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Page 1: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

Center for Biomarker Research in Medicine

COMET K1 Competence Center

CONFIDENTIAL Property of CBmed

About CBmed

CBmed GmbH ndash is a research center established in

2014 that is focused on identifying and validating

new biomarkers as well as conducting translational

biomarker research

CBmed is owned by several Austrian universities

and research institutes including medical

universities of Graz amp Vienna

CBmed runs international research projects in the

areas of data amp technology cancer and metabolism

amp inflammation funded by several national

funding agencies

2

CONFIDENTIAL Property of CBmed

CBmed ndash Our Vision

Our vision is to become the worldrsquos most recognized center for biomarker research in personalized medicine by 2030

This will be achieved by integrating cutting-edge technologies with international and interdisciplinary expertise in the fields of cancer metabolism and inflammation

Together with our scientific and industry partners we will develop solutions and products for patient care and cure

3

CONFIDENTIAL Property of CBmed

CBmed aims to establish an internationally competitive competence centre for systematic biomarker research

Mission (1)

MEDICAL MISSION

Easy to use targeted biomarkers

Minimally invasive biomarkers

Better and earlier diagnosis

Better therapies and treatment monitoring for

personalized medicine

4

CONFIDENTIAL Property of CBmed

CBmed aims to establish an internationally competitive competence centre for systematic biomarker research

Mission (2)

SCIENTIFIC MISSION

International excellence in biomarker research

Link national and international biomarker research efforts

Combination of analytical technologies and

advanced bioinformatics

Fast identification and validation of new biomarkers

5

CONFIDENTIAL Property of CBmed

CBmed aims to establish an internationally competitive competence centre for systematic biomarker research

Mission (3)

ECONOMIC MISSION

Hub providing relevant

infrastructure for biomarker research

Fast and effective translation of biomarkers into marketable

products

Attract and link international RampD companies and research

institutions

Create new business areas for Austrian SMEs

and industry initiate spin-offs and start-ups

6

CONFIDENTIAL Property of CBmed

bull Pharma bull Diagnostic bull Biotech

Only research collaborations can provide a sound basis for accessing human biological samples and associated medical data

For profit

PublicPrivate Partnership

Industry

Hospitals

Public

Biobanks

Non-profit

bull Technical expertise bull Medicalscientific

expertise

Expert Centre

Solutions

Project Requests

Biospecimens amp Data

7

CONFIDENTIAL Property of CBmed

CBmedlsquos USPs

Biobank amp Cohorts

International network of scientific and industry partners

Core Labs with cutting edge technology platforms

Fusion Technology with an innovative multi-OMICS approach

Biomarker discovery over a full clinical life cycle

Wide scope of research amp development in three main areas Data amp Technologies Cancer and Metabolism amp Inflammation

Close cooperation with large hospital organizations

8

CONFIDENTIAL Property of CBmed

Biomarker discovery over a full clinical life cycle

9

CONFIDENTIAL Property of CBmed

Biomarker discovery at CBmed

Fusion Technology

Core Labs

25 Biomarker RampD Projects

10

CONFIDENTIAL Property of CBmed

Biomarker discovery at CBmed

11

bull CBmed identifies and validates biomarker at all levels of clinical research including

Early diagnostics

Prognostic biomarkers

Predictive biomarkers

Translation to market

BIOMARKER IDENTIFICATION

BIOMARKER VALIDATION

BIOMARKER TRANSLATION

THERAPIES DIAGNOSTICS

CONFIDENTIAL Property of CBmed

International network of scientific and industry partners

12

CONFIDENTIAL Property of CBmed

Other scientific consortium members

435

125 95

95

20 5

Lead Partner

Shareholders Main scientific partners

Scientific Partners

13

CONFIDENTIAL Property of CBmed

Over 50 international partners on 4 continents

Pharma Industry

Information Technology

Biotech Industry

Research Organisations

Nutrition

Diagnostic Industry

CBmed Consortium Members Selected Industry Partners

14

CONFIDENTIAL Property of CBmed

Biobank amp Patient Cohorts

15

CONFIDENTIAL Property of CBmed

Biobanking amp Retrospective Cohorts

BBMRI-ERIC Expert Center ndash Bridge between Biobanks and Pharma amp Diagnostic Industry

bull CBmed is the first BBMRI-ERIC approved Expert Center

bull BBMRI-ERIC is the EU infrastructure providing a network for biobanks and biomolecular resources across Europe

bull For retrospective cohorts CBmed works closely with the Biobank Graz one of Europelsquos largest biobanks with ~75 million biospecimens

wwwbbmri-ericeu 16

CONFIDENTIAL Property of CBmed

BBMRI-ERIC ndash European Infrastructure

for Biobanks and Biomolecular Resources

bull Members Austria Italy Belgium Latvia Czech Republic Malta Estonia The Netherlands Finland Norway France Sweden Germany United Kingdom Greece

bull Observers Cyprus Poland Switzerland Turkey IARCWHO

bull 515 Biobanks over 60 Million Biospecimens

17

CONFIDENTIAL Property of CBmed

BBMRI-ERIC Expert Centre

bull Expert centres are key intermediaries between public and private sectors performing the analysis of biological samples under internationally standardized conditions

bull Their main goals are to

Provide access to primary data that can easily be shared in contrast to biological samples and

Provide high-quality information from biological samples to industry for further product development

Quoted from bdquoBBMRI-ERIC-Associated Expert Centres Trusted Partners V20ldquo

18

CONFIDENTIAL Property of CBmed

Retrospective Cohort Assembly ndash An Example

Colon Cancer Cohort with Early and Late Relapse

bull A project was identified for validation of immune infiltration as a biomarker for colon cancer relapse

bull Inclusion and exclusion criteria were defined in an eCRF bull Feasibility request sent to the Biobank Graz for FFPE

biospecimens from 100 stage II amp III colon cancer patients

bull In collaboration with the Oncology Department of the Medical University of Graz the cohorts were further refined with data regarding clinical outcome

bull An application for ethics approval was submitted to the Ethics Department of the medical university of Graz The Ethics approval was successfullly granted

bull Tissue samples were pseudonymised and sent to CBmed for analysis

Immune Cell Biomarkers in Colon Cancer

19

CONFIDENTIAL Property of CBmed

Clinical Researchers amp Prospective Cohorts

Prospective cohorts have many benefits

bull control sampling time points to observed patient response to therapy

bull access to biospecimens not normally collected as routine

bull control of sampling procedures

bull collection of fresh cells and tissues required for analysis by eg flow cytometry MALDI-MS imaging and development of PDX models

CBmed has built strong collaborations with clinical researchers from the Medical Universities of Graz amp Vienna enabling the initiation of a wide range of prospective collections

20

CONFIDENTIAL Property of CBmed

Prospective Cohorts

bull CBmed Prospectively collects Biospecimens in the following indications Type 1 amp 2 diabetes inflammatory bowel disease cardiovascular disease liver disease

(NAFLD NASH alcoholic liver disease hepatitis C cirrhosis) chronic kidney disease obesity metabolic bone disease fertility disorders (polycystic ovarian) sepsis

Cancer ndash breast prostate colorectal cancer lung endometrial ovarian hepatocellular melanoma urothelial renal cell pancreatic head amp neck bladder AML lymphoma

Healthy controls

bull Diverse biospecimen types Blood (serum plasma) tissue circulating tumor

cells circulating immune cells urine stool saliva cultures

bull Ethical Guidelines - Collected following the ethical guidelines of the Biobank Graz an international standard for Biobanking

bull Clinical Data Management - Clinical data collected in a clinical data management system in accordance with good clinical practice (GCP) CBmed has access to specimens with meticulous clinical characterization follow-up data and biomarker results

21

CONFIDENTIAL Property of CBmed

Close cooperation with large hospital organisations

22

CONFIDENTIAL Property of CBmed

Innovative use of Clinical Information for Biomarker Research

bull Access to biospecimens alone is worthless without associated high quality in-depth clinical data

bull CBmed works together with KAGes one of the largest hospital companies in Europe with a catchment area of 12 million people with the aim of developing IT solutions for extracting the relevant clinical data from structured and unstructured sources with a view to selecting the appropriate patients for biomarker research

Our Strengths

bull Expertise in

Data semantics

Biomedical Terminologies

Natural Language processing

Big data management (eg SAP HANA)

Predictive content analytics

23

CONFIDENTIAL Property of CBmed

Wide scope of RampD

Internal Biomarker Research Programmes

24

CONFIDENTIAL Property of CBmed

RampD Project Overview

Core Labs

NGS

Metabolomics

Immunology

Digital Pathology

MALDI-MS

Proteomics amp In-vivo Imaging

Disease Models (PDX ADX)

Technology Development eg electrochemical chip-based diagnostics

Patient Cohorts

AREA 1

Data amp Technology

Multi-omics

Clinical Data Management

Software

development ndash semantic

searching of clinical data

AREA 2

Cancer

AREA 3

Metabolism amp

Inflammation

bull Early Diagnostics including bull Tracking the Trace (CTCs in Urologic

Cancer) bull Metabolomics (Idiopathic Pulmonary

Arterial Hypertension) bull Sepsis amp Fungal Infection

bull Prognostic amp Predictive Markers (Patient Stratification) including bull Minimal Residual Disease in AML bull Immune Cell Characterisation as a

Biomarker in CRC bull Eukaryotic Initiation Factors in eg

Glioblastoma bull Biosensors for short-lived biomarkers

in diabetes bull Diabesity amp Cardiovascular disease

including microbiome analysis

bull Translation to Market bull Health Technology Assessment

25

CONFIDENTIAL Property of CBmed

Internal RampD Projects

bull Health technology assessment

Area 3 Metabolism

amp Inflammation

Area 1 Data

amp Technologies

Area 2 Cancer

bull Metabolomics bull Clinical information system bull Semantic data management

bull Next generation sequencing

bull Tracking the trace bull Minimal residual disease

and CAR T-cells

bull Diabesity

bull Cardiovascular disease bull Biosensors

bull Bone metabolism

bull Fertility bull Electrochemical biomarker detection

bull Liver function

bull Microbiome-gut-brain

bull Sepsis

bull Fungal infections

bull ADX models bull Eukaryotic initiation factors

bull Core Lab for Target Identify-cation and Probe Development

bull Clinical MALDI Applications bull Digital Pathology

bull Immunology bull Knowledge discovery amp data mining)

26

CONFIDENTIAL Property of CBmed

Disease Area Stronghold CANCER

OUR EXPERTISE Experts in Clinical Oncology and Pathology Deep clinical phenotyping through access to standardised clinical

documentation Pre-exisiting network of clinicians and researchers (basic amp

translational) Experience at clinical research including clinical trials

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

OUR SOLUTIONS Isolation amp analysis of circulating tumour cells (PARSORTIX amp Mobile Diagnostic System ndash blood

and other boldy fluids) Detection analysis and validation of circulating tumour DNA Development of discriminative multimarker panels for serum proteins and immune cell gene

expression signatures Highly sensitive method for detection of minimal residual disease in haematological malignancies Drug validation and development programmes (eg antibodies viral vector-based and anti-eIFs) Access to tumour tissue (patient amp autopsy derived) for generation of xenograft models (PDX amp

ADX)

27

CONFIDENTIAL Property of CBmed

Disease Area Stronghold METABOLISM amp INFLAMMATION

OUR EXPERTISE Experts in Clinical Endocrinology amp Metabolic Diseases In-vitro amp In-vivo analysis Experience of clinical study design planning and execution

OUR SOLUTIONS 16S rRNA microbiome profiling and analysis stand alone or in

combination with metabolomics (mass spectrometry) Gut permeability measurements (zonulin calprotectin

lactulosemannitol)

Assoc Prof Harald Sourij MD Area Leader Metab amp Inflamm

Clnical Endocrinologist

Assessment of neurochemical biomarkers by cerebral open flow microperfusion Non-invasive PET imaging methods for angiogenesis and inflammation in liver diseases Rodent models for various diseases (diabetes hepatocellular) Human glucose triple tracer techniques with tracers in accordance with GMP GLP and GCP

guidelines for meticulous characterization of glucose metabolism Glycerol tracer techniques for determination of lipid fluxes Lipidomics techniques for biomarker research in cardiovascular disease

28

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 2: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

About CBmed

CBmed GmbH ndash is a research center established in

2014 that is focused on identifying and validating

new biomarkers as well as conducting translational

biomarker research

CBmed is owned by several Austrian universities

and research institutes including medical

universities of Graz amp Vienna

CBmed runs international research projects in the

areas of data amp technology cancer and metabolism

amp inflammation funded by several national

funding agencies

2

CONFIDENTIAL Property of CBmed

CBmed ndash Our Vision

Our vision is to become the worldrsquos most recognized center for biomarker research in personalized medicine by 2030

This will be achieved by integrating cutting-edge technologies with international and interdisciplinary expertise in the fields of cancer metabolism and inflammation

Together with our scientific and industry partners we will develop solutions and products for patient care and cure

3

CONFIDENTIAL Property of CBmed

CBmed aims to establish an internationally competitive competence centre for systematic biomarker research

Mission (1)

MEDICAL MISSION

Easy to use targeted biomarkers

Minimally invasive biomarkers

Better and earlier diagnosis

Better therapies and treatment monitoring for

personalized medicine

4

CONFIDENTIAL Property of CBmed

CBmed aims to establish an internationally competitive competence centre for systematic biomarker research

Mission (2)

SCIENTIFIC MISSION

International excellence in biomarker research

Link national and international biomarker research efforts

Combination of analytical technologies and

advanced bioinformatics

Fast identification and validation of new biomarkers

5

CONFIDENTIAL Property of CBmed

CBmed aims to establish an internationally competitive competence centre for systematic biomarker research

Mission (3)

ECONOMIC MISSION

Hub providing relevant

infrastructure for biomarker research

Fast and effective translation of biomarkers into marketable

products

Attract and link international RampD companies and research

institutions

Create new business areas for Austrian SMEs

and industry initiate spin-offs and start-ups

6

CONFIDENTIAL Property of CBmed

bull Pharma bull Diagnostic bull Biotech

Only research collaborations can provide a sound basis for accessing human biological samples and associated medical data

For profit

PublicPrivate Partnership

Industry

Hospitals

Public

Biobanks

Non-profit

bull Technical expertise bull Medicalscientific

expertise

Expert Centre

Solutions

Project Requests

Biospecimens amp Data

7

CONFIDENTIAL Property of CBmed

CBmedlsquos USPs

Biobank amp Cohorts

International network of scientific and industry partners

Core Labs with cutting edge technology platforms

Fusion Technology with an innovative multi-OMICS approach

Biomarker discovery over a full clinical life cycle

Wide scope of research amp development in three main areas Data amp Technologies Cancer and Metabolism amp Inflammation

Close cooperation with large hospital organizations

8

CONFIDENTIAL Property of CBmed

Biomarker discovery over a full clinical life cycle

9

CONFIDENTIAL Property of CBmed

Biomarker discovery at CBmed

Fusion Technology

Core Labs

25 Biomarker RampD Projects

10

CONFIDENTIAL Property of CBmed

Biomarker discovery at CBmed

11

bull CBmed identifies and validates biomarker at all levels of clinical research including

Early diagnostics

Prognostic biomarkers

Predictive biomarkers

Translation to market

BIOMARKER IDENTIFICATION

BIOMARKER VALIDATION

BIOMARKER TRANSLATION

THERAPIES DIAGNOSTICS

CONFIDENTIAL Property of CBmed

International network of scientific and industry partners

12

CONFIDENTIAL Property of CBmed

Other scientific consortium members

435

125 95

95

20 5

Lead Partner

Shareholders Main scientific partners

Scientific Partners

13

CONFIDENTIAL Property of CBmed

Over 50 international partners on 4 continents

Pharma Industry

Information Technology

Biotech Industry

Research Organisations

Nutrition

Diagnostic Industry

CBmed Consortium Members Selected Industry Partners

14

CONFIDENTIAL Property of CBmed

Biobank amp Patient Cohorts

15

CONFIDENTIAL Property of CBmed

Biobanking amp Retrospective Cohorts

BBMRI-ERIC Expert Center ndash Bridge between Biobanks and Pharma amp Diagnostic Industry

bull CBmed is the first BBMRI-ERIC approved Expert Center

bull BBMRI-ERIC is the EU infrastructure providing a network for biobanks and biomolecular resources across Europe

bull For retrospective cohorts CBmed works closely with the Biobank Graz one of Europelsquos largest biobanks with ~75 million biospecimens

wwwbbmri-ericeu 16

CONFIDENTIAL Property of CBmed

BBMRI-ERIC ndash European Infrastructure

for Biobanks and Biomolecular Resources

bull Members Austria Italy Belgium Latvia Czech Republic Malta Estonia The Netherlands Finland Norway France Sweden Germany United Kingdom Greece

bull Observers Cyprus Poland Switzerland Turkey IARCWHO

bull 515 Biobanks over 60 Million Biospecimens

17

CONFIDENTIAL Property of CBmed

BBMRI-ERIC Expert Centre

bull Expert centres are key intermediaries between public and private sectors performing the analysis of biological samples under internationally standardized conditions

bull Their main goals are to

Provide access to primary data that can easily be shared in contrast to biological samples and

Provide high-quality information from biological samples to industry for further product development

Quoted from bdquoBBMRI-ERIC-Associated Expert Centres Trusted Partners V20ldquo

18

CONFIDENTIAL Property of CBmed

Retrospective Cohort Assembly ndash An Example

Colon Cancer Cohort with Early and Late Relapse

bull A project was identified for validation of immune infiltration as a biomarker for colon cancer relapse

bull Inclusion and exclusion criteria were defined in an eCRF bull Feasibility request sent to the Biobank Graz for FFPE

biospecimens from 100 stage II amp III colon cancer patients

bull In collaboration with the Oncology Department of the Medical University of Graz the cohorts were further refined with data regarding clinical outcome

bull An application for ethics approval was submitted to the Ethics Department of the medical university of Graz The Ethics approval was successfullly granted

bull Tissue samples were pseudonymised and sent to CBmed for analysis

Immune Cell Biomarkers in Colon Cancer

19

CONFIDENTIAL Property of CBmed

Clinical Researchers amp Prospective Cohorts

Prospective cohorts have many benefits

bull control sampling time points to observed patient response to therapy

bull access to biospecimens not normally collected as routine

bull control of sampling procedures

bull collection of fresh cells and tissues required for analysis by eg flow cytometry MALDI-MS imaging and development of PDX models

CBmed has built strong collaborations with clinical researchers from the Medical Universities of Graz amp Vienna enabling the initiation of a wide range of prospective collections

20

CONFIDENTIAL Property of CBmed

Prospective Cohorts

bull CBmed Prospectively collects Biospecimens in the following indications Type 1 amp 2 diabetes inflammatory bowel disease cardiovascular disease liver disease

(NAFLD NASH alcoholic liver disease hepatitis C cirrhosis) chronic kidney disease obesity metabolic bone disease fertility disorders (polycystic ovarian) sepsis

Cancer ndash breast prostate colorectal cancer lung endometrial ovarian hepatocellular melanoma urothelial renal cell pancreatic head amp neck bladder AML lymphoma

Healthy controls

bull Diverse biospecimen types Blood (serum plasma) tissue circulating tumor

cells circulating immune cells urine stool saliva cultures

bull Ethical Guidelines - Collected following the ethical guidelines of the Biobank Graz an international standard for Biobanking

bull Clinical Data Management - Clinical data collected in a clinical data management system in accordance with good clinical practice (GCP) CBmed has access to specimens with meticulous clinical characterization follow-up data and biomarker results

21

CONFIDENTIAL Property of CBmed

Close cooperation with large hospital organisations

22

CONFIDENTIAL Property of CBmed

Innovative use of Clinical Information for Biomarker Research

bull Access to biospecimens alone is worthless without associated high quality in-depth clinical data

bull CBmed works together with KAGes one of the largest hospital companies in Europe with a catchment area of 12 million people with the aim of developing IT solutions for extracting the relevant clinical data from structured and unstructured sources with a view to selecting the appropriate patients for biomarker research

Our Strengths

bull Expertise in

Data semantics

Biomedical Terminologies

Natural Language processing

Big data management (eg SAP HANA)

Predictive content analytics

23

CONFIDENTIAL Property of CBmed

Wide scope of RampD

Internal Biomarker Research Programmes

24

CONFIDENTIAL Property of CBmed

RampD Project Overview

Core Labs

NGS

Metabolomics

Immunology

Digital Pathology

MALDI-MS

Proteomics amp In-vivo Imaging

Disease Models (PDX ADX)

