SlideShare uma empresa Scribd logo
1 de 67
Eribis Pharmaceuticals AB

                      Novel Treatment of
                Acute Myocardial Infarction (AMI)




CONFIDENTIAL                                        1
Eribis presentation

                The Company
                The indication – background & market
                EP94
                Pre-clinical Development
                General Properties
                Clinical Development
                Intellectual Property
                Q & A session



CONFIDENTIAL                                            2
The Company




CONFIDENTIAL                 3
The Company
      Eribis Pharmaceuticals AB is a Uppsala-based biotech company founded
      in 2006, with the aim to develop new therapies for cardiovascular
      disease.




CONFIDENTIAL                                                                 4
Management

        Herman Krapf, Chief Executive Officer
        Erik Bissessar, Chief Business Officer and Medical Scientific
         Liason
        Peter Båvenholm, MD, Ph.D., Ass. Prof. Internal Medicine,
         Chief Medical Officer
        Fredrik Röök, Business Development
        Stefan Persson, Ph.D., Pharmacology and Toxicology
        Claes Lundberg, Ph.D., Project Management




CONFIDENTIAL                                                             5
Scientific Advisory Board

        Gerhard Wikström, MD, Ph.D., Ass Prof Cardiology, Uppsala
         University Hospital
        Lars Grip, MD, Ph.D., Professor in Cardiology, Sahlgrenska
         University Hospital
        John Pernow, MD, Ph.D., Prof in Cardiology, Karolinska
         University Hospital
        Garrett Gross, Ph.D.,Professor of Pharmacology, Medical
         College of Wisconsin
        Dan Atar, MD, Ph.D., Professor in Cardiology, Division of
         Cardiology, Oslo University Hospital Aker



CONFIDENTIAL                                                          6
Acute Myocardial Infarction (AMI)
                   background and market




CONFIDENTIAL                                       7
Cardiovascular disease (CVD)
               the major health problem

           CVD include;
              acute coronary syndromes (ACS)
              stroke
              periphereal arterial disease (PAD)
           Burden of CVD is increasing in parallel with increase in life
            expectancy
           Acute Myocardial Infarction (AMI) is the number one cause
            of death in the Western world
               mortality rates near 10%
               first cause of chronic heart failure




CONFIDENTIAL                                                                8
Acute coronary syndrome (ACS)


    Acute coronary syndrome (ACS) is comprises three diseases
    involving the coronary arteries: ST elevation myocardial infarction
    (STEMI), non ST elevation myocardial infarction (non-STEMI) and
    unstable angina.

    While ACS mortality declined in the last four decades in the USA as life
    expectancy increased, the decline largely represents the postponement
    of ACS deaths until older age.

    Thus, the burden of ACS is increasing in parallel with the increase in life
    expectancy.




CONFIDENTIAL                                                               9
Reperfusion therapy
       Primary Treatment O ptions for AMI

               Coronary Artery By-pass
               Graft (CABG)

               Percutaneous Coronary
               Intervention (PCI)




 Across the seven major markets in 2006 the number of
  cardiovascular procedures, including CABG and PCI were
  estimated at 7.0m
 Incidence rates for PCI amounts to 3.7m (nonSTEMI + STEMI)

                                                               10
Large unmet need
                        Acute Coronary Syndrome
                          - the major markets



   The American Heart Association (AHA) estimates that
   there were 1.2 million cases of ACS in 2007 in the US.
   This number includes both patients experiencing their first
   event as well as patients with relapses.
   Patients’ experiencing their first event is around 700,000;
   STEMI and NSTEMI accounting for 85% of these events.
   This incidence is similar to that in the five major markets in
   Europe.
   The total number of ACS cases in the US and the five
   major EU markets is therefore estimated at around
   2.5 – 3.0 million annually.


CONFIDENTIAL                                                    11
Metabolic and biochemic changes
                  caused by reperfusion

  Reperfusion injury (RI) limits the beneficial effects of revascularisation
   Studies in different species suggest that 20-70% of myocardial damage may come from RI
    (Gomes L 2007, Penna C 2008, Zhao ZQ, 2006)

  RI leads to functional and structural myocardial damage
   –generation of ROS
   –a fast restoration of pH
   –intracellular calcium overload
   –mitochondrial dysfunction
   –Apoptosis
               (Yellon DM, 2007)




   Cardioprotective strategies to minimize RI represents an
   unmet medical need

CONFIDENTIAL                                                                                12
Principles of ischemic pre- and
                              postconditioning




             Brief episodes of coronary artery occlusion are applied either before (preconditioning) or
             immediately after (postconditioning) the prolonged ischemic insult

  CONFIDENTIAL
Ref; Zhao ZQ et al., Am J Physiol Heart Circ Physiol, 2003;285:579-88                                     13
EP94
               Cardioprotection in acute myocardial
                         infarction (AMI)




CONFIDENTIAL                                          14
EP94 – First in class drug


          Novel pharmacological cardioprotective intervention
          Tetrapeptide (stabilized)
          Injectable, small volume
          Microgram dosage
          Cardioprotective effects in rodent and non-rodent animal
           models
          Low COGS (solid phase peptide synthesis)
          Patent protected




CONFIDENTIAL                                                          15
Tentative molecular signaling pathways
               involved in cardioprotection




CONFIDENTIAL                                            16
Mode of Action

    Acute Myocardial Infarction induces an ischemia/reperfusion-induced
     tissue damage

    It is anticipated that EP94’s mode of action reduces the
     ischemia/reperfusion damage through
         opoid receptors
         KATP channels
         iNOS




CONFIDENTIAL                                                         17
Preclinical results




CONFIDENTIAL                         18
Key studies presented:

      •   Rodent dose finding study
      •   Pig study, closed chest, iv.
      •   Pig study, open chest, infusion
      •   Pig study, closed chest, dose finding, iv.
      •   Pig study, closed chest, high-dose range finding, iv.
      •   Rodent study, dose finding, m.o.a. study




CONFIDENTIAL                                                      19
EP94 shows a dose dependent reduction of myocardial
                          infarction size in rats
                                                               25 min occlusion                          = Vehicle administration

                     -5       0                                                                             25         = EP94 administration

                                                                      Vehicle
                                                             EP94 (0.01 µg/kg x 1)
                                                              EP94 (0.1 µg/kg x 1)
     Post-surgery                                                                                                      2 hrs reperfusion
     stabilization                                             EP94 (1 µg/kg x 1)
     phase                                                     EP94 (5 µg/kg x 1)
                                                              EP94 (10 µg/kg x 1)


                                         60

                                         50

                                         40
                                                                            *                      *             *
                            IS/AAR (%)




                                         30                                            *
Pre-conditioning                         20

                                         10
                                                   N=12        N=6         N=12       N=12        N=12           N=9
                                         0
                                                    le         k g)          /kg)      / k g)    /kg)       /kg )
                                              V ehic (0.01 ug/          .1 ug P94 (1 ug P94 (5 ug 94 (10 ug
                                                  EP9  4      EP  94 (0        E           E      EP

  CONFIDENTIAL                                                   Study number 64-06                                                            20
EP94 i.v. administered early or late during ischaemia in a
                  closed chest MI pig model reduces myocardial infarction size
                  significantly

                                                        40 min occlusion                                                             = Vehicle administration

    60 min              5                    12                     19                 26                        33                     40           = EP94 administration

                                                                     Vehicle
  Post-surgery
                                     EP94 (1 µg/kg x 4) – Early intervention
  stabilization
                                                                                                                                                    4 hrs reperfusion
  phase
                                     EP94 (1 µg/kg x 3) – Late intervention

                                EP94 (0.2 µg/kg x 3) – Late intervention

                                           Closed chest pig MI/reperfusion model
                                     80
                                     70                                                 **
                                     60                       *
                        IS/AAR (%)




                                     50
                                     40
                                     30
                                                                              Early                         Late                             Late
                                     20
                                     10
                                                N =7                          N =4                          N =6                             N =6
                                      0

                                            hic
                                                le
                                                                          x   4)                        x   3)                           x   3)
                                          Ve                         / kg                           /kg                             / kg
                                                                   ug                             ug                              ug
                                                              (1                             (1                           (0.
                                                                                                                              2
                                                         94                             94                           94
                                                       EP                             EP                           EP
                       Mean ± SEM



CONFIDENTIAL        Study Report 09-01, Karlsson et al., Eur J Pharmacol 2011:651 pp146-151                                                                                  21
Intracoronary infusion of EP94 in pigs reduces
                  myocardial infarction size significantly
                                                                         30’              5’

