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Aposense Pipeline: From Platform to Products

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<strong>Aposense</strong><br />

Presentation at the UBS Global Life Sciences Conference<br />

Yoram Ashery, CEO<br />

September, 2012


FORWARD LOOKING STATEMENTS<br />

The following slides contain forward-looking statements that include, but are not limited <strong>to</strong>, projections about our<br />

business and our future revenues, expenses and profitability. Forward-looking statements involve known and<br />

unknown risks, uncertainties and other fac<strong>to</strong>rs which may cause the actual events, results, performance,<br />

circumstances or achievements of the Company <strong>to</strong> be materially different from those expressed or implied by such<br />

forward-looking statements due <strong>to</strong> fac<strong>to</strong>rs that include, but are not limited <strong>to</strong>: (1) our ability <strong>to</strong> develop and bring <strong>to</strong><br />

market new products, (2) our ability <strong>to</strong> successfully complete any necessary or required pre-clinical and clinical<br />

studies with our products, (3) our ability <strong>to</strong> receive regula<strong>to</strong>ry clearance or approval <strong>to</strong> market our products or<br />

changes in regula<strong>to</strong>ry environment, (4) our success in implementing our sales, marketing and manufacturing plans,<br />

(5) the level of adoption of our products by medical practitioners, (6) the emergence of other products that may make<br />

our products obsolete, (7) protection and validity of patents and other intellectual property rights, (8) the effect of<br />

competition by other companies and technologies, and (9) our ability <strong>to</strong> obtain reimbursement for our products from<br />

government and commercial payers. You are cautioned not <strong>to</strong> place undue reliance on these forward-looking<br />

statements, which speak only as of the date of this slides. The Company undertakes no obligation <strong>to</strong> update any<br />

forward-looking statements, <strong>to</strong> report events or <strong>to</strong> report the occurrence of unanticipated events that may lead <strong>to</strong> the<br />

actual events, results, performance, circumstances or achievements of the Company being different than as<br />

envisaged by such forward looking statements.<br />

2


Apop<strong>to</strong>sis, a biological process involved in most diseases…<br />

<br />

<br />

<br />

<br />

<br />

<br />

Cell Apop<strong>to</strong>sis<br />

Programmed Cell Death<br />

3


A new paper every 25 minutes<br />

22,000<br />

No. of New Publication relating <strong>to</strong> Apop<strong>to</strong>sis, p per Year<br />

20,000<br />

18,000<br />

16,000<br />

14,000<br />

12,000<br />

10,000<br />

8,000<br />

6,000<br />

4,000<br />

2,000<br />

-<br />

1988<br />

1990<br />

1992<br />

1994<br />

1996<br />

1998<br />

2000<br />

2002<br />

2004<br />

2006<br />

2008<br />

2010<br />

* Based on Medline search


MISSION<br />

Translate Apop<strong>to</strong>sis <strong>to</strong> Patient Care<br />

Diagnosis, Treatment<br />

5


Mechanism of Action<br />

Membrane alterations trigger<br />

conformational and electric changes<br />

in switch moiety<br />

• A set of membrane alterations specific <strong>to</strong> the apop<strong>to</strong>tic cells identified<br />

• A molecular switch designed <strong>to</strong> respond <strong>to</strong> the apop<strong>to</strong>tic membrane<br />