Technology Development eg electrochemical chip-based diagnostics

Patient Cohorts

AREA 1

Data amp Technology

Multi-omics

Clinical Data Management

Software

development ndash semantic

searching of clinical data

AREA 2

Cancer

AREA 3

Metabolism amp

Inflammation

bull Early Diagnostics including bull Tracking the Trace (CTCs in Urologic

Cancer) bull Metabolomics (Idiopathic Pulmonary

Arterial Hypertension) bull Sepsis amp Fungal Infection

bull Prognostic amp Predictive Markers (Patient Stratification) including bull Minimal Residual Disease in AML bull Immune Cell Characterisation as a

Biomarker in CRC bull Eukaryotic Initiation Factors in eg

Glioblastoma bull Biosensors for short-lived biomarkers

in diabetes bull Diabesity amp Cardiovascular disease

including microbiome analysis

bull Translation to Market bull Health Technology Assessment

25

CONFIDENTIAL Property of CBmed

Internal RampD Projects

bull Health technology assessment

Area 3 Metabolism

amp Inflammation

Area 1 Data

amp Technologies

Area 2 Cancer

bull Metabolomics bull Clinical information system bull Semantic data management

bull Next generation sequencing

bull Tracking the trace bull Minimal residual disease

and CAR T-cells

bull Diabesity

bull Cardiovascular disease bull Biosensors

bull Bone metabolism

bull Fertility bull Electrochemical biomarker detection

bull Liver function

bull Microbiome-gut-brain

bull Sepsis

bull Fungal infections

bull ADX models bull Eukaryotic initiation factors

bull Core Lab for Target Identify-cation and Probe Development

bull Clinical MALDI Applications bull Digital Pathology

bull Immunology bull Knowledge discovery amp data mining)

26

CONFIDENTIAL Property of CBmed

Disease Area Stronghold CANCER

OUR EXPERTISE Experts in Clinical Oncology and Pathology Deep clinical phenotyping through access to standardised clinical

documentation Pre-exisiting network of clinicians and researchers (basic amp

translational) Experience at clinical research including clinical trials

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

OUR SOLUTIONS Isolation amp analysis of circulating tumour cells (PARSORTIX amp Mobile Diagnostic System ndash blood

and other boldy fluids) Detection analysis and validation of circulating tumour DNA Development of discriminative multimarker panels for serum proteins and immune cell gene

expression signatures Highly sensitive method for detection of minimal residual disease in haematological malignancies Drug validation and development programmes (eg antibodies viral vector-based and anti-eIFs) Access to tumour tissue (patient amp autopsy derived) for generation of xenograft models (PDX amp

ADX)

27

CONFIDENTIAL Property of CBmed

Disease Area Stronghold METABOLISM amp INFLAMMATION

OUR EXPERTISE Experts in Clinical Endocrinology amp Metabolic Diseases In-vitro amp In-vivo analysis Experience of clinical study design planning and execution

OUR SOLUTIONS 16S rRNA microbiome profiling and analysis stand alone or in

combination with metabolomics (mass spectrometry) Gut permeability measurements (zonulin calprotectin

lactulosemannitol)

Assoc Prof Harald Sourij MD Area Leader Metab amp Inflamm

Clnical Endocrinologist

Assessment of neurochemical biomarkers by cerebral open flow microperfusion Non-invasive PET imaging methods for angiogenesis and inflammation in liver diseases Rodent models for various diseases (diabetes hepatocellular) Human glucose triple tracer techniques with tracers in accordance with GMP GLP and GCP

guidelines for meticulous characterization of glucose metabolism Glycerol tracer techniques for determination of lipid fluxes Lipidomics techniques for biomarker research in cardiovascular disease

28

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 3: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

CBmed ndash Our Vision

Our vision is to become the worldrsquos most recognized center for biomarker research in personalized medicine by 2030

This will be achieved by integrating cutting-edge technologies with international and interdisciplinary expertise in the fields of cancer metabolism and inflammation

Together with our scientific and industry partners we will develop solutions and products for patient care and cure

3

CONFIDENTIAL Property of CBmed

CBmed aims to establish an internationally competitive competence centre for systematic biomarker research

Mission (1)

MEDICAL MISSION

Easy to use targeted biomarkers

Minimally invasive biomarkers

Better and earlier diagnosis

Better therapies and treatment monitoring for

personalized medicine

4

CONFIDENTIAL Property of CBmed

CBmed aims to establish an internationally competitive competence centre for systematic biomarker research

Mission (2)

SCIENTIFIC MISSION

International excellence in biomarker research

Link national and international biomarker research efforts

Combination of analytical technologies and

advanced bioinformatics

Fast identification and validation of new biomarkers

5

CONFIDENTIAL Property of CBmed

CBmed aims to establish an internationally competitive competence centre for systematic biomarker research

Mission (3)

ECONOMIC MISSION

Hub providing relevant

infrastructure for biomarker research

Fast and effective translation of biomarkers into marketable

products

Attract and link international RampD companies and research

institutions

Create new business areas for Austrian SMEs

and industry initiate spin-offs and start-ups

6

CONFIDENTIAL Property of CBmed

bull Pharma bull Diagnostic bull Biotech

Only research collaborations can provide a sound basis for accessing human biological samples and associated medical data

For profit

PublicPrivate Partnership

Industry

Hospitals

Public

Biobanks

Non-profit

bull Technical expertise bull Medicalscientific

expertise

Expert Centre

Solutions

Project Requests

Biospecimens amp Data

7

CONFIDENTIAL Property of CBmed

CBmedlsquos USPs

Biobank amp Cohorts

International network of scientific and industry partners

Core Labs with cutting edge technology platforms

Fusion Technology with an innovative multi-OMICS approach

Biomarker discovery over a full clinical life cycle

Wide scope of research amp development in three main areas Data amp Technologies Cancer and Metabolism amp Inflammation

Close cooperation with large hospital organizations

8

CONFIDENTIAL Property of CBmed

Biomarker discovery over a full clinical life cycle

9

CONFIDENTIAL Property of CBmed

Biomarker discovery at CBmed

Fusion Technology

Core Labs

25 Biomarker RampD Projects

10

CONFIDENTIAL Property of CBmed

Biomarker discovery at CBmed

11

bull CBmed identifies and validates biomarker at all levels of clinical research including

Early diagnostics

Prognostic biomarkers

Predictive biomarkers

Translation to market

BIOMARKER IDENTIFICATION

BIOMARKER VALIDATION

BIOMARKER TRANSLATION

THERAPIES DIAGNOSTICS

CONFIDENTIAL Property of CBmed

International network of scientific and industry partners

12

CONFIDENTIAL Property of CBmed

Other scientific consortium members

435

125 95

95

20 5

Lead Partner

Shareholders Main scientific partners

Scientific Partners

13

CONFIDENTIAL Property of CBmed

Over 50 international partners on 4 continents

Pharma Industry

Information Technology

Biotech Industry

Research Organisations

Nutrition

Diagnostic Industry

CBmed Consortium Members Selected Industry Partners

14

CONFIDENTIAL Property of CBmed

Biobank amp Patient Cohorts

15

CONFIDENTIAL Property of CBmed

Biobanking amp Retrospective Cohorts

BBMRI-ERIC Expert Center ndash Bridge between Biobanks and Pharma amp Diagnostic Industry

bull CBmed is the first BBMRI-ERIC approved Expert Center

bull BBMRI-ERIC is the EU infrastructure providing a network for biobanks and biomolecular resources across Europe

bull For retrospective cohorts CBmed works closely with the Biobank Graz one of Europelsquos largest biobanks with ~75 million biospecimens

wwwbbmri-ericeu 16

CONFIDENTIAL Property of CBmed

BBMRI-ERIC ndash European Infrastructure

for Biobanks and Biomolecular Resources

bull Members Austria Italy Belgium Latvia Czech Republic Malta Estonia The Netherlands Finland Norway France Sweden Germany United Kingdom Greece

bull Observers Cyprus Poland Switzerland Turkey IARCWHO

bull 515 Biobanks over 60 Million Biospecimens

17

CONFIDENTIAL Property of CBmed

BBMRI-ERIC Expert Centre

bull Expert centres are key intermediaries between public and private sectors performing the analysis of biological samples under internationally standardized conditions

bull Their main goals are to

Provide access to primary data that can easily be shared in contrast to biological samples and

Provide high-quality information from biological samples to industry for further product development

Quoted from bdquoBBMRI-ERIC-Associated Expert Centres Trusted Partners V20ldquo

18

CONFIDENTIAL Property of CBmed

Retrospective Cohort Assembly ndash An Example

Colon Cancer Cohort with Early and Late Relapse

bull A project was identified for validation of immune infiltration as a biomarker for colon cancer relapse

bull Inclusion and exclusion criteria were defined in an eCRF bull Feasibility request sent to the Biobank Graz for FFPE

biospecimens from 100 stage II amp III colon cancer patients

bull In collaboration with the Oncology Department of the Medical University of Graz the cohorts were further refined with data regarding clinical outcome

bull An application for ethics approval was submitted to the Ethics Department of the medical university of Graz The Ethics approval was successfullly granted

bull Tissue samples were pseudonymised and sent to CBmed for analysis

Immune Cell Biomarkers in Colon Cancer

19

CONFIDENTIAL Property of CBmed

Clinical Researchers amp Prospective Cohorts

Prospective cohorts have many benefits

bull control sampling time points to observed patient response to therapy

bull access to biospecimens not normally collected as routine

bull control of sampling procedures

bull collection of fresh cells and tissues required for analysis by eg flow cytometry MALDI-MS imaging and development of PDX models

CBmed has built strong collaborations with clinical researchers from the Medical Universities of Graz amp Vienna enabling the initiation of a wide range of prospective collections

20

CONFIDENTIAL Property of CBmed

Prospective Cohorts

bull CBmed Prospectively collects Biospecimens in the following indications Type 1 amp 2 diabetes inflammatory bowel disease cardiovascular disease liver disease

(NAFLD NASH alcoholic liver disease hepatitis C cirrhosis) chronic kidney disease obesity metabolic bone disease fertility disorders (polycystic ovarian) sepsis

Cancer ndash breast prostate colorectal cancer lung endometrial ovarian hepatocellular melanoma urothelial renal cell pancreatic head amp neck bladder AML lymphoma

Healthy controls

bull Diverse biospecimen types Blood (serum plasma) tissue circulating tumor

cells circulating immune cells urine stool saliva cultures

bull Ethical Guidelines - Collected following the ethical guidelines of the Biobank Graz an international standard for Biobanking

bull Clinical Data Management - Clinical data collected in a clinical data management system in accordance with good clinical practice (GCP) CBmed has access to specimens with meticulous clinical characterization follow-up data and biomarker results

21

CONFIDENTIAL Property of CBmed

Close cooperation with large hospital organisations

22

CONFIDENTIAL Property of CBmed

Innovative use of Clinical Information for Biomarker Research

bull Access to biospecimens alone is worthless without associated high quality in-depth clinical data

bull CBmed works together with KAGes one of the largest hospital companies in Europe with a catchment area of 12 million people with the aim of developing IT solutions for extracting the relevant clinical data from structured and unstructured sources with a view to selecting the appropriate patients for biomarker research

Our Strengths

bull Expertise in

Data semantics

Biomedical Terminologies

Natural Language processing

Big data management (eg SAP HANA)

Predictive content analytics

23

CONFIDENTIAL Property of CBmed

Wide scope of RampD

Internal Biomarker Research Programmes

24

CONFIDENTIAL Property of CBmed

RampD Project Overview

Core Labs

NGS

Metabolomics

Immunology

Digital Pathology

MALDI-MS

Proteomics amp In-vivo Imaging

Disease Models (PDX ADX)

Technology Development eg electrochemical chip-based diagnostics

Patient Cohorts

AREA 1

Data amp Technology

Multi-omics

Clinical Data Management

Software

development ndash semantic

searching of clinical data

AREA 2

Cancer

AREA 3

Metabolism amp

Inflammation

bull Early Diagnostics including bull Tracking the Trace (CTCs in Urologic

Cancer) bull Metabolomics (Idiopathic Pulmonary

Arterial Hypertension) bull Sepsis amp Fungal Infection

bull Prognostic amp Predictive Markers (Patient Stratification) including bull Minimal Residual Disease in AML bull Immune Cell Characterisation as a

Biomarker in CRC bull Eukaryotic Initiation Factors in eg

Glioblastoma bull Biosensors for short-lived biomarkers

in diabetes bull Diabesity amp Cardiovascular disease

including microbiome analysis

bull Translation to Market bull Health Technology Assessment

25

CONFIDENTIAL Property of CBmed

Internal RampD Projects

bull Health technology assessment

Area 3 Metabolism

amp Inflammation

Area 1 Data

amp Technologies

Area 2 Cancer

bull Metabolomics bull Clinical information system bull Semantic data management

bull Next generation sequencing

bull Tracking the trace bull Minimal residual disease

and CAR T-cells

bull Diabesity

bull Cardiovascular disease bull Biosensors

bull Bone metabolism

bull Fertility bull Electrochemical biomarker detection

bull Liver function

bull Microbiome-gut-brain

bull Sepsis

bull Fungal infections

bull ADX models bull Eukaryotic initiation factors

bull Core Lab for Target Identify-cation and Probe Development

bull Clinical MALDI Applications bull Digital Pathology

bull Immunology bull Knowledge discovery amp data mining)

26

CONFIDENTIAL Property of CBmed

Disease Area Stronghold CANCER

OUR EXPERTISE Experts in Clinical Oncology and Pathology Deep clinical phenotyping through access to standardised clinical

documentation Pre-exisiting network of clinicians and researchers (basic amp

translational) Experience at clinical research including clinical trials

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

OUR SOLUTIONS Isolation amp analysis of circulating tumour cells (PARSORTIX amp Mobile Diagnostic System ndash blood

and other boldy fluids) Detection analysis and validation of circulating tumour DNA Development of discriminative multimarker panels for serum proteins and immune cell gene

expression signatures Highly sensitive method for detection of minimal residual disease in haematological malignancies Drug validation and development programmes (eg antibodies viral vector-based and anti-eIFs) Access to tumour tissue (patient amp autopsy derived) for generation of xenograft models (PDX amp

ADX)

27

CONFIDENTIAL Property of CBmed

Disease Area Stronghold METABOLISM amp INFLAMMATION

OUR EXPERTISE Experts in Clinical Endocrinology amp Metabolic Diseases In-vitro amp In-vivo analysis Experience of clinical study design planning and execution

OUR SOLUTIONS 16S rRNA microbiome profiling and analysis stand alone or in

combination with metabolomics (mass spectrometry) Gut permeability measurements (zonulin calprotectin

lactulosemannitol)

Assoc Prof Harald Sourij MD Area Leader Metab amp Inflamm

Clnical Endocrinologist

Assessment of neurochemical biomarkers by cerebral open flow microperfusion Non-invasive PET imaging methods for angiogenesis and inflammation in liver diseases Rodent models for various diseases (diabetes hepatocellular) Human glucose triple tracer techniques with tracers in accordance with GMP GLP and GCP

guidelines for meticulous characterization of glucose metabolism Glycerol tracer techniques for determination of lipid fluxes Lipidomics techniques for biomarker research in cardiovascular disease

28

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 4: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

CBmed aims to establish an internationally competitive competence centre for systematic biomarker research

Mission (1)

MEDICAL MISSION

Easy to use targeted biomarkers

Minimally invasive biomarkers

Better and earlier diagnosis

Better therapies and treatment monitoring for

personalized medicine

4

CONFIDENTIAL Property of CBmed

CBmed aims to establish an internationally competitive competence centre for systematic biomarker research

Mission (2)

SCIENTIFIC MISSION

International excellence in biomarker research

Link national and international biomarker research efforts

Combination of analytical technologies and

advanced bioinformatics

Fast identification and validation of new biomarkers

5

CONFIDENTIAL Property of CBmed

CBmed aims to establish an internationally competitive competence centre for systematic biomarker research

Mission (3)

ECONOMIC MISSION

Hub providing relevant

infrastructure for biomarker research

Fast and effective translation of biomarkers into marketable

products

Attract and link international RampD companies and research

institutions

Create new business areas for Austrian SMEs

and industry initiate spin-offs and start-ups

6

CONFIDENTIAL Property of CBmed

bull Pharma bull Diagnostic bull Biotech

Only research collaborations can provide a sound basis for accessing human biological samples and associated medical data

For profit

PublicPrivate Partnership

Industry

Hospitals

Public

Biobanks

Non-profit

bull Technical expertise bull Medicalscientific

expertise

Expert Centre

Solutions

Project Requests

Biospecimens amp Data

7

CONFIDENTIAL Property of CBmed

CBmedlsquos USPs

Biobank amp Cohorts

International network of scientific and industry partners

Core Labs with cutting edge technology platforms

Fusion Technology with an innovative multi-OMICS approach

Biomarker discovery over a full clinical life cycle

Wide scope of research amp development in three main areas Data amp Technologies Cancer and Metabolism amp Inflammation

Close cooperation with large hospital organizations

8

CONFIDENTIAL Property of CBmed

Biomarker discovery over a full clinical life cycle

9

CONFIDENTIAL Property of CBmed

Biomarker discovery at CBmed

Fusion Technology

Core Labs

25 Biomarker RampD Projects

10

CONFIDENTIAL Property of CBmed

Biomarker discovery at CBmed

11

bull CBmed identifies and validates biomarker at all levels of clinical research including

Early diagnostics

Prognostic biomarkers

Predictive biomarkers

Translation to market

BIOMARKER IDENTIFICATION

BIOMARKER VALIDATION

BIOMARKER TRANSLATION

THERAPIES DIAGNOSTICS

CONFIDENTIAL Property of CBmed

International network of scientific and industry partners

12

CONFIDENTIAL Property of CBmed

Other scientific consortium members

435

125 95

95

20 5

Lead Partner

Shareholders Main scientific partners

Scientific Partners

13

CONFIDENTIAL Property of CBmed

Over 50 international partners on 4 continents

Pharma Industry

Information Technology

Biotech Industry

Research Organisations

Nutrition

Diagnostic Industry

CBmed Consortium Members Selected Industry Partners

14

CONFIDENTIAL Property of CBmed

Biobank amp Patient Cohorts

15

CONFIDENTIAL Property of CBmed

Biobanking amp Retrospective Cohorts

BBMRI-ERIC Expert Center ndash Bridge between Biobanks and Pharma amp Diagnostic Industry

bull CBmed is the first BBMRI-ERIC approved Expert Center

bull BBMRI-ERIC is the EU infrastructure providing a network for biobanks and biomolecular resources across Europe

bull For retrospective cohorts CBmed works closely with the Biobank Graz one of Europelsquos largest biobanks with ~75 million biospecimens

wwwbbmri-ericeu 16

CONFIDENTIAL Property of CBmed

BBMRI-ERIC ndash European Infrastructure

for Biobanks and Biomolecular Resources

bull Members Austria Italy Belgium Latvia Czech Republic Malta Estonia The Netherlands Finland Norway France Sweden Germany United Kingdom Greece

bull Observers Cyprus Poland Switzerland Turkey IARCWHO

bull 515 Biobanks over 60 Million Biospecimens

17

CONFIDENTIAL Property of CBmed

BBMRI-ERIC Expert Centre

bull Expert centres are key intermediaries between public and private sectors performing the analysis of biological samples under internationally standardized conditions

bull Their main goals are to

Provide access to primary data that can easily be shared in contrast to biological samples and

Provide high-quality information from biological samples to industry for further product development

Quoted from bdquoBBMRI-ERIC-Associated Expert Centres Trusted Partners V20ldquo

18

CONFIDENTIAL Property of CBmed

Retrospective Cohort Assembly ndash An Example

Colon Cancer Cohort with Early and Late Relapse

bull A project was identified for validation of immune infiltration as a biomarker for colon cancer relapse

bull Inclusion and exclusion criteria were defined in an eCRF bull Feasibility request sent to the Biobank Graz for FFPE

biospecimens from 100 stage II amp III colon cancer patients

bull In collaboration with the Oncology Department of the Medical University of Graz the cohorts were further refined with data regarding clinical outcome

bull An application for ethics approval was submitted to the Ethics Department of the medical university of Graz The Ethics approval was successfullly granted

bull Tissue samples were pseudonymised and sent to CBmed for analysis

Immune Cell Biomarkers in Colon Cancer

19

CONFIDENTIAL Property of CBmed

Clinical Researchers amp Prospective Cohorts

Prospective cohorts have many benefits

bull control sampling time points to observed patient response to therapy

bull access to biospecimens not normally collected as routine

bull control of sampling procedures

bull collection of fresh cells and tissues required for analysis by eg flow cytometry MALDI-MS imaging and development of PDX models

CBmed has built strong collaborations with clinical researchers from the Medical Universities of Graz amp Vienna enabling the initiation of a wide range of prospective collections

