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Developing novel antimicrobials against ”difficult to treat” multi drug resistant bacteria Presentation at BioEquity, Stockholm, May 2013 Confidential Summary – Adenium Biotech • A spin-out from Novozymes, founded in 2011, strong VC syndicate • Management team with extensive experience, industry experienced Board of Directors and strong Scientific Advisory Board of KOL´s • ”First-in-class” Arenicin compounds with potent and selective activity against multi-drug resistant Gram-negative bacteria - Selection of clinical candidate/initiation of tox/safety in October 2013 - ”First in man” by end of 2014 • Funding requirement: - USD 10 mio to progress through phase I - USD 25 mio to progress through clinical ”proof of concept” in phase II Confidential 2 Adenium Biotech ApS • Management: - Peter Nordkild, MD, CEO, ex Novo Nordisk, Ferring, Egalet, ARTS Biologics - Søren Neve, PhD, project dir, ex Lundbeck, Novozymes • Board of Directors: - Khalid Islam, PhD, ex Arpida, chairman - Anker Lundmose, MD, ex Novo Nordisk, OSI Pharmaceuticals - Andreas Segerros, MSc, MBA, Sunstone Capital - Stephan Christgau, PhD, Novo Seeds - Casper Tind Hansen, MSc, Novo Ventures - Ejner Bech Jensen, MSc, VP R&D Novozymes A/S • Investors: - Novo Seeds - Sunstone Capital • Scientific advisory board: - Prof Brad Spellberg, US - Prof David Livermore, UK - Dr Bruce Montgomery, US - Dr Frank Fildes, UK - Prof Matt Cooper, AUS Confidential 3 Arenicin selection process. Adenium benefits from extensive AMP know how > 500 organisms screened for antimicrobial activity Several G+ but only one Gidentified ~40 AMP’s identified Confidential 4 Medical need for broad spectrum Gram-negative antimicrobial • Bacteria are rapidly becoming resistant to known antibiotics - 160.000 patients with nosocomial XDR Gram-negative infections in 2011 in USA alone - Carbapenem resistant Klebsiella increased from < 5 % to 29.6% in Italy over 5 years • Increasing resistance even to last and toxic resorts e.g. Colistin • GAIN legislation approved to grant priority review, fast track status and extend market exclusivity period with 5 years • GAIN pathogens: Acinetobacter, Klebsiella, Pseudomonas and E. Coli Confidential 5 Ideal Target Product Profile for multidrug resistant broad spectrum Gram-negative antimicrobial • • • • • • Novel mode of action Bactericidal Selective and specific Low frequency of resistance Active against GAIN pathogens Drugable Confidential 6 Arenicin: Unique MoA and broad spectrum Gram-negative activity • Arenicin is bactericidal with a novel, dual mode of action – Bacterial membrane penetration – Protein synthesis inhibition • Selective and specific - no hemolytic or cytotoxic activity in mammalian cells • Very low spontaneous mutational frequency and resistance • Broad spectrum activities against a wide range of XDR Gramnegative pathogens • Wide therapeutic window. 50 – 100 fold difference between effective dose and MTD in vivo • 21 AA peptide synthesized by standard solid phase synthesis Confidential 7 Arenicin and the cell membrane -MoA TEM of P.aeruginosa after incubation with AA143 Extracellular ATP after 10 min Fold change 25 20 Ar 15 col 10 pip 5 0 0 16 64 256 x MIC 1024 4096 Arenicin (Ar), colistin (col), and piperacillin (pip) induced release of ATP from E. coli. Exponential cells were incubated with drug for 10 minutes and ATP measured. yaxis is fold change relative to untreated and x-axis is fold MIC applied. P. aeruginosa incubated with 32 μg/mL AA143. Red arrow shows the membrane disruption. Blue arrow shows release of the cytoplasm. Confidential 8 Arenicin interferes with the phospholipid homeostasis • MlaC is a periplasmic binding protein maintaining phospholipid homeostasis of the dual cell membrane • Whole genome sequencing of E. Coli shows only one single L11R amino acid mutation in MlaC correlating well with the very low spontaneous mutational frequency Confidential 9 Arenicin shows low potential for resistance development Resistance Frequency (4 X MIC) Organism Isolate ID E. coli ATCC 25922 K. pneumoniae 3083583 P. aeruginosa ATCC 27853 A. baumannii 3083835 Confidential AA139 AA230 ≤ 2,50E-12 ≤ 2,50E-12 ≤ 1,38E-11 ≤ 1,38E-11 ≤ 2,61E-12 ≤ 2,61E-12 ≤ 2,65E-12 ≤ 2,65E-12 10 Arenicin is selective and specific for bacteria with low hemolytic and cytotoxic activity wt Confidential 11 Arenicin shows favorable efficacy compared to current treatment options MIC90 determinations (MDR strains) # strains AA139 AA230 Ceftazidime Ciprofloxacin