changes<br />

Enables membrane anchoring and<br />

subsequent intra-cellular accumulation<br />

<strong>Aposense</strong> (fluorescent labeled)<br />

Preservation of<br />

membrane<br />

integrity<br />

Interfacial<br />

NanoSwitch<br />

Activation of the<br />

Phospholipid<br />

Scrambling System<br />

(PLS)<br />

Permanent<br />

depolarization of<br />

plasma<br />

membrane<br />

potential<br />

Acidification of<br />

external<br />

membrane leaflet<br />

Irreversible<br />

loss of<br />

cellular pH<br />

control<br />

Annexin V


Molecular Imaging<br />

First sight of disease<br />

US Market<br />

PET Radiopharmaceuticals<br />

2009 $358 million<br />

2017E<br />

$3,430 million<br />

Source: Bio-Tech Systems report 2010


Molecular Imaging of Apop<strong>to</strong>sis:<br />

Multiple Opportunities<br />

Oncology<br />

Treatment Moni<strong>to</strong>ring<br />

Neurology<br />

Cardio-vascular<br />

Acute MI<br />

Responder<br />

Non-Responder<br />

CT<br />

PET [ 18 F]-ML-10<br />

Vulnerable<br />

Plaque<br />

• Radiation<br />

• Chemo-Radiation<br />

• Chemotherapy<br />

• Targeted / Biologics<br />

• Stroke<br />

• Neuro-muscular disorders<br />

• Traumatic Brain Injury (TBI)<br />

• Multiple Sclerosis<br />

• Atherosclerosis (vulnerable plaque)<br />

• Acute MI<br />

• Heart Failure<br />

• Transplant rejection<br />

9


Molecular Imaging of Apop<strong>to</strong>sis:<br />

Clinical Development Program<br />

Phase 1<br />

Phase 2a Phase 2b Phase 3<br />

Healthy volunteers<br />

Stroke<br />

Brain metastases<br />

R 2 = 0.84 between<br />

EarliTest and MRI 6-8<br />

weeks after treatment<br />

Brain metastases<br />

Lung (NSCLC)<br />

Head & Neck<br />

Clinical Centers<br />

U.S. 11<br />

Israel 3<br />

France 2<br />

10


Molecular Imaging of Apop<strong>to</strong>sis:<br />

Phase 2: Design and Status<br />

CA004<br />

Brain<br />

metastases<br />

∆<br />

∆<br />

SRS<br />

24h<br />

8 weeks<br />

Diagnosis &<br />

Eligibility<br />

Baseline<br />

Ana<strong>to</strong>mical<br />

Imaging<br />

Baseline<br />

ML-10<br />

Imaging<br />

Treatment<br />

Follow-up<br />

ML-10<br />

Imaging<br />

Follow-up<br />

Ana<strong>to</strong>mical<br />

Imaging<br />

1w<br />

Combined Chemo-Radiation<br />

7 weeks<br />

8 weeks<br />

CA007<br />

H&N and<br />

NSCLC<br />

∆<br />

∆<br />

Timeline<br />

CA004 Brain metastases treated with SRS<br />

Recruitment<br />

Completed<br />

CA007 H&N treated with chemo-radiation Oc<strong>to</strong>ber 2012<br />

CA007 Lung treated with chemo-radiation Postponed, image<br />

analysis<br />

Results<br />

November 2012<br />

February 2013<br />

Safety status:<br />

212 procedures<br />

106 patients<br />

No related<br />

adverse event<br />

Forward-Looking Information Notice: The Company’s assessments and estimates regarding the above timeline depend,<br />

among other fac<strong>to</strong>rs, on continuation of present patient recruitment rate, sufficient clinical data and successful clinical trials<br />

results analysis, and other risk fac<strong>to</strong>rs which apply <strong>to</strong> the Company’s activity, as described on Company’s annual reports


Commercialization Partner<br />

World’s widest PET radio-pharmacy network<br />

Labeling & Distribution<br />

• IBA <strong>to</strong> distribute radio-labeled ML-10 ready <strong>to</strong> inject<br />

• Global coverage with specific timelines<br />

12


<strong>Aposense</strong> ®<br />

Targeted<br />

Therapy<br />

(ATT)


N<br />

Targeting apop<strong>to</strong>sis<br />

Extending pharmaco-kinetics<br />

Selective activation on target<br />

Overcoming cancer cell resistance<br />

Oral administration<br />

<strong>Aposense</strong> ®<br />

Active Drug<br />

New Drug<br />

14


ATT-11T<br />

Irinotecan, SN-38<br />

Topoisomerase<br />

Conjugate<br />

Approved<br />

indications<br />

SN-38, the active metabolite of irinotecan<br />

(Camp<strong>to</strong>sar®, Pfizer)<br />

• metastatic colon cancer (US, EU)<br />

• small cell lung cancer (Japan)<br />

Also shown activity in ovarian and other<br />

gastrointestinal cancers<br />

Commercial<br />

Status<br />

Patent expired 2008/9<br />

Pre-expiration sales >$1.0B<br />

Mechanism<br />

Inhibits Topoisomerase I<br />

Topoisomerase I inhibition<br />

Limitations<br />

Toxicity<br />

Short half-life<br />

IV administered


ATT-11T: Prolonging SN-38 Half-life<br />

SN-38 half-life when released from ATT-11T is >5X longer<br />

Active moiety (SN-38) in ATT-11T compared <strong>to</strong> Irinotecan (dog study)<br />