20

CONFIDENTIAL Property of CBmed

Prospective Cohorts

bull CBmed Prospectively collects Biospecimens in the following indications Type 1 amp 2 diabetes inflammatory bowel disease cardiovascular disease liver disease

(NAFLD NASH alcoholic liver disease hepatitis C cirrhosis) chronic kidney disease obesity metabolic bone disease fertility disorders (polycystic ovarian) sepsis

Cancer ndash breast prostate colorectal cancer lung endometrial ovarian hepatocellular melanoma urothelial renal cell pancreatic head amp neck bladder AML lymphoma

Healthy controls

bull Diverse biospecimen types Blood (serum plasma) tissue circulating tumor

cells circulating immune cells urine stool saliva cultures

bull Ethical Guidelines - Collected following the ethical guidelines of the Biobank Graz an international standard for Biobanking

bull Clinical Data Management - Clinical data collected in a clinical data management system in accordance with good clinical practice (GCP) CBmed has access to specimens with meticulous clinical characterization follow-up data and biomarker results

21

CONFIDENTIAL Property of CBmed

Close cooperation with large hospital organisations

22

CONFIDENTIAL Property of CBmed

Innovative use of Clinical Information for Biomarker Research

bull Access to biospecimens alone is worthless without associated high quality in-depth clinical data

bull CBmed works together with KAGes one of the largest hospital companies in Europe with a catchment area of 12 million people with the aim of developing IT solutions for extracting the relevant clinical data from structured and unstructured sources with a view to selecting the appropriate patients for biomarker research

Our Strengths

bull Expertise in

Data semantics

Biomedical Terminologies

Natural Language processing

Big data management (eg SAP HANA)

Predictive content analytics

23

CONFIDENTIAL Property of CBmed

Wide scope of RampD

Internal Biomarker Research Programmes

24

CONFIDENTIAL Property of CBmed

RampD Project Overview

Core Labs

NGS

Metabolomics

Immunology

Digital Pathology

MALDI-MS

Proteomics amp In-vivo Imaging

Disease Models (PDX ADX)

Technology Development eg electrochemical chip-based diagnostics

Patient Cohorts

AREA 1

Data amp Technology

Multi-omics

Clinical Data Management

Software

development ndash semantic

searching of clinical data

AREA 2

Cancer

AREA 3

Metabolism amp

Inflammation

bull Early Diagnostics including bull Tracking the Trace (CTCs in Urologic

Cancer) bull Metabolomics (Idiopathic Pulmonary

Arterial Hypertension) bull Sepsis amp Fungal Infection

bull Prognostic amp Predictive Markers (Patient Stratification) including bull Minimal Residual Disease in AML bull Immune Cell Characterisation as a

Biomarker in CRC bull Eukaryotic Initiation Factors in eg

Glioblastoma bull Biosensors for short-lived biomarkers

in diabetes bull Diabesity amp Cardiovascular disease

including microbiome analysis

bull Translation to Market bull Health Technology Assessment

25

CONFIDENTIAL Property of CBmed

Internal RampD Projects

bull Health technology assessment

Area 3 Metabolism

amp Inflammation

Area 1 Data

amp Technologies

Area 2 Cancer

bull Metabolomics bull Clinical information system bull Semantic data management

bull Next generation sequencing

bull Tracking the trace bull Minimal residual disease

and CAR T-cells

bull Diabesity

bull Cardiovascular disease bull Biosensors

bull Bone metabolism

bull Fertility bull Electrochemical biomarker detection

bull Liver function

bull Microbiome-gut-brain

bull Sepsis

bull Fungal infections

bull ADX models bull Eukaryotic initiation factors

bull Core Lab for Target Identify-cation and Probe Development

bull Clinical MALDI Applications bull Digital Pathology

bull Immunology bull Knowledge discovery amp data mining)

26

CONFIDENTIAL Property of CBmed

Disease Area Stronghold CANCER

OUR EXPERTISE Experts in Clinical Oncology and Pathology Deep clinical phenotyping through access to standardised clinical

documentation Pre-exisiting network of clinicians and researchers (basic amp

translational) Experience at clinical research including clinical trials

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

OUR SOLUTIONS Isolation amp analysis of circulating tumour cells (PARSORTIX amp Mobile Diagnostic System ndash blood

and other boldy fluids) Detection analysis and validation of circulating tumour DNA Development of discriminative multimarker panels for serum proteins and immune cell gene

expression signatures Highly sensitive method for detection of minimal residual disease in haematological malignancies Drug validation and development programmes (eg antibodies viral vector-based and anti-eIFs) Access to tumour tissue (patient amp autopsy derived) for generation of xenograft models (PDX amp

ADX)

27

CONFIDENTIAL Property of CBmed

Disease Area Stronghold METABOLISM amp INFLAMMATION

OUR EXPERTISE Experts in Clinical Endocrinology amp Metabolic Diseases In-vitro amp In-vivo analysis Experience of clinical study design planning and execution

OUR SOLUTIONS 16S rRNA microbiome profiling and analysis stand alone or in

combination with metabolomics (mass spectrometry) Gut permeability measurements (zonulin calprotectin

lactulosemannitol)

Assoc Prof Harald Sourij MD Area Leader Metab amp Inflamm

Clnical Endocrinologist

Assessment of neurochemical biomarkers by cerebral open flow microperfusion Non-invasive PET imaging methods for angiogenesis and inflammation in liver diseases Rodent models for various diseases (diabetes hepatocellular) Human glucose triple tracer techniques with tracers in accordance with GMP GLP and GCP

guidelines for meticulous characterization of glucose metabolism Glycerol tracer techniques for determination of lipid fluxes Lipidomics techniques for biomarker research in cardiovascular disease

28

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 5: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

CBmed aims to establish an internationally competitive competence centre for systematic biomarker research

Mission (2)

SCIENTIFIC MISSION

International excellence in biomarker research

Link national and international biomarker research efforts

Combination of analytical technologies and

advanced bioinformatics

Fast identification and validation of new biomarkers

5

CONFIDENTIAL Property of CBmed

CBmed aims to establish an internationally competitive competence centre for systematic biomarker research

Mission (3)

ECONOMIC MISSION

Hub providing relevant

infrastructure for biomarker research

Fast and effective translation of biomarkers into marketable

products

Attract and link international RampD companies and research

institutions

Create new business areas for Austrian SMEs

and industry initiate spin-offs and start-ups

6

CONFIDENTIAL Property of CBmed

bull Pharma bull Diagnostic bull Biotech

Only research collaborations can provide a sound basis for accessing human biological samples and associated medical data

For profit

PublicPrivate Partnership

Industry

Hospitals

Public

Biobanks

Non-profit

bull Technical expertise bull Medicalscientific

expertise

Expert Centre

Solutions

Project Requests

Biospecimens amp Data

7

CONFIDENTIAL Property of CBmed

CBmedlsquos USPs

Biobank amp Cohorts

International network of scientific and industry partners

Core Labs with cutting edge technology platforms

Fusion Technology with an innovative multi-OMICS approach

Biomarker discovery over a full clinical life cycle

Wide scope of research amp development in three main areas Data amp Technologies Cancer and Metabolism amp Inflammation

Close cooperation with large hospital organizations

8

CONFIDENTIAL Property of CBmed

Biomarker discovery over a full clinical life cycle

9

CONFIDENTIAL Property of CBmed

Biomarker discovery at CBmed

Fusion Technology

Core Labs

25 Biomarker RampD Projects

10

CONFIDENTIAL Property of CBmed

Biomarker discovery at CBmed

11

bull CBmed identifies and validates biomarker at all levels of clinical research including

Early diagnostics

Prognostic biomarkers

Predictive biomarkers

Translation to market

BIOMARKER IDENTIFICATION

BIOMARKER VALIDATION

BIOMARKER TRANSLATION

THERAPIES DIAGNOSTICS

CONFIDENTIAL Property of CBmed

International network of scientific and industry partners

12

CONFIDENTIAL Property of CBmed

Other scientific consortium members

435

125 95

95

20 5

Lead Partner

Shareholders Main scientific partners

Scientific Partners

13

CONFIDENTIAL Property of CBmed

Over 50 international partners on 4 continents

Pharma Industry

Information Technology

Biotech Industry

Research Organisations

Nutrition

Diagnostic Industry

CBmed Consortium Members Selected Industry Partners

14

CONFIDENTIAL Property of CBmed

Biobank amp Patient Cohorts

15

CONFIDENTIAL Property of CBmed

Biobanking amp Retrospective Cohorts

BBMRI-ERIC Expert Center ndash Bridge between Biobanks and Pharma amp Diagnostic Industry

bull CBmed is the first BBMRI-ERIC approved Expert Center

bull BBMRI-ERIC is the EU infrastructure providing a network for biobanks and biomolecular resources across Europe

bull For retrospective cohorts CBmed works closely with the Biobank Graz one of Europelsquos largest biobanks with ~75 million biospecimens

wwwbbmri-ericeu 16

CONFIDENTIAL Property of CBmed

BBMRI-ERIC ndash European Infrastructure

for Biobanks and Biomolecular Resources

bull Members Austria Italy Belgium Latvia Czech Republic Malta Estonia The Netherlands Finland Norway France Sweden Germany United Kingdom Greece

bull Observers Cyprus Poland Switzerland Turkey IARCWHO

bull 515 Biobanks over 60 Million Biospecimens

17

CONFIDENTIAL Property of CBmed

BBMRI-ERIC Expert Centre

bull Expert centres are key intermediaries between public and private sectors performing the analysis of biological samples under internationally standardized conditions

bull Their main goals are to

Provide access to primary data that can easily be shared in contrast to biological samples and

Provide high-quality information from biological samples to industry for further product development

Quoted from bdquoBBMRI-ERIC-Associated Expert Centres Trusted Partners V20ldquo

18

CONFIDENTIAL Property of CBmed

Retrospective Cohort Assembly ndash An Example

Colon Cancer Cohort with Early and Late Relapse

bull A project was identified for validation of immune infiltration as a biomarker for colon cancer relapse

bull Inclusion and exclusion criteria were defined in an eCRF bull Feasibility request sent to the Biobank Graz for FFPE

biospecimens from 100 stage II amp III colon cancer patients

bull In collaboration with the Oncology Department of the Medical University of Graz the cohorts were further refined with data regarding clinical outcome

bull An application for ethics approval was submitted to the Ethics Department of the medical university of Graz The Ethics approval was successfullly granted

bull Tissue samples were pseudonymised and sent to CBmed for analysis

Immune Cell Biomarkers in Colon Cancer

19

CONFIDENTIAL Property of CBmed

Clinical Researchers amp Prospective Cohorts

Prospective cohorts have many benefits

bull control sampling time points to observed patient response to therapy

bull access to biospecimens not normally collected as routine

bull control of sampling procedures

bull collection of fresh cells and tissues required for analysis by eg flow cytometry MALDI-MS imaging and development of PDX models

CBmed has built strong collaborations with clinical researchers from the Medical Universities of Graz amp Vienna enabling the initiation of a wide range of prospective collections

20

CONFIDENTIAL Property of CBmed

Prospective Cohorts

bull CBmed Prospectively collects Biospecimens in the following indications Type 1 amp 2 diabetes inflammatory bowel disease cardiovascular disease liver disease

(NAFLD NASH alcoholic liver disease hepatitis C cirrhosis) chronic kidney disease obesity metabolic bone disease fertility disorders (polycystic ovarian) sepsis

Cancer ndash breast prostate colorectal cancer lung endometrial ovarian hepatocellular melanoma urothelial renal cell pancreatic head amp neck bladder AML lymphoma

Healthy controls

bull Diverse biospecimen types Blood (serum plasma) tissue circulating tumor

cells circulating immune cells urine stool saliva cultures

bull Ethical Guidelines - Collected following the ethical guidelines of the Biobank Graz an international standard for Biobanking

bull Clinical Data Management - Clinical data collected in a clinical data management system in accordance with good clinical practice (GCP) CBmed has access to specimens with meticulous clinical characterization follow-up data and biomarker results

21

CONFIDENTIAL Property of CBmed

Close cooperation with large hospital organisations

22

CONFIDENTIAL Property of CBmed

Innovative use of Clinical Information for Biomarker Research

bull Access to biospecimens alone is worthless without associated high quality in-depth clinical data

bull CBmed works together with KAGes one of the largest hospital companies in Europe with a catchment area of 12 million people with the aim of developing IT solutions for extracting the relevant clinical data from structured and unstructured sources with a view to selecting the appropriate patients for biomarker research

Our Strengths

bull Expertise in

Data semantics

Biomedical Terminologies

Natural Language processing

Big data management (eg SAP HANA)

Predictive content analytics

23

CONFIDENTIAL Property of CBmed

Wide scope of RampD

Internal Biomarker Research Programmes

24

CONFIDENTIAL Property of CBmed

RampD Project Overview

Core Labs

NGS

Metabolomics

Immunology

Digital Pathology

MALDI-MS

Proteomics amp In-vivo Imaging

Disease Models (PDX ADX)

Technology Development eg electrochemical chip-based diagnostics

Patient Cohorts

AREA 1

Data amp Technology

Multi-omics

Clinical Data Management

Software

development ndash semantic

searching of clinical data

AREA 2

Cancer

AREA 3

Metabolism amp

Inflammation

bull Early Diagnostics including bull Tracking the Trace (CTCs in Urologic

Cancer) bull Metabolomics (Idiopathic Pulmonary

Arterial Hypertension) bull Sepsis amp Fungal Infection

bull Prognostic amp Predictive Markers (Patient Stratification) including bull Minimal Residual Disease in AML bull Immune Cell Characterisation as a

Biomarker in CRC bull Eukaryotic Initiation Factors in eg

Glioblastoma bull Biosensors for short-lived biomarkers

in diabetes bull Diabesity amp Cardiovascular disease

including microbiome analysis

bull Translation to Market bull Health Technology Assessment

25

CONFIDENTIAL Property of CBmed

Internal RampD Projects

bull Health technology assessment

Area 3 Metabolism

amp Inflammation

Area 1 Data

amp Technologies

Area 2 Cancer

bull Metabolomics bull Clinical information system bull Semantic data management

bull Next generation sequencing

bull Tracking the trace bull Minimal residual disease

and CAR T-cells

bull Diabesity

bull Cardiovascular disease bull Biosensors

bull Bone metabolism

bull Fertility bull Electrochemical biomarker detection

bull Liver function

bull Microbiome-gut-brain

bull Sepsis

bull Fungal infections

bull ADX models bull Eukaryotic initiation factors

bull Core Lab for Target Identify-cation and Probe Development

bull Clinical MALDI Applications bull Digital Pathology

bull Immunology bull Knowledge discovery amp data mining)

26

CONFIDENTIAL Property of CBmed

Disease Area Stronghold CANCER

OUR EXPERTISE Experts in Clinical Oncology and Pathology Deep clinical phenotyping through access to standardised clinical

documentation Pre-exisiting network of clinicians and researchers (basic amp

translational) Experience at clinical research including clinical trials

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

OUR SOLUTIONS Isolation amp analysis of circulating tumour cells (PARSORTIX amp Mobile Diagnostic System ndash blood

and other boldy fluids) Detection analysis and validation of circulating tumour DNA Development of discriminative multimarker panels for serum proteins and immune cell gene

expression signatures Highly sensitive method for detection of minimal residual disease in haematological malignancies Drug validation and development programmes (eg antibodies viral vector-based and anti-eIFs) Access to tumour tissue (patient amp autopsy derived) for generation of xenograft models (PDX amp

ADX)

27

CONFIDENTIAL Property of CBmed

Disease Area Stronghold METABOLISM amp INFLAMMATION

OUR EXPERTISE Experts in Clinical Endocrinology amp Metabolic Diseases In-vitro amp In-vivo analysis Experience of clinical study design planning and execution

OUR SOLUTIONS 16S rRNA microbiome profiling and analysis stand alone or in

combination with metabolomics (mass spectrometry) Gut permeability measurements (zonulin calprotectin

lactulosemannitol)

Assoc Prof Harald Sourij MD Area Leader Metab amp Inflamm

Clnical Endocrinologist

Assessment of neurochemical biomarkers by cerebral open flow microperfusion Non-invasive PET imaging methods for angiogenesis and inflammation in liver diseases Rodent models for various diseases (diabetes hepatocellular) Human glucose triple tracer techniques with tracers in accordance with GMP GLP and GCP

guidelines for meticulous characterization of glucose metabolism Glycerol tracer techniques for determination of lipid fluxes Lipidomics techniques for biomarker research in cardiovascular disease

28

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 6: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

CBmed aims to establish an internationally competitive competence centre for systematic biomarker research

Mission (3)

ECONOMIC MISSION

Hub providing relevant

infrastructure for biomarker research

Fast and effective translation of biomarkers into marketable

products

Attract and link international RampD companies and research

institutions

Create new business areas for Austrian SMEs

and industry initiate spin-offs and start-ups

6

CONFIDENTIAL Property of CBmed

bull Pharma bull Diagnostic bull Biotech

Only research collaborations can provide a sound basis for accessing human biological samples and associated medical data

For profit

PublicPrivate Partnership

Industry

Hospitals

Public

Biobanks

Non-profit

bull Technical expertise bull Medicalscientific

expertise

Expert Centre

Solutions

Project Requests

Biospecimens amp Data

7

CONFIDENTIAL Property of CBmed

CBmedlsquos USPs

Biobank amp Cohorts

International network of scientific and industry partners

Core Labs with cutting edge technology platforms

Fusion Technology with an innovative multi-OMICS approach

Biomarker discovery over a full clinical life cycle

Wide scope of research amp development in three main areas Data amp Technologies Cancer and Metabolism amp Inflammation

Close cooperation with large hospital organizations

8

CONFIDENTIAL Property of CBmed

Biomarker discovery over a full clinical life cycle

9

CONFIDENTIAL Property of CBmed

Biomarker discovery at CBmed

Fusion Technology

Core Labs

25 Biomarker RampD Projects

10

CONFIDENTIAL Property of CBmed

Biomarker discovery at CBmed

11

bull CBmed identifies and validates biomarker at all levels of clinical research including

Early diagnostics

Prognostic biomarkers

Predictive biomarkers

Translation to market

BIOMARKER IDENTIFICATION

BIOMARKER VALIDATION

BIOMARKER TRANSLATION

THERAPIES DIAGNOSTICS

CONFIDENTIAL Property of CBmed

International network of scientific and industry partners

12

CONFIDENTIAL Property of CBmed

Other scientific consortium members

435

125 95

95

20 5

Lead Partner

Shareholders Main scientific partners

Scientific Partners

13

CONFIDENTIAL Property of CBmed

Over 50 international partners on 4 continents

Pharma Industry

Information Technology

Biotech Industry

Research Organisations

Nutrition

Diagnostic Industry

CBmed Consortium Members Selected Industry Partners

14

CONFIDENTIAL Property of CBmed

Biobank amp Patient Cohorts

15

CONFIDENTIAL Property of CBmed

Biobanking amp Retrospective Cohorts

BBMRI-ERIC Expert Center ndash Bridge between Biobanks and Pharma amp Diagnostic Industry

bull CBmed is the first BBMRI-ERIC approved Expert Center

bull BBMRI-ERIC is the EU infrastructure providing a network for biobanks and biomolecular resources across Europe

bull For retrospective cohorts CBmed works closely with the Biobank Graz one of Europelsquos largest biobanks with ~75 million biospecimens

wwwbbmri-ericeu 16

CONFIDENTIAL Property of CBmed

BBMRI-ERIC ndash European Infrastructure

for Biobanks and Biomolecular Resources

bull Members Austria Italy Belgium Latvia Czech Republic Malta Estonia The Netherlands Finland Norway France Sweden Germany United Kingdom Greece

bull Observers Cyprus Poland Switzerland Turkey IARCWHO

bull 515 Biobanks over 60 Million Biospecimens

17

CONFIDENTIAL Property of CBmed

BBMRI-ERIC Expert Centre

bull Expert centres are key intermediaries between public and private sectors performing the analysis of biological samples under internationally standardized conditions

bull Their main goals are to

Provide access to primary data that can easily be shared in contrast to biological samples and

Provide high-quality information from biological samples to industry for further product development

