaluronic acid is from 1 to 5 wt./wt.% of the total formulation. An even more preferred range is from 1.5 to 3.5 wt./wt.% of the total formulation.

Other ingredients may be added to the mixed micellar solution. For example, flavouring agents, antioxidants, salts, protease inhibitors or other pharmaceutically acceptable compound may be added.

In general the size of the micelle particles in the solution is about 1 to 10 nm, and preferably from 1 to 5 nm. Such a size distribution ensures effective absorption of the formulation, and therefore the pharmaceutical agent, through the membranes, for example the membranes in the oral and nasal cavities.

The specific concentrations of the essential ingredients can be determined by relatively straightforward experimentation. For absorption through the nasal and oral cavities, it is often desirable to increase, e.g. double or triple, the dosage which is normally required through injection of administration through the gastrointestinal tract.

As will be understood, the amount of each component of the formulation will ''WO 01115666 PCT/CA00/01019 16 vary depending on the pharmaceutical agent and the site of applications Preferred formulations oral or nasal application have the following combinations: i) sodium lauryl sulphate, sodium salicylate, disodium edetate, Phospholipon-H and sodium hyaluronate; ii) sodium lauryl sulphate, sodium salicylate, disodium edetate, lecithin and sodium hyaluronate; iii) sodium lauryl sulphate, sodium salicylate, disodium edetate, sodium hyaluronate and eyening of primrose oil; iv) sodium lauryl sulphate, sodium salicylate, disodium,edetate, Phospholipon-H and bacitracin; v) sodium lauryl sulphate, sodium salicylate, disodium edetate, Phospholipon-H, sodium hyaluronate and bacitracin; vi) sodium lauryl sulphate, sodium salicylate, disodium edetate, sodium hyaluronate, oleic acid and gamma linoleic acid; and vii) sodium lauryl sulphate, sodium salicylate, disodium edetate, trihydroxyoxo-cholanyl glycine, lecithin/and chenodeoxycholate.

For aerosol formulations, the addition of a mixture of phenol and m-cresol is preferred. Such an aerosol formulation may then be charged to an aerosol dispenser and then charged with a propellant, preferably a non-CFC propellant.

The therapeutic compositions of the present invention may be stored at room temperature or at cold temperature. Storage of proteinic drugs is preferable at a cold temperature to prevent degradation of the drugs and to extend their shelf life.

As indicated hereinbefore, generally, oral and nasal are the favourite sites of the administration but the composition can be applied to the rectal and vaginal mucosa.

According to the physiologically active peptide or protein used, the dosage form and the site of administration a specific administration method can be selected.

The composition of this invention is generally prepared as microfine mixed micellar particles (1 to 10 nm or less) by the virtue of its preparation methods used and suitable combinations of absorption enhancer characteristics. Preferably, size of the micelle particles in the mixed micellar composition is about 1 to 5 nm. Such mixed micelles tend to be smaller than the pores of the membranes in the oral cavity or the GI tract. It is therefore believed that the extremely small size of mixed micelles helps the encapsulated molecules penetrate efficiently through the mucosal membranes of the 3 0 oral cavity.

The desired size of aerosol droplets which are sprayed from the aerosol WO 01/15666 PCT/CA00/01019 17 dispenser will depend, in part, on where the pharmaceutical is to be deposited. For example, for deposition in the lungs, particle sizes of less than about 5 im are preferred whereas for absorption in the buccal cavity of the mouth, particle sizes of about 6pmr are preferred. For oral and nasal application, sprays are preferable, but also drops, chewable tablets, chewable gum and other suitable forms may be used Utilization of atomizer or aerosol spray devices (metered dose inhalers or nebulizers) can be used to further reduce the particle size for effective inhalation from the nasal or oral cavity so the drug may successfully reach to the specific site and be absorbed. It is also possible to utilize a drug delivery system such that an enteric coating is applied to the gelatin capsule to cause the micelles to be released only in the duodenum or in the proximity of the large intestine and not in the stomach.

It is believed that improvements in penetration and absorption of mixed micellar formulations in the mouth is achieved by mixing the mixed micellar formulation with propellants such as tetrafluoroethane,:heptafluoroethane, dimethylfluoropropane, tetrafluoropropane, butane, isobutane, dimethyl ether and other non-CFC and CFC propellants. Preferably they are delivered through metered dose spray devices.

Metered dose inhalers are known and are a popular pulmonary drug delivery form for some drugs. One of the benefits of using an atomizer or inhaler is that the potential for contamination is minimized because the devices are self contained.

The present formulation, including the propellant, is intended to improve the quality of absorption, stability and performance of many formulations. The compositions have been selected to give enhancement in the penetration through pores, and facilitate absorption of the drugs to reach therapeutic levels in the plasma.

Administration of the formulation into the buccal cavity is by spraying the formulation into the mouth, without inhalation, so that the droplets stay in the mouth rather than be drawn into the lungs.

The invention is illustrated by reference to the following examples.

Example 1 A first experiment was conducted to provide data for comparative purposes.

-2easily. Further, there is a good potential for prolonged delivery of large molecules through these membranes.

The oral routes have received far more attention than have the other routes. The sublingual mucosa includes the membrane of ventral surface of the tongue and the floor of the mouth whereas the buccal mucosa constitutes the lining of the cheek. The sublingual mucosa is relatively permeable thus giving rapid absorption and acceptable bioavailability of many drugs. Further, the sublingual mucosa is convenient, acceptable and easily accessible. This route has been investigated clinically for the delivery of a substantial number of drugs.

The ability of molecules to permeate through the oral mucosa appears to be related to molecular size, lipid solubility and peptide protein ionization. Small molecules, less than 1000 daltons appear to cross mucosa rapidly. As molecular size increases, the permeability decreases rapidly. Lipid soluble compounds are more permeable than non-lipid soluble molecules. Maximum absorption occurs when molecules are un-ionized or neutral in electrical charges. Therefore, charged molecules present the biggest challenges to absorption through the oral mucosae.

Many drug molecules are extremely large molecules with molecular weights exceeding 6000 daltons. These large molecules have very poor lipid solubility and are practically impermeable. Substances that facilitate the absorption or transport of large 20 molecules 2000 daltons) across biological membranes are known as enhancers, (Lee et al., Critical Reviews in Therapeutic drug Carrier Systems, 8,91, 1991; Lee et al., S Critical Reviews in Therapeutic drug Carrier Systems, 8,115, 1991,1992). Enhancers may be characterized as chelators, bile salts, fatty acids, synthetic hydrophilic and hydrophobic compounds, and biodegradable polymeric compounds.

Various mechanisms of action of enhancers have been proposed. These mechanisms of action, at least for protein and peptidic drugs include, reducing viscosity and/or elasticity of the mucous layer, facilitating transcellular transport by increasing the fluidity of the lipid bilayer of membranes, and increasing the thermodynamic activity of drugs (Critical Rev, 117-125, 1991, 1992).

30 Many enhancers have been tested so far and some have been found to be effective in facilitating mucosal administration of large molecule drugs. However, Shardly any penetration enhancing products have reached the marketplace. Reasons for -3this include the lack of a satisfactory safety profile respecting irritation, lowering of the barrier function, and impairment of the mucocilliary clearance protective mechanism.

The main factor to be considered in the use of enhancers, especially bile salts and some protein solubilizing agents, is extremely bitter and unpleasant taste. This makes their use almost impossible for human consumption on a daily basis. Several approaches were utilized to improve the taste of the bile salts based delivery systems, but none of them are commercially acceptable for human consumption to date. The approaches utilized include patches for buccal mucosa, bilayer tablets, controlled release tablets, use of protease inhibitors, buccally administered film patch devices, and various polymer matrices.

The basic problem associated with the above technologies is the use of large quantities of bile acids and their salts to promote the transport of the large molecules through membranes in the form of localized delivery systems using patches or tablets.

In spite of using protease inhibitors and polymer coatings, the technologies failed to deliver large molecule drugs in the required therapeutic concentrations. Further, the problem is compounded because of the localized site effect of the patch which resulted in severe tissue damage in the mouth. Most attempts were made to deliver large molecules via the oral, nasal, rectal, and vaginal routes using single bile acids or enhancing agents in combination with protease inhibitors and biodegradable polymeric 20 materials. However, it is extremely difficult to achieve therapeutic levels of large molecule drugs using these formulations. Single enhancing agents fail to loosen tight cellular junctions in the oral, nasal, rectal and vaginal cavities for a required period of time to allow the passage of large molecules through the mucosal membranes without further degradation. This problem makes it impractical to use the above mentioned systems for a commercial purpose.

In order to overcome the above mentioned problem of the bitter taste, irritation and the penetration of large molecules through the sublingual, buccal and GI tract *o mucosal lining, a system has now been designed where large molecule drug is encapsulated in mixed micelles made up of a combination of enhancers, e. g. yolk 30 proteins (lecithins). This system allows opening of the paracellular junctions (tight junctions) in oral membranes as well as in the GI tract by gI motility movement with a -4high degree of protease activity preserved, and protects molecules from premature degradation in the hostile acidic and proteolytic GI environment.

It is believed that the mixed micelles encapsulate molecules with a high degree of efficiency 90% encapsulation). These mixed micelles are extremely small in size (1 nm to 10 nm), and are smaller than the pores of the membranes in the oral cavity or the GI tract. It is therefore believed that the extremely small size of mixed micelles helps encapsulated molecules penetrate efficiently through the mucosal membranes of the oral cavity.

The absorption of large molecules, such as proteins and peptides, is believed to be enhanced by the diffusion of large molecules entrapped in the mixed micellar form through the aqueous pores and the cell structure perturbation of the tight paracellular junctions.

