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Company PresentationPAD KOL Day- December 14, 2018
This presentation contains express or implied forward-looking statements within the Private Securities Litigation Reform Act of 1995 and other U.S. Federalsecurities laws. For example, we are using forward-looking statements when we discuss the expected timing of obtaining regulatory approval for our variouspatient trials and clinical data readout, proposed trials that may occur in the future, the timing and implementation of our collaborations with various partnersand the execution of definitive agreements relating to such collaborations and the potential benefits and impact our products could have on improving patienthealth care. These forward-looking statements and their implications are based on the current expectations of our management only, and are subject to anumber of factors and uncertainties that could cause actual results to differ materially from those described in the forward-looking statements. The followingfactors, among others, could cause actual results to differ materially from those described in the forward-looking statements: changes in technology and marketrequirements; we may encounter delays or obstacles in launching and/or successfully completing our clinical trials; our products may not be approved byregulatory agencies, our technology may not be validated as we progress further and our methods may not be accepted by the scientific community; we may beunable to retain or attract key employees whose knowledge is essential to the development of our products; unforeseen scientific difficulties may develop withour process; our products may wind up being more expensive than we anticipate; results in the laboratory may not translate to equally good results in real clinicalsettings; results of preclinical studies may not correlate with the results of human clinical trials; our patents may not be sufficient; our products may harmrecipients; changes in legislation; inability to timely develop and introduce new technologies, products and applications; loss of market share and pressure onpricing resulting from competition, which could cause our actual results or performance to differ materially from those contemplated in such forward-lookingstatements. Except as otherwise required by law, we undertake no obligation to publicly release any revisions to these forward-looking statements to reflectevents or circumstances after the date hereof or to reflect the occurrence of unanticipated events. For a more detailed description of the risks and uncertaintiesaffecting us, reference is made to our reports filed from time to time with the Securities and Exchange Commission
Forward looking Statement
2
Critical Limb Ischemia
CLI CONSTITUTES THE MOST ADVANCED STAGE OF CHRONIC PERIPHERAL ARTERIAL DISEASE (PAD) AND INCLUDES REST PAIN AND ISCHEMIC FOOT LESIONSCLI IS CAUSED BY FATTY DEPOSITS IN LEG ARTERIES
THAT OBSTRUCT BLOOD FLOWRISK FACTORS INCLUDE SMOKING, DIABETES, HEAVY
WEIGHT, CARDIOVASCULAR PROBLEMS & HYPERTENSION
The problem
Chronic CLI, defined as > 2 weeks of rest pain, ulcers, or tissue loss attributed to arterial occlusive disease
Associated with great loss of both limb and life
Major amputation and death are the ultimate consequences of CLI, and a 1-year amputation rate of 15-25% is commonly reported, while amputation & mortality rate ranges 30-40%
Goals of therapy Reducing cardiovascular risk factors, relieving ischemic pain, healing
ulcers, preventing major amputation, improving quality of life and increasing survival
Wounds 5 Year Mortality vs Cancer
90
70
100
50
10
0
Perc
ent (
%)
30
80
60
40
208
18 18
45 47 4855
64
86
97
How do we fix CLI
The single evidence-based recommendation for treatment is revascularization
Does everyone do well with this? (1,3,4)
NO
How do we fix CLI
1414 patients had PVI; 71% with tissue loss
1-year – survival 80%, amputation free survival 71%, and freedom from major amputation were 81%,
Determinants of survival and major amputation after peripheral endovascular intervention for critical limb ischemia; Vierthaler, Luke et al. Journal of Vascular Surgery , Volume 62 , Issue 3 , 655 - 664.e8
The “tried and true” and why we are trying something new!
Prevent III Data 1 year survival 84% 1 year primary patency
61% 1 year primary assisted
patency 77% 1 year secondary patency
80% 1 year limb salvage 88%
Nov 2001 – Oct 2003 – 1404
patients with CLI were
randomized – 1 year f/u, 75% had tissue loss
What are we doing about this….