Quoted from bdquoBBMRI-ERIC-Associated Expert Centres Trusted Partners V20ldquo

18

CONFIDENTIAL Property of CBmed

Retrospective Cohort Assembly ndash An Example

Colon Cancer Cohort with Early and Late Relapse

bull A project was identified for validation of immune infiltration as a biomarker for colon cancer relapse

bull Inclusion and exclusion criteria were defined in an eCRF bull Feasibility request sent to the Biobank Graz for FFPE

biospecimens from 100 stage II amp III colon cancer patients

bull In collaboration with the Oncology Department of the Medical University of Graz the cohorts were further refined with data regarding clinical outcome

bull An application for ethics approval was submitted to the Ethics Department of the medical university of Graz The Ethics approval was successfullly granted

bull Tissue samples were pseudonymised and sent to CBmed for analysis

Immune Cell Biomarkers in Colon Cancer

19

CONFIDENTIAL Property of CBmed

Clinical Researchers amp Prospective Cohorts

Prospective cohorts have many benefits

bull control sampling time points to observed patient response to therapy

bull access to biospecimens not normally collected as routine

bull control of sampling procedures

bull collection of fresh cells and tissues required for analysis by eg flow cytometry MALDI-MS imaging and development of PDX models

CBmed has built strong collaborations with clinical researchers from the Medical Universities of Graz amp Vienna enabling the initiation of a wide range of prospective collections

20

CONFIDENTIAL Property of CBmed

Prospective Cohorts

bull CBmed Prospectively collects Biospecimens in the following indications Type 1 amp 2 diabetes inflammatory bowel disease cardiovascular disease liver disease

(NAFLD NASH alcoholic liver disease hepatitis C cirrhosis) chronic kidney disease obesity metabolic bone disease fertility disorders (polycystic ovarian) sepsis

Cancer ndash breast prostate colorectal cancer lung endometrial ovarian hepatocellular melanoma urothelial renal cell pancreatic head amp neck bladder AML lymphoma

Healthy controls

bull Diverse biospecimen types Blood (serum plasma) tissue circulating tumor

cells circulating immune cells urine stool saliva cultures

bull Ethical Guidelines - Collected following the ethical guidelines of the Biobank Graz an international standard for Biobanking

bull Clinical Data Management - Clinical data collected in a clinical data management system in accordance with good clinical practice (GCP) CBmed has access to specimens with meticulous clinical characterization follow-up data and biomarker results

21

CONFIDENTIAL Property of CBmed

Close cooperation with large hospital organisations

22

CONFIDENTIAL Property of CBmed

Innovative use of Clinical Information for Biomarker Research

bull Access to biospecimens alone is worthless without associated high quality in-depth clinical data

bull CBmed works together with KAGes one of the largest hospital companies in Europe with a catchment area of 12 million people with the aim of developing IT solutions for extracting the relevant clinical data from structured and unstructured sources with a view to selecting the appropriate patients for biomarker research

Our Strengths

bull Expertise in

Data semantics

Biomedical Terminologies

Natural Language processing

Big data management (eg SAP HANA)

Predictive content analytics

23

CONFIDENTIAL Property of CBmed

Wide scope of RampD

Internal Biomarker Research Programmes

24

CONFIDENTIAL Property of CBmed

RampD Project Overview

Core Labs

NGS

Metabolomics

Immunology

Digital Pathology

MALDI-MS

Proteomics amp In-vivo Imaging

Disease Models (PDX ADX)

Technology Development eg electrochemical chip-based diagnostics

Patient Cohorts

AREA 1

Data amp Technology

Multi-omics

Clinical Data Management

Software

development ndash semantic

searching of clinical data

AREA 2

Cancer

AREA 3

Metabolism amp

Inflammation

bull Early Diagnostics including bull Tracking the Trace (CTCs in Urologic

Cancer) bull Metabolomics (Idiopathic Pulmonary

Arterial Hypertension) bull Sepsis amp Fungal Infection

bull Prognostic amp Predictive Markers (Patient Stratification) including bull Minimal Residual Disease in AML bull Immune Cell Characterisation as a

Biomarker in CRC bull Eukaryotic Initiation Factors in eg

Glioblastoma bull Biosensors for short-lived biomarkers

in diabetes bull Diabesity amp Cardiovascular disease

including microbiome analysis

bull Translation to Market bull Health Technology Assessment

25

CONFIDENTIAL Property of CBmed

Internal RampD Projects

bull Health technology assessment

Area 3 Metabolism

amp Inflammation

Area 1 Data

amp Technologies

Area 2 Cancer

bull Metabolomics bull Clinical information system bull Semantic data management

bull Next generation sequencing

bull Tracking the trace bull Minimal residual disease

and CAR T-cells

bull Diabesity

bull Cardiovascular disease bull Biosensors

bull Bone metabolism

bull Fertility bull Electrochemical biomarker detection

bull Liver function

bull Microbiome-gut-brain

bull Sepsis

bull Fungal infections

bull ADX models bull Eukaryotic initiation factors

bull Core Lab for Target Identify-cation and Probe Development

bull Clinical MALDI Applications bull Digital Pathology

bull Immunology bull Knowledge discovery amp data mining)

26

CONFIDENTIAL Property of CBmed

Disease Area Stronghold CANCER

OUR EXPERTISE Experts in Clinical Oncology and Pathology Deep clinical phenotyping through access to standardised clinical

documentation Pre-exisiting network of clinicians and researchers (basic amp

translational) Experience at clinical research including clinical trials

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

OUR SOLUTIONS Isolation amp analysis of circulating tumour cells (PARSORTIX amp Mobile Diagnostic System ndash blood

and other boldy fluids) Detection analysis and validation of circulating tumour DNA Development of discriminative multimarker panels for serum proteins and immune cell gene

expression signatures Highly sensitive method for detection of minimal residual disease in haematological malignancies Drug validation and development programmes (eg antibodies viral vector-based and anti-eIFs) Access to tumour tissue (patient amp autopsy derived) for generation of xenograft models (PDX amp

ADX)

27

CONFIDENTIAL Property of CBmed

Disease Area Stronghold METABOLISM amp INFLAMMATION

OUR EXPERTISE Experts in Clinical Endocrinology amp Metabolic Diseases In-vitro amp In-vivo analysis Experience of clinical study design planning and execution

OUR SOLUTIONS 16S rRNA microbiome profiling and analysis stand alone or in

combination with metabolomics (mass spectrometry) Gut permeability measurements (zonulin calprotectin

lactulosemannitol)

Assoc Prof Harald Sourij MD Area Leader Metab amp Inflamm

Clnical Endocrinologist

Assessment of neurochemical biomarkers by cerebral open flow microperfusion Non-invasive PET imaging methods for angiogenesis and inflammation in liver diseases Rodent models for various diseases (diabetes hepatocellular) Human glucose triple tracer techniques with tracers in accordance with GMP GLP and GCP

guidelines for meticulous characterization of glucose metabolism Glycerol tracer techniques for determination of lipid fluxes Lipidomics techniques for biomarker research in cardiovascular disease

28

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 7: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

bull Pharma bull Diagnostic bull Biotech

Only research collaborations can provide a sound basis for accessing human biological samples and associated medical data

For profit

PublicPrivate Partnership

Industry

Hospitals

Public

Biobanks

Non-profit

bull Technical expertise bull Medicalscientific

expertise

Expert Centre

Solutions

Project Requests

Biospecimens amp Data

7

CONFIDENTIAL Property of CBmed

CBmedlsquos USPs

Biobank amp Cohorts

International network of scientific and industry partners

Core Labs with cutting edge technology platforms

Fusion Technology with an innovative multi-OMICS approach

Biomarker discovery over a full clinical life cycle

Wide scope of research amp development in three main areas Data amp Technologies Cancer and Metabolism amp Inflammation

Close cooperation with large hospital organizations

8

CONFIDENTIAL Property of CBmed

Biomarker discovery over a full clinical life cycle

9

CONFIDENTIAL Property of CBmed

Biomarker discovery at CBmed

Fusion Technology

Core Labs

25 Biomarker RampD Projects

10

CONFIDENTIAL Property of CBmed

Biomarker discovery at CBmed

11

bull CBmed identifies and validates biomarker at all levels of clinical research including

Early diagnostics

Prognostic biomarkers

Predictive biomarkers

Translation to market

BIOMARKER IDENTIFICATION

BIOMARKER VALIDATION

BIOMARKER TRANSLATION

THERAPIES DIAGNOSTICS

CONFIDENTIAL Property of CBmed

International network of scientific and industry partners

12

CONFIDENTIAL Property of CBmed

Other scientific consortium members

435

125 95

95

20 5

Lead Partner

Shareholders Main scientific partners

Scientific Partners

13

CONFIDENTIAL Property of CBmed

Over 50 international partners on 4 continents

Pharma Industry

Information Technology

Biotech Industry

Research Organisations

Nutrition

Diagnostic Industry

CBmed Consortium Members Selected Industry Partners

14

CONFIDENTIAL Property of CBmed

Biobank amp Patient Cohorts

15

CONFIDENTIAL Property of CBmed

Biobanking amp Retrospective Cohorts

BBMRI-ERIC Expert Center ndash Bridge between Biobanks and Pharma amp Diagnostic Industry

bull CBmed is the first BBMRI-ERIC approved Expert Center

bull BBMRI-ERIC is the EU infrastructure providing a network for biobanks and biomolecular resources across Europe

bull For retrospective cohorts CBmed works closely with the Biobank Graz one of Europelsquos largest biobanks with ~75 million biospecimens

wwwbbmri-ericeu 16

CONFIDENTIAL Property of CBmed

BBMRI-ERIC ndash European Infrastructure

for Biobanks and Biomolecular Resources

bull Members Austria Italy Belgium Latvia Czech Republic Malta Estonia The Netherlands Finland Norway France Sweden Germany United Kingdom Greece

bull Observers Cyprus Poland Switzerland Turkey IARCWHO

bull 515 Biobanks over 60 Million Biospecimens

17

CONFIDENTIAL Property of CBmed

BBMRI-ERIC Expert Centre

bull Expert centres are key intermediaries between public and private sectors performing the analysis of biological samples under internationally standardized conditions

bull Their main goals are to

Provide access to primary data that can easily be shared in contrast to biological samples and

Provide high-quality information from biological samples to industry for further product development

Quoted from bdquoBBMRI-ERIC-Associated Expert Centres Trusted Partners V20ldquo

18

CONFIDENTIAL Property of CBmed

Retrospective Cohort Assembly ndash An Example

Colon Cancer Cohort with Early and Late Relapse

bull A project was identified for validation of immune infiltration as a biomarker for colon cancer relapse

bull Inclusion and exclusion criteria were defined in an eCRF bull Feasibility request sent to the Biobank Graz for FFPE

biospecimens from 100 stage II amp III colon cancer patients

bull In collaboration with the Oncology Department of the Medical University of Graz the cohorts were further refined with data regarding clinical outcome

bull An application for ethics approval was submitted to the Ethics Department of the medical university of Graz The Ethics approval was successfullly granted

bull Tissue samples were pseudonymised and sent to CBmed for analysis

Immune Cell Biomarkers in Colon Cancer

19

CONFIDENTIAL Property of CBmed

Clinical Researchers amp Prospective Cohorts

Prospective cohorts have many benefits

bull control sampling time points to observed patient response to therapy

bull access to biospecimens not normally collected as routine

bull control of sampling procedures

bull collection of fresh cells and tissues required for analysis by eg flow cytometry MALDI-MS imaging and development of PDX models

CBmed has built strong collaborations with clinical researchers from the Medical Universities of Graz amp Vienna enabling the initiation of a wide range of prospective collections

20

CONFIDENTIAL Property of CBmed

Prospective Cohorts

bull CBmed Prospectively collects Biospecimens in the following indications Type 1 amp 2 diabetes inflammatory bowel disease cardiovascular disease liver disease

(NAFLD NASH alcoholic liver disease hepatitis C cirrhosis) chronic kidney disease obesity metabolic bone disease fertility disorders (polycystic ovarian) sepsis

Cancer ndash breast prostate colorectal cancer lung endometrial ovarian hepatocellular melanoma urothelial renal cell pancreatic head amp neck bladder AML lymphoma

Healthy controls

bull Diverse biospecimen types Blood (serum plasma) tissue circulating tumor

cells circulating immune cells urine stool saliva cultures

bull Ethical Guidelines - Collected following the ethical guidelines of the Biobank Graz an international standard for Biobanking

bull Clinical Data Management - Clinical data collected in a clinical data management system in accordance with good clinical practice (GCP) CBmed has access to specimens with meticulous clinical characterization follow-up data and biomarker results

21

CONFIDENTIAL Property of CBmed

Close cooperation with large hospital organisations

22

CONFIDENTIAL Property of CBmed

Innovative use of Clinical Information for Biomarker Research

bull Access to biospecimens alone is worthless without associated high quality in-depth clinical data

bull CBmed works together with KAGes one of the largest hospital companies in Europe with a catchment area of 12 million people with the aim of developing IT solutions for extracting the relevant clinical data from structured and unstructured sources with a view to selecting the appropriate patients for biomarker research

Our Strengths

bull Expertise in

Data semantics

Biomedical Terminologies

Natural Language processing

Big data management (eg SAP HANA)

Predictive content analytics

23

CONFIDENTIAL Property of CBmed

Wide scope of RampD

Internal Biomarker Research Programmes

24

CONFIDENTIAL Property of CBmed

RampD Project Overview

Core Labs

NGS

Metabolomics

Immunology

Digital Pathology

MALDI-MS

Proteomics amp In-vivo Imaging

Disease Models (PDX ADX)

Technology Development eg electrochemical chip-based diagnostics

Patient Cohorts

AREA 1

Data amp Technology

Multi-omics

Clinical Data Management

Software

development ndash semantic

searching of clinical data

AREA 2

Cancer

AREA 3

Metabolism amp

Inflammation

bull Early Diagnostics including bull Tracking the Trace (CTCs in Urologic

Cancer) bull Metabolomics (Idiopathic Pulmonary

Arterial Hypertension) bull Sepsis amp Fungal Infection

bull Prognostic amp Predictive Markers (Patient Stratification) including bull Minimal Residual Disease in AML bull Immune Cell Characterisation as a

Biomarker in CRC bull Eukaryotic Initiation Factors in eg

Glioblastoma bull Biosensors for short-lived biomarkers

in diabetes bull Diabesity amp Cardiovascular disease

including microbiome analysis

bull Translation to Market bull Health Technology Assessment

25

CONFIDENTIAL Property of CBmed

Internal RampD Projects

bull Health technology assessment

Area 3 Metabolism

amp Inflammation

Area 1 Data

amp Technologies

Area 2 Cancer

bull Metabolomics bull Clinical information system bull Semantic data management

bull Next generation sequencing

bull Tracking the trace bull Minimal residual disease

and CAR T-cells

bull Diabesity

bull Cardiovascular disease bull Biosensors

bull Bone metabolism

bull Fertility bull Electrochemical biomarker detection

bull Liver function

bull Microbiome-gut-brain

bull Sepsis

bull Fungal infections

bull ADX models bull Eukaryotic initiation factors

bull Core Lab for Target Identify-cation and Probe Development

bull Clinical MALDI Applications bull Digital Pathology

bull Immunology bull Knowledge discovery amp data mining)

26

CONFIDENTIAL Property of CBmed

Disease Area Stronghold CANCER

OUR EXPERTISE Experts in Clinical Oncology and Pathology Deep clinical phenotyping through access to standardised clinical

documentation Pre-exisiting network of clinicians and researchers (basic amp

translational) Experience at clinical research including clinical trials

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

OUR SOLUTIONS Isolation amp analysis of circulating tumour cells (PARSORTIX amp Mobile Diagnostic System ndash blood

and other boldy fluids) Detection analysis and validation of circulating tumour DNA Development of discriminative multimarker panels for serum proteins and immune cell gene

expression signatures Highly sensitive method for detection of minimal residual disease in haematological malignancies Drug validation and development programmes (eg antibodies viral vector-based and anti-eIFs) Access to tumour tissue (patient amp autopsy derived) for generation of xenograft models (PDX amp

ADX)

27

CONFIDENTIAL Property of CBmed

Disease Area Stronghold METABOLISM amp INFLAMMATION

OUR EXPERTISE Experts in Clinical Endocrinology amp Metabolic Diseases In-vitro amp In-vivo analysis Experience of clinical study design planning and execution

OUR SOLUTIONS 16S rRNA microbiome profiling and analysis stand alone or in

combination with metabolomics (mass spectrometry) Gut permeability measurements (zonulin calprotectin

lactulosemannitol)

Assoc Prof Harald Sourij MD Area Leader Metab amp Inflamm

Clnical Endocrinologist

Assessment of neurochemical biomarkers by cerebral open flow microperfusion Non-invasive PET imaging methods for angiogenesis and inflammation in liver diseases Rodent models for various diseases (diabetes hepatocellular) Human glucose triple tracer techniques with tracers in accordance with GMP GLP and GCP

guidelines for meticulous characterization of glucose metabolism Glycerol tracer techniques for determination of lipid fluxes Lipidomics techniques for biomarker research in cardiovascular disease

28

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 8: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

CBmedlsquos USPs

Biobank amp Cohorts

International network of scientific and industry partners

Core Labs with cutting edge technology platforms

Fusion Technology with an innovative multi-OMICS approach

Biomarker discovery over a full clinical life cycle

Wide scope of research amp development in three main areas Data amp Technologies Cancer and Metabolism amp Inflammation

Close cooperation with large hospital organizations

8

CONFIDENTIAL Property of CBmed

Biomarker discovery over a full clinical life cycle

9

CONFIDENTIAL Property of CBmed

Biomarker discovery at CBmed

Fusion Technology

Core Labs

25 Biomarker RampD Projects

10

CONFIDENTIAL Property of CBmed

Biomarker discovery at CBmed

11

bull CBmed identifies and validates biomarker at all levels of clinical research including

Early diagnostics

Prognostic biomarkers

Predictive biomarkers

Translation to market

BIOMARKER IDENTIFICATION

BIOMARKER VALIDATION

BIOMARKER TRANSLATION

THERAPIES DIAGNOSTICS

CONFIDENTIAL Property of CBmed

International network of scientific and industry partners

12

CONFIDENTIAL Property of CBmed

Other scientific consortium members

435

125 95

95

20 5

Lead Partner

Shareholders Main scientific partners

Scientific Partners

13

CONFIDENTIAL Property of CBmed

Over 50 international partners on 4 continents

Pharma Industry

Information Technology

Biotech Industry

Research Organisations

Nutrition

Diagnostic Industry

CBmed Consortium Members Selected Industry Partners

14

CONFIDENTIAL Property of CBmed

Biobank amp Patient Cohorts

15

CONFIDENTIAL Property of CBmed

Biobanking amp Retrospective Cohorts

BBMRI-ERIC Expert Center ndash Bridge between Biobanks and Pharma amp Diagnostic Industry

bull CBmed is the first BBMRI-ERIC approved Expert Center

bull BBMRI-ERIC is the EU infrastructure providing a network for biobanks and biomolecular resources across Europe

bull For retrospective cohorts CBmed works closely with the Biobank Graz one of Europelsquos largest biobanks with ~75 million biospecimens

wwwbbmri-ericeu 16

CONFIDENTIAL Property of CBmed

BBMRI-ERIC ndash European Infrastructure

for Biobanks and Biomolecular Resources

bull Members Austria Italy Belgium Latvia Czech Republic Malta Estonia The Netherlands Finland Norway France Sweden Germany United Kingdom Greece

bull Observers Cyprus Poland Switzerland Turkey IARCWHO

bull 515 Biobanks over 60 Million Biospecimens

17

CONFIDENTIAL Property of CBmed

BBMRI-ERIC Expert Centre

bull Expert centres are key intermediaries between public and private sectors performing the analysis of biological samples under internationally standardized conditions

bull Their main goals are to

Provide access to primary data that can easily be shared in contrast to biological samples and

Provide high-quality information from biological samples to industry for further product development

Quoted from bdquoBBMRI-ERIC-Associated Expert Centres Trusted Partners V20ldquo

18

CONFIDENTIAL Property of CBmed

Retrospective Cohort Assembly ndash An Example

Colon Cancer Cohort with Early and Late Relapse

bull A project was identified for validation of immune infiltration as a biomarker for colon cancer relapse

bull Inclusion and exclusion criteria were defined in an eCRF bull Feasibility request sent to the Biobank Graz for FFPE

biospecimens from 100 stage II amp III colon cancer patients

bull In collaboration with the Oncology Department of the Medical University of Graz the cohorts were further refined with data regarding clinical outcome

bull An application for ethics approval was submitted to the Ethics Department of the medical university of Graz The Ethics approval was successfullly granted

bull Tissue samples were pseudonymised and sent to CBmed for analysis

Immune Cell Biomarkers in Colon Cancer

19

CONFIDENTIAL Property of CBmed

Clinical Researchers amp Prospective Cohorts

Prospective cohorts have many benefits

bull control sampling time points to observed patient response to therapy

bull access to biospecimens not normally collected as routine

bull control of sampling procedures

bull collection of fresh cells and tissues required for analysis by eg flow cytometry MALDI-MS imaging and development of PDX models