    60 min                                            40 min occlusion         Infusion

  Post-surgery          Vehicle
  stabilization                                                                                4 hrs reperfusion
  phase                 EP94 (0.2 µg/min, 15 min)



                                            100   Open chest pig MI/reperfusion model
                                            90

                                            80

                                                                               **
                        % of area at risk




                                            70

                                            60

                                            50

                                            40

                                            30

                                            20

                                            10
                                                       N=5                     N=5
                                             0


                       Mean ± SEM                    Vehicle                   EP94

CONFIDENTIAL                                                                                                       22
                     Study Report 08-02, Karlsson et al., Eur J Pharmacol 2011:651 pp146-151
EP94 appears to reduce myocardial infarction
                  size dose-dependently
                                              40 min occlusion                                  = Vehicle administration

    60 min                                                       26             33               40          = EP94 administration


                                                     Vehicle
  Post-surgery
                                           EP94 (1 µg/kg x 3)
  stabilization
                                                                                                           4 hrs reperfusion
  phase
                                           EP94 (5 µg/kg x 3)

                                          EP94 (25 µg/kg x 3)

                        Closed chest pig MI/reperfusion model
                                     70

                                     60

                                     50
                        IS/AAR (%)




                                     40

                                     30

                                     20

                                     10
                                          N=6           N=6            N=6            N=6
                                      0
                                          Vehicle      1 ug/kg        5 ug/kg        25 ug/kg
                                                                                                         Mean ± SEM


CONFIDENTIAL                                        Study Report 11-02                                                               23
Ongoing studies
                   - preliminary results




CONFIDENTIAL                               24
Dose range finding study in a closed chest pig
                    model




                                          40 min occlusion               = Vehicle administration
                                                                                      = EP94 administration
    60 min             0                               26           33    40
                                              Vehicle

                                      EP94 (1 µg/kg x 3)
    Post-surgery                     EP94 (25 µg/kg x 3)
    stabilization                                                                   4 hrs reperfusion
    phase                            EP94 (125 µg/kg x 3)



                                OPTIONAL: EP94 (625 µg/kg x 3)

                           N = 12/group




CONFIDENTIAL                               Study protocol 2011-01                                             25
Results of the dose finding study is a…




CONFIDENTIAL                                             26
Rat acute myocardial infarction model – a combined dose
                     response and mode of action study

                                                 25 min occlusion                 = Vehicle administration
                 -10     0         5             10                                               = EP94 administration


                                                      Vehicle

                                           EP94 (0.5 µg/kg x 2)
     Post-surgery                          EP94 (1.0 µg/kg x 2)
     stabilization                                                                          2 hrs reperfusion
     phase                                 EP94 (2.5 µg/kg x 2)

                                           EP94 (5.0 µg/kg x 2)

                                               EP94 (10 µg/kg x 2)



1)     Opioid antagonists i.v.            2)     KATP channel antagonists i.v.               3)       iNOS inhibitor i.v.
       a) Naltrindole (delta) – 5 mg/kg          a) HMR1098 (sarc KATP blocker) – 6 mg/kg             a) 1400W
       b) Nor-BNI (kappa) – 0.3 mg/kg            b) 5-HD (mito KATP blocker) – 10 mg/kg
       c) CTOP (mu) – 0.1 mg/kg                                                                       b) 1400W + EP94
                                                 d) HMR1098 + EP94
       d) Naltrindole + EP94                     e) 5-HD + EP94
       e) Nor-BNI + EP94
       f) CTOP + EP94


CONFIDENTIAL                                     Study protocol 2010-01                                                   27
Rat acute myocardial infarction model – a combined dose
                         response and mode of action study - cont´ d


                                 Bell-shaped dose-response relationship in rat confirms
                                 previous results in rats
                        70,00

                        60,00
                                                                                **
                        50,00
                                                  ***            ***
           IS/AAR (%)




                        40,00

                        30,00

                        20,00

                        10,00
                                N=9       N=8     N = 10        N = 10          N=8   N=9   N=8
                         0,00
                                Vehicle   0.1      0.5            1.0           2.5   5.0   10.0
                                                           EP94 (ug/kg, i.v.)

                                                                                            Mean ± SEM
                                                                                            *** p < 0.001 vs vehicle
                                                                                             ** p < 0.01 vs vehicle
CONFIDENTIAL                                                                                                28
Rat acute myocardial infarction model – a combined dose
                             response and mode of action study - cont´ d


                              Blocking of mu-opioid receptors abolish the cardioprotective effects of
                              EP94
                     70,00

                     60,00
                                                                                                                                                             **                                 **
                     50,00                                                                                                              ***
        IS/AAR (%)




                     40,00

                     30,00

                     20,00

                     10,00

                      0,00       N=9                     N=9                             N=9                       N=9                   N = 10            N=9                N=9              N=9
                                                               )                           )                         )                      )                 4                                  4
                                  c   le                    kg                           kg                        kg                    kg                P9                  94              P9
                               hi                        g/                           g/                         g/                   g/                 E                  EP               E
                             Ve                      m                            m                             m                    u               +                    +                I+
                                                (5
                                                                           (0
                                                                             .1                          0.
                                                                                                            3                   (1                NT                 O
                                                                                                                                                                      P
                                                                                                                                                                                         BN
                                           NT                                                          I(                  94                                     CT                   r-
                                                                      O
                                                                       P                              N                  EP                                                         no
                                                                   CT                             r-B
                                                                                               No

     NT = naltrindole = selective delta-antagonist                                                                                                                              Mean ± SEM
     CTOP = selective mu-antagonist                                                                                                                                             *** p < 0.001 vs vehicle
     Nor-BNI = selective kappa-antagonist                                                                                                                                        ** p < 0.01 vs vehicle
CONFIDENTIAL                                                                                                                                                                                         29
Rat acute myocardial infarction model – a combined dose
                            response and mode of action study - cont´ d


                                           Effects of selective KATP ion channel antagonists
                    70,00

                    60,00

                    50,00
                                                           ***
       IS/AAR (%)




                    40,00

                    30,00

                    20,00

                    10,00
                                  N=9                    N = 10                              N=9                             N=9                         N=9                      N=9
                     0,00
                                      le                   kg
                                                              )                                   g)                           4                             g)                        94
                               hi
                                  c
                                                        g/                                 g/
                                                                                              k                              P9                       g/
                                                                                                                                                         k
                                                                                                                           E                                                      EP
                             Ve                   (1
                                                       u                               m                               +                      0
                                                                                                                                                  m                           +
                                                                                  (6                              98
                                             94                              98                                 10
                                                                                                                                           (1                            HD
                                                                                                                                      HD                              5-
                                           EP                              10                               R
                                                                                                                                   5-
                                                                       R                               HM
                                                                  HM

                                                                                                                                                                  Mean ± SEM
  HMR 1098 = sarcolemmal KATP channel antagonist                                                                                                                  *** p < 0.001 vs vehicle
  5-HD = mitochondrial KATP channel antagonist
CONFIDENTIAL                                                                                                                                                                                30
Rat acute myocardial infarction model – a combined dose
                            response and mode of action study - cont´ d


                                       Effects of iNOS inhibition on EP94-induced cardioprotection
                    70,00

                    60,00

                    50,00                                             ***                                                   ***
       IS/AAR (%)




                    40,00

                    30,00

                    20,00

                    10,00

                     0,00
                                    c le                            24- h                       u te                          e)                        e)
                             Vehi                               -                         ) - Ac                       (ac ut                    (ac ut
                                                         ipx 2)                     /kg iv                        EP94                     4 00W
                                                  ug/ kg                          mg                         e) +                       )+1
                                       EP9 4
                                             (1                             (0. 1                     (ac ut                      (24- h
                                                                     14 00W                    14 00W                      E P9 4




                                                                                                                                                  Mean ± SEM
                                                                                                                                                  n = 9/group
  1400W = iNOS inhibitor                                                                                                                          *** p < 0.001 vs vehicle

CONFIDENTIAL                                                                                                                                                       31
Conclusions



 • EP94 is effective in two different pig ischemia/reperfusion
   models (open vs closed chest)
 • EP94 produces a significant reduction of infarct size in pigs
   already at 1 µg/kg
 • The cardioprotective effect of EP94 seems to be dose-
   dependent in pigs
 • EP94 reduces the infarct size dose-dependently during both
   pre- and post-conditioning in rats
 • EP94 acts predominantly through mu-receptors in rats