Predicting bad outcomes
Predictors of poor open surgery outcomes
Dialysis dependency
Tissue loss
Age >75
Anemia (hematocrit <30%)
Advanced coronary artery disease
Predictors of poor endoluminal therapy
outcomes Current smoking
High modified PREVENT III score
Poor preoperative ambulation status
High MACEs
Discharge disposition SNFA. Schanzer, J. Mega, J. Meadows, R.H. Samson, D.F. Bandyk, M.S. ConteRiskstratification in critical limb ischemia: derivation and validation of a model to predict amputation-free survival using multicenter surgical outcomes dataJ Vasc Surg, 48 (2008), pp. 1464-1471. Schanzer, P.P. Goodney, Y. Li, M. Eslami, J. Cronenwett, L. Messina, et al.Validation of the PIII CLI risk score for the prediction of amputation-free survival in patients undergoing infrainguinal autogenous vein bypass for critical limb ischemiaJ Vasc Surg, 50 (2009), pp. 769-775
J Vasc Surg. 2015 Dec;62(6):1555-63. doi: 10.1016/j.jvs.2015.06.228. Epub 2015 Sep 26.Objective performance goals after endovascular intervention for critical limb ischemia.Davies MG1, El-Sayed HF2
Who needs more?
85% of patients get
a revascularization15%
are notcandidates for
revascularization
20% of patients
don’t benefit
How can we save limbs with CLI?
What we need to look at: Hyperbaric Oxygen Intermittent compression Spinal chord stimulation Medications Gene therapy Stem cell therapy Allogeneic
NOT GREAT
MAYBE A CURE
A Cure – Really?
Gene TherapyGene therapy utilizing growth factors, Vascular EndothelialGrowth Factor (VEGF), Fibroblast Growth Factor (FGF) andHepatocyte Growth Factor (HGF), has been investigated inmostly smaller clinical trials, with varying success withregard to the major efficacy endpoint, amputation-freesurvival (AFS).
A Cure – Really?
Cell therapy The potential benefit of cell therapy is that cell secretion is
multifactorial and therefore not based solely on a single growth factor.
Initiated by a Japanese study (11) comparing bone-marrow-and peripheral blood mononuclear cells (PBMC) injected into the limb muscles of patients with PAD, several cell-based studies have been performed, specifically in CLI patients with no option for revascularization.
Though the majority of studies have utilized intramuscular injections of the growth factor, the largest trial treated with with intra-arterial infusions of bone-marrow mononuclear cells
At 6 months there was no difference in the rate of major amputation
A Cure – Really?
Autologous or allogeneic cell utilization From an immunological point of view, autologous cell treatment
may theoretically provide an immunological advantage. Nevertheless, it has been shown that cells harvested from older
individuals, and in particular those with cardiovascular riskfactors or critical limb ischemia, are reduced in number andfunctionality
Furthermore, harvesting autologous cells from bone marrowinvolves an invasive procedure, while peripheral blood utilizationrequires granulocyte colony stimulation factor (G-CSF) treatmentthat potentially may cause harm due to the high white bloodcell content that is developed
A Cure – Potential Solution
PLX-PAD- Allogeneic Cell Therapy PLX-PAD is a cell therapy product, composed of placental
expanded adherent stromal cells. While PLX-PAD cells exhibitmembrane marker expression typical of classicalmesenchymal stromal cells, they have a minimal ability todifferentiate in vitro into cells of mesodermal lineage.
Allogeneic MSCs have been shown to exhibit lowimmunogenicity thus, utilizing allogeneic younger, morepotent cells, rather than treatment with cells harvested fromthe diseased patients themselves, therefore should be ofbenefit.
In this respect PLX-PAD cells from young healthy placentaltissue has the potential for higher efficacy than previouslyseen with autologous cell products.