The amount of physiologically active pharmaceutical agent in the compositions of this invention is typically a quantity that provides an effective amount of the drug to produce the physiological activity (therapeutic plasma level) for which the active pharmaceutical agent is being administered. In consideration of the fact that the bioavailability of any active substance can never be 100%, that is to say the administered dose of the active drug is not completely absorbed, it is preferable to incorporate a slightly larger amount than the desired dosage. Where the dosage form is a 20 spray (aerosol) or the like which is repeatedly dispensed from the same container, it is recommended that the unit dose will be slightly greater than the desired dose. It should be understood that dosage should vary with species of warm blooded animals such as o. man, domestic animals, and their body weights. The composition of this invention is prepared as microfine droplets (1 to 10 nm or less) by virtue of the preparation methods and the characteristics if suitable combinations of enhancer compound used. Atomizer or aerosol spray devices (metered dose inhalers or nebulizers) may be useful furthering effecting a sufficient reduction in particle size for effective inhalation from the nasal or oral cavity so that the drug may successfully be absorbed or reach the specific site.

o *The therapeutic composition of the present invention can be stored at room 30 temperature or at cold temperatures. It is preferable to store large molecule drugs at cold temperatures to prevent their degradation and to extend their shelf life. The mixed micellar therapeutic composition of the invention is applied to the mucosal membranes, and the sites of administration may be the same as those used for usual mucosal therapeutic preparations. Generally, oral, transdermal and nasal sites are favoured but the composition can be applied to the rectal and vaginal mucosa. According to the physiologically active pharmaceutical agent used, the dosage form and the site of administration, a specific administration method can be selected.

The term "edetate" is used herein to refer to pharmaceutically acceptable salts of ethylenediaminetetraacetic acid.

It has also been found that improvements in penetration and absorption of mixed micellar formulations can be achieved by mixing the mixed micellar formulation with propellants such as tetrafluoroethane, heptafluoroethane, dimethylfluoropropane, tetrafluoropropane, butane, isobutane, dimethyl ether and other non-CFC and CFC propellants. Preferably they are delivered through metered dose spray devices. Metered dose inhalers are known and are a popular pulmonary drug delivery form for some drugs. The present formulation, including the propellant is intended to improve the quality of absorption, stability and performance of many formulations. The compositions have been selected to give enhancement in the penetration through pores, and facilitate absorption of the drugs to reach therapeutic levels in the plasma. The present formulation may be absorbed buccally, by ensuring that the person does not inhale the formulation as it.is sprayed. One of the other benefits of using an atomizer or S* 20 inhaler is that the potential for contamination is minimized because the devices are self contained.

Disclosure of Invention Accordingly, the present invention provides a mixed micellar pharmaceutical formulation including a pharmaceutical agent in micellar form, water, an alkali metal lauryl sulphate in a concentration of from 1 to 10 wt./wt. of the total formulation, a pharmaceutically acceptable edetate in a concentration of from 1 to 10 wt./wt. of the total formulation, at least one alkali metal salicylate in a concentration of from 1 to S. wt./wt. of the total formulation, and at least one absorption enhancing compound 30 selected from the group consisting of lecithin, hyaluronic acid, pharmaceutically acceptable salts of hyaluronic acid, octylphenoxypolyethoxyethanol, glycolic acid, lactic acids chamomile extract, cucumber extract, oleic acid, linolenic acid, borage oil, evening primrose oil, trihydroxy oxo cholanylglycine, glycerin, polyglycerin, lysine, polylysine, triolein, chenodeoxycholate, deoxycholate and mixtures thereof, wherein each absorption enhancing compound is present in a concentration of from 1 to wt./wt. of the total formulation, and the total concentration of absorption enhancing compounds is less than 50 wt./wt. of the formulation.

In an embodiment, the alkali metal lauryl sulphate, the edetate and the alkali metal salicylate are each in a concentration of from 2 to 5 wt./wt. of the total formulation.

In one embodiment, the edetate is an alkali metal edetate. Preferably the alkali metal edetate is selected from the group consisting of disodium edetate, dipotassium edetate, and combinations thereof.

In a further embodiment, the alkali metal salicylate is sodium salicylate.

In another embodiment, the lecithin is selected from the group consisting of saturated phospholipid, e.g. Phospholipon-H (trade mark) saturated phospholipid, unsaturated phospholipid, e.g. Phospholipon-G (trade mark) unsaturated phospholipid, phosphatidylcholine, phosphatidyl serine, sphingomyelin, phosphatidylethanolamine, i 20 cephalin, and lysolecithin.

In one embodiment, one of the absorption enhancing compounds is selected from the group consisting of hyaluronic acid, pharmaceutically acceptable salts of hyaluronic acid and mixtures thereof, the concentration of such absorption enhancing compound being from about 1 to about 5 wt./wt. In another embodiment, suitable for delivery through nasal passages, mixed micellar pharmaceutical formulation is suitably diluted to avoid irritation of the nasal passages.

~Another aspect of the present invention provides a mixed micellar pharmaceutical formulation suitable for delivery by means of an aerosol andincluding a 30 pharmaceutical agent in micellar form, water, an alkali metal C8 to C22 alkyl sulphate S in a concentration of from 1 to 10 wt./wt. of the total formulation, a pharmaceutically acceptable edetate in a concentration of from 1 to 10 wt./wt. of the total formulation, at least one alkali metal salicylate in a concentration of from 1 to 10 wt./wt. of the total formulation, and at least one absorption enhancing compound selected from the group consisting of lecithin, hyaluronic acid, pharmaceutically acceptable salts of hyaluronic acid, octylphenoxypolyethoxyethanol, glycolic acid, lactic acid, chamomile extract, cucumber extract, oleic acid, linolenic acid, borage oil, evening primrose oil, menthol, trihydroxy oxo cholanylglycine and pharmaceutically acceptable salts thereof, glycerin, polyglycerin, lysine, polylysine, polidocanol alkyl ethers and analogues thereof, triolein, chenodeoxycholate, deoxycholate and mixtures thereof, wherein each absorption enhancing compound is present in a concentration of from 1 to 10 wt./wt. of the total formulation, and the total concentration of absorption enhancing compounds is less than 50 wt./wt. of the formulation.

Yet another aspect of the present invention provides that the mixed micellar aerosol pharmaceutical formulation additionally includes i) a phenol selected from the group consisting of phenol and methyl phenol in a concentration of from 1 to 10 wt./wt.

of the total formulation, and ii) a propellant selected from the group consisting of Cl- C2 dialkyl ether, butanes, fluorocarbon propellant, hydrogen-containing fluorocarbon propellant, chlorofluorocarbon propellant, hydrogen-containing chlorofluorocarbon propellant, and mixtures thereof.

In one embodiment, the alkali metal C8 to C22 alkyl sulphate is in a concentration of from 2 to 5 wt./wt. of the total formulation.

In another embodiment, the lecithin is saturated or unsaturated, preferably selected from the group consisting of phosphatidylcholine, phosphatidyl serine, 25 sphingomyelin, phosphatidylethanolamine, cephalin, and lysolecithin.

In yet another embodiment, one of the absorption enhancing compounds is selected from the group consisting of hyaluronic acid, pharmaceutically acceptable salts of hyaluronic acid, polidocanol alkyl ethers, trihydroxy oxo cholanyl glycine, polyoxyethylene ethers and mixtures thereof, the concentration of such absorption 30 enhancing compound being from about 1 to about 5 wt./wt. In yet another embodiment, the formulation includes a combination selected from the group consisting of i) sodium lauryl sulphate, sodium salicylate, disodium *O0 oooo edetate, saturated phospholipid and sodium hyaluronate; ii) sodium lauryl sulphate, sodium salicylate, disodium edetate, lecithin and sodium hyaluronate; iii) sodium lauryl sulphate, sodium salicylate, disodium edetate, sodium hyaluronate and evening primrose oil; iv) sodium lauryl sulphate, sodium salicylate, disodium edetate, saturated phospholipid and bacitracin; v) sodium lauryl sulphate, sodium salicylate, disodium edetate, saturated phospholipid, sodium hyaluronate, and bacitracin; vi) sodium lauryl sulphate, sodium salicylate, disodium edetate, sodium hyaluronate, oleic acid and gamma linoleic acid; vii) sodium lauryl sulphate, sodium salicylate, disodium edetate, saturated phospholipid, and glycolic acid; and viii) sodium lauryl sulphate, sodium salicylate, disodium edetate, saturated phospholipid, glycolic acid and lactic acid.

Preferably, the ratio of pharmaceutical agent, e. g. insulin, to propellant is from 1:19 to 1:3.

In yet another embodiment, the mixed micellar pharmaceutical formulation is contained in an aerosol dispenser.

For insulin-containing and some other formulations, the formulation may also contain at least one inorganic salt which opens channels in the gastrointestinal tract and may provide additional stimulation to release insulin. Non-limiting examples of inorganic salts are sodium, potassium, calcium and zinc salts, especially sodium chloride, potassium chloride, calcium chloride, zinc chloride and sodium bicarbonate.

It will be recognized by those skilled in the art that for many pharmaceutical formulations it is usual to add at least one antioxidant to prevent degradation and 25 oxidation of the pharmaceutically active ingredients. It will also be understood by those skilled in the art that colorants, flavouring agents and non-therapeutic amounts of other compounds may be included in the formulation. Typical flavouring agents are menthol and sorbitol.

In one embodiment the antioxidant is selected from the group consisting of S0. 30 tocopherol, deteroxime mesylate, methyl paraben, ethyl paraben and ascorbic acid and mixtures thereof. A preferred antioxidant is tocopherol.

**go In preferred embodiments at least one protease inhibitor is added to the formulation to inhibit degradation of the pharmaceutical agent by the action of proteolytic enzymes. Of the known protease inhibitors, most are effective at concentrations of from 1 to 3 wt./wt. of the formulation.