N=325 Colistin Gentamicin Meropenem Tigecycline MIC (µg/ml) E.coli N=55 1 0.5 >32 >4 0.25 >32 4 0.5 K.pneumonia N=75 4 4 >32 >4 8 >32 >16 4 P.aeruginosa N=75 8 2 >32 >4 2 >32 >16 >8 A.baumanii N=120 2 2 >32 >4 8 >32 >16 4 Confidential 12 Arenicin shows good activity in animal models of UTI and Pneumonia • Arenicin shows good efficacy in the UTI model with ED50 at 1.8 mg/kg in the bladder • Arenicin shows good efficacy in the Pneumonia model Confidential 13 Arenicin is well tolerated with a wide therapeutic window • Favorable MTD in mini-pigs and mice at 30-50 mg/kg • No observed adverse effect level (NOAEL) at 30 mg/kg • Therapeutic window (NOAEL/ED50 bladder) of 75 • Three times longer half-life than Meropenem in mini-pigs • Well distributed with a high volume of distribution of 900 ml Confidential 14 Product profiles of Meropenem, Colistin and Arenicin Indications Meropenem Colistin Arenicin Pneumonia Complicated urinary tract infections Coverage +++ +++ +++ +++ +++ +++ XDR E.coli ++ +++ +++ XDR P.aeruginosa ++ +++ +++ XDR A.baumannii + +++ +++ KPC K.pneumonia - +++ +++ Colistin G- Bacteria - - +++ Oral no no no IV yes yes yes IT no yes ? Renal/Hepatic yes yes yes Neurological no yes no Hypersensitivity yes yes yes Bactericidal yes yes yes Administration Confidential 15 Milestone plan • In vivo efficacy against key pathogens Pseudomonas, Acinetobacter and Klebsiella in pneumonia • Two leads identified for lead optimization • Clinical candidate selection • IND enabling tox/safety completed • IND filing • First in man initiation • Initiation of clinical ”Proof of Concept” (phase II) • Completion of clinical PoC Confidential Completed Completed Oct 2013 Q4 2014 Q4 2014 Q1 2015 Q2 2016 Q2 2017 16 External activities and cost for development of Arenicin in cUTI Task 2013 2014 2015 2016 2017 2018 2019 Cost MUSD Lead candidate selection Synthesis of 2 kg of cGMP material (Pre clin , phI) 2.0 5 Fill and finish ( phI ) 0.3 3 9 Pre-clinical tox/ safety 0.5 3 CTA/IND 0.1 12 Phase I (SAD/MAD) 2.0 6 cGMP production for ph II and III 10.0 3 Fill and finish (phII, phIII) 0.7 3 SPA meeting 0.3 12 Phase II (a and b) cUTI Phase III studies cUTI 6.0 NDA submission Total / Year 30.0 18 6 1.0 1.8 2.1 Confidential 13.0 14.0 10.0 10.3 0.3 52.2 17 Intellectual property Broad IP portfolio with composition of matter and method of use patents. NZ family WO # Type Description Issued/priority Expires 10865 WO07023163 Composition of matter Arenicin-3 26.08.2005 26.08.2025 11526 WO154525A1 Composition of matter Arenicin-3 variants 12.06.2010 12.06.2030 11704 WO070032A1 Medical use Treatment of UTI with Arenicin-3 11.12.2009 11.12.2029 EP12166275 Medical use Treatment of pneumonia with Arenicin-3 variants 01.05.2012 01.05.2033 Future patents on specific variants and formulations possible. Confidential 18 Competitive Gram-negative antibiotics with novel MoA in development Compound Company Development Spectrum Target E.coli Klebsiella Pseudomonas Acinetobacter Single pathogen ACHN975 Achaogen PhI LpxC inhibitor ÷ ÷ ÷ Pol 7080 Polyphor ltd PhI Membrane modulator ÷ ÷ ÷ BioPhage PA BioControl pH2 Undefines (Virus) ÷ ÷ ÷ IC 43 Novartis ph2 Immunostimulant (Vaccine) ÷ ÷ ÷ KB001 Sanofi Ph2 PcrV inhibitor ÷ ÷ ÷ Broad Gram-Negative GP-4 Trius Preclinical GyrB/ParE RX04 Sanofi Preclinical 50S ribisomal subunit Confidential 19 Antimicrobial deals 2009-2012 2012 2011 2011 2011 2011 2010 2009 2009 2009 2009 2009 Target company Inhibitex, Inc. Mpex Pharmaceuticals, Inc Inspire Pharmaceuticals, Inc. Adolor Crucell N.V. Middlebrook Pharmaceuticals Prolysis Targanta Therapeutics Genelabs Techn. Calixa Novexel Upfront Clinical Deal Stage of Value Total Deal Lead Buyer ($m) Value ($m) Product Bristol-Myers Squibb Company 2,500 Aptalis Pharma Inc. 224 Merck 430 Cubist 190 415 Johnson & Johnson 2,274 Victory Pharma 17 17 Biota 11 11 Pre-clinical The Medicines Company 42 100 GSK 57 57 Cubist 93 403 2 AstraZeneca 350 425 2 Confidential 20 Key Value Drivers for Investment • Broad spectrum XDR Gram-negative first in class drug with unique MoA and strong patent position • Significantly increased interest in antimicrobials area with GAIN Act/LPAD introduction • No new MoA programs in clinical development • Good safety and tox properties and solid in vivo PoC package • Phase II data package to be established for USD 25 mio • Experienced team to execute development plan Confidential 21 Contact details Dr Peter Nordkild Mobile: + 45 25 47 16 46 Email: [email protected] Website: www. Adeniumbiotech.com Confidential 22