Therapeutic Development for CLI
Single Chemical
Compound
Autologous Cell Therapy
Single Biological Compound Cocktail of
Chemical / Biological
compoundsHGF FGFVEGF
CD34
Bone Marro
w
Allogeneic Cell Therapy
Disease ComplexityComplex diseases
requires adaptive multi-factorial treatments
Healthy donor, young cells; Immediate availability of cell
Non-limited quantity Consistent cell quality and
standardization Immuno-privileged
PLX-PAD Mechanism of Action
Live Cellvizio imaging following IV administration of FITC labeled Dextran in Hind Limb Ischemic
Preclinical Model
Placebo
PLX-PAD treated
Placebo PLX-PAD
Day 21
Day 0
PLX-PAD increase tibia blood flow in vivo
Clinical Development Status -PLX-PAD in PAD
• Two completed Phase I/II studies in CLI in U.S. and Germany, N=27
• Appropriate safety profile
• Positive trends of efficacy (pain reduction and increase in tissue perfusion), defining inclusion/exclusion criteria for pivotal studies
• Dose identification: two treatments of 300 million cells, two months apart• Completed multinational Phase II study in intermittent claudication (IC) - U.S., Germany, S. Korea and
Israel, N=172 • Appropriate safety profile• Increase in Maximal Walking Distance • Reduce number of surgeries • Significant reduction in HbA1c and CRP levels• Confirmation to the phase III design including: dose (300m cells), dose regimen (2 administrations),
safety• Ongoing multinational Pivotal Phase III study in CLI in U.S., Europe and Israel N=246
• Primary endpoint- time to event (amputation or death)• Dosing regimen: 2 treatments of 300 million cells, two months apart
• Amputation Free Survival at 6 months:
• US (total n=12) - 100%
• Germany (total n=15) - 93%• Comparison to published data on no-option CLI:
‒ TASC II: 20% death and 40% major amputations in 6m
‒ TAMARIS (n=259 control pts.): 76% AFS in 6m (196/259)
‒ Meta-analyses (Benoit 2011, Weems 2015): 67%-77% AFS at 6m ‒ The majority of events usually occur in the first 6m
Phase I/II CLI Clinical Trials – PLX-PAD
20
Hemodynamic Efficacy Parameters
• Improvement of the quality of life within the first 3m• Higher improvement at 2 weeks repeated dosing• Improvement in quality of life maintained for 12m
Increase of mean TcPO2
• Improvement of TcPO2 - after 1 month• Earlier and higher improvement at 2 weeks repeated dosing• Improvement in TcPO2 maintained for 24 months in German study
Reduction of Pain Score (VAS)USA Germany
• Overall pain decrease at month 3 • Most notable decrease with repeated dose
21
Phase II IC Study PLX-PAD-MWD 300-300 Million Group
* p = 0.032, 0.014** p = 0.019, 0.015*** p = 0.044, 0.017
At least 1 RevascularizationEvent n (%)
PBO-PBO(N=50)
300M-PBO(N=37)
150M-150M(N=37)
300M-300M(N=48)
300M-300M(N=11)
2 DonorsWeek 65 6 (12.0) 6 (16.2) 7 (18.9) 3 (6.3) 0 (0)
Hazard Ratio* 1.50 1.64 0.51 NA95% CI 0.48, 4.66 0.55, 4.88 0.13, 2.05p-value 0.485 0.376 0.345
Odds Ratio** 1.52 1.77 0.49 NA95% CI 0.36, 6.36 0.45, 7.15 0.07, 2.49p-value 0.716 0.515 0.527
Phase II IC Study PLX-PAD-Clinically driven Revascularization by Week 65
PBO-PBO(n=51)
300-300(n=48)
Major amputations 3.9 % 0 %
Malignancies 7.8 % 2.1 %
Infections 33.3 % 33.3 %
Peripheral vascular disorders 29.4 % 22.9 %
Cardiac disorders 9.8 % 6.3 %
Renal disorders 9.8 % 6.3 %
Ophthalmologic disorders 11.8 % 4.2 %
Phase II IC Study PLX-PAD-Favorable Safety Profile
Ongoing CLI Phase III Study -Overview
Design Phase III, randomized, Double-Blind, Placebo-controlled (2:1)
Study population CLI subjects with minor tissue loss, unsuitable for revascularization
Countries Germany, UK, U.S., Poland, Hungary, Czech republic, Bulgaria, Macedonia, Israel
Sample size 246 patientsDoses tested 300M cells vs. Placebo (randomization ratio 2:1)
Administration IM injections in the affected leg, 2 treatments, at 8-week intervalPrimary efficacy endpoint
Time to occurrence of major amputation of leg or death (AFS)
Main Secondary & exploratory efficacy endpoints
Composite efficacy endpoint; Pain; Complete wound healing; Quality-of-life; Adjudicated amputations; TcPO2; cytokine levels
Follow Up length 12 months
Before
Area:1.4cm²
8 Weeks After
Area:0 cm² Full Wound Closure
Area:4.3 cm² Area:0.2cm²Reduction of
96%
Ongoing Phase III CLI Study
Before
Area:9.8 cm²
8 Weeks After
Area:0.5cm²Reduction of 95%
Area:6.8 cm² Area:3.1 cm²Reduction of
54%
Ongoing Phase III CLI Study
Where is the need ?