Non-limiting examples of effective protease inhibitors are bacitracin, soyabean trypsin, aprotinin and bacitracin derivatives, e. g. bacitracin methylene disalicylate.

Bacitracin is the most effective of those named when used in concentrations of from to 2 wt./wt. Soyabean trypsin and aprotinin may be used in concentrations of about 1 to 2 wt./wt. of the formulation.

The pharmaceutical agent may be selected from a wide variety of macromolecular agents, depending on the disorder being treated, generally with molecular weights greater than about 1000 and especially between about 1000 and 2 000 000. Preferred pharmaceutical agents are selected from the group consisting of insulin, heparin, low molecular weight heparin, hirulog, hirugen, huridine, interferons, interleukins, cytokins, mono and polyclonal antibodies, immunoglobins, chemotherapeutic agents, vaccines, glycoproteins, bacterial toxoids, hormones, calcitonins, insulin like growth factors (IGF), glucagon like peptides (GLP-1), large molecule antibiotics, protein based thrombolytic compounds, platelet inhibitors, DNA, S RNA, gene therapeutics and antisense oligonucleotides, and small molecule drugs, e. g.

opioids, narcotics, analgesics, NSAIDS, steroids, hypnotics, pharmaceutical 25 preparations for the treatment of chronic pain, morphine and the like.

The present invention also provides a process for making a pharmaceutical formulation suitable for delivery through transdermal membranes including: a) preparing a pharmaceutical agent composition in micellar form in an aqueous medium by adding the pharmaceutical agent, an alkali metal salicylate in a 30 concentration of from 1 to 10 wt./wt. of the total formulation, an alkali metal lauryl sulphate in a concentration of from 1 to 10 wt./wt. of the total formulation and a ooooo pharmaceutically acceptable edetate in a concentration of from 1 to 10 wt./wt. of the aqueous micellar pharmaceutical agent formulation; b) slowly adding the micellar pharmaceutical agent composition to at least one absorption enhancing compound selected from the group consisting of lecithin, hyaluronic acid, pharmaceutically acceptable salts of hyaluronic acid, octylphenoxypolyethoxyethanol, glycolic acid, lactic acid, chamomile extract, cucumber extract, oleic acid, linolenic acid, borage oil, evening primrose oil, trihydroxy oxo cholanylglycine, glycerin, polyglycerin, lysine, polylysine, triolein, chenodeoxycholate, deoxycholate and mixtures thereof, while mixing vigorously, to form a mixed micellar formulation; wherein the amount of the absorption enhancing compounds are each present in a concentration of from 1 to 10 wt./wt. of the total formulation, and the total concentration of alkali metal salicylate, alkali metal lauryl sulphate, edetate and absorption enhancing compounds is less than 50 wt./wt. of the formulation.

In one embodiment, the process provides an additional step of adding, while continuing vigorous mixing, at least one absorption enhancing compound different from that added in step selected from the group consisting of lecithin, hyaluronic acid, pharmaceutically acceptable salts of hyaluronic acid, octylphenoxypolyethoxyethanol, glycolic acid, lactic acid, chamomile extract, cucumber extract, oleic acid, linolenic acid, borage oil, evening of primrose oil, trihydroxy oxo cholanylglycine, glycerin, polyglycerin, lysine, polylysine, triolein, chenodeoxycholate, deoxycholate and mixtures thereof.

In one embodiment the alkali metal lauryl sulphate is sodium lauryl sulphate.

In another embodiment the alkali metal salicylate is sodium salicylate.

25 In a further embodiment the alkali metal edetate may be selected from the group consisting of disodium edetate and dipotassium edetate.

In yet another embodiment, the formulation has a combination selected from the group consisting of i) saturated phospholipid and sodium hyaluronate; ii) saturated phospholipid and glycolic acid; iii) lecithin and sodium hyaluronate; iv) saturated 30 phospholipid, glycolic acid and lactic acid; v) sodium hyaluronate and evening primrose oil; vi) saturated phospholipid and bacitracin; vii) saturated phospholipid, sodium S hyaluronate and bacitracin; and viii) sodium hyaluronate, oleic acid, and gamma linoleic -11 acid. The present invention also provides a process for making a mixed micellar pharmaceutical formulation suitable for delivery by means of an aerosol including: a) preparing a pharmaceutical agent composition in micellar form in an aqueous medium by adding the pharmaceutical agent, an alkali metal C8 to C22 alkyl sulphate in a concentration of from 1 to 10 wt./wt. of the total formulation, a pharmaceutically acceptable edetate in a concentration of from 1 to 10 wt./wt. of the total formulation, at least one alkali metal salicylate in a concentration of from 1 to 10 wt./wt. of the total formulation; b) slowly adding the micellar proteinic pharmaceutical agent composition to at least one absorption enhancing compound selected from the group consisting of lecithin, hyaluronic acid, pharmaceutically acceptable salts of hyaluronic acid, octylphenoxypolyethoxyethanol, glycolic acid, lactic acid, chamomile extract, cucumber extract, oleic acid, linolenic acid, borage oil, evening primrose oil, menthol, trihydroxy oxo cholanylglycine and pharmaceutically acceptable salts thereof, glycerin, polyglycerin, lysine, polylysine, polidocanol alkyl ethers and analogues thereof, triolein, chenodeoxycholate, deoxycholate and mixtures thereof, while mixing vigorously, to form a mixed micellar formulation; and optionally c) an additional step of adding, while continuing vigorous mixing, at least one absorption enhancing compound different from that added in step selected from the group consisting of lecithin, hyaluronic acid, pharmaceutically acceptable salts of hyaluronic acid, glycolic acid, lactic acid, chamomile extract, cucumber extract, oleic *acid, linoleic acid, linolenic acid, monoolein, borage oil, evening primrose oil, glycerin, polyglycerin, lysine, polylysine, triolein, polyoxyethylene ethers and analogues thereof, .polidocanol alkyl ethers and analogues thereof, and mixtures thereof; 25 d) mixing the mixed micellar formulation resulting from steps a) to c) with a phenol selected from the group consisting of phenol, m-cresol and mixtures thereof; and subsequently e) placing the formulation into an aerosol dispenser and charging the dispenser with a propellant; 30 wherein each of the absorption enhancing compounds are present in a concentration of from 1 to 10 wt./wt. of the total formulation, and the total *eo oooo -12concentration of alkali metal salicylate, alkali metal C8 to C22 alkyl sulphate, edetate and absorption enhancing compounds is less than 50 wt./wt. of the formulation.

The vigorous mixing may be accomplished by using high speed stirrers, e.g.

magnetic stirrers or propellor stirrers, or by sonication.

In one embodiment, the mixed micellar formulation is formed by sonication of the aqueous micellar pharmaceutical agent composition in the presence of lecithin.

The present invention also provides a method for administering mixed micellar pharmaceutical formulations of the present invention, by spraying the intermixed formulation into the mouth with a metered dose spray device.

The present invention also provides a method for administration of a pharmaceutical agent in a buccal cavity of a human being by spraying into the cavity, without inhalation, from a metered dose spray dispenser, a mixed micellar pharmaceutical formulation and a propellant including: i) a pharmaceutical agent in micellar form, water, an alkali metal lauryl sulphate in a concentration of from 1 to 10 wt./wt. of the total formulation, a pharmaceutically acceptable edetate in a concentration of from 1 to 10 wt./wt. of the total formulation, at least one alkali metal salicylate in a concentration of from 1 to 10 wt./wt. of the total formulation, and at least one absorption enhancing compound selected from the group consisting of lecithin, hyaluronic acid, pharmaceutically acceptable salts of S. hyaluronic acid, octylphenoxypolyethoxyethanol, glycolic acid, lactic acid, chamomile extract, cucumber extract, oleic acid, linolenic acid, borage oil, evening primrose oil, trihydroxy oxo cholanylglycine, glycerin, polyglycerin, lysine, polylysine, triolein, 25 chenodeoxycholate, deoxycholate and mixtures thereof, wherein each absorption enhancing compound is present in a concentration of from 1 to 10 wt./wt. of the total formulation, and the total concentration of absorption enhancing compounds are less than 50 wt./wt. of the formulation; a phenol selected from the group consisting of phenol and methyl phenol in a 30 concentration of from 1 to 10 wt./wt. of the total formulation; and iii) a propellant selected from the group consisting of Cl-C2 dialkyl ether, butanes, fluorocarbon propellant, hydrogen-containing fluorocarbon propellant, o.

13 chlorofluorocarbon propellant, hydrogen-containing chlorofluorocarbon propellant, and mixtures thereof Modes For Carrying Out The Invention The present invention provides an improved method for delivery of macromolecular (high molecular weight) pharmaceutical agents, particularly through the membranes in the nose, mouth, vagina or rectum. The preferred delivery is through oral and nasal cavities. The pharmaceutical agents cover a wide spectrum of agents, including proteins, peptides, hormones, vaccines and drugs. The molecular weights of the macromolecular pharmaceutical agents are preferably above 1000, especially between 1000 and 2 000 000.

a As will be understood, the concentration of the pharmaceutical agent is an amount sufficient to be effective in treating or preventing a disorder or to regulate a 25 physiological condition in an animal or human. The concentration or amount of pharmaceutical agent administered will depend on the parameters determined for the agent and the method of administration, e.g. oral, nasal. For example, nasal formulations tend to require much lower concentrations of some ingredients in order to avoid irritation or burning of the nasal passages. It is sometimes desirable to dilute an 30 oral formulation up to 10-100 times in order to provide a suitable nasal formulation.

S: The mixed micellar formulation is prepared by first preparing a first micellar composition which contains the pharmaceutically active agents, alkali metal C8 to C22 -14alkyl sulphate, edetate and alkali metal salicylate. For those compositions intended for administration through the nasal, oral, vaginal or rectal cavities, the first micellar composition is then added to at least one of the absorption enhancing compounds to form a mixed micellar composition. At least one other absorption enhancing compound may also be added subsequently. Preferably the first absorption enhancing compound is lecithin.