CBmed has built strong collaborations with clinical researchers from the Medical Universities of Graz amp Vienna enabling the initiation of a wide range of prospective collections

20

CONFIDENTIAL Property of CBmed

Prospective Cohorts

bull CBmed Prospectively collects Biospecimens in the following indications Type 1 amp 2 diabetes inflammatory bowel disease cardiovascular disease liver disease

(NAFLD NASH alcoholic liver disease hepatitis C cirrhosis) chronic kidney disease obesity metabolic bone disease fertility disorders (polycystic ovarian) sepsis

Cancer ndash breast prostate colorectal cancer lung endometrial ovarian hepatocellular melanoma urothelial renal cell pancreatic head amp neck bladder AML lymphoma

Healthy controls

bull Diverse biospecimen types Blood (serum plasma) tissue circulating tumor

cells circulating immune cells urine stool saliva cultures

bull Ethical Guidelines - Collected following the ethical guidelines of the Biobank Graz an international standard for Biobanking

bull Clinical Data Management - Clinical data collected in a clinical data management system in accordance with good clinical practice (GCP) CBmed has access to specimens with meticulous clinical characterization follow-up data and biomarker results

21

CONFIDENTIAL Property of CBmed

Close cooperation with large hospital organisations

22

CONFIDENTIAL Property of CBmed

Innovative use of Clinical Information for Biomarker Research

bull Access to biospecimens alone is worthless without associated high quality in-depth clinical data

bull CBmed works together with KAGes one of the largest hospital companies in Europe with a catchment area of 12 million people with the aim of developing IT solutions for extracting the relevant clinical data from structured and unstructured sources with a view to selecting the appropriate patients for biomarker research

Our Strengths

bull Expertise in

Data semantics

Biomedical Terminologies

Natural Language processing

Big data management (eg SAP HANA)

Predictive content analytics

23

CONFIDENTIAL Property of CBmed

Wide scope of RampD

Internal Biomarker Research Programmes

24

CONFIDENTIAL Property of CBmed

RampD Project Overview

Core Labs

NGS

Metabolomics

Immunology

Digital Pathology

MALDI-MS

Proteomics amp In-vivo Imaging

Disease Models (PDX ADX)

Technology Development eg electrochemical chip-based diagnostics

Patient Cohorts

AREA 1

Data amp Technology

Multi-omics

Clinical Data Management

Software

development ndash semantic

searching of clinical data

AREA 2

Cancer

AREA 3

Metabolism amp

Inflammation

bull Early Diagnostics including bull Tracking the Trace (CTCs in Urologic

Cancer) bull Metabolomics (Idiopathic Pulmonary

Arterial Hypertension) bull Sepsis amp Fungal Infection

bull Prognostic amp Predictive Markers (Patient Stratification) including bull Minimal Residual Disease in AML bull Immune Cell Characterisation as a

Biomarker in CRC bull Eukaryotic Initiation Factors in eg

Glioblastoma bull Biosensors for short-lived biomarkers

in diabetes bull Diabesity amp Cardiovascular disease

including microbiome analysis

bull Translation to Market bull Health Technology Assessment

25

CONFIDENTIAL Property of CBmed

Internal RampD Projects

bull Health technology assessment

Area 3 Metabolism

amp Inflammation

Area 1 Data

amp Technologies

Area 2 Cancer

bull Metabolomics bull Clinical information system bull Semantic data management

bull Next generation sequencing

bull Tracking the trace bull Minimal residual disease

and CAR T-cells

bull Diabesity

bull Cardiovascular disease bull Biosensors

bull Bone metabolism

bull Fertility bull Electrochemical biomarker detection

bull Liver function

bull Microbiome-gut-brain

bull Sepsis

bull Fungal infections

bull ADX models bull Eukaryotic initiation factors

bull Core Lab for Target Identify-cation and Probe Development

bull Clinical MALDI Applications bull Digital Pathology

bull Immunology bull Knowledge discovery amp data mining)

26

CONFIDENTIAL Property of CBmed

Disease Area Stronghold CANCER

OUR EXPERTISE Experts in Clinical Oncology and Pathology Deep clinical phenotyping through access to standardised clinical

documentation Pre-exisiting network of clinicians and researchers (basic amp

translational) Experience at clinical research including clinical trials

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

OUR SOLUTIONS Isolation amp analysis of circulating tumour cells (PARSORTIX amp Mobile Diagnostic System ndash blood

and other boldy fluids) Detection analysis and validation of circulating tumour DNA Development of discriminative multimarker panels for serum proteins and immune cell gene

expression signatures Highly sensitive method for detection of minimal residual disease in haematological malignancies Drug validation and development programmes (eg antibodies viral vector-based and anti-eIFs) Access to tumour tissue (patient amp autopsy derived) for generation of xenograft models (PDX amp

ADX)

27

CONFIDENTIAL Property of CBmed

Disease Area Stronghold METABOLISM amp INFLAMMATION

OUR EXPERTISE Experts in Clinical Endocrinology amp Metabolic Diseases In-vitro amp In-vivo analysis Experience of clinical study design planning and execution

OUR SOLUTIONS 16S rRNA microbiome profiling and analysis stand alone or in

combination with metabolomics (mass spectrometry) Gut permeability measurements (zonulin calprotectin

lactulosemannitol)

Assoc Prof Harald Sourij MD Area Leader Metab amp Inflamm

Clnical Endocrinologist

Assessment of neurochemical biomarkers by cerebral open flow microperfusion Non-invasive PET imaging methods for angiogenesis and inflammation in liver diseases Rodent models for various diseases (diabetes hepatocellular) Human glucose triple tracer techniques with tracers in accordance with GMP GLP and GCP

guidelines for meticulous characterization of glucose metabolism Glycerol tracer techniques for determination of lipid fluxes Lipidomics techniques for biomarker research in cardiovascular disease

28

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 9: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Biomarker discovery over a full clinical life cycle

9

CONFIDENTIAL Property of CBmed

Biomarker discovery at CBmed

Fusion Technology

Core Labs

25 Biomarker RampD Projects

10

CONFIDENTIAL Property of CBmed

Biomarker discovery at CBmed

11

bull CBmed identifies and validates biomarker at all levels of clinical research including

Early diagnostics

Prognostic biomarkers

Predictive biomarkers

Translation to market

BIOMARKER IDENTIFICATION

BIOMARKER VALIDATION

BIOMARKER TRANSLATION

THERAPIES DIAGNOSTICS

CONFIDENTIAL Property of CBmed

International network of scientific and industry partners

12

CONFIDENTIAL Property of CBmed

Other scientific consortium members

435

125 95

95

20 5

Lead Partner

Shareholders Main scientific partners

Scientific Partners

13

CONFIDENTIAL Property of CBmed

Over 50 international partners on 4 continents

Pharma Industry

Information Technology

Biotech Industry

Research Organisations

Nutrition

Diagnostic Industry

CBmed Consortium Members Selected Industry Partners

14

CONFIDENTIAL Property of CBmed

Biobank amp Patient Cohorts

15

CONFIDENTIAL Property of CBmed

Biobanking amp Retrospective Cohorts

BBMRI-ERIC Expert Center ndash Bridge between Biobanks and Pharma amp Diagnostic Industry

bull CBmed is the first BBMRI-ERIC approved Expert Center

bull BBMRI-ERIC is the EU infrastructure providing a network for biobanks and biomolecular resources across Europe

bull For retrospective cohorts CBmed works closely with the Biobank Graz one of Europelsquos largest biobanks with ~75 million biospecimens

wwwbbmri-ericeu 16

CONFIDENTIAL Property of CBmed

BBMRI-ERIC ndash European Infrastructure

for Biobanks and Biomolecular Resources

bull Members Austria Italy Belgium Latvia Czech Republic Malta Estonia The Netherlands Finland Norway France Sweden Germany United Kingdom Greece

bull Observers Cyprus Poland Switzerland Turkey IARCWHO

bull 515 Biobanks over 60 Million Biospecimens

17

CONFIDENTIAL Property of CBmed

BBMRI-ERIC Expert Centre

bull Expert centres are key intermediaries between public and private sectors performing the analysis of biological samples under internationally standardized conditions

bull Their main goals are to

Provide access to primary data that can easily be shared in contrast to biological samples and

Provide high-quality information from biological samples to industry for further product development

Quoted from bdquoBBMRI-ERIC-Associated Expert Centres Trusted Partners V20ldquo

18

CONFIDENTIAL Property of CBmed

Retrospective Cohort Assembly ndash An Example

Colon Cancer Cohort with Early and Late Relapse

bull A project was identified for validation of immune infiltration as a biomarker for colon cancer relapse

bull Inclusion and exclusion criteria were defined in an eCRF bull Feasibility request sent to the Biobank Graz for FFPE

biospecimens from 100 stage II amp III colon cancer patients

bull In collaboration with the Oncology Department of the Medical University of Graz the cohorts were further refined with data regarding clinical outcome

bull An application for ethics approval was submitted to the Ethics Department of the medical university of Graz The Ethics approval was successfullly granted

bull Tissue samples were pseudonymised and sent to CBmed for analysis

Immune Cell Biomarkers in Colon Cancer

19

CONFIDENTIAL Property of CBmed

Clinical Researchers amp Prospective Cohorts

Prospective cohorts have many benefits

bull control sampling time points to observed patient response to therapy

bull access to biospecimens not normally collected as routine

bull control of sampling procedures

bull collection of fresh cells and tissues required for analysis by eg flow cytometry MALDI-MS imaging and development of PDX models

CBmed has built strong collaborations with clinical researchers from the Medical Universities of Graz amp Vienna enabling the initiation of a wide range of prospective collections

20

CONFIDENTIAL Property of CBmed

Prospective Cohorts

bull CBmed Prospectively collects Biospecimens in the following indications Type 1 amp 2 diabetes inflammatory bowel disease cardiovascular disease liver disease

(NAFLD NASH alcoholic liver disease hepatitis C cirrhosis) chronic kidney disease obesity metabolic bone disease fertility disorders (polycystic ovarian) sepsis

Cancer ndash breast prostate colorectal cancer lung endometrial ovarian hepatocellular melanoma urothelial renal cell pancreatic head amp neck bladder AML lymphoma

Healthy controls

bull Diverse biospecimen types Blood (serum plasma) tissue circulating tumor

cells circulating immune cells urine stool saliva cultures

bull Ethical Guidelines - Collected following the ethical guidelines of the Biobank Graz an international standard for Biobanking

bull Clinical Data Management - Clinical data collected in a clinical data management system in accordance with good clinical practice (GCP) CBmed has access to specimens with meticulous clinical characterization follow-up data and biomarker results

21

CONFIDENTIAL Property of CBmed

Close cooperation with large hospital organisations

22

CONFIDENTIAL Property of CBmed

Innovative use of Clinical Information for Biomarker Research

bull Access to biospecimens alone is worthless without associated high quality in-depth clinical data

bull CBmed works together with KAGes one of the largest hospital companies in Europe with a catchment area of 12 million people with the aim of developing IT solutions for extracting the relevant clinical data from structured and unstructured sources with a view to selecting the appropriate patients for biomarker research

Our Strengths

bull Expertise in

Data semantics

Biomedical Terminologies

Natural Language processing

Big data management (eg SAP HANA)

Predictive content analytics

23

CONFIDENTIAL Property of CBmed

Wide scope of RampD

Internal Biomarker Research Programmes

24

CONFIDENTIAL Property of CBmed

RampD Project Overview

Core Labs

NGS

Metabolomics

Immunology

Digital Pathology

MALDI-MS

Proteomics amp In-vivo Imaging

Disease Models (PDX ADX)

Technology Development eg electrochemical chip-based diagnostics

Patient Cohorts

AREA 1

Data amp Technology

Multi-omics

Clinical Data Management

Software

development ndash semantic

searching of clinical data

AREA 2

Cancer

AREA 3

Metabolism amp

Inflammation

bull Early Diagnostics including bull Tracking the Trace (CTCs in Urologic

Cancer) bull Metabolomics (Idiopathic Pulmonary

Arterial Hypertension) bull Sepsis amp Fungal Infection

bull Prognostic amp Predictive Markers (Patient Stratification) including bull Minimal Residual Disease in AML bull Immune Cell Characterisation as a

Biomarker in CRC bull Eukaryotic Initiation Factors in eg

Glioblastoma bull Biosensors for short-lived biomarkers

in diabetes bull Diabesity amp Cardiovascular disease

including microbiome analysis

bull Translation to Market bull Health Technology Assessment

25

CONFIDENTIAL Property of CBmed

Internal RampD Projects

bull Health technology assessment

Area 3 Metabolism

amp Inflammation

Area 1 Data

amp Technologies

Area 2 Cancer

bull Metabolomics bull Clinical information system bull Semantic data management

bull Next generation sequencing

bull Tracking the trace bull Minimal residual disease

and CAR T-cells

bull Diabesity

bull Cardiovascular disease bull Biosensors

bull Bone metabolism

bull Fertility bull Electrochemical biomarker detection

bull Liver function

bull Microbiome-gut-brain

bull Sepsis

bull Fungal infections

bull ADX models bull Eukaryotic initiation factors

bull Core Lab for Target Identify-cation and Probe Development

bull Clinical MALDI Applications bull Digital Pathology

bull Immunology bull Knowledge discovery amp data mining)

26

CONFIDENTIAL Property of CBmed

Disease Area Stronghold CANCER

OUR EXPERTISE Experts in Clinical Oncology and Pathology Deep clinical phenotyping through access to standardised clinical

documentation Pre-exisiting network of clinicians and researchers (basic amp

translational) Experience at clinical research including clinical trials

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

OUR SOLUTIONS Isolation amp analysis of circulating tumour cells (PARSORTIX amp Mobile Diagnostic System ndash blood

and other boldy fluids) Detection analysis and validation of circulating tumour DNA Development of discriminative multimarker panels for serum proteins and immune cell gene

expression signatures Highly sensitive method for detection of minimal residual disease in haematological malignancies Drug validation and development programmes (eg antibodies viral vector-based and anti-eIFs) Access to tumour tissue (patient amp autopsy derived) for generation of xenograft models (PDX amp

ADX)

27

CONFIDENTIAL Property of CBmed

Disease Area Stronghold METABOLISM amp INFLAMMATION

OUR EXPERTISE Experts in Clinical Endocrinology amp Metabolic Diseases In-vitro amp In-vivo analysis Experience of clinical study design planning and execution

OUR SOLUTIONS 16S rRNA microbiome profiling and analysis stand alone or in

combination with metabolomics (mass spectrometry) Gut permeability measurements (zonulin calprotectin

lactulosemannitol)

Assoc Prof Harald Sourij MD Area Leader Metab amp Inflamm

Clnical Endocrinologist

Assessment of neurochemical biomarkers by cerebral open flow microperfusion Non-invasive PET imaging methods for angiogenesis and inflammation in liver diseases Rodent models for various diseases (diabetes hepatocellular) Human glucose triple tracer techniques with tracers in accordance with GMP GLP and GCP

guidelines for meticulous characterization of glucose metabolism Glycerol tracer techniques for determination of lipid fluxes Lipidomics techniques for biomarker research in cardiovascular disease

28

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 10: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Biomarker discovery at CBmed

Fusion Technology

Core Labs

25 Biomarker RampD Projects

10

CONFIDENTIAL Property of CBmed

Biomarker discovery at CBmed

11

bull CBmed identifies and validates biomarker at all levels of clinical research including

Early diagnostics

Prognostic biomarkers

Predictive biomarkers

Translation to market

BIOMARKER IDENTIFICATION

BIOMARKER VALIDATION

BIOMARKER TRANSLATION

THERAPIES DIAGNOSTICS

CONFIDENTIAL Property of CBmed

International network of scientific and industry partners

12

CONFIDENTIAL Property of CBmed

Other scientific consortium members

435

125 95

95

20 5

Lead Partner

Shareholders Main scientific partners

Scientific Partners

13

CONFIDENTIAL Property of CBmed

Over 50 international partners on 4 continents

Pharma Industry

Information Technology

Biotech Industry

Research Organisations

Nutrition

Diagnostic Industry

CBmed Consortium Members Selected Industry Partners

14

CONFIDENTIAL Property of CBmed

Biobank amp Patient Cohorts

15

CONFIDENTIAL Property of CBmed

Biobanking amp Retrospective Cohorts

BBMRI-ERIC Expert Center ndash Bridge between Biobanks and Pharma amp Diagnostic Industry

bull CBmed is the first BBMRI-ERIC approved Expert Center

bull BBMRI-ERIC is the EU infrastructure providing a network for biobanks and biomolecular resources across Europe

bull For retrospective cohorts CBmed works closely with the Biobank Graz one of Europelsquos largest biobanks with ~75 million biospecimens

wwwbbmri-ericeu 16

CONFIDENTIAL Property of CBmed

BBMRI-ERIC ndash European Infrastructure

for Biobanks and Biomolecular Resources

bull Members Austria Italy Belgium Latvia Czech Republic Malta Estonia The Netherlands Finland Norway France Sweden Germany United Kingdom Greece

bull Observers Cyprus Poland Switzerland Turkey IARCWHO

bull 515 Biobanks over 60 Million Biospecimens

17

CONFIDENTIAL Property of CBmed

BBMRI-ERIC Expert Centre

bull Expert centres are key intermediaries between public and private sectors performing the analysis of biological samples under internationally standardized conditions

bull Their main goals are to

Provide access to primary data that can easily be shared in contrast to biological samples and

Provide high-quality information from biological samples to industry for further product development

Quoted from bdquoBBMRI-ERIC-Associated Expert Centres Trusted Partners V20ldquo

18

CONFIDENTIAL Property of CBmed

Retrospective Cohort Assembly ndash An Example

Colon Cancer Cohort with Early and Late Relapse

bull A project was identified for validation of immune infiltration as a biomarker for colon cancer relapse

bull Inclusion and exclusion criteria were defined in an eCRF bull Feasibility request sent to the Biobank Graz for FFPE

biospecimens from 100 stage II amp III colon cancer patients

bull In collaboration with the Oncology Department of the Medical University of Graz the cohorts were further refined with data regarding clinical outcome

bull An application for ethics approval was submitted to the Ethics Department of the medical university of Graz The Ethics approval was successfullly granted

bull Tissue samples were pseudonymised and sent to CBmed for analysis

Immune Cell Biomarkers in Colon Cancer

19

CONFIDENTIAL Property of CBmed

Clinical Researchers amp Prospective Cohorts

Prospective cohorts have many benefits

bull control sampling time points to observed patient response to therapy

bull access to biospecimens not normally collected as routine

bull control of sampling procedures

bull collection of fresh cells and tissues required for analysis by eg flow cytometry MALDI-MS imaging and development of PDX models

CBmed has built strong collaborations with clinical researchers from the Medical Universities of Graz amp Vienna enabling the initiation of a wide range of prospective collections

20

CONFIDENTIAL Property of CBmed

Prospective Cohorts

bull CBmed Prospectively collects Biospecimens in the following indications Type 1 amp 2 diabetes inflammatory bowel disease cardiovascular disease liver disease

(NAFLD NASH alcoholic liver disease hepatitis C cirrhosis) chronic kidney disease obesity metabolic bone disease fertility disorders (polycystic ovarian) sepsis

Cancer ndash breast prostate colorectal cancer lung endometrial ovarian hepatocellular melanoma urothelial renal cell pancreatic head amp neck bladder AML lymphoma

Healthy controls

bull Diverse biospecimen types Blood (serum plasma) tissue circulating tumor

cells circulating immune cells urine stool saliva cultures

bull Ethical Guidelines - Collected following the ethical guidelines of the Biobank Graz an international standard for Biobanking

bull Clinical Data Management - Clinical data collected in a clinical data management system in accordance with good clinical practice (GCP) CBmed has access to specimens with meticulous clinical characterization follow-up data and biomarker results

21

CONFIDENTIAL Property of CBmed

Close cooperation with large hospital organisations

22

CONFIDENTIAL Property of CBmed

Innovative use of Clinical Information for Biomarker Research

bull Access to biospecimens alone is worthless without associated high quality in-depth clinical data

bull CBmed works together with KAGes one of the largest hospital companies in Europe with a catchment area of 12 million people with the aim of developing IT solutions for extracting the relevant clinical data from structured and unstructured sources with a view to selecting the appropriate patients for biomarker research

Our Strengths

bull Expertise in

Data semantics

Biomedical Terminologies

Natural Language processing

Big data management (eg SAP HANA)

Predictive content analytics

23

CONFIDENTIAL Property of CBmed

Wide scope of RampD

Internal Biomarker Research Programmes

24

CONFIDENTIAL Property of CBmed

RampD Project Overview

Core Labs

NGS

Metabolomics

Immunology

Digital Pathology

MALDI-MS

Proteomics amp In-vivo Imaging

Disease Models (PDX ADX)