CONFIDENTIAL                                                       32
General properties,
               Toxicology and Safety
                   Pharmacology




CONFIDENTIAL                           33
EP 94 – General properties

      Tetrapeptide
      Manufactured by solid phase peptide synthesis
      Lyophilized powder
      Solubility: Good solubility in water
      Stability of drug substance:
           Stable at +4°C for more than 2 years

      Stability of drug product:
           Stable at -18°C, +4°C and 25°C for more than 6 months in saline




CONFIDENTIAL                                                                  34
Toxicology & Safety

        Single dose tox. study in rats and pigs
        Repeat dose tox. study, 14 days, in rats and pigs
        Safety Pharmacology
        Genotoxicity
        Pharmacokinetics and ADME




CONFIDENTIAL                                                 35
Clinical Development




CONFIDENTIAL                          36
Key factors for success with EP94 in a
               clinical development programme

            Selection of patient population
              STEMI patients
              An adequate risk stratification algoritm

            Selection of primary endpoint
              Optimal method used to detect infarct size reduction




CONFIDENTIAL                                                   37
Clinical development of EP 94
                Phase I study



         Study Objective: Dose-escalation study to evaluated
          the safety, and tolerability in healthy individuals
         Design: single-center, double-blind
         Estimated number of healthy volunteers: 40
         Primary outcome measures: tolerability, safety, PK
          and hemodynamic parameters




CONFIDENTIAL                                                    38
Clinical development of EP 94
                Phase II, proof-of-concept study

      Study Objective: Dose-escalation study to investigate the cardioprotective
       effect of ERIBIS Peptide 94 given as an adjunct to percutaneous coronary
       intervention (PCI) in subjects with an acute STEMI


      Design: randomized, placebo-controlled, double-blind and multicenter
         Estimated number of patients: 350-400


      Primary outcome measure:
        To demonstrate a dose-dependent positive trend for myocardial salvage
          and myocardial salvage index using a modified single contrast enhanced
          steady-state free precession (SSFP) cine cardiovascular magnetic
          resonance (CMR) examination performed one week after the acute event


CONFIDENTIAL                                                                   39
Clinical development of EP 94
                Phase II, proof-of-concept study



      Secondary outcome measure:
         ST-resolution on 12 lead ECG 90 minutes after PCI
         Tropinin, CK-MB 3 to 6 hrs, 6 to 12 hrs, 18 to 24 hrs and 36 hrs after
          randomization (Peak and AUC)
         To determine Left Ventricular Ejection Fraction (LVEF) and Wall Motion
          Score Index (WMSI) 6 weeks and 6 months after PCI
         Myocardial salvage index 6 months after PCI
         Incidence of cardiac death and total mortality, stroke, new-onset heart
          failure, and re-hospitalization for any congestive heart failure 6 month
          follow-up visit



CONFIDENTIAL                                                                   40
Intellectual Property




CONFIDENTIAL                           41
Intelectual Property

       The IPR comprises patent protection for:
        Chemical structure of peptides and peptide-based compounds
        Clinical Utility
        Pharmaceutical Composition
        PCT application was filed in August 2007
        Regional and National patent applications submitted early
       2009 in EU, USA, Canada, Australia, India, China and Japan.
        EU patent grant subject for approval, EPO decision to grant
       obtained Feb 2011



CONFIDENTIAL                                                           42
Summary

                First in class
                Significant cardioprotective effect
                Clear unmet medical need & large
                 market size
                New therapeutic principle
                Significant preclinical results
                  - good clinical prognosis

CONFIDENTIAL                                           43
Q & A answers

1. Does the peptide pass the blood brain barrier?
2. Does the NO-group give rise to worries in relation to
toxicology?
3. Does the NO-group give rise to worries in relation to
Carcinogenicity?
4. Are other receptors hit by this peptide?



CONFIDENTIAL                                           44
NO-study
 EP94 has been evaluated with and without NO and acylation in response
    to the EU patent office’s questions regarding Eribis application. To
    show that the specific groups at position 2, acylation, and pos 4, NO-
    group, are both necessary to have the cardioprotective effect shown
    with EP94.
 5 different peptides were compared with EP94 in this pre-conditioning
    study.
          •without NO-group of the 4th amino acid
          •without acylation of 2nd amino acid
          •without both acylation and NO-group
          •with Asp instead of acylation on 2nd amino acid
          •with Arg-Asp instead of acylation on 2nd amino acid

 EP94 does not exert a significant level of cardioprotective activity without
   these specific groups in the second and fourth position on EP94.

CONFIDENTIAL                                                              45
Do you have rodent data?
       How does EP94 and morphine perform together in the
       models?
       Any efficacy measures/differentiation from morphine/other
       opioids.
       Answer:
       Eribis has performed a series of studies on rodents that
       answer these questions.
       This data will be available when Zealand performs a DD.
       There is too much data to discuss during this initial
       meeting.

CONFIDENTIAL                                                      46
Morphine cont’

   Morphine is regularly used as pre-medications in the pig studies. EP94
   exerts its cardioprotective properties despite approx 13-333-fold higher
   morphine doses in pigs. However, morphine has not regularly been
   used as pre-medication in the explorative rat efficacy (cardioprotection)
   studies conducted in Moscow.

   MI patients are usually treated with morphine in the emergency room to
   reduce pain and anxiety. Thus, one exploratory study in rats has been
   conducted to address the possibility of an interaction between EP94
   and morphine. This study did not reveal any synergistic, additive or
   antagonistic effects of morphine on EP94-induced cardioprotection.
   Consequently, EP94 has been used in combination with morphine in
   the pig studies to mimic the clinical situation as closely as possible. The
   pigs are routinely premedicated with 0.5 mg/kg/hr of morphine.



CONFIDENTIAL                                                              47
How is the peptide cleared?

   Answer:

      It is anticipated that EP94 is degraded by various endo-
      and exo-peptidases in the blood stream. The
      degradation products are believed to be excreted in the
      urine or partly utilized by the body. This will be verified
      by dedicated ADME studies in the near future.




CONFIDENTIAL                                                    48
Have you tried the peptide, but without the NO-group, in your
  models?
  Data from Rodents (cardio protective effect with EP94 (with and
  without NO) - Y see study 257/10
                 es
  How does nitroglycerin perform in your models?
  - Not evaluated
  How does nitroglycerin and morphine perform together in the
  models? (against EP94)
  - Not evaluated
  Models where EP94 does not work (MOA)?
  - EP94 has been shown to be cardioprotective in all models tested so
  far, i.e. 2 different species and in total 5 different models.
CONFIDENTIAL                                                        49
Any cellular assays (all in vitro receptor data (cell lines over-
      expression the receptors) and work performed on primary
      cells and specific cell lines that express the receptors).


       Receptor binding to the human opioid receptors (µ,
       δ, κ) expressed on CHO and HEK-293 cells.
               - Study available during the DD process.




CONFIDENTIAL                                                        50
Speculations on down stream target?
         To investigate a possible downstream pathway which
         may be mediating the beneficial effect of EP94 we
         administered either the sarcolemmal KATP channel
         antagonist, HMR 1098, or the mitochondrial KATP
         channel antagonist, 5-HD, to rats prior to EP94
         administration.

         Both antagonists completely abolished the
         cardioprotective effect of EP94 which suggests an
         important role for the KATP channel as a key mediator
         in the pathway by which EP94 reduces infarct size
         similar to that seen with a number of other
         cardioprotective agents as well as ischemic
         preconditioning and postconditioning.
CONFIDENTIAL                                                51
Are the coronary arteries also affected?


          Potential effects on coronary arteries have not been
          investigated.




CONFIDENTIAL                                                     52
Speculations on general cardiovascular
               safety of EP94.

  • EP94 does not affect blood pressure or heart rate in
    anaesthesized animals (rats and pigs) at doses levels
    ranging from 20 – 75 µg/kg (cf. pharmacological efficacy
    studies)
  • EP94 does not have significant effects on blood pressure in
    and only a minor and late effect on heart rate in consious
    rats at doses of 5-10 mg/kg (ESR08-006).
  • The very low doses needed for pharmacological efficacy and
    the short t1/2 (approx 40 min) is anticipated to reduce
    cardiovascular safety risks to a minimum.



CONFIDENTIAL                                                      53
" In-vivo SAR" (opioid component vs. the nitric oxide effects).
    Unknown

     Toxicology: Metabolism/metabolites and their distribution.

    No evaluation of metabolites has been performed. It is anticipated that the bond
    between amino acid 2 and 3 is susceptible to proteolytic cleavage and that the
    major metabolites will contain 2 amino acids each.