Concentration, ng/mL (log scale)<br />

10.0<br />

1.0<br />

0.1<br />

0.0<br />

* Not detectable<br />

Slow<br />

Clearance<br />

ATT-11T<br />

irinotecan<br />

* *<br />

0 4 8 12 16 20 24 28 32 36 40 44 48<br />

t 1/2 (hr)<br />

14<br />

12<br />

10<br />

8<br />

6<br />

4<br />

2<br />

0<br />

SN-38 derived from ATT-11T vs. Irinotecan X5.2<br />

12.1<br />

2.3<br />

irinotecan<br />

ATT-11T<br />

Results reproduced in additional studies<br />

16


ATT-11T is >13X More Selective <strong>to</strong> Tumor<br />

Bio-distribution studies in A375 bearing mice; concentration of SN38 (active metabolite) in Tumor and Muscle<br />

ng/gr*hr<br />

(AUC)<br />

4000<br />

3000<br />

3855<br />

Tumor<br />

Tumor/Muscle Selectivity Ratio<br />

2000<br />

1000<br />

0<br />

ATT-11T<br />

1153<br />

Irinotecan<br />

200<br />

160<br />

120<br />

200<br />

ng/gr*hr<br />

(AUC)<br />

80<br />

Muscle<br />

80<br />

40<br />

14.8<br />

60<br />

40<br />

78<br />

0<br />

ATT-11T<br />

Irinotecan<br />

20<br />

0<br />

19.2<br />

ATT-11T<br />

Irinotecan


ATT-11T showed superior efficacy<br />

Melanoma<br />

Model A375<br />

Ovarian Carcinoma<br />

Model OVCAR<br />

Tumor size (mm 3 )<br />

4000<br />

Human<br />

3500 melanoma<br />

implanted in<br />

3000 mice<br />

Non-Treated<br />

(Control group)<br />

Irinotecan<br />

(75 X 3 mg)<br />

Tumor size (mm 3 )<br />

Control-vehicle<br />

1000<br />

CPT-11 3x18mg/kg<br />

900<br />

ATT-11T 3x20mg/kg<br />

800<br />

Non-Treated<br />

(Control group)<br />

Irinotecan<br />

(3 X 18 mg)<br />

2500<br />

2000<br />

700<br />

600<br />

500<br />

1500<br />

400<br />

1000<br />

500<br />

0<br />

10 15 20 25 30 35 40 45 50 55 60<br />

ATT-11T<br />

(5 X 9 mg)<br />

300<br />

200<br />

100<br />

0<br />

ATT-11T<br />

(3 X 20 mg)<br />

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41<br />

Tx End<br />

Tx End


ATT-11T Preliminary Safety<br />

MTD studies: daily administration in rats (n=3 per group); no <strong>to</strong>xicity observed<br />

Weight<br />

(% from<br />

baseline)<br />

110<br />

105<br />

100<br />

ATT-11T, 200 mg/Kg, PO<br />

95<br />

90<br />

85<br />

80<br />

Irinotecan, 90 mg/Kg, IP<br />

75<br />

70<br />

1 2 3 4 5<br />

Days<br />

Irinotecan<br />

ATT-11T<br />

Weight at day 5(%) 77-96 99-102<br />

Diarrhea 2 / 3 None


TEVA agreement<br />

• TEVA collaboration: generic cy<strong>to</strong><strong>to</strong>xics conjugated <strong>to</strong> <strong>Aposense</strong>® molecule (2005)<br />