14 days after failed bypass surgery Or non progression of healing or actual failure
This RX may be a common adjunct
2 weeks after failed percutaneous revascularization Should check PVRs – TCPO2 – 1 week after procedure
Patients without target vessels in the foot
Non ambulatory but alert and oriented patients With no target vessels
Other co morbidities
LARGER THAN THE CURRENT
TRIAL
PERIPHERAL ARTERY DISEASE (PAD& CRITICAL LIMB ISCHEMIA (CLI)
PREVALENCE, ECONOMIC COST AND MARKET OPPORTUNITY
Mary L. Yost, M.B.A. President THE SAGE GROUP LLC Research and Consulting
PERIPHERAL ARTERY DISEASE (PAD)
2015 U.S. PREVALENCE OF
SELECTED CHRONIC DISEASES(Millions)
Source: Alzheimer’s Assoc, American Cancer Society, American Heart Association, Heidenreich PA. Circulation 2011;123:933-44, Menke A. JAMA 2015; 314:1021-9 and Yost ML. CLI Suppl 2016 THE SAGE GROUP.
PAD: THE IGNORED CARDIOVASCULAR DISEASE
UNDERESTIMATED
UNDERDIAGNOSED
UNDERTREATED
MORBIDITY, MORTALITY & COSTS
Source: Yost ML. PAD Vol. I THE SAGE GROUP 2003.
U.S. COMPARISON OF PAD ESTIMATES
YEAR CRIQUI/PARTNERS
(Mill)
DIABETES METHOD
(Mill)
NEHLER
(Mill)
1995 8-12 11 13
2015 11-18 20 18
Source: Criqui MH. Circulation 1985; 71:510-15, Nehler MA. J Vasc Surg 2014;60: 686-95 and Yost ML. CLI US epidemiology supplement 2016 THE SAGE GROUP.
AGE & DIABETESSIGNIFICANT PAD RISK FACTORS
PAD Prevalence ↑ with AgeAge 40-59 = 3%Age 70+ = 19%
Diabetes & PAD Population Age 50 + PAD Prevalence 10% to 20% in Normal GlucosePAD Prevalence 30% to 40% in DM
Yost ML. CLI Vol I & II Atlanta, GA. THE SAGE GROUP; 2010. Criqui MH. Circulation 1985; 71:510.
U.S. PAD PREVALENCE 2015-2030
(Millions)
Source: Yost ML. CLI US epidemiology supplement 2016. THE SAGE GROUP.
AGING & DIABETES DRIVING GLOBAL PAD GROWTH
Source: UN Population Division and International Diabetes Federation.
PAD WORLDWIDE ESTIMATES
164 Million 2000
202 Million 2010
24% due to Aging
Source: Fowkes FGR. Lancet 2013; 382(9901): 1329-40.
