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This presentation is copyright ©2006 by Alteon Inc.Any duplication, use or distribution of this presentation is strictly prohibited without prior written authorization from Alteon Inc.
This presentation is copyright This presentation is copyright ©©2006 by Alteon Inc.2006 by Alteon Inc.Any duplication, use or distribution of this presentation is strAny duplication, use or distribution of this presentation is strictly prohibited without prior written authorization from Alteonictly prohibited without prior written authorization from Alteon Inc. Inc.
ALTEONALTEON
Breakthrough Medicines For Cardiovascular Aging and Complications of Diabetes
Breakthrough Medicines For Cardiovascular Breakthrough Medicines For Cardiovascular Aging and Complications of DiabetesAging and Complications of Diabetes
BIO InvestorForum 2006October 2006
BIO InvestorForum 2006October 2006
Noah Berkowitz, M.D., Ph.D.President & CEO
Noah Berkowitz, M.D., Ph.D.President & CEO
Safe Harbor Statement
Certain statements made in the course of this presentation may be forward-looking and involve a number of risks and uncertainties, including, but not limited to:
• Our technology and product development efforts (including the possibility that early clinical trial results may not be predictive of results that will be obtained in large-scale testing or the possibility that any clinical trials may not demonstrate sufficient safety and efficacy to obtain requisite approvals or result in marketable products)
• Anticipated operating losses and capital• Anticipated regulatory filing dates and clinical trial initiation dates• Our estimates regarding our capital requirements and our needs for additional financing • Our ability to obtain sufficient additional financing in near term• Uncertainties associated with obtaining and enforcing our patents and with the patent rights of others• Our selection and licensing of product candidates• Technological change and competition• Our ability to attract collaborative partners and other third parties with acceptable development,
regulatory and commercialization expertise• Our ability to form and maintain collaborative relationships, including those relating to the
development and commercialization of our product candidates• Other risks identified in Alteon’s filings with the Securities and Exchange Commission
Actual results, events or performance may differ materially. Alteon undertakes no obligation to publicly release the result of any revision to these forward-looking statements that may be made to reflect events or circumstances after the date hereof or to reflect the occurrence of unanticipated events.
Post-Transaction Development Pipeline: Two Phase 2 Cardiovascular Compounds Plus Pipeline
Preclinical Phase 1 Phase 2 Phase 3 NDA
Development Drugs/Indications
Alagebrium
Alagebrium
Alagebrium
ALT-2074
AGE Breakers
GPx Mimetics
Discovery
2nd Generation
Chronic Heart Failure
Nephropathy
Retinopathy
Acute Coronary Syndrome
Other
*
*Trial open or within 3 months of launch pending financing
*
*
20-30%DiabeticPatients
Prevalence:~13.9 Million (U.S.)
ALT-2074Acute Coronary Syndrome
> $10 BILLION/YEAR(Worldwide Estimate)
Market Specialization and SegmentationA Recipe For Success
25- 44%of DiabeticPatients
Prevalence:~5 Million (U.S.)
> $5 BILLION/YEAR(Worldwide Estimate)
Sources: AHA; National Quality Measures Clearing House; Analyst Estimates
AlagebriumChronic Heart Failure
ALT-2074
• Lipid peroxides causeinflammation
• ALT-2074 metabolizeslipid peroxides
• Treats acute ischemicinjury
Related Therapeutic AreasDifferent Mechanisms of Action
Alagebrium
• Targets Advanced GlycationEnd Products (A.G.E.s)
• Alagebrium breaks A.G.E.Crosslinks
• Restores structure andfunction of tissues
ALT-2074Metabolizes Oxidized Lipids
ALT-2074Metabolizes Oxidized Lipids
Orally Dosed Phase 2 Small Molecule>50 patients in Phase 1 & 2 - anti-inflammatoryindication
Novel Anti-Inflammatory Mechanism of Action
• Glutathione Peroxidase (GPx) Mimetic• Metabolizes Lipid Peroxides• Decreases over-expression of key cytokines and messengers
Rapid Action
Restores Function
• Acute, ischemia-reperfusion protection without hemodynamic instability
Alteon’s Proprietary Genetic TestAllows Better Clinical Trial Design
• Haptoglobin (Hp), a protein that binds free hemoglobin, actsas an antioxidant and anti-atherosclerotic agent. Recycles iron,and inhibits Hb(Fe)-mediated lipid oxidation.