• TEVA <strong>to</strong> invest up <strong>to</strong> $11M<br />

• $2M in equity, up <strong>to</strong> $9M in development (after <strong>Aposense</strong> invests $2M)<br />

• Economics<br />

After Teva’s full investment, <strong>Aposense</strong> <strong>to</strong> choose between:<br />

• 7% royalty<br />

• 32% share in proceeds and participate in 25% of costs; and<br />

• 50% share in proceeds and costs<br />

• IND 2013 (updated)<br />

Forward-Looking Information Notice: The Company’s assessments and estimates<br />

regarding the above timeline depend, among other fac<strong>to</strong>rs, on continuation of present patient<br />

recruitment rate, sufficient clinical data and successful clinical trials results analysis, and other<br />

risk fac<strong>to</strong>rs which apply <strong>to</strong> the Company’s activity, as described on Company’s annual reports


ATT-GEM<br />

Conjugate<br />

Approved<br />

Indications<br />

(solid<br />

tumors)<br />

Commercial<br />

Status<br />

Mechanism<br />

Limitations<br />

Gemcitabine (Gemzar®, Eli Lilly)<br />

Pancreas<br />

Bladder<br />

Lung (NSCLC)<br />

Breast<br />

Ovarian<br />

Patent expired 2010-2013<br />

Peak sales $1.72B (2008)<br />

Blocking DNA synthesis<br />

Tumor resistance (cellular uptake<br />

is depends on hENT-1)<br />

Short half-life (32-94 minutes)<br />

Toxicity (neutropenia)<br />

IV administration<br />

Resistant<br />

Source: Spratlin et al. Clin Can Res (2004)<br />

Responsive


ATT-GEM potent in resistant cells<br />

hENT-1 inhibited K562 cells<br />

Growing cells (% of control)<br />

100<br />

80<br />

60<br />

40<br />

20<br />

0<br />

100<br />

80<br />

60<br />

40<br />

20<br />

0<br />

Resistant<br />

cells<br />

0 0.2 0.4 0.6 0.8 1<br />

Resistant<br />

cells<br />

0 0.2 0.4 0.6 0.8 1<br />

DP (Dipyridamole), 10μM for 30min<br />

Incubation time with the drug: 72h<br />

GEM<br />

GEM+DP<br />

TBE-es ATT-GEM2<br />

TBE-es+DP<br />

ATT-GEM2+DP<br />

GEM<br />

GEM+DP<br />

Tes ATT-GEM1<br />

Tes+DP ATT-GEM1+DP<br />

90<br />

80<br />

70<br />

60<br />

50<br />

40<br />

30<br />

20<br />

10<br />

0<br />

Resistant index =<br />

0.8<br />

4.7<br />

IC50 (*) Resistant<br />

IC50 Normal<br />

ATT-GEM1 ATT-GEM2 Gemcitabine<br />

* IC50 = concentration<br />

required <strong>to</strong> kill 50% of cells<br />

83<br />

CONFIDENTIAL


ATT-GEM<br />

Initial in-vivo performance data in responding (sensitive) tumor<br />

(HCT116 colon carcinoma)<br />

Similar efficacy in responsive tumors, with safety benefit<br />

Weight (% of control)<br />

Tumor growth inhibition<br />

115<br />

2000<br />

Control<br />

110<br />

105<br />

100<br />

1800<br />

1600<br />

1400<br />

1200<br />

Gemcitabine 50mg<br />

Gemcitabine 100mg<br />

ATT-GEM1 120mg<br />

ATT-GEM2 120mg<br />

95<br />

1000<br />

800<br />

90<br />

600<br />

85<br />

400<br />

80<br />

0 5 10 15 20 25 30<br />

200<br />

0<br />

0 5 10 15 20 25 30


ATT-LD<br />

Long-acting levodopa for treatment of Parkinson’s disease<br />

Parkinson’s<br />

disease<br />

Progressive neuro-degenerative disorder, caused<br />

by depletion of the neuro-transmitter dopamine<br />

Prevalence 1.4 million (US, 5 EU and JP)<br />

Levodopa (L-Dopa) mainstay treatment of<br />

moderate-advanced PD<br />

Mechanism<br />

Precursor of dopamine<br />

Key Limitations<br />

Short half-life (45-90 minutes)<br />

Absorbed mainly in the duodenum, only 5-10%<br />

reaches the brain


The short half-life problem


ATT-LD Significantly Extends Levodopa Formation<br />

Rat model; concentration levels under effective range (should be increased)<br />