When making the aerosol formulation, the phenol and/or m-cresol and/or isotonic agent, e. g. glycerin, are then added. The formulation is then put into an aerosol dispenser and the dispenser charged with propellant. The propellant, which is under pressure, is in liquid form in the dispenser. In the present invention, when the composition of the present invention is in a dispenser, the aqueous phase may be separated from the propellant phase. Preferably, however, the ratios of the ingredients are adjusted by simple experimentation so that the aqueous and propellant phases become one, i.e. there is one phase. If there are two phases, it is necessary to shake the dispenser prior to dispensing a portion of the contents, e. g. through a metered valve.

The dispensed dose of pharmaceutical agent is propelled from the metered valve in a fine spray.

Although the present invention has such wide applicability, the invention is S described hereinafter with particular reference to insulin and its analogues, which are used for the treatment of diabetes.

S-As indicated hereinbefore, the compositions of the present invention require that 25 the pharmaceutical formulation be in mixed micellar form.

In the case of insulin, which is intended for administration through nasal or oral cavities, the first micellar solution may be made by adding a buffer solution to powdered insulin, and then stirring until the powder is dissolved and a clear solution is obtained. A typical buffer solution is an aqueous solution of sodium salicylate and 30 sodium lauryl sulphate and disodium edetate. Typical concentration of sodium salicylate and sodium lauryl sulphate in the aqueous solution are about 3 to 20 wt./wt. of each compound in the solution. Typically, insulin is present in the micellar solution in an 15 amount which will give a concentration of about 2 to 4 wt./wt. of the final formulation. Typically the concentration may be about 10 wt./wt. of the first micellar composition.

The micellar solution is then added slowly to the first absorption enhancing compound, e. g. lecithin while mixing vigorously, e. g. sonicating, to form a mixed micelle liposomal solution. At least one other absorption enhancing compound selected from the group consisting of lecithin, hyaluronic acid, pharmaceutically acceptable salts of hyaluronic acid, octylphenoxypolyethoxyethanol, glycolic acid, lactic acid, chamomile extract, cucumber extract, oleic acid, linolenic acid, borage oil, evening primrose oil, trihydroxy oxo cholanylglycine, glycerin, polyglycerin, lysine, polylysine, triolein, chenodeoxycholate, deoxycholate is then added. The mixing may be done with a high speed mixer or sonicator to ensure uniform micelle particle size distribution within the formulation.

Each of the absorption enhancing compounds, when present, is in a concentration of from 1 to 10 wt./wt. of the total formulation.

Preferred salts of hyaluronic acid are alkali metal hyaluronates, alkaline earth hyaluronates and aluminium hyaluronate. The preferred salt is sodium hyaluronate. The preferred concentration of hyaluronic acid or pharmaceutically acceptable salts of hyaluronic acid is from 1 to 5 wt./wt. of the total formulation. An even more preferred range is from 1.5 to 3.5 wt./wt. of the total formulation.

Other ingredients may be added to the mixed micellar solution. For example, S 0 S* flavouring agents, antioxidants, salts, protease inhibitors or other pharmaceutically S..acceptable compounds may be added.

In general, the size of the micelle particles in the solution is about 1 to 10 nm, 25 and preferably from 1 to 5 nm. Such a size distribution ensures effective absorption of the formulation, and therefore the pharmaceutical agent, through the membranes, for example the membranes in the oral and nasal cavities.

The specific concentrations of the essential ingredients can be determined by relatively straightforward experimentation. For absorption through the nasal and oral S 30 cavities, it is often desirable to increase, e. g. double or triple, the dosage which is normally required through injection or administration through the gastrointestinal tract.

-16- As will be understood, the amount of each component of the formulation will vary depending on the pharmaceutical agent and the site of application. Preferred formulations for oral or nasal application have the following combinations: i) sodium lauryl sulphate, sodium salicylate, disodium edetate, Phospholipon-H and sodium hyaluronate; ii) sodium lauryl sulphate, sodium salicylate, disodium edetate, lecithin and sodium hyaluronate; iii) sodium lauryl sulphate, sodium salicylate, disodium edetate, sodium hyaluronate and evening primrose oil; iv) sodium lauryl sulphate, sodium salicylate, disodium edetate, Phospholipon-H and bacitracin; v) sodium lauryl sulphate, sodium salicylate, disodium edetate, Phospholipon-H, sodium hyaluronate and bacitracin; vi) sodium lauryl sulphate, sodium salicylate, disodium edetate, sodium hyaluronate, oleic acid and gamma linoleic acid; and vii) sodium lauryl sulphate, sodium salicylate, disodium edetate, trihydroxyoxo-cholanyl glycine, lecithin and chenodeoxycholate.

For aerosol formulations, the addition of a mixture of phenol and m-cresol is preferred. Such an aerosol formulation may then be placed in an aerosol dispenser and then charged with a propellant, preferably a non-CFC propellant.

The therapeutic compositions of the present invention may be stored at room temperature or at a cold temperature. Storage of large molecule drugs is preferable at a cold temperature to prevent degradation of the drugs and to extend their shelf life.

As indicated hereinbefore, generally, oral and nasal membranes are the favourite sites of the administration but the composition can be applied to the rectal and vaginal mucosa. According to the physiologically active peptide, protein or other large molecule drug used, the dosage form, and the site of administration, a specific administration method can be selected.

25 The formulation of this invention is generally prepared as microfine mixed micellar particles (1 to 10 nm or less) by virtue of the preparation methods and characteristics of suitable combinations of absorption enhancers used. Preferably, size of the micelle particles in the mixed micellar composition is about 1 to 5 nm. Such mixed micelles tend to be smaller than the pores of the membranes in the oral cavity or 30 the GI tract. It is therefore believed that the extremely small size of mixed micelles helps the encapsulated molecules penetrate efficiently through the mucosal membranes of the oral cavity.

-17- The desired size of aerosol droplets which are sprayed from the aerosol dispenser will depend, in part, on where the pharmaceutical is to be deposited. For example, for deposition in the lungs, particle sizes of less than about 5 pm are preferred whereas for absorption in the buccal cavity of the mouth, particle sizes of about 6-10 lpm are preferred.

For oral and nasal application, sprays are preferable, but drops, chewable tablets, chewable gum and other suitable forms may also be used. Utilization of atomizer or aerosol spray devices (metered dose inhalers or nebulizers) can be used to further reduce the particle size for effective inhalation from the nasal or oral cavity so the drug may successfully reach to the specific site and be absorbed. It is also possible to utilize a drug delivery system such that an enteric coating is applied to the gelatin capsule to cause the micelles to be released only in the duodenum or in the proximity of the large intestine and not in the stomach.

It is believed that improvements in penetration and absorption of mixed micellar formulations in the mouth is achieved by mixing the mixed micellar formulation with propellants such as tetrafluoroethane, heptafluoroethane, dimethylfluoropropane, tetrafluoropropane, butane, isobutane, dimethyl ether and other non-CFC and CFC propellants. Preferably they are delivered through metered dose spray devices. Metered dose inhalers are known and are a popular pulmonary drug delivery form for some drugs. One of the benefits of using an atomizer or inhaler is that the potential for contamination is minimized because the devices are self contained.

:see% The present formulation, including the propellant, is intended to improve the quality of absorption, stability and performance of many formulations. The compositions have been selected to give enhancement in the penetration through pores, 25 and facilitate absorption of the drugs to reach therapeutic levels in the plasma.

invention is illustrated by reference to the following examples.

WO 01/15666 PCT/CA00/01019 18 This example does not fall within the scope of the present invention.

A solution was prepared using 0.5 g sodium lauryl sulphate, 0.5 g sodium salicylate and 0.25 g disodium edetate dissolved in 10 mL of water. To this solution mg (1000 units) of insulin was added and dissolved completely while stirring, to give about 100 units/mL insulin solution.

In one set of tests, five healthy non-diabetic human volunteers were tested with insulin, by injection. In another set of tests the volunteers were tested with insulin, taken orally. The volunteers fasted from midnight prior to the test, with no food being taken during the 4 hour study.

On the first day, the volunteers received 10 units insulin by injection (regular fast acting insulin, available from Eli Lilly). On the second day, the volunteers received 100 units (1 mL volume per drop, approximately 20 drops) of the aboveprepared oral insulin (10 times the injection dose). In both tests, blood glucose levels were monitored every 15 minutes by Bayer's Glucometer Elite.

The average results for the five volunteers, of the first day's trial (sub-cutaneous injection with 10 units) were as follows: Table I Time*: 0 15 30 60 75 90 120 150 180 Avg: 5.8 5.8 5.4 5.0 4.6 4.3 3.8 3.6 3.4 Time*: 210 240 Avg: 4.2 time in minutes The results for each of the five volunteers, of the second day's trial (oral drops with 100 units) were as follows: Table II Time*: 0 15 30 60 75 90 120 150 180 Subject Nos: 1 6.2 5.8 5.2 5.0 4.9 5.0 5.0 4.8 4.7 2 5.8 5.4 5.0 4.7 4.9 4.3 5.0 5.5 5.2 3 4.8 4.6 4.3 4.3 4.4 4.6 4.8 4.7 5.2 4 6.6 6.1 5.8 5.5 5.1 4.9 5.0 5.0 5.9 WO 01/15666 PCT/CA00/01019 19 6.0 5.8 5.7 5.5 5.1 4.8 4.7 4.9 Time*: 210 240 Subject Nos: 1 5.5 2 5.8 6.1 3 5.5 5.1 4 6.2 6.8 5.9 6.7 time in minutes These tests indicate that compared to the injection method, oral insulin gives a faster onset of action and lowers blood glucose levels without creating hypoglycaemic condition. Due to the hepatic glucose production, there was a rebound effect. This is believed to be due to the incomplete absorption of insulin.