PAD COUNTRY/REGIONAL PREVALENCE
(Millions)
COUNTRY/REGION 2015
CHINA 42-60
INDIA 41-54
WESTERN EUROPE 29
UNITED STATES 20
SOUTH AMERICA 16
JAPAN 10
MEXICO 5
TOTAL 163-194
Source: Yost ML. CLI US Supplement 2016, Yost ML. PAD & CLI W Europe 2017, Yost PAD & CLI Japan 2017, Yost ML. China PAD & CLI 2017, Yost ML. India PAD 2018, Yost ML. South America Diabetes & PAD 2013 and Yost ML. Mexico Diabetes & PAD 2014.
PAD THE MOST PREVALENT CARDIOVASCULAR DISEASE
(Millions)
CVD = Cerebrovascular Disease IHD = Ischemic Heart Disease (AMI + Angina + Chronic IHD + Ischemic CHF)
Source: Roth GA. J Am Coll Cardiol. 2017 Jul 4;70(1):1-25 and Fowkes FGR. Lancet 2013;382(9901):1329-40.
ECONOMIC COSTS
$223†-$414‡ BILLION
†U.S. REACH population inpatient costs + outpatient medication = $11,280 X 19.8 Mil PAD in 2015 ‡Margolis managed care population all-cause hospitalizations + medications + other =
$20,895 x 19.8 Mil PAD. Per pt. costs in 2015 $.
PADANNUAL ECONOMIC BURDEN*
*Total Costs Inpatient and Outpatient in 2015
Source: Mahoney EM. Circ Cardiovasc Qual Outcomes 2008;1:38-45, Margolis J. J Manag Care Pharm 2005; 11(9): 727-24 and Yost ML. Real cost of PAD 2011 THE SAGE GROUP.
HOSPITAL COSTS REPRESENT MAJORITY OF PAD COSTS
Source Mahoney EM. Circ Cardiovasc Qual Outcomes 2008;1:38-45, Margolis J. J Manag Care Pharm 2005; 11(9):727-24 and Yost ML. Real cost of PAD 2011 THE SAGE GROUP.
NON-PAD COSTS ARE SIGNIFICANT
Source: Mahoney EM. Circ Cardiovasc Qual Outcomes 2008;1:38-45, Mahoney EM. Circ Cardiovasc Qual Outcomes 2010;3:642-51, Margolis J. J Manag Care Pharm 2005;11(9):727-24, Hirsch AJ. Vasc Med 2008;13:209-15 and Jaff MR. Ann Vasc Surg 2010;24:577-87.
WHO PAYS THE PAD BILL?
Source: AHRQ. Healthcare Cost and Utilization Project. HCUP Query. ICD-9 diagnosis codes PAD 440.20-29, 443.9 & 443.81. https://www.ahrq.gov/research/data/hcup/index.html. Last updated Jan 2018. Accessed Jan 29, 2018.
10%-21% Medicare Patients Treated for PAD
(2003-2012)
$22,756-$72,159* Expenditure per Patient(Range reflects definition of PAD and types of treatments included, i.e. LT Care)
AK Amputation Third Most Commonly Performed Procedure
PAD PATIENTS IN MEDICARE
*2015$ X 2015 Medicare beneficiaries w/ PAD
Source: Kalbaugh CA. J Am Heart Assoc 2017;6:e003796, Nehler MR. J Vasc Surg 2014:60(3);686-95, Hirsch AJ. Vasc Med 2008;13:209-15, Jaff MR. Ann Vasc Surg 2010;24:577-87 and Yost ML. Real cost of PAD 2011 THE SAGE GROUP.
2015 ANNUAL MEDICARE EXPENDITURES PAD & AVERAGE
Source: Jaff MR. Ann Vasc Surg 2010;24:577-87, CMS .gov. CMS releases 2015 national health expenditures and Yost ML. Real cost of PAD 2011. THE SAGE GROUP.
2015 ANNUAL ECONOMIC BURDEN*
(Billions $)
*Direct costs in the United States: PAD & CAD costs inflated to 2015 $. Direct cost of diabetes is 2012 and cancer 2014.