    ADME will be performed in the near future.




CONFIDENTIAL                                                                      54
A list of all published patent applications and
               patents and their status.
           PCT application PD53743CA00 - Novel Enkephalin
             Analogues - Eribis Pharmaceuticals AB

           EU pat appl. No 07 794 118.5
           A “Decision to Grant” will be announced in Q2-2011

           Eribis Pharmaceuticals AB owns the IP rights




CONFIDENTIAL                                                     55
FTO analysis of key IP

          FTO analysis has not been performed, however
          patentability has been evaluated by third party
          patent attorneys.
              - statements are in the handouts.




CONFIDENTIAL                                                56
Thank you for listening!




               Contact;
               Herman Krapf, CEO
               herman.krapf@ eribispharma.se
               Erik Bissessar Founder & Chief Business Officer
               erik.bissessar@ eribispharma.se

CONFIDENTIAL                                                     57
Back-up bilder




CONFIDENTIAL                    58
Chemistry Manufacturing
                   Control (CMC)




CONFIDENTIAL                             59
EP 94 – General properties

      Tetrapeptide
      Manufactured by solid phase peptide synthesis
      Lyophilized powder
      Solubility: Good solubility in water
      Stability of drug substance:
           Stable at +4°C for more than 2 years

      Stability of drug product:
           Stable at -18°C, +4°C and 25°C for more than 6 months in saline




CONFIDENTIAL                                                                  60
Specification

 Test                     Method                      Specifications
 Appearance               Visual observation          Off-white to yellow powder
 Mass spectral analysis   EP 2.2.43; ESI              M = 571.2 +/- 1.0
 Amino acid analysis      Pre-column derivatisation   Gly:1; Tyr:1; Dab:1;
                          with OPA/Fmoc-Cl            Phe (pNO2).1
                          EPA 2.2.56
 RP-HPLC                  EP 2.2.29                   Purity > 98.0% (area%)
 Related Impurities by    EP 2.2.29                   Sum impurities < 2%
 RP-HPLC
 Water content            Karl Fischer, EP2.5.12      To be reported
 Acetate                  HPLC with UV detection      To be reported
 Residual TFA             HPLC with UV detection      < 0.1% (tentative)



CONFIDENTIAL                                                                   61
Specification cont’d

          Test                    Method           Specifications
          Residual organic        GC <USP 467>     Individual according to ICH
          solvents                                 Q3

          Bioburden               EP 2.6.12        Aerobic bacteria < 10 CFU/0.1g
                                                   Anerobic bacteria < 10 CFU/0.1g
                                  <USP 61>         Yeasts and moulds < 10 CFU/0.1g

          Bacterial endotoxins    EP 2.6.14 <USP   < 5 EU/mg (tentative)
                                  85>
          Net peptide content     Pre-column       To be reported
          (NPC)                   derivatisation
          by AAA                  with OPA/Fmoc-
                                  Cl
                                  EPA 2.2.56
          Mass balance            Calculation      To be reported
                                  NPC+acetate+w
                                  ater

CONFIDENTIAL                                                                         62
EP 94

                Manufactured by Polypeptide
                Part no: SP080384
                Storage temp: 4°C

Lot no          HPLC analysis Date
CF 07314            97.7%     26.3.2008
CF 07314            95,8%     11.2.2010




CONFIDENTIAL                                   63
EP 94

                Manufactured by Polypeptide
                Part no: SP080384B
                Storage temp: 4°C

Lot no         HPLC analysis Date
MZ77114           98.9%      07.05.2009




CONFIDENTIAL                                   64
Drug Product
                  Stability of EP 94 in Saline

         Stability (non- ICH) of EP94, 0.1mg/mL in 9 mg/mL NaCl
         (preserved with NaN3 1mg/mL)




      Temp       Time 0    14 days   2.5 mo     4.5 mo    6 mo
        -18°C                 96.5      96.5       96.6      96.5
         4°C       96.5*      96.5      96.6       96.4      96.2
       Ambient                96.6      96.6       96.0      95.5
      * Area %




CONFIDENTIAL                                                        65
CMC - T do list
                      o

                Drug Substance
                 Analytical development
                 Specification
                 Stability ICH
                 Manufacturing

                Drug Product
                 Analytical development
                 Preformulation
                 Interaction with packaging mtr
                 Stability ICH
                 Manufacturing for tox and clinical

                Regulatory
                 IND/CTA chapter

CONFIDENTIAL                                           66
Refererences
               1.   Thom T, Haase N, et al. Writing Group Members. Heart Disease and Stroke
                    Statistics--2006 Update. Circulation; A Report From the American Heart Association
                    Statistics Committee and Stroke Statistics Subcommittee; January 11, 2006; 2006.
                    CIRCULATIONAHA.105.171600.
               2.   Bishop E. Heart disease may actually be rising; researchers claim deaths are now
                    being delayed to a later age group. Wall Street Journal. 1996 November 13, 1996;
                    pB3(W) pB6(E) col 1 (11 col in)
               3.   Gerber Y, Jacobsen SJ, Killian J, Weston S, Roger VL. Impact of Participation Bias in a
                    Population-Based Study of Myocardial Infarction in Olmsted County, Minnesota, 2002
                    to 2004. Circulation. 2006;13:e827.
               4.   Eribis Peptide 94 Reduces Infarct Size in Rat Hearts Via Activation of Centrally
                    Located μ Opioid Receptors. J Cardiovasc Pharmacol. 2011 Nov 29 Gross GJ, Hsu A,
                    Nithipatikom K, Bobrova I, Bissessar E.
               5.   Dose-dependent cardioprotection of enkephalin analogue Eribis peptide 94 and cardiac
                    expression of opioid receptors in a porcine model of ischaemia and reperfusion.
                    Eur J Pharmacol. 2012 Jan 15;674(2-3):378-83 Karlsson LO, Bergh N, Li L,
                    Bissessar E, Bobrova I, Gross GJ, Akyürek LM, Grip L.
               6.   Opioid receptor agonist Eribis peptide 94 reduces infarct size in different porcine
                    models for myocardial ischaemia and reperfusion. Eur J Pharmacol. 2011 Jan
                    25;651(1-3):146-51 Karlsson LO, Grip L, Bissessar E, Bobrova I, Gustafsson T,
                    Kavianipour M, Odenstedt J, Wikström G, Gonon AT.




CONFIDENTIAL                                                                                                  67

Mais conteúdo relacionado

Semelhante a Eribis 2011

Advanced cardiac life support(acls)
Advanced cardiac life support(acls)Advanced cardiac life support(acls)
Advanced cardiac life support(acls)omar143
 
myocardial Reperfusion injury
myocardial Reperfusion injurymyocardial Reperfusion injury
myocardial Reperfusion injurydibufolio
 
No reflow phenomenon by dr. deepchandh
No reflow phenomenon by dr. deepchandhNo reflow phenomenon by dr. deepchandh
No reflow phenomenon by dr. deepchandhDeep Chandh
 
Nursing care of client with Coronary artery disease part 2 of 2
Nursing care of client with Coronary artery disease part 2 of 2Nursing care of client with Coronary artery disease part 2 of 2
Nursing care of client with Coronary artery disease part 2 of 2Carmela Domocmat
 
Acute Coronary Syndrome (NSTEMI)
Acute Coronary Syndrome (NSTEMI) Acute Coronary Syndrome (NSTEMI)
Acute Coronary Syndrome (NSTEMI) Muhammad Asim Rana
 
Peripartum Cardiomyopathy
Peripartum CardiomyopathyPeripartum Cardiomyopathy
Peripartum CardiomyopathyNishant Tyagi
 
ESC 2010 Research Highlights : A slideshow presentation
ESC 2010 Research Highlights : A slideshow presentationESC 2010 Research Highlights : A slideshow presentation
ESC 2010 Research Highlights : A slideshow presentationtheheart.org
 
Mana Of Susp Mi Fina Lfinal
Mana Of Susp Mi Fina LfinalMana Of Susp Mi Fina Lfinal
Mana Of Susp Mi Fina Lfinalhospital
 
Effect of carvedilol on atrial remodeling in canine model of atrial fibrillation
Effect of carvedilol on atrial remodeling in canine model of atrial fibrillationEffect of carvedilol on atrial remodeling in canine model of atrial fibrillation
Effect of carvedilol on atrial remodeling in canine model of atrial fibrillationCardiovascular Diagnosis and Therapy (CDT)
 