• Three variations of Hp exist: Hp 1-1, Hp 1-2 and Hp 2-2.
• In diabetes, Hp 2-2 fails to inhibit lipid oxidation, leading to worsening atherosclerosis and death from ischemic heart tissue.
40%45%15%Prevalence
2-22-11-1Hp Type
0
5
10
15
20
25
30
35
Death CHF
Source: Diabetes 2005; 54: 2802-2806
HP 1-1 HP 2-2
Haptoglobin Typing Predicts Clinical Event Rate
Haptoglobin Type and 30 Days Post MI Events in Diabetics
0
.2
.4
.6
.8
1
Even
t Fre
e Su
rviv
al
0 5 10 15 20 25 30 35Time (Days)
HP 1-1
HP 2-2
1-1
1-12-2
2-2
Even
t %
Hp2-2 Phenotype Hyperglycemia - Oxidative Damage In Vitro
Increase in oxidative stress in Hp2-2 phenotype in cultured CHO cells in high glucose.Effect is abolished by the chelator DFO
Source: Adapted from Circulation Research, 205; 96; 435-441
0
10
20
30
40
50
60
70
1 2 3 4
Hp1-1
Hp2-2
% In
crea
se in
Oxi
datio
n *
* *
GlucoseDFO
L-
H-
H+
L+
% o
f Mic
e W
ith E
leva
ted
LPI
Source: Adapted from Circulation Research, 205; 96; 435-441
0
10
20
30
40
50
60
70
80
90
Wild type(Hp-1)
non diabetic
Wild type(Hp-1)
diabetic
Knockout(Hp-0)
non diabetic
Knockout(Hp-0)
diabetic
Knockout(Hp-2)
non diabetic
Knockout(Hp-2) diabetic
Hp2-2 Phenotype Diabetes - Oxidative Damage In Vivo
Preclinical Studies of ALT-2074 Model Anticipated Clinical Program
Preclinical
Myocardial protection in ratsand genetically engineered mice
PLACEBO
-
TREATED
+
Animal Model:
• Diabetes
• Hp 2-2
• Ischemia Reperfusion Injury
• Size of Infarct
Source: Data presented at the ACC, March 2006
ALT-2074 Reduces MI Size in Hp 2-2 DM Mice
• Mouse model for ischemiareperfusion injury(controlled heart attack)
• High risk diabetic mice,genetically engineered tomodel the humancondition
• Occlusion of the coronaryartery followed byrestoration of blood flow
• Infarcts are representedas Infarct Area/Area atrisk
• 0.5mg/kg to 5mg/kg ofALT-2074 yielded similarresults
Approximately an 85% reduction in infarct size followinga single oral administration of ALT-2074
n=13 in each group
P=0.001
05
101520253035404550
IA/R
A (%
)
Placebo ALT-2074
Type Placebo-controlled, 2 arm
First Patient treated Q3 2006
First Interpretable Q2 2007Results
# of Patients 60
Duration 5 days
Centers 4 (currently); in Israel
Endpoints Myocardial Damage (CK leak)Holter, clinical events
ALT-2074: Phase 2 Study inHigh Risk Diabetic Patients Undergoing PCI
A.G.E.s Induced InflammationTriggers Measurable Pathology
Results in Expressionof Growth Factors andCytokines
↑ IL-1↑ TNFα↑ TGFβ
↑ NFκβ↓ eNOS
Resulting Pathologies:
• Vascular Stiffening• Chronic Heart Failure• Nephropathy
Source: Diabetes, Brownlee,Vol. 54, June 2005
Intracellular protein glycation
AGE precursorsGlucose
MatrixIntracellular transducers
Transcription factors
Glucose
DNA
Transcription
AGEreceptor
AGEplasmaproteins
AGEreceptor
ROS
NF-κβ
Macrophagemesangial cellmRNA
Proteins
Integrins
Endothelial cell
RNA
Alagebrium: A Novel “TherapeuticRemodeling” Agent
N
SCl
O
• Breaks A.G.E. Crosslinks
• Phase 1 and 2 clinical trials in >1000 patients:Safe and well toleratedEncouraging Phase 2 data in CHF in 45 patients
• Our Strategy:Chronic heart failure indicationDiabetic patients onlyAlteon diagnostic test identifies highest riskdiabetic patients
Diastolic Heart Failure Epidemic
• Increasing prevalence among heart failure patientsin three successive five year periods (38%, 47% and 54%)
• Mortality Rates - 1 year - 22-29%; 5 years - 65%
• ~ 50% heart failure hospitalizations
• No regulatory approvals in DHF