Source: Yost ML. Real cost of PAD 2011 THE SAGE GROUP, Mahoney EM. Circ Cardiovasc Qual Outcomes 2008;1:38-45, American Cancer Society website and ADA Diabetes Care 2013;36(4):1033-46.
CRITICAL LIMB ISCHEMIA(CLI)
THE MOST SEVERE AND DEADLY FORM OF PAD
PAD/CLI AMPUTATION & MORTALITY INCREASE WITH DISEASE SEVERITY
Source: Reinecke H. Eur J 2015; Eur Heart J. 2015 Apr 14;36(15):932-8.
2.0-3.4 Million
≈700,000-800,000 Treated w/ Revascularization or Amputation-Major & Minor
2015 U.S. CLI PREVALENCE
Source: Yost ML. CLI US supplement 2016 THE SAGE GROUP, Nehler MA. J Vasc Surg 2014;60:686-95, Yost ML. PAD. Interventional market analysis based on treatment with angioplasty or atherectomy. THE SAGE GROUP 2012 and Kolte D. Circulation 2017;136:167-76.
U.S. CLI PREVALENCE 2015-2030
(Millions)
Source: Yost ML. CLI US epidemiology supplement 2016. THE SAGE GROUP.
GLOBAL CLI ESTIMATES-2010(Millions)
*Nehler CLI 11.3% of Prevalent PAD**Yost CLI 15% of Prevalent PAD
Source: Fowkes FGR. Lancet 2013; 382(9901): 1329-40, Nehler MA. J Vasc Surg 2014; 60:686-95 and Yost ML. CLI US supplement 2016 THE SAGE GROUP
PAD CLI CLI 11%* 15%**
202 22 30
COUNTRY/REGIONAL CLI PREVALENCE
(Millions)
COUNTRY/REGION 2015
CHINA 5.6-6.3
INDIA 4.2-6.2
WESTERN EUROPE 4.2
UNITED STATES 3.4
SOUTH AMERICA 1.5
JAPAN 1.0
MEXICO 0.6
TOTAL CLI 20.5-23.2
Source: Yost ML. CLI US Supplement 2016, Yost ML. PAD & CLI W Europe 2017, Yost PAD & CLI Japan 2017, Yost ML. China PAD & CLI 2017, Yost ML. India PAD 2018, Yost ML. South America Diabetes & PAD 2013 and Yost ML. Mexico Diabetes & PAD 2014.
TREATMENT COSTS INCREASE WITH DISEASE SEVERITY
Source: Mustapha JA . J Am Heart Assoc 2018;7e009724.
MA Frequently the First and Only Treatment for CLI
65,000-80,000 MA Performed Annually
$11.3 Billion Inpatient & Outpatient Costs
$67 Billion Total Costs*
MAJOR AMPUTATION (MA)
*Direct Inpatient and Outpatient Costs, Lifetime Costs and Unreimbursed Patient Costs in 2015 $
Source: Allie DE. Eurointervention 2005; 1(1): 60-69, Goodney PP. Cardiovasc Qual Outcomes 2012;5:94-102. 2012, Yost ML. Cost-benefit analysis of critical limb ischemia in the era of the Affordable Care Act. Endovasc Today 2014, Dillingham TR. Arch Phys Med Rehabil 2005;86:480-6 and THE SAGE GROUP estimates.
CLI INTERVENTIONAL COSTS
PATIENT COST (2016$)
TYPE OF COST
Dua $24,700* Hospital Cost ET & BP
Kolte $31,400 Hospital Cost ET,BP, MA
Agarwal $31,700* Hospital Cost ET
$32,500* Hospital Cost BP
Mustapha $49,200 BP Inpatient & Outpatient
$49,700 ET Inpatient & Outpatient
$55,700 MA Inpatient & Outpatient
KolteMustapha
CLI Costs(CLI treatments only)
$4-$12 Billion
*2015 $ ET = Endovascular, BP=Bypass & MA = Major Amputation
Source: Dua A. Ann Vasc Surg 2016;33:144-8, Agarwal S. J Am Coll Cardiol 2016;67:1901-13, Kolte D. Circulation 2017;136:167-76, Mustapha JA . J Am Heart Assoc 2018;7e009724.