Angina pectoris
Angina pectorisAngina pectoris
Angina pectorisAMMU M
 
Higher event rate in patients with known CAD despite a normal myocardial perf...
Higher event rate in patients with known CAD despite a normal myocardial perf...Higher event rate in patients with known CAD despite a normal myocardial perf...
Higher event rate in patients with known CAD despite a normal myocardial perf...Cardiovascular Diagnosis and Therapy (CDT)
 
Approach to heart failure cases
Approach to heart failure casesApproach to heart failure cases
Approach to heart failure caseshospital
 
Fourth universal definition of myocardial
Fourth universal definition of myocardialFourth universal definition of myocardial
Fourth universal definition of myocardialRamachandra Barik
 
Role of ACE Inhibitors as Secondary Prevention in ACS
Role of ACE Inhibitors as Secondary Prevention in ACSRole of ACE Inhibitors as Secondary Prevention in ACS
Role of ACE Inhibitors as Secondary Prevention in ACSPERKI Pekanbaru
 
myocardialinfractionramesh-170504133703 (1).pdf
myocardialinfractionramesh-170504133703 (1).pdfmyocardialinfractionramesh-170504133703 (1).pdf
myocardialinfractionramesh-170504133703 (1).pdfjiregnaetichadako
 
Pci or throm or pi in stemi best strategy(apicon 09022019)-final
Pci or throm or pi in stemi best strategy(apicon 09022019)-finalPci or throm or pi in stemi best strategy(apicon 09022019)-final
Pci or throm or pi in stemi best strategy(apicon 09022019)-finalDr.Vinod Sharma
 

Semelhante a Eribis 2011 (20)

Advanced cardiac life support(acls)
Advanced cardiac life support(acls)Advanced cardiac life support(acls)
Advanced cardiac life support(acls)
 
myocardial Reperfusion injury
myocardial Reperfusion injurymyocardial Reperfusion injury
myocardial Reperfusion injury
 
No reflow phenomenon by dr. deepchandh
No reflow phenomenon by dr. deepchandhNo reflow phenomenon by dr. deepchandh
No reflow phenomenon by dr. deepchandh
 
Nursing care of client with Coronary artery disease part 2 of 2
Nursing care of client with Coronary artery disease part 2 of 2Nursing care of client with Coronary artery disease part 2 of 2
Nursing care of client with Coronary artery disease part 2 of 2
 
Acute Coronary Syndrome (NSTEMI)
Acute Coronary Syndrome (NSTEMI) Acute Coronary Syndrome (NSTEMI)
Acute Coronary Syndrome (NSTEMI)
 
Angina pectoris
Angina pectorisAngina pectoris
Angina pectoris
 
Peripartum Cardiomyopathy
Peripartum CardiomyopathyPeripartum Cardiomyopathy
Peripartum Cardiomyopathy
 
ESC 2010 Research Highlights : A slideshow presentation
ESC 2010 Research Highlights : A slideshow presentationESC 2010 Research Highlights : A slideshow presentation
ESC 2010 Research Highlights : A slideshow presentation
 
Mana Of Susp Mi Fina Lfinal
Mana Of Susp Mi Fina LfinalMana Of Susp Mi Fina Lfinal
Mana Of Susp Mi Fina Lfinal
 
Effect of carvedilol on atrial remodeling in canine model of atrial fibrillation
Effect of carvedilol on atrial remodeling in canine model of atrial fibrillationEffect of carvedilol on atrial remodeling in canine model of atrial fibrillation
Effect of carvedilol on atrial remodeling in canine model of atrial fibrillation
 
Angina pectoris
Angina pectorisAngina pectoris
Angina pectoris
 
Higher event rate in patients with known CAD despite a normal myocardial perf...
Higher event rate in patients with known CAD despite a normal myocardial perf...Higher event rate in patients with known CAD despite a normal myocardial perf...
Higher event rate in patients with known CAD despite a normal myocardial perf...
 
Rsi
RsiRsi
Rsi
 
Approach to heart failure cases
Approach to heart failure casesApproach to heart failure cases
Approach to heart failure cases
 
Fourth universal definition of myocardial
Fourth universal definition of myocardialFourth universal definition of myocardial
Fourth universal definition of myocardial
 
Myocarditis.pptx
Myocarditis.pptxMyocarditis.pptx
Myocarditis.pptx
 
Role of ACE Inhibitors as Secondary Prevention in ACS
Role of ACE Inhibitors as Secondary Prevention in ACSRole of ACE Inhibitors as Secondary Prevention in ACS
Role of ACE Inhibitors as Secondary Prevention in ACS
 
Myocardial infarction
Myocardial infarctionMyocardial infarction
Myocardial infarction
 
myocardialinfractionramesh-170504133703 (1).pdf
myocardialinfractionramesh-170504133703 (1).pdfmyocardialinfractionramesh-170504133703 (1).pdf
myocardialinfractionramesh-170504133703 (1).pdf
 
Pci or throm or pi in stemi best strategy(apicon 09022019)-final
Pci or throm or pi in stemi best strategy(apicon 09022019)-finalPci or throm or pi in stemi best strategy(apicon 09022019)-final
Pci or throm or pi in stemi best strategy(apicon 09022019)-final
 