Example 2 Another experiment, not within the scope of the present invention, was performed for comparative purposes.

Oral insulin (100 units) was formulated in (Phospholipon-H, 10 mg) without any sodium lauryl sulphate, sodium salicylate, edetate or absorption enhancers, to evaluate its efficacy of blood glucose lowering in a fasted state, for healthy volunteers.

Volunteers were asked to fast overnight and not have any breakfast prior to dosing. Volunteers were asked to take this oral insulin formulation in their mouth and swallow it. Blood glucose levels were monitored every 15 minutes using Bayer's glucometer Elite for 3 hours, and the average results for 5 volunteers are shown in Table III.

Table III Time*:0 15 30 45 60 75 90 120 150 180 Avg: 5.6 5.8 5.8 5.7 5.7 5.8 5.7 5.7 5.8 5.7 time in minutes WO 01/15666 PCTICA00/01019 20 This indicates that orally administered insulin with lecithin alone has no effect on blood glucose lowering.

Example 3 A further experiment, not within the scope of the present invention, was performed for comparative purposes.

Oral insulin (100 units) was formulated with sodium salicylate and alkali metal edetate (both 5% by wt.) to evaluate its efficacy of blood glucose lowering in fasted state in healthy volunteers.

Volunteers were asked to fast overnight and not have any breakfast prior to dosing. Volunteers were asked to take this oral insulin formulation in their mouth and swallow it. Blood glucose levels were monitored every 15 minutes using Bayer's glucometer Elite for 3 hours and the average results for 5 volunteers are shown in Table

IV.

Table IV Time*:0 15 30 45 60 75 90 120 150 180 Avg: 5.8 5.8 5.8 5.9 5.8 5.9 5.7 5.9 6.2 time in minutes This indicates that orally administered insulin with sodium salicylate and alkali metal edetate alone has no effect on blood glucose lowering. In addition, this formulation caused irritation and burning sensation, which lasted for several hours.

Example 4 A further experiment, not within the scope of the present invention, was performed for comparative purposes.

Oral insulin (100 units) was formulated using sodium salicylate and alkali metal edetate (both 5% by wt.) with Phospholipon-H (10 mg) and tested on healthy subjects.

Blood glucose levels were monitored every 15 minutes using Bayer's glucometer Elite for 3 hours and the results are shown in Table V.

1, WO 01/15666 PCT/CA00/01019 21 Table V Time*: 0 15 30 45 60 90 120 180 Avg: 5.3 5:3 5.3 5.4 5.6 5.7 5.7 5.8 time in minutes This indicates that orally administered insulin with sodium salicylate, alkali metal edetate and Phospholipon-H has no effect on blood glucose lowering.

Example Another experiment, not within the scope of the present invention, was performed for comparative purposes.

Oral insulin (50 units) was formulated using only alkali metal lauryl sulphate by wt). Blood glucose levels were monitored every 15 minutes using Bayer's glucometer Elite for 3 hours and the average results for four volunteers are shown in Table VI.

Table VI Time*: 0 15 30 60 90 120 180 Avg: 5.8 5.6 5.4 5.3 5.4 5.4 5.6 time in minutes This data shows that orally administered insulin with only alkali metal lauryl sulphate has little metabolic effect on the blood glucose lowering in healthy subjects.

This formulation caused substantial burning sensation and irritation in the subjects and lasted for two days.

Example 6 Yet another experiment, within the scope of the present invention, was performed.

Mixed micellar oral insulin (50 units) was formulated using alkali metal lauryl sulphate and sodium salicylate (both 4.4% by wt.) and alkali metal edetate by wt) with Phospholipon-H (10 mg) and tested on healthy volunteers.

The method involved mixing the sodium lauryl sulphate, sodium salicylate and alkali metal edetate with water in a beaker with a magnetic stirrer at medium speed WO 01115666 PCT/CA00/01019 22 until the ingredients were dissolved, to form buffer solution. Insulin powder was placed in a beaker and to this powder was added the buffer solution. The solution was continuously stirred using a magnetic stir bar until all of the insulin powder was dissolved and a clear solution obtained. The micellar solution so formed was stored in clean glass bottles and refrigerated.

Mixed micellar liposomal insulin was then prepared in a glass beaker, in which was placed the Phospholipon-H and a small amount ofisopropyl alcohol. The mixture was stirred at a high speed (1000 rpm) for about 10 minutes to ensure complete dissolution of the Phospholipon-H. To this solution was added the micellar insulin solution very slowly, drop wise, using glass dropper, with continuous stirring at a high speed. The solution was stirred continuously for another 30 minutes at a high speed to ensure uniform micellar particle size distribution.

Samples of the mixed micellar solution were taken orally by the volunteers.

Blood glucose levels were monitored every 15 minutes using Bayer's glucometer Elite for 3 hours and the average results for 5 volunteers are shown in Table

VII.

Table VII Time*: 0 15 30 45 60 90 120 150 180 Avg: 6.5 6.1 5.5 5.3 5.3 5.4 5.5 5.5 time in minutes This data shows that orally administered insulin with alkali metal lauryl sulphate combined with the sodium salicylate and alkali metal edetate with Phospholipon-H has a small metabolic effect on blood glucose levels in healthy volunteers.

Example 7 An experiment, within the scope of the present invention, was performed. In this example, the formulation was for oral administration.

Oral insulin (50 units) was formulated using alkali metal lauryl sulphate and sodium salicylate (both 4.4% by wt.) and alkali metal edetate by wt.) with Phospholipon-H (10 mg) and sodium hyaluronate by wt). This formulation was tested on healthy subjects under fasting condition.

WO 01/15666 PCT/CA00/01019 23 The method involved mixing the sodium lauryl sulphate, sodium salicylate and alkali metal edetate with water in a beaker with a magnetic stirrer at medium speed until the ingredients were dissolved, to form buffer solution. Insulin powder was placed in a beaker and to this powder was added the buffer solution. The solution was continuously stirred using a magnetic stir bar until all of the insulin powder was dissolved and a clear solution obtained. The micellar solution so formed was stored in clean glass bottles and refrigerated.

Mixed micellar liposomal insulin was then prepared in a glass beaker, in which was placed the Phospholipon-H and a small amount ofisopropyl alcohol. The mixture was stirred at a high speed (1000 rpm) for about 10 minutes to ensure complete dissolution of the Phospholipon-H. To this solution was added the micellar insulin solution very slowly, drop wise, using glass dropper, with continuous stirring at a high speed. The solution was stirred continuously for another 30 minutes at a high speed to ensure uniform micellar particle size distribution. The hyaluronate and small amounts of menthol and sorbitol were then added, with continuous stirring.

Samples of the mixed micellar solution were taken orally by the volunteers.

VIII.

Table VIII Time*: 0 15 30 45 60 90 120 150 180 Avg: 6.5 5.9 5.6 5.4 4.9 5.0 4.9 5.2 5.4 time in minutes This data shows that orally administered insulin with alkali metal lauryl sulphate, sodium salicylate, alkali metal edetate, Phospholipon-H and sodium hyaluronate has resulted in lowering of blood glucose levels in healthy subjects better than the above mentioned formulations.

Example 8 A further experiment, within the scope of the present invention, was performed.

In this example, the formulation was for oral administration.

WO 01/15666 PCT/CAOO/01019 24 A buffer solution was prepared using 0.5 g sodium lauryl sulphate, 0.5 g sodium salicylate and 0.25 g disodium edetate dissolved in 10 mL of water. The solution was added to insulin and mixed, to form micellar insulin.

Separately, 100 mg of powdered Phosphatidylcholin-H was added to a glass beaker and to this powder was added 10 mL 50% ethanol. The powder was dissolved completely. To this solution 16 mg (400 units) of micellar insulin solution dissolved in 3 mL of the buffer solution to (give 30 units/mL insulin solution) was added slowly with vigorous mixing, to form a mixed micellar solution. To this was added 0.6 mL of sodium hyaluronate and 0.2 ml of 2% menthol solution containing 3% sorbitol.

In one set of tests, ten Type II diabetic human volunteers who took insulin, by injection three times a day, were studied. In another set of tests the volunteers were tested with insulin, taken orally. The volunteers fasted from midnight prior to the test, with no food being taken during the 4 hour study.

On the first day, the volunteers received 10 units insulin by injection (regular fast acting insulin, available from Eli Lilly). On the second day, the volunteers received 30 units (1 mL volume per drop, approximately 20 drops) of the aboveprepared oral insulin (3 times the injection dose). In both tests, blood glucose levels were monitored every 15 minutes by Bayer's Glucometer Elite.

The results, showing the average for the ten volunteers, were as shown: Table IX Blood glucose levels (mmol/L) Time (minutes) Oral Dose Injection units) (10 units) 0 6.4 6.8 15 5.8 6.9 5.4 6.1 5.3 5.8 5.3 5.8 5.2 5.8 90 5.2 5.4 105 5.2 5.4 WO 01/15666 PCT/CA00/01019 25 120 5.1 5.2 135 5.1 5.1 150 5.2 4.9 165 5.3 4.9 180 5.3 4.8 195 5.4 4.8 210 5.4 5.2 225 5.6 5.2 240 5.6 5.4 The results show that the oral insulin formulation of the present invention, at a dosage of three times higher than the injected level, is comparable to the injected insulin.

Example 9 This example illustrates a method for making a mixed micellar formulation according to the present invention.