CLI A LARGE MARKET
WITH SIGNIFICANT POTENTIAL
U.S.CLI LIMB MARKETPOTENTIAL VS 2015 ACTUAL
(Numbers in 000’s)
Yost ML. U.S. CLI by Rutherford Category. Prevalence and markets in patients and limbs. THE SAGE GROUP. 2017.
U.S. 2015 CLI INTERVENTIONAL MARKET
(Limbs R 4-6)
$23.5 Billion*
*Inpatient Interventional Cost = $31,400Interventional = BP, ET and MA
Source: Yost ML. U.S. CLI by Rutherford Category. Prevalence and markets in patients and limbs. THE SAGE GROUP. 2017 and Kolte D. Circulation 2017;136:167-76.
U.S. CELL THERAPYMARKET OPPORTUNITY
($ Billions)
*Cell therapy priced at $35,000 based on current PAD/CLI treatment costs.
Source: Yost ML. U.S. CLI by Rutherford Category. Prevalence and markets in patients and limbs. THE SAGE GROUP and THE SAGE GROUP estimates.
PAD IS HIGHLY PREVALENT AND COMMONLY UNDERESTIMATED
PAD MACROECONOMIC COST IS HIGH $223-$414 BILLION
HOSPITAL COSTS ACCOUNT FOR THE MAJORITY OF TOTAL PAD COSTS
HOSPITAL COSTS ARE SIGNIFICANTLY INCREASED BY CARDIOVASCULAR AND NON-PAD EVENTS
2015 ECONOMIC BURDEN OF PAD EXCEEDS THAT OF DIABETES, CAD AND ALL CANCERS COMBINED
CONCLUSIONS
U.S. CLI ESTIMATED AT 2.0 TO 3.4 MILLION
MORTALITY AND AMPUTATION INCREASE WITH DISEASE SEVERITY
CLI COSTS INCREASE WITH DISEASE SEVERITY—EARLIER DIAGNOSIS AND TREATMENT LIKELY TO REDUCE COSTS
CLI PER PATIENT COSTS FOR INTERVENTIONAL THERAPY ARE HIGH—INPATIENT COSTS $31,000-$33,000 INPATIENT + OUTPATIENT COSTS $49,000-$56,000
THE MARKET OPPORTUNITY FOR CELL THERAPIES ESTIMATED AT $4.4 TO $9.1 BILLION—ASSUMING SAFETY AND EFFICACY FAVORABLE
CONCLUSIONS
PLURISTEM in one slide
63
Placenta
Technology
Allogeneic off-the-shelf
Simple IM administration
Adaptive slow release secretion of cytokines
Long term regenerative effect
Placenta Derived Cells
• Ethically accepted• Rich & Diverse• Highly potent
Pro-angiogenicImmunoregulatory
• Young donors • Unlimited source & Easy to
collect• Ability to manufacture
treatments for over 20,000 patients per placenta
The Placenta Project wasLaunched by the US NationalInstitutes of Health (NIH) tofurther explore the role of theplacenta in health and disease
http://www.the-scientist.com/?articles.view/articleNo/43618/title/The-Prescient-Placenta/
65
Best In Class GMP Facility3D Manufacturing, In-house Cell Production
Manufacturing Process Approved by:65
Pluristem Approach
66
Quality
Cold Chain
Technology Raw Materials Manufacturing
Clinical Development
Regulation
Process Development
Reduces inflammationStimulates growth of collateral
blood vesselsStimulates repair of damaged
muscle
PLX-R18 PLX-PADPLX-IMMUNE
PLX Products
Stimulates regeneration of damaged bone marrow
to produce blood cells (white, red and platelets)
Inhibits Cancer Cell Growth
Next step- apply for IND approval of clinical trials
Phase III - Radiation Exposure DamagePhase I - Bone Marrow Deficiencies
Phase II - Intermittent Claudication (IC)Phase III – Critical Limb Ischemia (CLI)
Phase III- Hip Fracture
67
Indication
Critical Limb Ischemia (CLI)
Intermittent Claudication (IC)
Hip Fracture
Acute Radiation Syndrome (ARS)
Location
U.S.Europe, Israel*
U.S., EuropeSouth Korea,
Israel
U.S. Europe, Israel
U.S.