Eribis 2011

  • 1. Eribis Pharmaceuticals AB Novel Treatment of Acute Myocardial Infarction (AMI) CONFIDENTIAL 1
  • 2. Eribis presentation  The Company  The indication – background & market  EP94  Pre-clinical Development  General Properties  Clinical Development  Intellectual Property  Q & A session CONFIDENTIAL 2
  • 4. The Company Eribis Pharmaceuticals AB is a Uppsala-based biotech company founded in 2006, with the aim to develop new therapies for cardiovascular disease. CONFIDENTIAL 4
  • 5. Management  Herman Krapf, Chief Executive Officer  Erik Bissessar, Chief Business Officer and Medical Scientific Liason  Peter Båvenholm, MD, Ph.D., Ass. Prof. Internal Medicine, Chief Medical Officer  Fredrik Röök, Business Development  Stefan Persson, Ph.D., Pharmacology and Toxicology  Claes Lundberg, Ph.D., Project Management CONFIDENTIAL 5
  • 6. Scientific Advisory Board  Gerhard Wikström, MD, Ph.D., Ass Prof Cardiology, Uppsala University Hospital  Lars Grip, MD, Ph.D., Professor in Cardiology, Sahlgrenska University Hospital  John Pernow, MD, Ph.D., Prof in Cardiology, Karolinska University Hospital  Garrett Gross, Ph.D.,Professor of Pharmacology, Medical College of Wisconsin  Dan Atar, MD, Ph.D., Professor in Cardiology, Division of Cardiology, Oslo University Hospital Aker CONFIDENTIAL 6
  • 7. Acute Myocardial Infarction (AMI) background and market CONFIDENTIAL 7
  • 8. Cardiovascular disease (CVD) the major health problem  CVD include;  acute coronary syndromes (ACS)  stroke  periphereal arterial disease (PAD)  Burden of CVD is increasing in parallel with increase in life expectancy  Acute Myocardial Infarction (AMI) is the number one cause of death in the Western world  mortality rates near 10%  first cause of chronic heart failure CONFIDENTIAL 8
  • 9. Acute coronary syndrome (ACS) Acute coronary syndrome (ACS) is comprises three diseases involving the coronary arteries: ST elevation myocardial infarction (STEMI), non ST elevation myocardial infarction (non-STEMI) and unstable angina. While ACS mortality declined in the last four decades in the USA as life expectancy increased, the decline largely represents the postponement of ACS deaths until older age. Thus, the burden of ACS is increasing in parallel with the increase in life expectancy. CONFIDENTIAL 9
  • 10. Reperfusion therapy Primary Treatment O ptions for AMI Coronary Artery By-pass Graft (CABG) Percutaneous Coronary Intervention (PCI)  Across the seven major markets in 2006 the number of cardiovascular procedures, including CABG and PCI were estimated at 7.0m  Incidence rates for PCI amounts to 3.7m (nonSTEMI + STEMI) 10
  • 11. Large unmet need Acute Coronary Syndrome - the major markets The American Heart Association (AHA) estimates that there were 1.2 million cases of ACS in 2007 in the US. This number includes both patients experiencing their first event as well as patients with relapses. Patients’ experiencing their first event is around 700,000; STEMI and NSTEMI accounting for 85% of these events. This incidence is similar to that in the five major markets in Europe. The total number of ACS cases in the US and the five major EU markets is therefore estimated at around 2.5 – 3.0 million annually. CONFIDENTIAL 11
  • 12. Metabolic and biochemic changes caused by reperfusion Reperfusion injury (RI) limits the beneficial effects of revascularisation Studies in different species suggest that 20-70% of myocardial damage may come from RI (Gomes L 2007, Penna C 2008, Zhao ZQ, 2006) RI leads to functional and structural myocardial damage –generation of ROS –a fast restoration of pH –intracellular calcium overload –mitochondrial dysfunction –Apoptosis (Yellon DM, 2007) Cardioprotective strategies to minimize RI represents an unmet medical need CONFIDENTIAL 12
  • 13. Principles of ischemic pre- and postconditioning Brief episodes of coronary artery occlusion are applied either before (preconditioning) or immediately after (postconditioning) the prolonged ischemic insult CONFIDENTIAL Ref; Zhao ZQ et al., Am J Physiol Heart Circ Physiol, 2003;285:579-88 13
  • 14. EP94 Cardioprotection in acute myocardial infarction (AMI) CONFIDENTIAL 14
  • 15. EP94 – First in class drug  Novel pharmacological cardioprotective intervention  Tetrapeptide (stabilized)  Injectable, small volume  Microgram dosage  Cardioprotective effects in rodent and non-rodent animal models  Low COGS (solid phase peptide synthesis)  Patent protected CONFIDENTIAL 15
  • 16. Tentative molecular signaling pathways involved in cardioprotection CONFIDENTIAL 16
  • 17. Mode of Action  Acute Myocardial Infarction induces an ischemia/reperfusion-induced tissue damage  It is anticipated that EP94’s mode of action reduces the ischemia/reperfusion damage through  opoid receptors  KATP channels  iNOS CONFIDENTIAL 17
  • 19. Key studies presented: • Rodent dose finding study • Pig study, closed chest, iv. • Pig study, open chest, infusion • Pig study, closed chest, dose finding, iv. • Pig study, closed chest, high-dose range finding, iv. • Rodent study, dose finding, m.o.a. study CONFIDENTIAL 19
  • 20. EP94 shows a dose dependent reduction of myocardial infarction size in rats 25 min occlusion = Vehicle administration -5 0 25 = EP94 administration Vehicle EP94 (0.01 µg/kg x 1) EP94 (0.1 µg/kg x 1) Post-surgery 2 hrs reperfusion stabilization EP94 (1 µg/kg x 1) phase EP94 (5 µg/kg x 1) EP94 (10 µg/kg x 1) 60 50 40 * * * IS/AAR (%) 30 * Pre-conditioning 20 10 N=12 N=6 N=12 N=12 N=12 N=9 0 le k g) /kg) / k g) /kg) /kg ) V ehic (0.01 ug/ .1 ug P94 (1 ug P94 (5 ug 94 (10 ug EP9 4 EP 94 (0 E E EP CONFIDENTIAL Study number 64-06 20
  • 21. EP94 i.v. administered early or late during ischaemia in a closed chest MI pig model reduces myocardial infarction size significantly 40 min occlusion = Vehicle administration 60 min 5 12 19 26 33 40 = EP94 administration Vehicle Post-surgery EP94 (1 µg/kg x 4) – Early intervention stabilization 4 hrs reperfusion phase EP94 (1 µg/kg x 3) – Late intervention EP94 (0.2 µg/kg x 3) – Late intervention Closed chest pig MI/reperfusion model 80 70 ** 60 * IS/AAR (%) 50 40 30 Early Late Late 20 10 N =7 N =4 N =6 N =6 0 hic le x 4) x 3) x 3) Ve / kg /kg / kg ug ug ug (1 (1 (0. 2 94 94 94 EP EP EP Mean ± SEM CONFIDENTIAL Study Report 09-01, Karlsson et al., Eur J Pharmacol 2011:651 pp146-151 21
  • 22. Intracoronary infusion of EP94 in pigs reduces myocardial infarction size significantly 30’ 5’ 60 min 40 min occlusion Infusion Post-surgery Vehicle stabilization 4 hrs reperfusion phase EP94 (0.2 µg/min, 15 min) 100 Open chest pig MI/reperfusion model 90 80 ** % of area at risk 70 60 50 40 30 20 10 N=5 N=5 0 Mean ± SEM Vehicle EP94 CONFIDENTIAL 22 Study Report 08-02, Karlsson et al., Eur J Pharmacol 2011:651 pp146-151
  • 23. EP94 appears to reduce myocardial infarction size dose-dependently 40 min occlusion = Vehicle administration 60 min 26 33 40 = EP94 administration Vehicle Post-surgery EP94 (1 µg/kg x 3) stabilization 4 hrs reperfusion phase EP94 (5 µg/kg x 3) EP94 (25 µg/kg x 3) Closed chest pig MI/reperfusion model 70 60 50 IS/AAR (%) 40 30 20 10 N=6 N=6 N=6 N=6 0 Vehicle 1 ug/kg 5 ug/kg 25 ug/kg Mean ± SEM CONFIDENTIAL Study Report 11-02 23
  • 24. Ongoing studies - preliminary results CONFIDENTIAL 24
  • 25. Dose range finding study in a closed chest pig model 40 min occlusion = Vehicle administration = EP94 administration 60 min 0 26 33 40 Vehicle EP94 (1 µg/kg x 3) Post-surgery EP94 (25 µg/kg x 3) stabilization 4 hrs reperfusion phase EP94 (125 µg/kg x 3) OPTIONAL: EP94 (625 µg/kg x 3) N = 12/group CONFIDENTIAL Study protocol 2011-01 25
  • 26. Results of the dose finding study is a… CONFIDENTIAL 26
  • 27. Rat acute myocardial infarction model – a combined dose response and mode of action study 25 min occlusion = Vehicle administration -10 0 5 10 = EP94 administration Vehicle EP94 (0.5 µg/kg x 2) Post-surgery EP94 (1.0 µg/kg x 2) stabilization 2 hrs reperfusion phase EP94 (2.5 µg/kg x 2) EP94 (5.0 µg/kg x 2) EP94 (10 µg/kg x 2) 1) Opioid antagonists i.v. 2) KATP channel antagonists i.v. 3) iNOS inhibitor i.v. a) Naltrindole (delta) – 5 mg/kg a) HMR1098 (sarc KATP blocker) – 6 mg/kg a) 1400W b) Nor-BNI (kappa) – 0.3 mg/kg b) 5-HD (mito KATP blocker) – 10 mg/kg c) CTOP (mu) – 0.1 mg/kg b) 1400W + EP94 d) HMR1098 + EP94 d) Naltrindole + EP94 e) 5-HD + EP94 e) Nor-BNI + EP94 f) CTOP + EP94 CONFIDENTIAL Study protocol 2010-01 27
  • 28. Rat acute myocardial infarction model – a combined dose response and mode of action study - cont´ d Bell-shaped dose-response relationship in rat confirms previous results in rats 70,00 60,00 ** 50,00 *** *** IS/AAR (%) 40,00 30,00 20,00 10,00 N=9 N=8 N = 10 N = 10 N=8 N=9 N=8 0,00 Vehicle 0.1 0.5 1.0 2.5 5.0 10.0 EP94 (ug/kg, i.v.) Mean ± SEM *** p < 0.001 vs vehicle ** p < 0.01 vs vehicle CONFIDENTIAL 28
  • 29. Rat acute myocardial infarction model – a combined dose response and mode of action study - cont´ d Blocking of mu-opioid receptors abolish the cardioprotective effects of EP94 70,00 60,00 ** ** 50,00 *** IS/AAR (%) 40,00 30,00 20,00 10,00 0,00 N=9 N=9 N=9 N=9 N = 10 N=9 N=9 N=9 ) ) ) ) 4 4 c le kg kg kg kg P9 94 P9 hi g/ g/ g/ g/ E EP E Ve m m m u + + I+ (5 (0 .1 0. 3 (1 NT O P BN NT I( 94 CT r- O P N EP no CT r-B No NT = naltrindole = selective delta-antagonist Mean ± SEM CTOP = selective mu-antagonist *** p < 0.001 vs vehicle Nor-BNI = selective kappa-antagonist ** p < 0.01 vs vehicle CONFIDENTIAL 29
  • 30. Rat acute myocardial infarction model – a combined dose response and mode of action study - cont´ d Effects of selective KATP ion channel antagonists 70,00 60,00 50,00 *** IS/AAR (%) 40,00 30,00 20,00 10,00 N=9 N = 10 N=9 N=9 N=9 N=9 0,00 le kg ) g) 4 g) 94 hi c g/ g/ k P9 g/ k E EP Ve (1 u m + 0 m + (6 98 94 98 10 (1 HD HD 5- EP 10 R 5- R HM HM Mean ± SEM HMR 1098 = sarcolemmal KATP channel antagonist *** p < 0.001 vs vehicle 5-HD = mitochondrial KATP channel antagonist CONFIDENTIAL 30
  • 31. Rat acute myocardial infarction model – a combined dose response and mode of action study - cont´ d Effects of iNOS inhibition on EP94-induced cardioprotection 70,00 60,00 50,00 *** *** IS/AAR (%) 40,00 30,00 20,00 10,00 0,00 c le 24- h u te e) e) Vehi - ) - Ac (ac ut (ac ut ipx 2) /kg iv EP94 4 00W ug/ kg mg e) + )+1 EP9 4 (1 (0. 1 (ac ut (24- h 14 00W 14 00W E P9 4 Mean ± SEM n = 9/group 1400W = iNOS inhibitor *** p < 0.001 vs vehicle CONFIDENTIAL 31
  • 32. Conclusions • EP94 is effective in two different pig ischemia/reperfusion models (open vs closed chest) • EP94 produces a significant reduction of infarct size in pigs already at 1 µg/kg • The cardioprotective effect of EP94 seems to be dose- dependent in pigs • EP94 reduces the infarct size dose-dependently during both pre- and post-conditioning in rats • EP94 acts predominantly through mu-receptors in rats CONFIDENTIAL 32
  • 33. General properties, Toxicology and Safety Pharmacology CONFIDENTIAL 33
  • 34. EP 94 – General properties  Tetrapeptide  Manufactured by solid phase peptide synthesis  Lyophilized powder  Solubility: Good solubility in water  Stability of drug substance:  Stable at +4°C for more than 2 years  Stability of drug product:  Stable at -18°C, +4°C and 25°C for more than 6 months in saline CONFIDENTIAL 34
  • 35. Toxicology & Safety  Single dose tox. study in rats and pigs  Repeat dose tox. study, 14 days, in rats and pigs  Safety Pharmacology  Genotoxicity  Pharmacokinetics and ADME CONFIDENTIAL 35
  • 37. Key factors for success with EP94 in a clinical development programme  Selection of patient population  STEMI patients  An adequate risk stratification algoritm  Selection of primary endpoint  Optimal method used to detect infarct size reduction CONFIDENTIAL 37