In a 250 mL capacity glass beaker was added 5 g sodium lauryl sulphate, 5 g sodium salicylate and 2.5 g edetate. The beaker was placed on the hot plate with a magnetic stirrer. To this dry powder mixture was added 100 mL distilled water and the mixture was stirred, using the magnetic stir bar, at a medium speed until all the powder was dissolved. The buffer solution was stored in a clean glass bottle at room temperature (pH A micellar insulin solution was then prepared in a 50 mL capacity glass beaker, into which was placed 11.54 mg insulin powder. To this powder was added 10 mL of the buffer solution. The solution was continuously stirred using a magnetic stir bar until all of the insulin powder was dissolved and a clear solution obtained. The micellar solution so formed was stored in clean glass bottles and refrigerated.

A 2% menthol solution was then prepared from 100 mg menthol crystals, dissolved in 5 mL ethanol. To this solution was added 5 mg FD C blue dye. The solution was stirred for 10 minutes and stored in a glass bottle at room temperature.

Mixed micellar liposomal insulin was then prepared in a 50 mL glass beaker, in WO 01/15666 pCT/CA00/01019 26 which was placed 100 mg of phosphatidylcholine (Sigma, type I=EH, hydrogenated).

To this powder was added 10 mL ofisopropyl alcohol. The mixture was stirred at a high speed (1000 rpm) for about 10 minutes to ensure complete dissolution of the phosphatidylcholine. To this solution was added the micellar insulin solution very slowly, drop wise, using glass dropper, with continuous stirring at a high speed. The solution was stirred continuously for another 30 minutes at a high speed to ensure uniform micellar particle size distribution. To this solution was added 1 mL of the 2% menthol solution and 50 mg sodium hyaluronate. The semi-clear, translucent, light blue colour, liposomal insulin mixed micellar solution (final volume 15 mL) was stored in a clean glass bottle and refrigerated. The solution had a pH of If the phosphatidylcholine powder does not dissolve completely, then heating up to about 45 °C may be required, e.g. using a water bath.

It has been found that if the micellar insulin composition is not added slowly, then the mixed micellar formulation will not be formed and the formulation will be gelatinous and sticky.

Example The formulation of Example 9 was tested in a manner similar to that indicated in Example 8 except that the formulation of the present invention was administered nasally.

On the first day, the ten volunteers each received 10 units insulin injection (regular fast acting, Eli Lilly). On the second day, the volunteers received 20 units of the "oral" insulin of Example 9 (2 times the injection dose). The "oral" insulin was administered as drops (0.4 mL volume per drop, approximately 4 large drops in total, i.e. two drops in each nostril).

The results, showing the average for the ten volunteers, were as follows: Table X Blood glucose levels (mmol/L) Time (minutes) Nasal Dose Injection (20 units) (10 units) n 7.4 6.8 WO 01/15666 PCT/CA0O/01019 27 6.7 5.9 6.8 5.3 6.3 5.0 6.3 75 5.2 5.8 5.1 5.2 105 5.0 120 4.6 5.2 135 4.5 4.2 150 4.3 4.6 165 4.3 180 4.8 4.1 195 5.3 4.3 210 5.4 225 5.7 4.7 240 5.6 The results show that the nasal insulin formulation of the present invention, at a dosage of twice the injected level, is comparable to the injected insulin.

Example 11 The formula of Example 9 was taken and tests performed to determine the insulin action on meal glucose on healthy volunteers.

Usually, diabetic patients take an insulin injection 30 minutes prior to a meal, because injected insulin takes a long time to take effect. Injected insulin is slowly absorbed into bloodstream within 60 minutes and has metabolic effect on meal glucose levels.

The mixed micellar formulation of Example 9 was tested in healthy volunteers under controlled conditions to determine the oral insulin effect on meal glucose when compared to injected insulin.

In one set of tests, ten healthy non-diabetic human volunteers were tested with insulin, by injection. In another set of tests the volunteers were tested with insulin, WO 01/15666 PCT/CA00/01019 28 taken orally. The volunteers fasted from midnight prior to the tests, with food being taken 30 minutes after dosing. The meals were standard Sastacal 240 mL liquid diet approved by the Diabetic Society, containing 400 calories.

On the first day, the volunteers received 10 units insulin by injection (regular fast acting insulin, available from Eli Lilly). On the second day, the volunteers received 30 units of the above-prepared oral insulin (3 times the injection dose). In both tests, blood glucose levels were monitored every 15 minutes by Bayer's Glucometer Elite. The results are shown below: Table XI Blood glucose levels (mmol/L) Time (minutes) Oral Dose Injection units) (10 units) 0 5.7 5.2 5.6 30 5.0 5.4 5.3 5.4 5.4 5.6 6.3 6.6 6.9 105 6.0 5.9 120 5.8 5.6 135 5.5 5.1 150 5.1 4.8 165 4.9 4.6 180 4.8 4.3 The results indicate that the oral insulin helps control meal glucose levels in healthy volunteers when compared to injected insulin.

Example 12 The mixed micellar formulation of Example 9 was tested in diabetic volunteers under controlled conditions to determine the oral insulin effect on meal glucose when WO 01/15666 PCT/CA00/01019 29 compared to injected insulin.

In one set of tests, ten Type II diabetic human volunteers who took insulin, by injection three times a day, were studied. In another set of tests the volunteers were tested with insulin, taken orally. The volunteers fasted from midnight prior to the tests, with food being taken 30 minutes after dosing. The meals were standard Sastacal 240 mL liquid diet approved by the Diabetic Society, containing 400 calories.

On the first day, the volunteers received 10 units insulin by injection (regular fast acting insulin, available from Eli Lilly). On the second day, the volunteers received 30 units of the above-prepared oral insulin (3 times the injection dose). In both tests, blood glucose levels were monitored every 15 minutes by Bayer's Glucometer Elite.

The average results for the 10 volunteers were as follows: Table XII Blood glucose levels (mmol/L) Time (minutes) Oral Dose Injection units) (10 units) 0 8.8 8.7 8.1 8.8 8.0 8.9 45 8.4 10.1 10.2 11.8 11.8 11.8 12.3 12.2 105 10.8 11.2 120 9.6 10.4 135 8.1 8.4 150 6.9 7.3 165 6.2 180 4.8 4.3 The results indicate that oral insulin helps to control meal glucose levels in diabetic patients when compared to injected insulin.

WO 01/15666 PCT/CA00/01019 30 Example 13 A chewable gum insulin formulation was prepared by vigorously stirring the liposomal insulin mixed micellar solution of Example 9 while adding guar gum, beeswax, powdered acacia, oleic acid, gamma-linoleic acid and sorbitol. For each units of insulin, the mixture contained 100 mg guar gum, 50 mg beeswax, 50 mg powdered acacia, 100 mg oleic acid, 100 mg gamma-linoleic acid and 1 mL 3% sorbitol in ethanol solution. The mixture was then poured into a flat tray coated with polytetrafluoroethylene until the mixture was about 10 mm deep. The mixture then solidified and after solidification was cut into sticks about 1 cm by 3 cm. Each stick contained about 30 units insulin.

The mixed micellar formulation in chewable stick form was tested in diabetic volunteers under controlled conditions to determine the oral insulin effect on meal glucose when compared to injected insulin.

In one set of tests, five Type II diabetic human volunteers who took insulin, by injection three times a day, were studied. In another set of tests the volunteers were tested with the chewable gum insulin, taken orally. The volunteers fasted from midnight prior to the tests, with food being taken 30 minutes after dosing. The meals were standard Sastacal 240 mL liquid diet approved by the Diabetic Society, containing 400 calories.

On the first day, the volunteers received 10 units insulin by injection (regular fast acting insulin, available from Eli Lilly). On the second day, the volunteers received 30 units of the above-prepared chewable gum oral insulin (3 times the injection dose). In both tests, blood glucose levels were monitored every 15 minutes by Bayer's Glucometer Elite.

The average results for the five volunteers were as follows: Table XIII Blood glucose levels (mmol/L) Time (minutes) Oral Dose Injection units) (10 units) 0 9.1 8.8 1< o1 8.2 WO 01/15666 PCT/CA00/01019 -31 9.3 10.2 8.4 11.2 9.2 12.1 10.3 90 12.9 11.8 105 13.2 11.6 120 12.8 11.0 135 12.2 10.2 150 11.6 9.6 165 11.0 180 10.6 9.1 195 10.0 8.7 210 9.5 8.2 225 8.8 240 8.2 Example 14 Another experiment, within the scope of the present invention, was performed.

In this example, the formulation was for oral administration.

A buffer solution was prepared using 0.5 g sodium lauryl sulphate, 0.5 g sodium salicylate and 0.25 g disodium edetate dissolved in 10 mL of water. The solution was added to 8 mg (200 units) insulin and mixed, to form micellar insulin.

To this micellar solution were added 0.2 g bacitracin and 0.5 g evening of primrose oil and the solution was mixed vigorously to form a mixed micellar insulin solution (about 20 units/mL).

Six human volunteers were studied. The volunteers fasted from midnight prior to the test, with no food being taken during the 4 hour study.

On the first day, the volunteers received 10 units insulin by injection (regular fast acting insulin, available from Eli Lilly). On the second day, the volunteers received 20 units of the above-prepared oral insulin (twice the injection dose). In both tests, blood glucose levels were monitored at intervals by Bayer's Glucometer Elite.

WO 01/15666 PCT/CA00/01019 32 The results, showing the average for the six volunteers, were as follows: Table XIV Blood glucose levels (mmol/L) Time (minutes) Oral Dose Injection (20 units) (10 units) 0 8.8 7.9 8.4 7.9 8.1 8.2 7.4 8.3 60 6.3 7.6 5.1 6.2 120 5.0 5.2 150 4.8 4.6 180 5.1 3.9 210 5.3 4.4 240 5.6 5.2 The results show that the oral insulin formulation of the present invention, at a dosage of twice the injected level, is comparable to the injected insulin.

Example A further experiment was performed to show another method of making the mixed micellar formulation of the present invention.