Company Pipeline
Pre-Clinical Phase 2Phase 1 Phase 3Product
PLX-PAD
PLX-PAD
PLX-PAD
PLX-R18
* One Multinational trial- U.S- phase 3, Europe- via adaptive pathway allowing early marketing approval
FDA Animal Rule
68
Funding
69
70
Accelerated Pathways Adaptive Pathways
A Change In Regulatory Environment-Regenerative Medicine
“Cell therapies…hold significant promise for transformative and
potentially curative treatments for some of humanity’s most troubling
and intractable maladies”
FDA COMMISSIONER SCOTT GOTTLIEB, M.D., AUGUST 2017
21st Century Cures Act
Critical Limb Ischemia (CLI) Hip Fracture Acute Radiation Syndrome (ARS)
Special Pathways
FDA Expanded Access FDA Fast Track Approval EMA Adaptive Regulatory
Pathway PMDA Accelerated Regulatory
Pathway
EMA Adaptive Regulatory Pathway
FDA Animal Rule Pathway FDA Orphan Drug Designation
71
Phase III Clinical Development Program
Critical Limb Ischemia (CLI) Hip Fracture Acute Radiation Syndrome (ARS)
Study Phase III, single pivotal Phase III Phase III Ready (FDA Animal Rule)
Countries U.S., Europe, Israel U.S., Europe, Israel U.S.
N (size) 246 Patients 240 Patients 120 NHPs
Expected Data
Europe- H1 2020U.S.- H1 2021
H2 2020 H2 2019
Funding 8 million $- European Union 8.7 million $- European Union
Full funding- U.S. government
Special Pathways
FDA Expanded AccessFDA Fast Track ApprovalEMA Adaptive Regulatory PathwayPMDA Accelerated Regulatory Pathway
EMA Adaptive Regulatory Pathway
FDA Animal Rule PathwayFDA Orphan Drug Designation
COMPANY CONFIDENTIAL
Based on these assumptions, PLX-PAD has the potential to achieve sales of ~$1.4B in the US CLI market
72
Assumptions and Sales: CLIForecast Results
CLI Patient Share EmergingCompetitors’ Share
Market Access Factor Price
Scenario 22.5% 40% 50% $25,000
worldwide sales: ~$2.7B US sales: ~$1.4B
CLI Expanded Access Program (EAP)
73
• CLI Expanded Access Program cleared by FDA to enrollpatients unsuitable for inclusion in the ongoing Phase 3clinical trial
• Program to enroll an initial 100 CLI Rutherford Category 5patients
• FDA approved cost recovery for the treatment
EAP allows for the collection of real-world data while the Phase 3 trial is ongoing
74
Pluristem keeps IP and manufacturing rights in all collaborations
Partnerships and Collaborations
75
Expected Milestones
Data Phase III CLI (Europe)
Data Phase III CLI (U.S)
3 Indications Approved for
Marketing
Expanded Access real world data
End of Enrollment Phase III CLI (EU)
End of Enrollment Phase III CLI (U.S)
H1/2019 H2/2019 H1/2020 H2/2020 H1/2021
• Expanded Access Program- Collection of real-world data in parallel to pivotal Phase III study, including revenues from treatments.
• Fast Track Designation- FDA guidance and increased possibility for a priority review • Adaptive Pathway Program (EMA)- perusing conditional marketing approval following
data on 50% (n=123) of patients
Data Pivotal ARS
Data Phase III Hip Fracture
Contract with US Gov. ARS