500<br />

450<br />

5 hrs steady levodopa formation<br />

PO 45mg/kg 7M<br />

PO 180mg/kg 8M<br />

400<br />

350<br />

Levodopa, ng/ml<br />

300<br />

250<br />

200<br />

150<br />

100<br />

50<br />

0<br />

0 60 120 180 240 300 360 420 480<br />

Time, min<br />

* Levodopa T ½ in rat 42-48 minutes


<strong>Pipeline</strong><br />

Molecular Imaging<br />

Discovery Pre-Clinical Phase 1 Phase 2 Phase 3<br />

ML-10<br />

Apop<strong>to</strong>sis Imaging<br />

Therapeutic<br />

Oncology<br />

ATT-11<br />

ATT-GEM<br />

CRC, Esophageal, SCLC<br />

Pancreatic cancer<br />

Neurology<br />

ATT-LD<br />

Parkinson’s Disease


New Product Initiation Process<br />

Identify unmet<br />

clinical needs<br />

Select active<br />

therapeutic<br />

Apply <strong>Aposense</strong>®<br />

technology <strong>to</strong> create<br />

a new drug that<br />

addresses the need<br />

R&D


Discovery<br />

In Vivo<br />

In Vitro<br />

• Medicinal chemistry<br />

• Rational drug design<br />

• Molecular modeling<br />

• Synthesis via network of contrac<strong>to</strong>rs<br />

• Fully equipped biochemistry lab<br />

• Licensed radioactive suite for β<br />

emitters<br />

• Cancer cell lines bank<br />

• Established apop<strong>to</strong>sis models<br />

• Cy<strong>to</strong><strong>to</strong>xic drug handling<br />

• Cell culture<br />

unit<br />

• Animal house,<br />

wild type species<br />

and immune<br />

deficient mice<br />

• An array of established<br />

xenograft mice models<br />

• In-house his<strong>to</strong>logy unit for sectioning<br />

and various staining techniques with<br />

<strong>to</strong>p tier his<strong>to</strong>pathologists consultancy<br />

• Expertise in IV and oral formulations,<br />

including poorly soluble drugs<br />

• CRO network for formal pre-clinical<br />

development, PK/PD, oralbioavailability,<br />

ADME and<br />

<strong>to</strong>xicology studies<br />

• In-house management of<br />

CMC via contrac<strong>to</strong>rs<br />

Final<br />

Drug Product


Financial Information<br />

Shareholder Base<br />

Cash position:<br />

$25.3 million<br />

(June 30, 2012)<br />

11%<br />

31%<br />

Cash used for operations:<br />

FY2010<br />

FY2011<br />

Jun 30, 2012<br />

$5.5 million<br />

$6.7 million<br />

$3.8 million<br />

21%<br />

4%<br />

14%<br />

20%<br />

Private Investment Firms<br />

Public Listing:<br />

TASE: APOS<br />

Venture Capital<br />

Financial Institutions (≥5%)<br />

Big Pharma<br />

Direc<strong>to</strong>rs, Officer & Employees<br />

Public, Institutions (


Summary<br />

• Core Core Capabilities<br />

Capabilities<br />

– Novel platform technologies<br />

– Full drug development capabilities<br />

– New Product Generation Process<br />

• <strong>Pipeline</strong><br />

<strong>Pipeline</strong><br />

– Lead clinical program: Apop<strong>to</strong>sis Imaging (ML-10) near completion of phase 2<br />

– Growing & maturing pre-clinical portfolio: 3 new drugs, major unmet needs<br />

– New compounds continuously added by application of platform<br />

• Corporate Infrastructure<br />

– Experienced board and management team<br />

– Strong financial position


Thank you.

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