In a 250 mL round bottom flask was added 100 mg of saturated lecithin powder purchased from the American Lecithin Co. To this powder was added 5 mL of absolute ethanol (USP grade). The flask was then attached to a rotary evaporator equipped with the vacuum pump and nitrogen inlet for inert atmosphere condition to minimize oxidation of the lecithin. The flask was rotated at 100-150 rpm under vacuum. The solution in the flask was heated to 60 0 C by means of water bath to dissolve the powder completely. After complete dissolution of the powder, heating was stopped and the rotation speed was increased to 300 rpm, under vacuum in nitrogen atmosphere until the alcohol evaporated completely, leaving a uniform film on the side of the flask. The rotation was continued for at least 30 minutes to ensure uniform coating of film on the wall and complete solvent removal. After 30 minutes the rotation was stopped and the vacuum was released.

To this flask was added micellar insulin solution which had been prepared from an aqueous solution of insulin, sodium lauryl sulphate, sodium salicylate and disodium edetate.

The flask was shaken with the help of shaker plate. Shaking was continued for at least minutes and then the solution was sonicated with a high frequency sonicating probe for another 60 minutes in order to form small uniform mixed micelles. The mixed micelles so obtained were analyzed by Malvern Zeta (trade mark) particle size distribution measurement equipment equipped with the laser light scattering device. The mixed micelles particle size distribution obtained by this method was between 2 and 9nm. To this solution was added 1 mL of 2% menthol solution and 50 mg sodium hyaluronate. The semi-clear, translucent, light blue colour solution (final volume 10mL) was stored in a clean glass bottle and refrigerated.

S. 15 The solution had a pH of Example 16 Another experiment, within the scope of the present invention, was performed.

A buffer solution was prepared using 0.5 g sodium lauryl sulphate, 0.5g sodium 20 salicylate and 0.25 g disodium edetate dissolved in 10mL of water. The solution was added to 8 mg (200 units) insulin and mixed, to form micellar insulin.

To this micellar solution were added 0.5 g borage oil and the solution was mixed S"vigorously to form a mixed micellar insulin solution (about 20 units/mL).

In the specification the term "comprising" shall be understood to have a broad meaning similar to the term "including" and will be understood to imply the inclusion of a stated integer or step or group of integers or steps but not the exclusion of any other integer or step or group of integers or steps. This definition also applies to variations on the term "comprising" such as "comprise" and "comprises".

Claims

1. A process for making a pharmaceutical formulation suitable for delivery through mucosal membranes including: a) preparing a pharmaceutical agent composition in micellar form in an aqueous medium by adding a pharmaceutical agent, an alkali metal salicylate in a concentration of from 1 to wt./wt.% of the total formulation, an alkali metal C8 to C22 alkyl sulphate in a concentration of from 1 to 10 wt./wt. of the total formulation and a pharmaceutically acceptable edetate in a concentration of from 1 to 10 wt./wt. of the total formulation; b) slowly adding the micellar pharmaceutical agent composition, while mixing, to at least one absorption enhancing compound, while continuing to mix vigorously, said absorption enhancing compound being selected from the group consisting of lecithin, hyaluronic acid, pharmaceutically acceptable salts of hyaluronic acid, octylphenoxypolyethoxyethanol, glycolic acid, lactic acid, chamomile extract, cucumber extract, oleic acid, linolenic acid, borage oil, evening primrose oil, menthol, trihydroxy oxo cholanylglyine and pharmaceutically acceptable 15 salts thereof, glycerin, polyglycerin, lysine, polylysine, polidocanol alkyl ethers and analogues thereof, triolein, chenodeoxycholate, deoxycholate and mixtures of any two or more thereof, wherein the amount of each absorption enhancing compound is present in a concentration of from 1 to 10 wt./wt. of the total formulation, and the total concentration of alkali metal salicylate, alkali metal C8 to C22 alkyl sulphate, edetate and absorption enhancing compounds is less than 20 50 wt./wt. of the formulation.

2. The process according to Claim 1 wherein there is an additional step of adding, while S continuing mixing, at least one absorption enhancing compound different from that added in step selected from the group consisting of lecithin, hyaluronic acid, pharmaceutically acceptable salts of hyaluronic acid, octylphenoxypolyethoxyethanol, glycolic acid, lactic acid, chamomile extract, cucumber extract, oleic acid, linolenic acid, borage oil, evening of primrose oil, trihydroxy oxo cholanylglycine, glycerin, polyglycerin, lysine, polylysine, triolein, chenodeoxycholate, deoxycholate and mixtures of any two or more thereof.

3. A process according to Claim 1, wherein the absorption enhancing compound in step b) is selected from the group consisting of saturated phospholipid, unsaturated phospholipid, phosphatidylcholine, phophatidyl serine, sphingomyelin, phophatidylethanolamine, cephalin, lecithin, lysolecithin and mixtures thereof.

4. A process according to Claim 1, wherein one of the absorption enhancing compound is lecithin and another absorption enhancing compound is selected from the group consisting of hyaluronic acid, pharmaceutically acceptable salts of hyaluronic acid and mixtures thereof, the concentration of said another enhancing compound being from about 1 to about 5 wt./wt.%. S o

5. A process according to Claim 1, wherein the absorption enhancing compounds comprise combinations selected from the group consisting of i) saturated phospholipid and sodium hyaluronate; ii) saturated phospholipid and glycolic acid; iii) lecithin and sodium hyaluronate; iv) saturated phospholipid, glycolic acid and lactic acid; v) sodium hyaluronate and evening primrose 20 oil; vi) saturated phospholipid and bacitracin; vii) saturated phospholipid, sodium hyaluronate and bacitracin; and viii) sodium hyaluronate, oleic acid and gamma linoleic acid. The process according to any one of Claims 1 to5, wherein the pharmaceutical agent is selected from the group consisting of insulin, heparin, so-called low molecular weight heparin, -36- hirulog, hirugen, huridin, interferons, interleukins, cytokines, mono and polyclonal antibodies, chemotherapeutic agents, vaccines, glycoproteins, bacterial toxoids, hormones, calcitonins, insulin like growth factors (IGF), glucagon like peptides (GLP-1), large molecule antibiotics, protein based thrombolytic compounds, platelet inhibitors, DNA, RNA, gene therapeutics, antisense oligonucleotides, opioids, narcotics, analgesics, NSAIDS, steroids, hypnotics, pharmaceutical preparations for the treatment of chronic pain, morphine or a mixture of any two or more thereof.

7. The process according to any one of Claims 1 to 6, wherein in step b) the micellar pharmaceutical agent composition is added to lecithin, with sonication, to form a mixed micellar composition; and c) while continuing to mix, adding at least one absorption enhancing compound selected from the group consisting of hyaluronic acid, pharmaceutically acceptable salts of hyaluronic acid, octylphenoxypolyethoxyethanol, glycolic acid, lactic acid, chamomile extract, cucumber extract, oleic acid, linolenic acid, borage oil, evening primrose oil, trihydroxy oxo cholanylglycine, glycerin, polyglycerin, lysine, polylysine, triolein, chenodeoxycholate, deoxycholate and mixtures of any two or more thereof; wherein the amount of lecithin and the absorption enhancing compound are each present in a concentration of from 1 to 10 wt./wt. of the total formulation, and the total concentration of alkali metal salicylate, alkali metal C8 to C22 alkyl sulphate, edetate and absorption enhancing compounds is less than 50 wt./wt. of the 20 formulation. S8. The process according to any one of Claims 1 to 7, wherein the absorption enhancing compound is formed into a film prior to the addition of the micellar pharmaceutical agent composition. -37-

9. The process according to any one of Claims 1 to 8 wherein subsequent to the addition of the micellar pharmaceutical agent composition a second absorption enhancing compound is added, said second absorption enhancing compound being different from the absorption enhancing compound previously used. The process according to any one of Claims 1 to 9 wherein a phenol selected from the group consisting of phenol, methyl phenol and mixtures thereof is added to the micellar formulation and the resulting formulation placed in a container, and the container is subsequently charged with a propellant.

11. The process according to Claim 10, wherein the propellant is selected from the group consisting oftetrafluoroethane, tetrafluoropropane, dimethylfluoropropane, heptafluoropropane, dimethyl ether, n-butane, isobutane, or a mixture of any two or more thereof. S12. The process according to any one of Claims 1 to 11, wherein the pharmaceutical agent is insulin.

13. A process for making a pharmaceutical composition suitable for delivery through 20 mucosal membranes, substantially as hereinbefore described with reference to any one of Examples 6 to 9, or 13 to 16. S 14. A pharmaceutical formulation prepared by the process of any one of Claims 1 to13. -38- A mixed micellar pharmaceutical formulation including a pharmaceutical agent in micellar form, water, an alkali metal C8 to C22 alkyl sulphate in a concentration of from 1 to wt./wt. of the total formulation, a pharmaceutically acceptable edetate in a concentration of from 1 to 10 wt./wt. of the total formulation, at least one alkali metal salicylate in a concentration of from 1 to 10 wt./wt. of the total formulation, and at least one absorption enhancing compound, said absorption enhancing compound being selected from the group consisting of chenodeoxycholate, deoxycholate and mixtures of any two or more thereof, wherein the amount of each absorption enhancing compound is present in a concentration of from 1 to wt./wt. of the total formulation, and the total concentration of absorption enhancing compounds is less than 50 wt./wt. of the formulation.