Technology Development eg electrochemical chip-based diagnostics

Patient Cohorts

AREA 1

Data amp Technology

Multi-omics

Clinical Data Management

Software

development ndash semantic

searching of clinical data

AREA 2

Cancer

AREA 3

Metabolism amp

Inflammation

bull Early Diagnostics including bull Tracking the Trace (CTCs in Urologic

Cancer) bull Metabolomics (Idiopathic Pulmonary

Arterial Hypertension) bull Sepsis amp Fungal Infection

bull Prognostic amp Predictive Markers (Patient Stratification) including bull Minimal Residual Disease in AML bull Immune Cell Characterisation as a

Biomarker in CRC bull Eukaryotic Initiation Factors in eg

Glioblastoma bull Biosensors for short-lived biomarkers

in diabetes bull Diabesity amp Cardiovascular disease

including microbiome analysis

bull Translation to Market bull Health Technology Assessment

25

CONFIDENTIAL Property of CBmed

Internal RampD Projects

bull Health technology assessment

Area 3 Metabolism

amp Inflammation

Area 1 Data

amp Technologies

Area 2 Cancer

bull Metabolomics bull Clinical information system bull Semantic data management

bull Next generation sequencing

bull Tracking the trace bull Minimal residual disease

and CAR T-cells

bull Diabesity

bull Cardiovascular disease bull Biosensors

bull Bone metabolism

bull Fertility bull Electrochemical biomarker detection

bull Liver function

bull Microbiome-gut-brain

bull Sepsis

bull Fungal infections

bull ADX models bull Eukaryotic initiation factors

bull Core Lab for Target Identify-cation and Probe Development

bull Clinical MALDI Applications bull Digital Pathology

bull Immunology bull Knowledge discovery amp data mining)

26

CONFIDENTIAL Property of CBmed

Disease Area Stronghold CANCER

OUR EXPERTISE Experts in Clinical Oncology and Pathology Deep clinical phenotyping through access to standardised clinical

documentation Pre-exisiting network of clinicians and researchers (basic amp

translational) Experience at clinical research including clinical trials

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

OUR SOLUTIONS Isolation amp analysis of circulating tumour cells (PARSORTIX amp Mobile Diagnostic System ndash blood

and other boldy fluids) Detection analysis and validation of circulating tumour DNA Development of discriminative multimarker panels for serum proteins and immune cell gene

expression signatures Highly sensitive method for detection of minimal residual disease in haematological malignancies Drug validation and development programmes (eg antibodies viral vector-based and anti-eIFs) Access to tumour tissue (patient amp autopsy derived) for generation of xenograft models (PDX amp

ADX)

27

CONFIDENTIAL Property of CBmed

Disease Area Stronghold METABOLISM amp INFLAMMATION

OUR EXPERTISE Experts in Clinical Endocrinology amp Metabolic Diseases In-vitro amp In-vivo analysis Experience of clinical study design planning and execution

OUR SOLUTIONS 16S rRNA microbiome profiling and analysis stand alone or in

combination with metabolomics (mass spectrometry) Gut permeability measurements (zonulin calprotectin

lactulosemannitol)

Assoc Prof Harald Sourij MD Area Leader Metab amp Inflamm

Clnical Endocrinologist

Assessment of neurochemical biomarkers by cerebral open flow microperfusion Non-invasive PET imaging methods for angiogenesis and inflammation in liver diseases Rodent models for various diseases (diabetes hepatocellular) Human glucose triple tracer techniques with tracers in accordance with GMP GLP and GCP

guidelines for meticulous characterization of glucose metabolism Glycerol tracer techniques for determination of lipid fluxes Lipidomics techniques for biomarker research in cardiovascular disease

28

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 11: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Biomarker discovery at CBmed

11

bull CBmed identifies and validates biomarker at all levels of clinical research including

Early diagnostics

Prognostic biomarkers

Predictive biomarkers

Translation to market

BIOMARKER IDENTIFICATION

BIOMARKER VALIDATION

BIOMARKER TRANSLATION

THERAPIES DIAGNOSTICS

CONFIDENTIAL Property of CBmed

International network of scientific and industry partners

12

CONFIDENTIAL Property of CBmed

Other scientific consortium members

435

125 95

95

20 5

Lead Partner

Shareholders Main scientific partners

Scientific Partners

13

CONFIDENTIAL Property of CBmed

Over 50 international partners on 4 continents

Pharma Industry

Information Technology

Biotech Industry

Research Organisations

Nutrition

Diagnostic Industry

CBmed Consortium Members Selected Industry Partners

14

CONFIDENTIAL Property of CBmed

Biobank amp Patient Cohorts

15

CONFIDENTIAL Property of CBmed

Biobanking amp Retrospective Cohorts

BBMRI-ERIC Expert Center ndash Bridge between Biobanks and Pharma amp Diagnostic Industry

bull CBmed is the first BBMRI-ERIC approved Expert Center

bull BBMRI-ERIC is the EU infrastructure providing a network for biobanks and biomolecular resources across Europe

bull For retrospective cohorts CBmed works closely with the Biobank Graz one of Europelsquos largest biobanks with ~75 million biospecimens

wwwbbmri-ericeu 16

CONFIDENTIAL Property of CBmed

BBMRI-ERIC ndash European Infrastructure

for Biobanks and Biomolecular Resources

bull Members Austria Italy Belgium Latvia Czech Republic Malta Estonia The Netherlands Finland Norway France Sweden Germany United Kingdom Greece

bull Observers Cyprus Poland Switzerland Turkey IARCWHO

bull 515 Biobanks over 60 Million Biospecimens

17

CONFIDENTIAL Property of CBmed

BBMRI-ERIC Expert Centre

bull Expert centres are key intermediaries between public and private sectors performing the analysis of biological samples under internationally standardized conditions

bull Their main goals are to

Provide access to primary data that can easily be shared in contrast to biological samples and

Provide high-quality information from biological samples to industry for further product development

Quoted from bdquoBBMRI-ERIC-Associated Expert Centres Trusted Partners V20ldquo

18

CONFIDENTIAL Property of CBmed

Retrospective Cohort Assembly ndash An Example

Colon Cancer Cohort with Early and Late Relapse

bull A project was identified for validation of immune infiltration as a biomarker for colon cancer relapse

bull Inclusion and exclusion criteria were defined in an eCRF bull Feasibility request sent to the Biobank Graz for FFPE

biospecimens from 100 stage II amp III colon cancer patients

bull In collaboration with the Oncology Department of the Medical University of Graz the cohorts were further refined with data regarding clinical outcome

bull An application for ethics approval was submitted to the Ethics Department of the medical university of Graz The Ethics approval was successfullly granted

bull Tissue samples were pseudonymised and sent to CBmed for analysis

Immune Cell Biomarkers in Colon Cancer

19

CONFIDENTIAL Property of CBmed

Clinical Researchers amp Prospective Cohorts

Prospective cohorts have many benefits

bull control sampling time points to observed patient response to therapy

bull access to biospecimens not normally collected as routine

bull control of sampling procedures

bull collection of fresh cells and tissues required for analysis by eg flow cytometry MALDI-MS imaging and development of PDX models

CBmed has built strong collaborations with clinical researchers from the Medical Universities of Graz amp Vienna enabling the initiation of a wide range of prospective collections

20

CONFIDENTIAL Property of CBmed

Prospective Cohorts

bull CBmed Prospectively collects Biospecimens in the following indications Type 1 amp 2 diabetes inflammatory bowel disease cardiovascular disease liver disease

(NAFLD NASH alcoholic liver disease hepatitis C cirrhosis) chronic kidney disease obesity metabolic bone disease fertility disorders (polycystic ovarian) sepsis

Cancer ndash breast prostate colorectal cancer lung endometrial ovarian hepatocellular melanoma urothelial renal cell pancreatic head amp neck bladder AML lymphoma

Healthy controls

bull Diverse biospecimen types Blood (serum plasma) tissue circulating tumor

cells circulating immune cells urine stool saliva cultures

bull Ethical Guidelines - Collected following the ethical guidelines of the Biobank Graz an international standard for Biobanking

bull Clinical Data Management - Clinical data collected in a clinical data management system in accordance with good clinical practice (GCP) CBmed has access to specimens with meticulous clinical characterization follow-up data and biomarker results

21

CONFIDENTIAL Property of CBmed

Close cooperation with large hospital organisations

22

CONFIDENTIAL Property of CBmed

Innovative use of Clinical Information for Biomarker Research

bull Access to biospecimens alone is worthless without associated high quality in-depth clinical data

bull CBmed works together with KAGes one of the largest hospital companies in Europe with a catchment area of 12 million people with the aim of developing IT solutions for extracting the relevant clinical data from structured and unstructured sources with a view to selecting the appropriate patients for biomarker research

Our Strengths

bull Expertise in

Data semantics

Biomedical Terminologies

Natural Language processing

Big data management (eg SAP HANA)

Predictive content analytics

23

CONFIDENTIAL Property of CBmed

Wide scope of RampD

Internal Biomarker Research Programmes

24

CONFIDENTIAL Property of CBmed

RampD Project Overview

Core Labs

NGS

Metabolomics

Immunology

Digital Pathology

MALDI-MS

Proteomics amp In-vivo Imaging

Disease Models (PDX ADX)

Technology Development eg electrochemical chip-based diagnostics

Patient Cohorts

AREA 1

Data amp Technology

Multi-omics

Clinical Data Management

Software

development ndash semantic

searching of clinical data

AREA 2

Cancer

AREA 3

Metabolism amp

Inflammation

bull Early Diagnostics including bull Tracking the Trace (CTCs in Urologic

Cancer) bull Metabolomics (Idiopathic Pulmonary

Arterial Hypertension) bull Sepsis amp Fungal Infection

bull Prognostic amp Predictive Markers (Patient Stratification) including bull Minimal Residual Disease in AML bull Immune Cell Characterisation as a

Biomarker in CRC bull Eukaryotic Initiation Factors in eg

Glioblastoma bull Biosensors for short-lived biomarkers

in diabetes bull Diabesity amp Cardiovascular disease

including microbiome analysis

bull Translation to Market bull Health Technology Assessment

25

CONFIDENTIAL Property of CBmed

Internal RampD Projects

bull Health technology assessment

Area 3 Metabolism

amp Inflammation

Area 1 Data

amp Technologies

Area 2 Cancer

bull Metabolomics bull Clinical information system bull Semantic data management

bull Next generation sequencing

bull Tracking the trace bull Minimal residual disease

and CAR T-cells

bull Diabesity

bull Cardiovascular disease bull Biosensors

bull Bone metabolism

bull Fertility bull Electrochemical biomarker detection

bull Liver function

bull Microbiome-gut-brain

bull Sepsis

bull Fungal infections

bull ADX models bull Eukaryotic initiation factors

bull Core Lab for Target Identify-cation and Probe Development

bull Clinical MALDI Applications bull Digital Pathology

bull Immunology bull Knowledge discovery amp data mining)

26

CONFIDENTIAL Property of CBmed

Disease Area Stronghold CANCER

OUR EXPERTISE Experts in Clinical Oncology and Pathology Deep clinical phenotyping through access to standardised clinical

documentation Pre-exisiting network of clinicians and researchers (basic amp

translational) Experience at clinical research including clinical trials

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

OUR SOLUTIONS Isolation amp analysis of circulating tumour cells (PARSORTIX amp Mobile Diagnostic System ndash blood

and other boldy fluids) Detection analysis and validation of circulating tumour DNA Development of discriminative multimarker panels for serum proteins and immune cell gene

expression signatures Highly sensitive method for detection of minimal residual disease in haematological malignancies Drug validation and development programmes (eg antibodies viral vector-based and anti-eIFs) Access to tumour tissue (patient amp autopsy derived) for generation of xenograft models (PDX amp

ADX)

27

CONFIDENTIAL Property of CBmed

Disease Area Stronghold METABOLISM amp INFLAMMATION

OUR EXPERTISE Experts in Clinical Endocrinology amp Metabolic Diseases In-vitro amp In-vivo analysis Experience of clinical study design planning and execution

OUR SOLUTIONS 16S rRNA microbiome profiling and analysis stand alone or in

combination with metabolomics (mass spectrometry) Gut permeability measurements (zonulin calprotectin

lactulosemannitol)

Assoc Prof Harald Sourij MD Area Leader Metab amp Inflamm

Clnical Endocrinologist

Assessment of neurochemical biomarkers by cerebral open flow microperfusion Non-invasive PET imaging methods for angiogenesis and inflammation in liver diseases Rodent models for various diseases (diabetes hepatocellular) Human glucose triple tracer techniques with tracers in accordance with GMP GLP and GCP

guidelines for meticulous characterization of glucose metabolism Glycerol tracer techniques for determination of lipid fluxes Lipidomics techniques for biomarker research in cardiovascular disease

28

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 12: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

International network of scientific and industry partners

12

CONFIDENTIAL Property of CBmed

Other scientific consortium members

435

125 95

95

20 5

Lead Partner

Shareholders Main scientific partners

Scientific Partners

13

CONFIDENTIAL Property of CBmed

Over 50 international partners on 4 continents

Pharma Industry

Information Technology

Biotech Industry

Research Organisations

Nutrition

Diagnostic Industry

CBmed Consortium Members Selected Industry Partners

14

CONFIDENTIAL Property of CBmed

Biobank amp Patient Cohorts

15

CONFIDENTIAL Property of CBmed

Biobanking amp Retrospective Cohorts

BBMRI-ERIC Expert Center ndash Bridge between Biobanks and Pharma amp Diagnostic Industry

bull CBmed is the first BBMRI-ERIC approved Expert Center

bull BBMRI-ERIC is the EU infrastructure providing a network for biobanks and biomolecular resources across Europe

bull For retrospective cohorts CBmed works closely with the Biobank Graz one of Europelsquos largest biobanks with ~75 million biospecimens

wwwbbmri-ericeu 16

CONFIDENTIAL Property of CBmed

BBMRI-ERIC ndash European Infrastructure

for Biobanks and Biomolecular Resources

bull Members Austria Italy Belgium Latvia Czech Republic Malta Estonia The Netherlands Finland Norway France Sweden Germany United Kingdom Greece

bull Observers Cyprus Poland Switzerland Turkey IARCWHO

bull 515 Biobanks over 60 Million Biospecimens

17

CONFIDENTIAL Property of CBmed

BBMRI-ERIC Expert Centre

bull Expert centres are key intermediaries between public and private sectors performing the analysis of biological samples under internationally standardized conditions

bull Their main goals are to

Provide access to primary data that can easily be shared in contrast to biological samples and

Provide high-quality information from biological samples to industry for further product development

Quoted from bdquoBBMRI-ERIC-Associated Expert Centres Trusted Partners V20ldquo

18

CONFIDENTIAL Property of CBmed

Retrospective Cohort Assembly ndash An Example

Colon Cancer Cohort with Early and Late Relapse

bull A project was identified for validation of immune infiltration as a biomarker for colon cancer relapse

bull Inclusion and exclusion criteria were defined in an eCRF bull Feasibility request sent to the Biobank Graz for FFPE

biospecimens from 100 stage II amp III colon cancer patients

bull In collaboration with the Oncology Department of the Medical University of Graz the cohorts were further refined with data regarding clinical outcome

bull An application for ethics approval was submitted to the Ethics Department of the medical university of Graz The Ethics approval was successfullly granted

bull Tissue samples were pseudonymised and sent to CBmed for analysis

Immune Cell Biomarkers in Colon Cancer

19

CONFIDENTIAL Property of CBmed

Clinical Researchers amp Prospective Cohorts

Prospective cohorts have many benefits

bull control sampling time points to observed patient response to therapy

bull access to biospecimens not normally collected as routine

bull control of sampling procedures

bull collection of fresh cells and tissues required for analysis by eg flow cytometry MALDI-MS imaging and development of PDX models

CBmed has built strong collaborations with clinical researchers from the Medical Universities of Graz amp Vienna enabling the initiation of a wide range of prospective collections

20

CONFIDENTIAL Property of CBmed

Prospective Cohorts

bull CBmed Prospectively collects Biospecimens in the following indications Type 1 amp 2 diabetes inflammatory bowel disease cardiovascular disease liver disease

(NAFLD NASH alcoholic liver disease hepatitis C cirrhosis) chronic kidney disease obesity metabolic bone disease fertility disorders (polycystic ovarian) sepsis

Cancer ndash breast prostate colorectal cancer lung endometrial ovarian hepatocellular melanoma urothelial renal cell pancreatic head amp neck bladder AML lymphoma

Healthy controls

bull Diverse biospecimen types Blood (serum plasma) tissue circulating tumor

cells circulating immune cells urine stool saliva cultures

bull Ethical Guidelines - Collected following the ethical guidelines of the Biobank Graz an international standard for Biobanking

bull Clinical Data Management - Clinical data collected in a clinical data management system in accordance with good clinical practice (GCP) CBmed has access to specimens with meticulous clinical characterization follow-up data and biomarker results

21

CONFIDENTIAL Property of CBmed

Close cooperation with large hospital organisations

22

CONFIDENTIAL Property of CBmed

Innovative use of Clinical Information for Biomarker Research

bull Access to biospecimens alone is worthless without associated high quality in-depth clinical data

bull CBmed works together with KAGes one of the largest hospital companies in Europe with a catchment area of 12 million people with the aim of developing IT solutions for extracting the relevant clinical data from structured and unstructured sources with a view to selecting the appropriate patients for biomarker research

Our Strengths

bull Expertise in

Data semantics

Biomedical Terminologies

Natural Language processing

Big data management (eg SAP HANA)

Predictive content analytics

23

CONFIDENTIAL Property of CBmed

Wide scope of RampD

Internal Biomarker Research Programmes

24

CONFIDENTIAL Property of CBmed

RampD Project Overview

Core Labs

NGS

Metabolomics

Immunology

Digital Pathology

MALDI-MS

Proteomics amp In-vivo Imaging

Disease Models (PDX ADX)

Technology Development eg electrochemical chip-based diagnostics

Patient Cohorts

AREA 1

Data amp Technology

Multi-omics

Clinical Data Management

Software

development ndash semantic

searching of clinical data

AREA 2

Cancer

AREA 3

Metabolism amp

Inflammation

bull Early Diagnostics including bull Tracking the Trace (CTCs in Urologic

Cancer) bull Metabolomics (Idiopathic Pulmonary

Arterial Hypertension) bull Sepsis amp Fungal Infection

bull Prognostic amp Predictive Markers (Patient Stratification) including bull Minimal Residual Disease in AML bull Immune Cell Characterisation as a

Biomarker in CRC bull Eukaryotic Initiation Factors in eg

Glioblastoma bull Biosensors for short-lived biomarkers

in diabetes bull Diabesity amp Cardiovascular disease

including microbiome analysis

bull Translation to Market bull Health Technology Assessment

25

CONFIDENTIAL Property of CBmed

Internal RampD Projects

bull Health technology assessment

Area 3 Metabolism

amp Inflammation

Area 1 Data

amp Technologies

Area 2 Cancer

bull Metabolomics bull Clinical information system bull Semantic data management

bull Next generation sequencing

bull Tracking the trace bull Minimal residual disease

and CAR T-cells

bull Diabesity

bull Cardiovascular disease bull Biosensors

bull Bone metabolism

bull Fertility bull Electrochemical biomarker detection

bull Liver function

bull Microbiome-gut-brain

bull Sepsis

bull Fungal infections

bull ADX models bull Eukaryotic initiation factors

bull Core Lab for Target Identify-cation and Probe Development

bull Clinical MALDI Applications bull Digital Pathology

bull Immunology bull Knowledge discovery amp data mining)

26

CONFIDENTIAL Property of CBmed

Disease Area Stronghold CANCER

OUR EXPERTISE Experts in Clinical Oncology and Pathology Deep clinical phenotyping through access to standardised clinical

documentation Pre-exisiting network of clinicians and researchers (basic amp

translational) Experience at clinical research including clinical trials

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

OUR SOLUTIONS Isolation amp analysis of circulating tumour cells (PARSORTIX amp Mobile Diagnostic System ndash blood

and other boldy fluids) Detection analysis and validation of circulating tumour DNA Development of discriminative multimarker panels for serum proteins and immune cell gene

expression signatures Highly sensitive method for detection of minimal residual disease in haematological malignancies Drug validation and development programmes (eg antibodies viral vector-based and anti-eIFs) Access to tumour tissue (patient amp autopsy derived) for generation of xenograft models (PDX amp

ADX)