• Chronic heart failure, accounting for 700,000 hospitaladmissions per year
• More than $20 billion in healthcare costs
Impaired filling (elevated atrialpressures)Normal or impaired ejectionfraction30-50% of all heart failure cases70% of elderly heart failurepatientsNo current therapy available
Alagebrium reverses ventricular and aortic stiffening associatedwith diastolic dysfunction
Diastolic dysfunction in heart failure:
Source: William H. Luer, M.D., Tulane School of Medicine
Rationale For Alagebrium in Heart Failure
A.G.E.s are Increased in Aging Myocardium
Source: Cardiac Diastolic Dysfunction and AGE in Aging, S.-Y. Li, et al
Alagebrium Reduces LV Mass
44.14.24.34.44.54.64.74.84.9
5
Aging Aging + Diabetes Aging + Diabetes + ALT711
LV Mass, g/kg
P<0.05 vs. Aging P< 0.05 vs. Aging and Diabetes
Liu, J, et al Glycation end-product cross-link breaker reduces collagen and improves cardiac function in aging diabetic heart. A, J Physiol Heart Circ Physiol. 2003; 285L 2857-2591
Pressure-Volume Loops Indicating Differences Between Systolic and Diastolic Dysfunction
Source: N Engl J Med 351;11, September 9, 2004
(volume loaded)
0
5
10
15
20
25
30
35
40
0 10 20 30 40 50 60 70 80 90 100
End-Diastolic Volume Index (ml/m2)
End
-Dia
stol
ic P
ress
ure
(mm
Hg)
Low Volume, High Pressure
High Volume, Low Pressure
Male mongrel dogs. ALT-711: 1 mg/kg, oral, 4 weeksAdapted from Asif et al, PNAS 2000
Untreated Aged Dogs
*
* p < 0.001
** Treated Aged Dogs
Young DogsControl
Short-Term Dosing With Alagebrium Restores Flexibility In The Left Ventricle In Aged Dogs
Alagebrium to be Evaluated in NIH-Funded Phase 2 Clinical Study Focused on Cardiovascular Aging
Source: Unpublished
Comparison of Systolic and Diastolic Heart Failure
Source: Adapted from Circulation. 2006;113:1966-1973
<0.0015.95 ± 0.48*3.09 ± 0.36*Myocardial Stiffness Modulus, kN/m2
(Con: 2.2 ± 0.3)
<0.00162 ± 234 ± 2*LVEF, % (Con: 70 ± 3%)
<0.00180 ± 4120 ± 7*LVEDVIangiomL/m2 (Con: 72 ± 4
0.10326 ± 2*22 ± 2*LVEDP, mm Hg (Con: 10 ± 1)
<0.001172 ± 7*122 ± 5LVPSP, mm Hg (Con: 120 ± 6)
p Systolic vs
Diastolic
Diastolic
(n=22)
Systolic
(n=22)
Con = Control Population*P < 0.05 vs control population
Key Clinical Findings for Alagebriumin Heart Failure
Meaningful reduction in left ventricular mass (p=0.036), inunprecedented timeframe
Marked improvement in initialphase of left ventricular diastolic filling (p=0.045)
Statistically significant improvements in multiple QOLmeasurements (p < 0.01)
Sickest patient population (class III heart failure) benefited most
Source: Kitzman, Zile, et al; Presented as Poster at Societyof Geriatric Cardiology Annual Meeting, 2003
*Distensibility Improvement andRemodeling in Diastolic Heart Failure
DIAMOND Study
Source: Thohan, Koerner, et al; Presented as Poster at theAmerican Heart Association Annual Meeting, 2005
Patients with Impaired Ejection Fraction and Diastolic Dysfunction: Efficacy and
Safety Trial of Alagebrium
PEDESTAL Study
Improvements observed for:
Diastolic function (E/A, DT,IVRT)
Hemodynamics (LAP, PASP)
LV remodeling (LAV, LVEDV,LV mass)
NYHA score
No alterations in heart rate, bloodpressure or physical exam
Alagebrium: Phase 2b Study in High Risk Diabetic Patients With Diastolic Heart Failure
Type Placebo Control, 3 armScreened with AlteonTest
# of Patients 300
Initiate 1Q 2007
Duration 6 months dosing
First Interpretable Q2 2008Results
Centers 20; U.S.; Target max 9 monthaccrual