16. The mixed micellar pharmaceutical formulation according to either one of Claims 14 or further including lecithin. :**go t @0 0 15 17. The formulation according to any one of Claims 14 to 16, wherein the alkali metal C8 to C22 alkyl sulphate is sodium lauryl sulphate and the alkali metal salicylate is sodium salicylate. 0

18. The formulation according to either one of Claims 16 or 17, wherein the lecithin is selected from the group consisting of saturated phospholipid, unsaturated phospholipid, 20 phosphatidylcholine, phosphatidyl serine, sphingomyelin, phosphatidylethanolamine, cephalin, lysolecithin and mixtures of any two or more thereof. 0

19. A formulation according to any one of Claims 14 to 18, further including a second absorption compound selected from the group consisting of hyaluronic acid, pharmaceutically -39- acceptable salts of hyaluronic acid and mixtures thereof, the concentration of said second absorption enhancing compound being from about 1 to 5 wt./wt.% of the total formulation. A formulation according to Claim 15, wherein said alkali metal alkyl sulfate is sodium lauryl sulfate, said alkali metal salicylate is sodium salicylate, said pharmaceutically acceptable edetate is disodium edetate, and the at least one absorption enhancing compound includes combinations selected from the group consisting of saturated phospholipid and sodium hyaluronate; (ii) lecithin and sodium hyaluronate; (iii) sodium hyaluronate and evening primrose oil; (iv) saturated phospholipid and bacitracin; saturated phospholipid, sodium hyaluronate and bacitracin; (vi) sodium hyaluronate, oleic acid and gamma linoleic acid; (vii) saturated phospholipid and glyolic acid; and (viii) saturated phospholipid, glycolic acid and lactic acid.

21. The formulation according to Claim 15, wherein the formulation includes sodium lauryl sulphate, sodium salicylate, disodium trihydroxy oxo-cholanyl glycine, lecithin and 0 chenodeoxycholate. :o 22. The formulation according to any one of Claims 14 to 21, wherein the pharmaceutical agent is selected from the group consisting of insulin, heparin, low molecular weight heparin, hirulog, hirugen, huridine, interferons, interleukins, cytokins, mono and polyclonal antibodies, 20 chemotherapeutic agents, vaccines, glycoproteins, bacterial toxoids, hormones, calcitonins, oinsulin like growth factors (IGF), glucagon like peptides (GLP-1), large molecule antibiotics, protein based thrombolytic compounds, platelet inhibitors, DNA, RNA, gene therapeutics S antisense oligonucleotides, opioids, narcotics, analgesics, NSAIDS, steroids, hypnotics, 0 pharmaceutical preparations for the treatment of chronic pain, morphine or a mixture of any two or more thereof.

23. The formulation according to any one of Claims 14 to 21, wherein the pharmaceutical agent is insulin.

24. A formulation according to any one of Claims 14 to 23, wherein the absorption enhancing compounds are lecithin; further including a second absorption enhancing compound selected from the group consisting of hyaluronic acid, pharmaceutically acceptable salts of hyaluronic acid and mixtures thereof. The formulation according to any one of Claims 14 to 24, wherein the formulation additionally includes a phenol selected from the group consisting of phenol, methyl phenol and mixtures thereof. o••o°

26. The formulation according to any one of Claims 14 to 25, wherein the formulation is contained in an aerosol container and the container is charged with a propellant.

27. The formulation according to Claim 26, wherein the propellant is selected from the 20 group consisting of tetrafluoroethane, tetrafluoropropane, dimethylfluoropropane, 4 heptafluoropropane, dimethyl ether, n-butane, isobutane or a mixture of any two or more thereof. 44* S* 28. A pharmaceutical formulation substantially as hereinbefore described with reference to any one of Examples 6 to 9 or 13 to 16. -41-

29. A pharmaceutical formulation including insulin in micellar form, alkali metal lauryl sulphate in a concentration of from 1 to 1 Owt./wt% of the total formulation, alkali metal edetate in a concentration of from 1 to 10wt./wt% of the total formulation, sodium salicylate in a concentration of from 1 to 10wt./wt% of the total formulation; a phospholipid, and/or a phosphatidylcholine. The formulation according to Claim 29, which includes sodium hyaluronate.

31. The formulation of either one of Claims 29 or 30, wherein the edetate is disodium edetate.

32. A mixed micellar pharmaceutical formulation including: insulin, sodium lauryl sulphate in a concentration of from 1 to 10 wt./wt.% of the total 15 formulation, S Slasodium salicylate in a concentration of from 1 to 10 wt./wt.% of the total formulation, alkali metal edetate in a concentration of from 1 to 10 wt./wt.% of the total formulation, and lecithin in a concentration of from 1 to 10 wt./wt.% of the total formulation.

33. A mixed micellar pharmaceutical formulation including: insulin, •sodium lauryl sulphate in a concentration of from 1 to 10 wt./wt.% of the total formulation, -42- sodium salicylate in a concentration of from 1 to 10 wt./wt.% of the total formulation, alkali metal edetate in a concentration of from 1 to 10 wt./wt.% of the total formulation, lecithin in a concentration of from 1 to 10 wt./wt.% of the total formulation, and sodium hyaluronate in a concentration of from 1 to 10 wt./wt.% of the total formulation, wherein the total concentration of sodium salicylate, sodium lauryl sulphate, edetate, lecithin and sodium hyaluronate is less than 50 wt./wt% of the formulation.

34. A pharmaceutical formulation according to any one of Claims 14 or 33, further including menthol, wherein the total concentration of sodium salicylate, sodium lauryl sulphate, edetate, a lecithin, sodium hyaluronate and menthol is less than 50 wt./wt.% of the formulation. A pharmaceutical formulation according to any one of Claims 32 to 34, wherein the lecithin is a saturated phospholipid. 15 36. A pharmaceutical formulation according to any one of Claims 32 to 34, wherein the lecithin is a phosphatidylcholine.

37. A pharmaceutical formulation including: the formulation of any one of Claims 14 to 25 and 28 to 36, 20 guar gum, beeswax, powdered acacia, S* oleic acid, gamma-linoleic acid, and -43- sorbitol.

38. The formulation of Claim 37, in the form of a chewable gum.

39. A pharmaceutical formulation including: insulin in mixed micellar form, sodium lauryl sulphate in a concentration of from I to 10wt./wt% of the total formulation, sodium salicylate in a concentration of from 1 to 10wt./wt% of the total formulation, disodium edetate in a concentration of from 1 to 10wt./wt% of the total formulation, bacitracin in a concentration of from 1 to 10wt./wt% of the total formulation, and evening primrose oil in a concentration of from 1 to 10wt./wt% of the total formulation. 15 40. A pharmaceutical formulation including: insulin in mixed micellar form, sodium lauryl sulphate in a concentration of from 1 to 10wt./wt% of the total formulation, sodium salicylate in a concentration of from 1 to 10wt./wt% of the total formulation, 20 disodium edetate in a concentration of from 1 to 10wt./wt% of the total formulation, S: bacitracin in a concentration of from 1 to 10wt./wt% of the total formulation, and borage oil in a concentration of from 1 to 10wt./wt% of the total formulation. ooo A mixed micellar pharmaceutical formulation including: insulin, sodium lauryl sulphate in a concentration of from 1 to 10 wt./wt.% of the total formulation, sodium salicylate in a concentration of from 1 to 10 wt./wt.% of the total formulation, disodium edetate in a concentration of from 1 to 10 wt./wt.% of the total formulation, bacitracin in a concentration of from 1 to 10 wt./wt.% of the total formulation, evening primrose oil in a concentration of from 1 to 10 wt./wt.% of the total formulation, wherein the total concentration of sodium salicylate, sodium lauryl sulphate, edetate, bacitracin and evening primrose oil is less than 50 wt./wt.% of the formulation.

42. A mixed micellar pharmaceutical formulation including: insulin, sodium lauryl sulphate in a concentration of from 1 to 10 wt./wt.% of the total formulation, 15 sodium salicylate in a concentration of from 1 to 10 wt./wt.% of the total formulation, disodium edetate in a concentration of from 1 to 10 wt./wt.% of the total formulation, and borage oil in a concentration of from 1 to 10 wt./wt.% of the total formulation. 20 43. The formulation of any one of Claims 14 to 42 in a form suitable for oral administration.

44. The pharmaceutical formulation of any one of Claims 14 to 19, 22 to 30 or 32 to 43, wherein the formulation includes combinations selected from the group consisting of i) sodium lauryl sulphate, polidocanol 10 lauryl ether, sodium oxo cholanyl glycine and lecithin; ii) sodium lauryl sulphate, polidocanol 10 lauryl ether, phosphatidyl choline, oleic acid; iii) sodium lauryl sulphate, polidocanol 10 lauryl ether, sodium hyaluronate and lecithin; iv) sodium lauryl sulphate, polidocanol 9 lauryl ether, triolein and polylysine; v) sodium lauryl sulphate, polyoxyethylene ether (10 lauryl), trihydroxy oxo cholanyl glycine and lecithin, vi) sodium lauryl sulphate, polidocanol 20 lauryl ether, evening of primrose oil and lecithin, and vii) sodium lauryl sulphate, trihydroxy oxo-cholanyl glycine, lecithin and chenodeoxycholate. A method for administration of a pharmaceutical agent in a buccal cavity of a human being by spraying into the cavity, without inhalation, from a metered dose spray dispenser, a mixed micellar pharmaceutical formulation according to any one of claims 14 to 37 and 38 to 43.

46. A metered dose dispenser containing the pharmaceutical formulation according to any one of claims 14 to 37 and 38 to 43. 2

47. A method of treating diabetes in a patient requiring such treatment, the method including administering to the patient a therapeutically effective amount of the formulation of any one of Claims 22, 23 or 28 to 44.

48. A method of delivering insulin to the buccal mucosa including spraying an effective amount of said insulin to the buccal mucosa using a metered dose dispenser, while resisting substantial inhalation of said insulin. DATED THIS SIXTEENTH DAY OF MAY, 2003. GENEREX PHARMACEUTICALS, INC. BY PIZZEYS PATENT TRADE MARK ATTORNEYS