27

CONFIDENTIAL Property of CBmed

Disease Area Stronghold METABOLISM amp INFLAMMATION

OUR EXPERTISE Experts in Clinical Endocrinology amp Metabolic Diseases In-vitro amp In-vivo analysis Experience of clinical study design planning and execution

OUR SOLUTIONS 16S rRNA microbiome profiling and analysis stand alone or in

combination with metabolomics (mass spectrometry) Gut permeability measurements (zonulin calprotectin

lactulosemannitol)

Assoc Prof Harald Sourij MD Area Leader Metab amp Inflamm

Clnical Endocrinologist

Assessment of neurochemical biomarkers by cerebral open flow microperfusion Non-invasive PET imaging methods for angiogenesis and inflammation in liver diseases Rodent models for various diseases (diabetes hepatocellular) Human glucose triple tracer techniques with tracers in accordance with GMP GLP and GCP

guidelines for meticulous characterization of glucose metabolism Glycerol tracer techniques for determination of lipid fluxes Lipidomics techniques for biomarker research in cardiovascular disease

28

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 13: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Other scientific consortium members

435

125 95

95

20 5

Lead Partner

Shareholders Main scientific partners

Scientific Partners

13

CONFIDENTIAL Property of CBmed

Over 50 international partners on 4 continents

Pharma Industry

Information Technology

Biotech Industry

Research Organisations

Nutrition

Diagnostic Industry

CBmed Consortium Members Selected Industry Partners

14

CONFIDENTIAL Property of CBmed

Biobank amp Patient Cohorts

15

CONFIDENTIAL Property of CBmed

Biobanking amp Retrospective Cohorts

BBMRI-ERIC Expert Center ndash Bridge between Biobanks and Pharma amp Diagnostic Industry

bull CBmed is the first BBMRI-ERIC approved Expert Center

bull BBMRI-ERIC is the EU infrastructure providing a network for biobanks and biomolecular resources across Europe

bull For retrospective cohorts CBmed works closely with the Biobank Graz one of Europelsquos largest biobanks with ~75 million biospecimens

wwwbbmri-ericeu 16

CONFIDENTIAL Property of CBmed

BBMRI-ERIC ndash European Infrastructure

for Biobanks and Biomolecular Resources

bull Members Austria Italy Belgium Latvia Czech Republic Malta Estonia The Netherlands Finland Norway France Sweden Germany United Kingdom Greece

bull Observers Cyprus Poland Switzerland Turkey IARCWHO

bull 515 Biobanks over 60 Million Biospecimens

17

CONFIDENTIAL Property of CBmed

BBMRI-ERIC Expert Centre

bull Expert centres are key intermediaries between public and private sectors performing the analysis of biological samples under internationally standardized conditions

bull Their main goals are to

Provide access to primary data that can easily be shared in contrast to biological samples and

Provide high-quality information from biological samples to industry for further product development

Quoted from bdquoBBMRI-ERIC-Associated Expert Centres Trusted Partners V20ldquo

18

CONFIDENTIAL Property of CBmed

Retrospective Cohort Assembly ndash An Example

Colon Cancer Cohort with Early and Late Relapse

bull A project was identified for validation of immune infiltration as a biomarker for colon cancer relapse

bull Inclusion and exclusion criteria were defined in an eCRF bull Feasibility request sent to the Biobank Graz for FFPE

biospecimens from 100 stage II amp III colon cancer patients

bull In collaboration with the Oncology Department of the Medical University of Graz the cohorts were further refined with data regarding clinical outcome

bull An application for ethics approval was submitted to the Ethics Department of the medical university of Graz The Ethics approval was successfullly granted

bull Tissue samples were pseudonymised and sent to CBmed for analysis

Immune Cell Biomarkers in Colon Cancer

19

CONFIDENTIAL Property of CBmed

Clinical Researchers amp Prospective Cohorts

Prospective cohorts have many benefits

bull control sampling time points to observed patient response to therapy

bull access to biospecimens not normally collected as routine

bull control of sampling procedures

bull collection of fresh cells and tissues required for analysis by eg flow cytometry MALDI-MS imaging and development of PDX models

CBmed has built strong collaborations with clinical researchers from the Medical Universities of Graz amp Vienna enabling the initiation of a wide range of prospective collections

20

CONFIDENTIAL Property of CBmed

Prospective Cohorts

bull CBmed Prospectively collects Biospecimens in the following indications Type 1 amp 2 diabetes inflammatory bowel disease cardiovascular disease liver disease

(NAFLD NASH alcoholic liver disease hepatitis C cirrhosis) chronic kidney disease obesity metabolic bone disease fertility disorders (polycystic ovarian) sepsis

Cancer ndash breast prostate colorectal cancer lung endometrial ovarian hepatocellular melanoma urothelial renal cell pancreatic head amp neck bladder AML lymphoma

Healthy controls

bull Diverse biospecimen types Blood (serum plasma) tissue circulating tumor

cells circulating immune cells urine stool saliva cultures

bull Ethical Guidelines - Collected following the ethical guidelines of the Biobank Graz an international standard for Biobanking

bull Clinical Data Management - Clinical data collected in a clinical data management system in accordance with good clinical practice (GCP) CBmed has access to specimens with meticulous clinical characterization follow-up data and biomarker results

21

CONFIDENTIAL Property of CBmed

Close cooperation with large hospital organisations

22

CONFIDENTIAL Property of CBmed

Innovative use of Clinical Information for Biomarker Research

bull Access to biospecimens alone is worthless without associated high quality in-depth clinical data

bull CBmed works together with KAGes one of the largest hospital companies in Europe with a catchment area of 12 million people with the aim of developing IT solutions for extracting the relevant clinical data from structured and unstructured sources with a view to selecting the appropriate patients for biomarker research

Our Strengths

bull Expertise in

Data semantics

Biomedical Terminologies

Natural Language processing

Big data management (eg SAP HANA)

Predictive content analytics

23

CONFIDENTIAL Property of CBmed

Wide scope of RampD

Internal Biomarker Research Programmes

24

CONFIDENTIAL Property of CBmed

RampD Project Overview

Core Labs

NGS

Metabolomics

Immunology

Digital Pathology

MALDI-MS

Proteomics amp In-vivo Imaging

Disease Models (PDX ADX)

Technology Development eg electrochemical chip-based diagnostics

Patient Cohorts

AREA 1

Data amp Technology

Multi-omics

Clinical Data Management

Software

development ndash semantic

searching of clinical data

AREA 2

Cancer

AREA 3

Metabolism amp

Inflammation

bull Early Diagnostics including bull Tracking the Trace (CTCs in Urologic

Cancer) bull Metabolomics (Idiopathic Pulmonary

Arterial Hypertension) bull Sepsis amp Fungal Infection

bull Prognostic amp Predictive Markers (Patient Stratification) including bull Minimal Residual Disease in AML bull Immune Cell Characterisation as a

Biomarker in CRC bull Eukaryotic Initiation Factors in eg

Glioblastoma bull Biosensors for short-lived biomarkers

in diabetes bull Diabesity amp Cardiovascular disease

including microbiome analysis

bull Translation to Market bull Health Technology Assessment

25

CONFIDENTIAL Property of CBmed

Internal RampD Projects

bull Health technology assessment

Area 3 Metabolism

amp Inflammation

Area 1 Data

amp Technologies

Area 2 Cancer

bull Metabolomics bull Clinical information system bull Semantic data management

bull Next generation sequencing

bull Tracking the trace bull Minimal residual disease

and CAR T-cells

bull Diabesity

bull Cardiovascular disease bull Biosensors

bull Bone metabolism

bull Fertility bull Electrochemical biomarker detection

bull Liver function

bull Microbiome-gut-brain

bull Sepsis

bull Fungal infections

bull ADX models bull Eukaryotic initiation factors

bull Core Lab for Target Identify-cation and Probe Development

bull Clinical MALDI Applications bull Digital Pathology

bull Immunology bull Knowledge discovery amp data mining)

26

CONFIDENTIAL Property of CBmed

Disease Area Stronghold CANCER

OUR EXPERTISE Experts in Clinical Oncology and Pathology Deep clinical phenotyping through access to standardised clinical

documentation Pre-exisiting network of clinicians and researchers (basic amp

translational) Experience at clinical research including clinical trials

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

OUR SOLUTIONS Isolation amp analysis of circulating tumour cells (PARSORTIX amp Mobile Diagnostic System ndash blood

and other boldy fluids) Detection analysis and validation of circulating tumour DNA Development of discriminative multimarker panels for serum proteins and immune cell gene

expression signatures Highly sensitive method for detection of minimal residual disease in haematological malignancies Drug validation and development programmes (eg antibodies viral vector-based and anti-eIFs) Access to tumour tissue (patient amp autopsy derived) for generation of xenograft models (PDX amp

ADX)

27

CONFIDENTIAL Property of CBmed

Disease Area Stronghold METABOLISM amp INFLAMMATION

OUR EXPERTISE Experts in Clinical Endocrinology amp Metabolic Diseases In-vitro amp In-vivo analysis Experience of clinical study design planning and execution

OUR SOLUTIONS 16S rRNA microbiome profiling and analysis stand alone or in

combination with metabolomics (mass spectrometry) Gut permeability measurements (zonulin calprotectin

lactulosemannitol)

Assoc Prof Harald Sourij MD Area Leader Metab amp Inflamm

Clnical Endocrinologist

Assessment of neurochemical biomarkers by cerebral open flow microperfusion Non-invasive PET imaging methods for angiogenesis and inflammation in liver diseases Rodent models for various diseases (diabetes hepatocellular) Human glucose triple tracer techniques with tracers in accordance with GMP GLP and GCP

guidelines for meticulous characterization of glucose metabolism Glycerol tracer techniques for determination of lipid fluxes Lipidomics techniques for biomarker research in cardiovascular disease

28

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 14: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Over 50 international partners on 4 continents

Pharma Industry

Information Technology

Biotech Industry

Research Organisations

Nutrition

Diagnostic Industry

CBmed Consortium Members Selected Industry Partners

14

CONFIDENTIAL Property of CBmed

Biobank amp Patient Cohorts

15

CONFIDENTIAL Property of CBmed

Biobanking amp Retrospective Cohorts

BBMRI-ERIC Expert Center ndash Bridge between Biobanks and Pharma amp Diagnostic Industry

bull CBmed is the first BBMRI-ERIC approved Expert Center

bull BBMRI-ERIC is the EU infrastructure providing a network for biobanks and biomolecular resources across Europe

bull For retrospective cohorts CBmed works closely with the Biobank Graz one of Europelsquos largest biobanks with ~75 million biospecimens

wwwbbmri-ericeu 16

CONFIDENTIAL Property of CBmed

BBMRI-ERIC ndash European Infrastructure

for Biobanks and Biomolecular Resources

bull Members Austria Italy Belgium Latvia Czech Republic Malta Estonia The Netherlands Finland Norway France Sweden Germany United Kingdom Greece

bull Observers Cyprus Poland Switzerland Turkey IARCWHO

bull 515 Biobanks over 60 Million Biospecimens

17

CONFIDENTIAL Property of CBmed

BBMRI-ERIC Expert Centre

bull Expert centres are key intermediaries between public and private sectors performing the analysis of biological samples under internationally standardized conditions

bull Their main goals are to

Provide access to primary data that can easily be shared in contrast to biological samples and

Provide high-quality information from biological samples to industry for further product development

Quoted from bdquoBBMRI-ERIC-Associated Expert Centres Trusted Partners V20ldquo

18

CONFIDENTIAL Property of CBmed

Retrospective Cohort Assembly ndash An Example

Colon Cancer Cohort with Early and Late Relapse

bull A project was identified for validation of immune infiltration as a biomarker for colon cancer relapse

bull Inclusion and exclusion criteria were defined in an eCRF bull Feasibility request sent to the Biobank Graz for FFPE

biospecimens from 100 stage II amp III colon cancer patients

bull In collaboration with the Oncology Department of the Medical University of Graz the cohorts were further refined with data regarding clinical outcome

bull An application for ethics approval was submitted to the Ethics Department of the medical university of Graz The Ethics approval was successfullly granted

bull Tissue samples were pseudonymised and sent to CBmed for analysis

Immune Cell Biomarkers in Colon Cancer

19

CONFIDENTIAL Property of CBmed

Clinical Researchers amp Prospective Cohorts

Prospective cohorts have many benefits

bull control sampling time points to observed patient response to therapy

bull access to biospecimens not normally collected as routine

bull control of sampling procedures

bull collection of fresh cells and tissues required for analysis by eg flow cytometry MALDI-MS imaging and development of PDX models

CBmed has built strong collaborations with clinical researchers from the Medical Universities of Graz amp Vienna enabling the initiation of a wide range of prospective collections

20

CONFIDENTIAL Property of CBmed

Prospective Cohorts

bull CBmed Prospectively collects Biospecimens in the following indications Type 1 amp 2 diabetes inflammatory bowel disease cardiovascular disease liver disease

(NAFLD NASH alcoholic liver disease hepatitis C cirrhosis) chronic kidney disease obesity metabolic bone disease fertility disorders (polycystic ovarian) sepsis

Cancer ndash breast prostate colorectal cancer lung endometrial ovarian hepatocellular melanoma urothelial renal cell pancreatic head amp neck bladder AML lymphoma

Healthy controls

bull Diverse biospecimen types Blood (serum plasma) tissue circulating tumor

cells circulating immune cells urine stool saliva cultures

bull Ethical Guidelines - Collected following the ethical guidelines of the Biobank Graz an international standard for Biobanking

bull Clinical Data Management - Clinical data collected in a clinical data management system in accordance with good clinical practice (GCP) CBmed has access to specimens with meticulous clinical characterization follow-up data and biomarker results

21

CONFIDENTIAL Property of CBmed

Close cooperation with large hospital organisations

22

CONFIDENTIAL Property of CBmed

Innovative use of Clinical Information for Biomarker Research

bull Access to biospecimens alone is worthless without associated high quality in-depth clinical data

bull CBmed works together with KAGes one of the largest hospital companies in Europe with a catchment area of 12 million people with the aim of developing IT solutions for extracting the relevant clinical data from structured and unstructured sources with a view to selecting the appropriate patients for biomarker research

Our Strengths

bull Expertise in

Data semantics

Biomedical Terminologies

Natural Language processing

Big data management (eg SAP HANA)

Predictive content analytics

23

CONFIDENTIAL Property of CBmed

Wide scope of RampD

Internal Biomarker Research Programmes

24

CONFIDENTIAL Property of CBmed

RampD Project Overview

Core Labs

NGS

Metabolomics

Immunology

Digital Pathology

MALDI-MS

Proteomics amp In-vivo Imaging

Disease Models (PDX ADX)

Technology Development eg electrochemical chip-based diagnostics

Patient Cohorts

AREA 1

Data amp Technology

Multi-omics

Clinical Data Management

Software

development ndash semantic

searching of clinical data

AREA 2

Cancer

AREA 3

Metabolism amp

Inflammation

bull Early Diagnostics including bull Tracking the Trace (CTCs in Urologic

Cancer) bull Metabolomics (Idiopathic Pulmonary

Arterial Hypertension) bull Sepsis amp Fungal Infection

bull Prognostic amp Predictive Markers (Patient Stratification) including bull Minimal Residual Disease in AML bull Immune Cell Characterisation as a

Biomarker in CRC bull Eukaryotic Initiation Factors in eg

Glioblastoma bull Biosensors for short-lived biomarkers

in diabetes bull Diabesity amp Cardiovascular disease

including microbiome analysis

bull Translation to Market bull Health Technology Assessment

25

CONFIDENTIAL Property of CBmed

Internal RampD Projects

bull Health technology assessment

Area 3 Metabolism

amp Inflammation

Area 1 Data

amp Technologies

Area 2 Cancer

bull Metabolomics bull Clinical information system bull Semantic data management

bull Next generation sequencing

bull Tracking the trace bull Minimal residual disease

and CAR T-cells

bull Diabesity

bull Cardiovascular disease bull Biosensors

bull Bone metabolism

bull Fertility bull Electrochemical biomarker detection

bull Liver function

bull Microbiome-gut-brain

bull Sepsis

bull Fungal infections

bull ADX models bull Eukaryotic initiation factors

bull Core Lab for Target Identify-cation and Probe Development

bull Clinical MALDI Applications bull Digital Pathology

bull Immunology bull Knowledge discovery amp data mining)

26

CONFIDENTIAL Property of CBmed

Disease Area Stronghold CANCER

OUR EXPERTISE Experts in Clinical Oncology and Pathology Deep clinical phenotyping through access to standardised clinical

documentation Pre-exisiting network of clinicians and researchers (basic amp

translational) Experience at clinical research including clinical trials

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

OUR SOLUTIONS Isolation amp analysis of circulating tumour cells (PARSORTIX amp Mobile Diagnostic System ndash blood

and other boldy fluids) Detection analysis and validation of circulating tumour DNA Development of discriminative multimarker panels for serum proteins and immune cell gene

expression signatures Highly sensitive method for detection of minimal residual disease in haematological malignancies Drug validation and development programmes (eg antibodies viral vector-based and anti-eIFs) Access to tumour tissue (patient amp autopsy derived) for generation of xenograft models (PDX amp

ADX)

27

CONFIDENTIAL Property of CBmed

Disease Area Stronghold METABOLISM amp INFLAMMATION

OUR EXPERTISE Experts in Clinical Endocrinology amp Metabolic Diseases In-vitro amp In-vivo analysis Experience of clinical study design planning and execution

OUR SOLUTIONS 16S rRNA microbiome profiling and analysis stand alone or in

combination with metabolomics (mass spectrometry) Gut permeability measurements (zonulin calprotectin

lactulosemannitol)

Assoc Prof Harald Sourij MD Area Leader Metab amp Inflamm

Clnical Endocrinologist

Assessment of neurochemical biomarkers by cerebral open flow microperfusion Non-invasive PET imaging methods for angiogenesis and inflammation in liver diseases Rodent models for various diseases (diabetes hepatocellular) Human glucose triple tracer techniques with tracers in accordance with GMP GLP and GCP

guidelines for meticulous characterization of glucose metabolism Glycerol tracer techniques for determination of lipid fluxes Lipidomics techniques for biomarker research in cardiovascular disease

28

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 15: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Biobank amp Patient Cohorts

15

CONFIDENTIAL Property of CBmed

Biobanking amp Retrospective Cohorts

BBMRI-ERIC Expert Center ndash Bridge between Biobanks and Pharma amp Diagnostic Industry

bull CBmed is the first BBMRI-ERIC approved Expert Center

bull BBMRI-ERIC is the EU infrastructure providing a network for biobanks and biomolecular resources across Europe

bull For retrospective cohorts CBmed works closely with the Biobank Graz one of Europelsquos largest biobanks with ~75 million biospecimens

wwwbbmri-ericeu 16

CONFIDENTIAL Property of CBmed

BBMRI-ERIC ndash European Infrastructure

for Biobanks and Biomolecular Resources

bull Members Austria Italy Belgium Latvia Czech Republic Malta Estonia The Netherlands Finland Norway France Sweden Germany United Kingdom Greece

bull Observers Cyprus Poland Switzerland Turkey IARCWHO

bull 515 Biobanks over 60 Million Biospecimens

17

CONFIDENTIAL Property of CBmed

BBMRI-ERIC Expert Centre

bull Expert centres are key intermediaries between public and private sectors performing the analysis of biological samples under internationally standardized conditions

bull Their main goals are to

Provide access to primary data that can easily be shared in contrast to biological samples and

Provide high-quality information from biological samples to industry for further product development

Quoted from bdquoBBMRI-ERIC-Associated Expert Centres Trusted Partners V20ldquo

18

CONFIDENTIAL Property of CBmed

Retrospective Cohort Assembly ndash An Example

Colon Cancer Cohort with Early and Late Relapse

bull A project was identified for validation of immune infiltration as a biomarker for colon cancer relapse

bull Inclusion and exclusion criteria were defined in an eCRF bull Feasibility request sent to the Biobank Graz for FFPE

biospecimens from 100 stage II amp III colon cancer patients

bull In collaboration with the Oncology Department of the Medical University of Graz the cohorts were further refined with data regarding clinical outcome

bull An application for ethics approval was submitted to the Ethics Department of the medical university of Graz The Ethics approval was successfullly granted

bull Tissue samples were pseudonymised and sent to CBmed for analysis

Immune Cell Biomarkers in Colon Cancer

19

CONFIDENTIAL Property of CBmed

Clinical Researchers amp Prospective Cohorts

Prospective cohorts have many benefits

bull control sampling time points to observed patient response to therapy

bull access to biospecimens not normally collected as routine

bull control of sampling procedures

bull collection of fresh cells and tissues required for analysis by eg flow cytometry MALDI-MS imaging and development of PDX models