Endpoints Cardiac function, mass and pressure, clinical endpoints
External Support for Alagebrium in Nephropathy
A Randomized, Placebo-Controlled Trial of Alagebrium in PatientsWith Insulin-Dependent Type 1 Diabetes and Microalbuminuria
Principal Investigators:
Mark Cooper, MB, BS, Ph.D, FRACP, FAHAAssociate Director and Professor
Baker Heart Research Institute, Melbourne, Australia
Hans-Henrik Parving, M.D.Professor
Steno Diabetes Center, Gentofte, Denmark
Alagebrium Indicates Protective Effect in Preclinical Diabetic Nephropathy Model
Source: American Jouranl of Nephrology, 2006: Vol. 26, 430-436
• Treatment with alagebrium rapidly decrease serum A.G.E.s• Alagebrium treatment results in clearances of A.G.E.s in urine
Decreases Proteinuria
The urinary albumin/creatinine ratio is much lower in db/db mice treated for 3 months with alagebrium (long-termstudy). Urinary albumin/creatinine ratios were determined at the end of the study in 3-month-old, 7-month-old, and 12-month-old treated and untreated db/db mice.
Source: Am J Nephrol 2006; 26: 430-436
Source: American Jouranl of Nephrology, 2006: Vol. 26, 430-436
Alagebrium Indicates Protective Effect in Preclinical Diabetic Nephropathy Model
• Treatment with alagebrium appears to preserve kidney structures• Alagebrium appears to prevent or delay development of renal pathology
Experienced Management Team
Noah Berkowitz, M.D., Ph.D., President & CEOIMPATH, IDGene, Physician Choice
Malcolm MacNab, M.D., Ph.D.,VP, Clinical DevelopmentNovartis, Ciba Geigy
Howard B. Haimes, Ph.D, Executive Director, Preclinical ScienceOrganogenesis, Bioheart
Post-Merger Board of Directors
Noah Berkowitz, M.D., Ph.D.President & CEO, HaptoGuard; VP Clinical Development, IMPATH; Founder, Physician Choice
Marilyn G. BreslowFormer President/Analyst, W.P. Stewart; General Partner, Concord Partners; VP, Dillon, Read & Co.; Polaroid Corp.; Peat Marwick
Kenneth I. MochPresident & CEO, Alteon; President & CEO, Biocyte Corporation; Mng.General Partner, Catalyst Ventures; VP, The Liposome Company
Thomas A. MooreFormer President & CEO, Biopure; President & CEO, Nelson Communications; President, Procter & Gamble’s Worldwide Prescription and OTC Healthcare Products
George M. Naimark, Ph.D.President, Naimark & Barba; President, Naimark & Associates
Mary TannerPrincipal and Founder, Life Sciences Partners; Senior Managing Director, Bear Stearns; Managing Director, Lehman Brothers
Wayne P. YetterCEO Verispan; President and CEO, Odyssey Pharmaceuticals; Chairman & CEO, Synavant; CEO AstraMerck; Executive at Pfizer, Merck, Novartis, IMS
Alteon Pro-forma Capitalization
Total Shares Outstanding 129.3Current Warrants and Options 22.2New Financing Warrants 10.0
Fully Diluted Shares 161.5
Shares (Millions)
Financing Dependent 2006/7 Milestones
Q1 2006 ALT-2074 - ACC Presentation of ProprietaryAnimal Model - Completed
Q3 2006 ALT-2074 – Began Dosing Phase 2 Study on Cardiac Protection Following Angioplasty in ACS Patients
Q4 2006 ALT-2074 - Initiate Phase 2 Anti-inflammatoryBiomarker Trial
Q4 2006 Anticipated Start of JDRF Funded Study
Q1 2007 Alagebrium - Initiate Phase 2b CHF Trial
Q2 2007 ALT-2074 - Post Angioplasty Trial Results
ALTEON
This presentation is copyright 2006 by Alteon Inc.Any duplication, use or distribution of this presentation is strictly prohibited without prior written authorization from Alteon Inc.
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