  • 38. Clinical development of EP 94 Phase I study  Study Objective: Dose-escalation study to evaluated the safety, and tolerability in healthy individuals  Design: single-center, double-blind  Estimated number of healthy volunteers: 40  Primary outcome measures: tolerability, safety, PK and hemodynamic parameters CONFIDENTIAL 38
  • 39. Clinical development of EP 94 Phase II, proof-of-concept study  Study Objective: Dose-escalation study to investigate the cardioprotective effect of ERIBIS Peptide 94 given as an adjunct to percutaneous coronary intervention (PCI) in subjects with an acute STEMI  Design: randomized, placebo-controlled, double-blind and multicenter  Estimated number of patients: 350-400  Primary outcome measure:  To demonstrate a dose-dependent positive trend for myocardial salvage and myocardial salvage index using a modified single contrast enhanced steady-state free precession (SSFP) cine cardiovascular magnetic resonance (CMR) examination performed one week after the acute event CONFIDENTIAL 39
  • 40. Clinical development of EP 94 Phase II, proof-of-concept study  Secondary outcome measure:  ST-resolution on 12 lead ECG 90 minutes after PCI  Tropinin, CK-MB 3 to 6 hrs, 6 to 12 hrs, 18 to 24 hrs and 36 hrs after randomization (Peak and AUC)  To determine Left Ventricular Ejection Fraction (LVEF) and Wall Motion Score Index (WMSI) 6 weeks and 6 months after PCI  Myocardial salvage index 6 months after PCI  Incidence of cardiac death and total mortality, stroke, new-onset heart failure, and re-hospitalization for any congestive heart failure 6 month follow-up visit CONFIDENTIAL 40
  • 42. Intelectual Property The IPR comprises patent protection for:  Chemical structure of peptides and peptide-based compounds  Clinical Utility  Pharmaceutical Composition  PCT application was filed in August 2007  Regional and National patent applications submitted early 2009 in EU, USA, Canada, Australia, India, China and Japan.  EU patent grant subject for approval, EPO decision to grant obtained Feb 2011 CONFIDENTIAL 42
  • 43. Summary  First in class  Significant cardioprotective effect  Clear unmet medical need & large market size  New therapeutic principle  Significant preclinical results - good clinical prognosis CONFIDENTIAL 43
  • 44. Q & A answers 1. Does the peptide pass the blood brain barrier? 2. Does the NO-group give rise to worries in relation to toxicology? 3. Does the NO-group give rise to worries in relation to Carcinogenicity? 4. Are other receptors hit by this peptide? CONFIDENTIAL 44
  • 45. NO-study EP94 has been evaluated with and without NO and acylation in response to the EU patent office’s questions regarding Eribis application. To show that the specific groups at position 2, acylation, and pos 4, NO- group, are both necessary to have the cardioprotective effect shown with EP94. 5 different peptides were compared with EP94 in this pre-conditioning study. •without NO-group of the 4th amino acid •without acylation of 2nd amino acid •without both acylation and NO-group •with Asp instead of acylation on 2nd amino acid •with Arg-Asp instead of acylation on 2nd amino acid EP94 does not exert a significant level of cardioprotective activity without these specific groups in the second and fourth position on EP94. CONFIDENTIAL 45
  • 46. Do you have rodent data? How does EP94 and morphine perform together in the models? Any efficacy measures/differentiation from morphine/other opioids. Answer: Eribis has performed a series of studies on rodents that answer these questions. This data will be available when Zealand performs a DD. There is too much data to discuss during this initial meeting. CONFIDENTIAL 46
  • 47. Morphine cont’ Morphine is regularly used as pre-medications in the pig studies. EP94 exerts its cardioprotective properties despite approx 13-333-fold higher morphine doses in pigs. However, morphine has not regularly been used as pre-medication in the explorative rat efficacy (cardioprotection) studies conducted in Moscow. MI patients are usually treated with morphine in the emergency room to reduce pain and anxiety. Thus, one exploratory study in rats has been conducted to address the possibility of an interaction between EP94 and morphine. This study did not reveal any synergistic, additive or antagonistic effects of morphine on EP94-induced cardioprotection. Consequently, EP94 has been used in combination with morphine in the pig studies to mimic the clinical situation as closely as possible. The pigs are routinely premedicated with 0.5 mg/kg/hr of morphine. CONFIDENTIAL 47
  • 48. How is the peptide cleared? Answer: It is anticipated that EP94 is degraded by various endo- and exo-peptidases in the blood stream. The degradation products are believed to be excreted in the urine or partly utilized by the body. This will be verified by dedicated ADME studies in the near future. CONFIDENTIAL 48
  • 49. Have you tried the peptide, but without the NO-group, in your models? Data from Rodents (cardio protective effect with EP94 (with and without NO) - Y see study 257/10 es How does nitroglycerin perform in your models? - Not evaluated How does nitroglycerin and morphine perform together in the models? (against EP94) - Not evaluated Models where EP94 does not work (MOA)? - EP94 has been shown to be cardioprotective in all models tested so far, i.e. 2 different species and in total 5 different models. CONFIDENTIAL 49
  • 50. Any cellular assays (all in vitro receptor data (cell lines over- expression the receptors) and work performed on primary cells and specific cell lines that express the receptors). Receptor binding to the human opioid receptors (µ, δ, κ) expressed on CHO and HEK-293 cells. - Study available during the DD process. CONFIDENTIAL 50
  • 51. Speculations on down stream target? To investigate a possible downstream pathway which may be mediating the beneficial effect of EP94 we administered either the sarcolemmal KATP channel antagonist, HMR 1098, or the mitochondrial KATP channel antagonist, 5-HD, to rats prior to EP94 administration. Both antagonists completely abolished the cardioprotective effect of EP94 which suggests an important role for the KATP channel as a key mediator in the pathway by which EP94 reduces infarct size similar to that seen with a number of other cardioprotective agents as well as ischemic preconditioning and postconditioning. CONFIDENTIAL 51
  • 52. Are the coronary arteries also affected? Potential effects on coronary arteries have not been investigated. CONFIDENTIAL 52
  • 53. Speculations on general cardiovascular safety of EP94. • EP94 does not affect blood pressure or heart rate in anaesthesized animals (rats and pigs) at doses levels ranging from 20 – 75 µg/kg (cf. pharmacological efficacy studies) • EP94 does not have significant effects on blood pressure in and only a minor and late effect on heart rate in consious rats at doses of 5-10 mg/kg (ESR08-006). • The very low doses needed for pharmacological efficacy and the short t1/2 (approx 40 min) is anticipated to reduce cardiovascular safety risks to a minimum. CONFIDENTIAL 53
  • 54. " In-vivo SAR" (opioid component vs. the nitric oxide effects). Unknown Toxicology: Metabolism/metabolites and their distribution. No evaluation of metabolites has been performed. It is anticipated that the bond between amino acid 2 and 3 is susceptible to proteolytic cleavage and that the major metabolites will contain 2 amino acids each. ADME will be performed in the near future. CONFIDENTIAL 54
  • 55. A list of all published patent applications and patents and their status. PCT application PD53743CA00 - Novel Enkephalin Analogues - Eribis Pharmaceuticals AB EU pat appl. No 07 794 118.5 A “Decision to Grant” will be announced in Q2-2011 Eribis Pharmaceuticals AB owns the IP rights CONFIDENTIAL 55
  • 56. FTO analysis of key IP FTO analysis has not been performed, however patentability has been evaluated by third party patent attorneys. - statements are in the handouts. CONFIDENTIAL 56
  • 57. Thank you for listening! Contact; Herman Krapf, CEO herman.krapf@ eribispharma.se Erik Bissessar Founder & Chief Business Officer erik.bissessar@ eribispharma.se CONFIDENTIAL 57
  • 59. Chemistry Manufacturing Control (CMC) CONFIDENTIAL 59
  • 60. EP 94 – General properties  Tetrapeptide  Manufactured by solid phase peptide synthesis  Lyophilized powder  Solubility: Good solubility in water  Stability of drug substance:  Stable at +4°C for more than 2 years  Stability of drug product:  Stable at -18°C, +4°C and 25°C for more than 6 months in saline CONFIDENTIAL 60
  • 61. Specification Test Method Specifications Appearance Visual observation Off-white to yellow powder Mass spectral analysis EP 2.2.43; ESI M = 571.2 +/- 1.0 Amino acid analysis Pre-column derivatisation Gly:1; Tyr:1; Dab:1; with OPA/Fmoc-Cl Phe (pNO2).1 EPA 2.2.56 RP-HPLC EP 2.2.29 Purity > 98.0% (area%) Related Impurities by EP 2.2.29 Sum impurities < 2% RP-HPLC Water content Karl Fischer, EP2.5.12 To be reported Acetate HPLC with UV detection To be reported Residual TFA HPLC with UV detection < 0.1% (tentative) CONFIDENTIAL 61
  • 62. Specification cont’d Test Method Specifications Residual organic GC <USP 467> Individual according to ICH solvents Q3 Bioburden EP 2.6.12 Aerobic bacteria < 10 CFU/0.1g Anerobic bacteria < 10 CFU/0.1g <USP 61> Yeasts and moulds < 10 CFU/0.1g Bacterial endotoxins EP 2.6.14 <USP < 5 EU/mg (tentative) 85> Net peptide content Pre-column To be reported (NPC) derivatisation by AAA with OPA/Fmoc- Cl EPA 2.2.56 Mass balance Calculation To be reported NPC+acetate+w ater CONFIDENTIAL 62
  • 63. EP 94  Manufactured by Polypeptide  Part no: SP080384  Storage temp: 4°C Lot no HPLC analysis Date CF 07314 97.7% 26.3.2008 CF 07314 95,8% 11.2.2010 CONFIDENTIAL 63
  • 64. EP 94  Manufactured by Polypeptide  Part no: SP080384B  Storage temp: 4°C Lot no HPLC analysis Date MZ77114 98.9% 07.05.2009 CONFIDENTIAL 64
  • 65. Drug Product Stability of EP 94 in Saline Stability (non- ICH) of EP94, 0.1mg/mL in 9 mg/mL NaCl (preserved with NaN3 1mg/mL) Temp Time 0 14 days 2.5 mo 4.5 mo 6 mo -18°C 96.5 96.5 96.6 96.5 4°C 96.5* 96.5 96.6 96.4 96.2 Ambient 96.6 96.6 96.0 95.5 * Area % CONFIDENTIAL 65
  • 66. CMC - T do list o  Drug Substance  Analytical development  Specification  Stability ICH  Manufacturing  Drug Product  Analytical development  Preformulation  Interaction with packaging mtr  Stability ICH  Manufacturing for tox and clinical  Regulatory  IND/CTA chapter CONFIDENTIAL 66
  • 67. Refererences 1. Thom T, Haase N, et al. Writing Group Members. Heart Disease and Stroke Statistics--2006 Update. Circulation; A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee; January 11, 2006; 2006. CIRCULATIONAHA.105.171600. 2. Bishop E. Heart disease may actually be rising; researchers claim deaths are now being delayed to a later age group. Wall Street Journal. 1996 November 13, 1996; pB3(W) pB6(E) col 1 (11 col in) 3. Gerber Y, Jacobsen SJ, Killian J, Weston S, Roger VL. Impact of Participation Bias in a Population-Based Study of Myocardial Infarction in Olmsted County, Minnesota, 2002 to 2004. Circulation. 2006;13:e827. 4. Eribis Peptide 94 Reduces Infarct Size in Rat Hearts Via Activation of Centrally Located μ Opioid Receptors. J Cardiovasc Pharmacol. 2011 Nov 29 Gross GJ, Hsu A, Nithipatikom K, Bobrova I, Bissessar E. 5. Dose-dependent cardioprotection of enkephalin analogue Eribis peptide 94 and cardiac expression of opioid receptors in a porcine model of ischaemia and reperfusion. Eur J Pharmacol. 2012 Jan 15;674(2-3):378-83 Karlsson LO, Bergh N, Li L, Bissessar E, Bobrova I, Gross GJ, Akyürek LM, Grip L. 6. Opioid receptor agonist Eribis peptide 94 reduces infarct size in different porcine models for myocardial ischaemia and reperfusion. Eur J Pharmacol. 2011 Jan 25;651(1-3):146-51 Karlsson LO, Grip L, Bissessar E, Bobrova I, Gustafsson T, Kavianipour M, Odenstedt J, Wikström G, Gonon AT. CONFIDENTIAL 67

Notas do Editor

  1. Bullets Founded 2006 Cardiovascular disease Ventuer cap
  2. Ref: veronique L Roger, 2007
  3. PCI slide shows stewnt thrombosis Percutaneous Coronary Intervention ( PCI ) ACC/AHA/SCAI Guidelines A joint 2005 American College of Cardiology/ American Heart Association/ Society for Cardiovascular Angiography and Interventions report gives guidelines for the management of patients undergoing PCI.  The report strongly recommends that PCI should be performed in facilities that have an experienced cardiovascular surgical team available as emergency backup for all procedures. 1. Peters RJG, et al. BMJ . 2007;334:1265-1269. 2. Gibler WB, et al. Circulation . 2005;111:2699-2710. 3. Medi C, et al. Med J Aust . 2007;186:197-202.
  4. Small IPost non-pharmacologic clinical studies: Staat P, Circulation 2005 STEMI, no signs of spontaneous reperfusion, reperfusion &lt;6 h after onset chest pain IPost protocol consisted of 4 cycles of 1-min inflation of angioplasty baloon, applied within 1 min of reopening of the vessel a 36% reduction of AUC for serum CK release was reported Provided proof of concept Thibault H, Circulation, 2008 Confirmed long-term benefit of IPost in a similar design as the Staat study 2005, except that, SPECT and ECHO were performed 6 and 12 months after PCI Found a 40% reduction in infarct size (enzymes and SPECT) and improved LVEF and wall motion score index (WMSI) Studies by Laskey WK (2005, 2008), Ma X, 2006 confirmed the above studies
  5. ADME is an acronym in pharmacokinetics and pharmacology for a bsorption, d istribution, m etabolism, and e xcretion, and describes the disposition of a pharmaceutical compound within an organism. The four criteria all influence the drug levels and kinetics of drug exposure to the tissues and hence influence the performance and pharmacological activity of the compound as a drug
  6. Safety Treatment-emergent events Leading to premature discontinuation SAEs
  7. Safety Treatment-emergent events Leading to premature discontinuation SAEs