CBmed has built strong collaborations with clinical researchers from the Medical Universities of Graz amp Vienna enabling the initiation of a wide range of prospective collections

20

CONFIDENTIAL Property of CBmed

Prospective Cohorts

bull CBmed Prospectively collects Biospecimens in the following indications Type 1 amp 2 diabetes inflammatory bowel disease cardiovascular disease liver disease

(NAFLD NASH alcoholic liver disease hepatitis C cirrhosis) chronic kidney disease obesity metabolic bone disease fertility disorders (polycystic ovarian) sepsis

Cancer ndash breast prostate colorectal cancer lung endometrial ovarian hepatocellular melanoma urothelial renal cell pancreatic head amp neck bladder AML lymphoma

Healthy controls

bull Diverse biospecimen types Blood (serum plasma) tissue circulating tumor

cells circulating immune cells urine stool saliva cultures

bull Ethical Guidelines - Collected following the ethical guidelines of the Biobank Graz an international standard for Biobanking

bull Clinical Data Management - Clinical data collected in a clinical data management system in accordance with good clinical practice (GCP) CBmed has access to specimens with meticulous clinical characterization follow-up data and biomarker results

21

CONFIDENTIAL Property of CBmed

Close cooperation with large hospital organisations

22

CONFIDENTIAL Property of CBmed

Innovative use of Clinical Information for Biomarker Research

bull Access to biospecimens alone is worthless without associated high quality in-depth clinical data

bull CBmed works together with KAGes one of the largest hospital companies in Europe with a catchment area of 12 million people with the aim of developing IT solutions for extracting the relevant clinical data from structured and unstructured sources with a view to selecting the appropriate patients for biomarker research

Our Strengths

bull Expertise in

Data semantics

Biomedical Terminologies

Natural Language processing

Big data management (eg SAP HANA)

Predictive content analytics

23

CONFIDENTIAL Property of CBmed

Wide scope of RampD

Internal Biomarker Research Programmes

24

CONFIDENTIAL Property of CBmed

RampD Project Overview

Core Labs

NGS

Metabolomics

Immunology

Digital Pathology

MALDI-MS

Proteomics amp In-vivo Imaging

Disease Models (PDX ADX)

Technology Development eg electrochemical chip-based diagnostics

Patient Cohorts

AREA 1

Data amp Technology

Multi-omics

Clinical Data Management

Software

development ndash semantic

searching of clinical data

AREA 2

Cancer

AREA 3

Metabolism amp

Inflammation

bull Early Diagnostics including bull Tracking the Trace (CTCs in Urologic

Cancer) bull Metabolomics (Idiopathic Pulmonary

Arterial Hypertension) bull Sepsis amp Fungal Infection

bull Prognostic amp Predictive Markers (Patient Stratification) including bull Minimal Residual Disease in AML bull Immune Cell Characterisation as a

Biomarker in CRC bull Eukaryotic Initiation Factors in eg

Glioblastoma bull Biosensors for short-lived biomarkers

in diabetes bull Diabesity amp Cardiovascular disease

including microbiome analysis

bull Translation to Market bull Health Technology Assessment

25

CONFIDENTIAL Property of CBmed

Internal RampD Projects

bull Health technology assessment

Area 3 Metabolism

amp Inflammation

Area 1 Data

amp Technologies

Area 2 Cancer

bull Metabolomics bull Clinical information system bull Semantic data management

bull Next generation sequencing

bull Tracking the trace bull Minimal residual disease

and CAR T-cells

bull Diabesity

bull Cardiovascular disease bull Biosensors

bull Bone metabolism

bull Fertility bull Electrochemical biomarker detection

bull Liver function

bull Microbiome-gut-brain

bull Sepsis

bull Fungal infections

bull ADX models bull Eukaryotic initiation factors

bull Core Lab for Target Identify-cation and Probe Development

bull Clinical MALDI Applications bull Digital Pathology

bull Immunology bull Knowledge discovery amp data mining)

26

CONFIDENTIAL Property of CBmed

Disease Area Stronghold CANCER

OUR EXPERTISE Experts in Clinical Oncology and Pathology Deep clinical phenotyping through access to standardised clinical

documentation Pre-exisiting network of clinicians and researchers (basic amp

translational) Experience at clinical research including clinical trials

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

OUR SOLUTIONS Isolation amp analysis of circulating tumour cells (PARSORTIX amp Mobile Diagnostic System ndash blood

and other boldy fluids) Detection analysis and validation of circulating tumour DNA Development of discriminative multimarker panels for serum proteins and immune cell gene

expression signatures Highly sensitive method for detection of minimal residual disease in haematological malignancies Drug validation and development programmes (eg antibodies viral vector-based and anti-eIFs) Access to tumour tissue (patient amp autopsy derived) for generation of xenograft models (PDX amp

ADX)

27

CONFIDENTIAL Property of CBmed

Disease Area Stronghold METABOLISM amp INFLAMMATION

OUR EXPERTISE Experts in Clinical Endocrinology amp Metabolic Diseases In-vitro amp In-vivo analysis Experience of clinical study design planning and execution

OUR SOLUTIONS 16S rRNA microbiome profiling and analysis stand alone or in

combination with metabolomics (mass spectrometry) Gut permeability measurements (zonulin calprotectin

lactulosemannitol)

Assoc Prof Harald Sourij MD Area Leader Metab amp Inflamm

Clnical Endocrinologist

Assessment of neurochemical biomarkers by cerebral open flow microperfusion Non-invasive PET imaging methods for angiogenesis and inflammation in liver diseases Rodent models for various diseases (diabetes hepatocellular) Human glucose triple tracer techniques with tracers in accordance with GMP GLP and GCP

guidelines for meticulous characterization of glucose metabolism Glycerol tracer techniques for determination of lipid fluxes Lipidomics techniques for biomarker research in cardiovascular disease

28

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 16: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Biobanking amp Retrospective Cohorts

BBMRI-ERIC Expert Center ndash Bridge between Biobanks and Pharma amp Diagnostic Industry

bull CBmed is the first BBMRI-ERIC approved Expert Center

bull BBMRI-ERIC is the EU infrastructure providing a network for biobanks and biomolecular resources across Europe

bull For retrospective cohorts CBmed works closely with the Biobank Graz one of Europelsquos largest biobanks with ~75 million biospecimens

wwwbbmri-ericeu 16

CONFIDENTIAL Property of CBmed

BBMRI-ERIC ndash European Infrastructure

for Biobanks and Biomolecular Resources

bull Members Austria Italy Belgium Latvia Czech Republic Malta Estonia The Netherlands Finland Norway France Sweden Germany United Kingdom Greece

bull Observers Cyprus Poland Switzerland Turkey IARCWHO

bull 515 Biobanks over 60 Million Biospecimens

17

CONFIDENTIAL Property of CBmed

BBMRI-ERIC Expert Centre

bull Expert centres are key intermediaries between public and private sectors performing the analysis of biological samples under internationally standardized conditions

bull Their main goals are to

Provide access to primary data that can easily be shared in contrast to biological samples and

Provide high-quality information from biological samples to industry for further product development

Quoted from bdquoBBMRI-ERIC-Associated Expert Centres Trusted Partners V20ldquo

18

CONFIDENTIAL Property of CBmed

Retrospective Cohort Assembly ndash An Example

Colon Cancer Cohort with Early and Late Relapse

bull A project was identified for validation of immune infiltration as a biomarker for colon cancer relapse

bull Inclusion and exclusion criteria were defined in an eCRF bull Feasibility request sent to the Biobank Graz for FFPE

biospecimens from 100 stage II amp III colon cancer patients

bull In collaboration with the Oncology Department of the Medical University of Graz the cohorts were further refined with data regarding clinical outcome

bull An application for ethics approval was submitted to the Ethics Department of the medical university of Graz The Ethics approval was successfullly granted

bull Tissue samples were pseudonymised and sent to CBmed for analysis

Immune Cell Biomarkers in Colon Cancer

19

CONFIDENTIAL Property of CBmed

Clinical Researchers amp Prospective Cohorts

Prospective cohorts have many benefits

bull control sampling time points to observed patient response to therapy

bull access to biospecimens not normally collected as routine

bull control of sampling procedures

bull collection of fresh cells and tissues required for analysis by eg flow cytometry MALDI-MS imaging and development of PDX models

CBmed has built strong collaborations with clinical researchers from the Medical Universities of Graz amp Vienna enabling the initiation of a wide range of prospective collections

20

CONFIDENTIAL Property of CBmed

Prospective Cohorts

bull CBmed Prospectively collects Biospecimens in the following indications Type 1 amp 2 diabetes inflammatory bowel disease cardiovascular disease liver disease

(NAFLD NASH alcoholic liver disease hepatitis C cirrhosis) chronic kidney disease obesity metabolic bone disease fertility disorders (polycystic ovarian) sepsis

Cancer ndash breast prostate colorectal cancer lung endometrial ovarian hepatocellular melanoma urothelial renal cell pancreatic head amp neck bladder AML lymphoma

Healthy controls

bull Diverse biospecimen types Blood (serum plasma) tissue circulating tumor

cells circulating immune cells urine stool saliva cultures

bull Ethical Guidelines - Collected following the ethical guidelines of the Biobank Graz an international standard for Biobanking

bull Clinical Data Management - Clinical data collected in a clinical data management system in accordance with good clinical practice (GCP) CBmed has access to specimens with meticulous clinical characterization follow-up data and biomarker results

21

CONFIDENTIAL Property of CBmed

Close cooperation with large hospital organisations

22

CONFIDENTIAL Property of CBmed

Innovative use of Clinical Information for Biomarker Research

bull Access to biospecimens alone is worthless without associated high quality in-depth clinical data

bull CBmed works together with KAGes one of the largest hospital companies in Europe with a catchment area of 12 million people with the aim of developing IT solutions for extracting the relevant clinical data from structured and unstructured sources with a view to selecting the appropriate patients for biomarker research

Our Strengths

bull Expertise in

Data semantics

Biomedical Terminologies

Natural Language processing

Big data management (eg SAP HANA)

Predictive content analytics

23

CONFIDENTIAL Property of CBmed

Wide scope of RampD

Internal Biomarker Research Programmes

24

CONFIDENTIAL Property of CBmed

RampD Project Overview

Core Labs

NGS

Metabolomics

Immunology

Digital Pathology

MALDI-MS

Proteomics amp In-vivo Imaging

Disease Models (PDX ADX)

Technology Development eg electrochemical chip-based diagnostics

Patient Cohorts

AREA 1

Data amp Technology

Multi-omics

Clinical Data Management

Software

development ndash semantic

searching of clinical data

AREA 2

Cancer

AREA 3

Metabolism amp

Inflammation

bull Early Diagnostics including bull Tracking the Trace (CTCs in Urologic

Cancer) bull Metabolomics (Idiopathic Pulmonary

Arterial Hypertension) bull Sepsis amp Fungal Infection

bull Prognostic amp Predictive Markers (Patient Stratification) including bull Minimal Residual Disease in AML bull Immune Cell Characterisation as a

Biomarker in CRC bull Eukaryotic Initiation Factors in eg

Glioblastoma bull Biosensors for short-lived biomarkers

in diabetes bull Diabesity amp Cardiovascular disease

including microbiome analysis

bull Translation to Market bull Health Technology Assessment

25

CONFIDENTIAL Property of CBmed

Internal RampD Projects

bull Health technology assessment

Area 3 Metabolism

amp Inflammation

Area 1 Data

amp Technologies

Area 2 Cancer

bull Metabolomics bull Clinical information system bull Semantic data management

bull Next generation sequencing

bull Tracking the trace bull Minimal residual disease

and CAR T-cells

bull Diabesity

bull Cardiovascular disease bull Biosensors

bull Bone metabolism

bull Fertility bull Electrochemical biomarker detection

bull Liver function

bull Microbiome-gut-brain

bull Sepsis

bull Fungal infections

bull ADX models bull Eukaryotic initiation factors

bull Core Lab for Target Identify-cation and Probe Development

bull Clinical MALDI Applications bull Digital Pathology

bull Immunology bull Knowledge discovery amp data mining)

26

CONFIDENTIAL Property of CBmed

Disease Area Stronghold CANCER

OUR EXPERTISE Experts in Clinical Oncology and Pathology Deep clinical phenotyping through access to standardised clinical

documentation Pre-exisiting network of clinicians and researchers (basic amp

translational) Experience at clinical research including clinical trials

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

OUR SOLUTIONS Isolation amp analysis of circulating tumour cells (PARSORTIX amp Mobile Diagnostic System ndash blood

and other boldy fluids) Detection analysis and validation of circulating tumour DNA Development of discriminative multimarker panels for serum proteins and immune cell gene

expression signatures Highly sensitive method for detection of minimal residual disease in haematological malignancies Drug validation and development programmes (eg antibodies viral vector-based and anti-eIFs) Access to tumour tissue (patient amp autopsy derived) for generation of xenograft models (PDX amp

ADX)

27

CONFIDENTIAL Property of CBmed

Disease Area Stronghold METABOLISM amp INFLAMMATION

OUR EXPERTISE Experts in Clinical Endocrinology amp Metabolic Diseases In-vitro amp In-vivo analysis Experience of clinical study design planning and execution

OUR SOLUTIONS 16S rRNA microbiome profiling and analysis stand alone or in

combination with metabolomics (mass spectrometry) Gut permeability measurements (zonulin calprotectin

lactulosemannitol)

Assoc Prof Harald Sourij MD Area Leader Metab amp Inflamm

Clnical Endocrinologist

Assessment of neurochemical biomarkers by cerebral open flow microperfusion Non-invasive PET imaging methods for angiogenesis and inflammation in liver diseases Rodent models for various diseases (diabetes hepatocellular) Human glucose triple tracer techniques with tracers in accordance with GMP GLP and GCP

guidelines for meticulous characterization of glucose metabolism Glycerol tracer techniques for determination of lipid fluxes Lipidomics techniques for biomarker research in cardiovascular disease

28

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 17: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

BBMRI-ERIC ndash European Infrastructure

for Biobanks and Biomolecular Resources

bull Members Austria Italy Belgium Latvia Czech Republic Malta Estonia The Netherlands Finland Norway France Sweden Germany United Kingdom Greece

bull Observers Cyprus Poland Switzerland Turkey IARCWHO

bull 515 Biobanks over 60 Million Biospecimens

17

CONFIDENTIAL Property of CBmed

BBMRI-ERIC Expert Centre

bull Expert centres are key intermediaries between public and private sectors performing the analysis of biological samples under internationally standardized conditions

bull Their main goals are to

Provide access to primary data that can easily be shared in contrast to biological samples and

Provide high-quality information from biological samples to industry for further product development

Quoted from bdquoBBMRI-ERIC-Associated Expert Centres Trusted Partners V20ldquo

18

CONFIDENTIAL Property of CBmed

Retrospective Cohort Assembly ndash An Example

Colon Cancer Cohort with Early and Late Relapse

bull A project was identified for validation of immune infiltration as a biomarker for colon cancer relapse

bull Inclusion and exclusion criteria were defined in an eCRF bull Feasibility request sent to the Biobank Graz for FFPE

biospecimens from 100 stage II amp III colon cancer patients

bull In collaboration with the Oncology Department of the Medical University of Graz the cohorts were further refined with data regarding clinical outcome

bull An application for ethics approval was submitted to the Ethics Department of the medical university of Graz The Ethics approval was successfullly granted

bull Tissue samples were pseudonymised and sent to CBmed for analysis

Immune Cell Biomarkers in Colon Cancer

19

CONFIDENTIAL Property of CBmed

Clinical Researchers amp Prospective Cohorts

Prospective cohorts have many benefits

bull control sampling time points to observed patient response to therapy

bull access to biospecimens not normally collected as routine

bull control of sampling procedures

bull collection of fresh cells and tissues required for analysis by eg flow cytometry MALDI-MS imaging and development of PDX models

CBmed has built strong collaborations with clinical researchers from the Medical Universities of Graz amp Vienna enabling the initiation of a wide range of prospective collections

20

CONFIDENTIAL Property of CBmed

Prospective Cohorts

bull CBmed Prospectively collects Biospecimens in the following indications Type 1 amp 2 diabetes inflammatory bowel disease cardiovascular disease liver disease

(NAFLD NASH alcoholic liver disease hepatitis C cirrhosis) chronic kidney disease obesity metabolic bone disease fertility disorders (polycystic ovarian) sepsis

Cancer ndash breast prostate colorectal cancer lung endometrial ovarian hepatocellular melanoma urothelial renal cell pancreatic head amp neck bladder AML lymphoma

Healthy controls

bull Diverse biospecimen types Blood (serum plasma) tissue circulating tumor

cells circulating immune cells urine stool saliva cultures

bull Ethical Guidelines - Collected following the ethical guidelines of the Biobank Graz an international standard for Biobanking

bull Clinical Data Management - Clinical data collected in a clinical data management system in accordance with good clinical practice (GCP) CBmed has access to specimens with meticulous clinical characterization follow-up data and biomarker results

21

CONFIDENTIAL Property of CBmed

Close cooperation with large hospital organisations

22

CONFIDENTIAL Property of CBmed

Innovative use of Clinical Information for Biomarker Research

bull Access to biospecimens alone is worthless without associated high quality in-depth clinical data

bull CBmed works together with KAGes one of the largest hospital companies in Europe with a catchment area of 12 million people with the aim of developing IT solutions for extracting the relevant clinical data from structured and unstructured sources with a view to selecting the appropriate patients for biomarker research

Our Strengths

bull Expertise in

Data semantics

Biomedical Terminologies

Natural Language processing

Big data management (eg SAP HANA)

Predictive content analytics

23

CONFIDENTIAL Property of CBmed

Wide scope of RampD

Internal Biomarker Research Programmes

24

CONFIDENTIAL Property of CBmed

RampD Project Overview

Core Labs

NGS

Metabolomics

Immunology

Digital Pathology

MALDI-MS

Proteomics amp In-vivo Imaging

Disease Models (PDX ADX)

Technology Development eg electrochemical chip-based diagnostics

Patient Cohorts

AREA 1

Data amp Technology

Multi-omics

Clinical Data Management

Software

development ndash semantic

searching of clinical data

AREA 2

Cancer

AREA 3

Metabolism amp

Inflammation

bull Early Diagnostics including bull Tracking the Trace (CTCs in Urologic

Cancer) bull Metabolomics (Idiopathic Pulmonary

Arterial Hypertension) bull Sepsis amp Fungal Infection

bull Prognostic amp Predictive Markers (Patient Stratification) including bull Minimal Residual Disease in AML bull Immune Cell Characterisation as a

Biomarker in CRC bull Eukaryotic Initiation Factors in eg

Glioblastoma bull Biosensors for short-lived biomarkers

in diabetes bull Diabesity amp Cardiovascular disease

including microbiome analysis

bull Translation to Market bull Health Technology Assessment

25

CONFIDENTIAL Property of CBmed

Internal RampD Projects

bull Health technology assessment

Area 3 Metabolism

amp Inflammation

Area 1 Data

amp Technologies

Area 2 Cancer

bull Metabolomics bull Clinical information system bull Semantic data management

bull Next generation sequencing

bull Tracking the trace bull Minimal residual disease

and CAR T-cells

bull Diabesity

bull Cardiovascular disease bull Biosensors

bull Bone metabolism

bull Fertility bull Electrochemical biomarker detection

bull Liver function

bull Microbiome-gut-brain

bull Sepsis

bull Fungal infections

bull ADX models bull Eukaryotic initiation factors

bull Core Lab for Target Identify-cation and Probe Development

bull Clinical MALDI Applications bull Digital Pathology

bull Immunology bull Knowledge discovery amp data mining)

26

CONFIDENTIAL Property of CBmed

Disease Area Stronghold CANCER

OUR EXPERTISE Experts in Clinical Oncology and Pathology Deep clinical phenotyping through access to standardised clinical

documentation Pre-exisiting network of clinicians and researchers (basic amp

translational) Experience at clinical research including clinical trials

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

OUR SOLUTIONS Isolation amp analysis of circulating tumour cells (PARSORTIX amp Mobile Diagnostic System ndash blood

and other boldy fluids) Detection analysis and validation of circulating tumour DNA Development of discriminative multimarker panels for serum proteins and immune cell gene

expression signatures Highly sensitive method for detection of minimal residual disease in haematological malignancies Drug validation and development programmes (eg antibodies viral vector-based and anti-eIFs) Access to tumour tissue (patient amp autopsy derived) for generation of xenograft models (PDX amp

ADX)

27

CONFIDENTIAL Property of CBmed

Disease Area Stronghold METABOLISM amp INFLAMMATION

OUR EXPERTISE Experts in Clinical Endocrinology amp Metabolic Diseases In-vitro amp In-vivo analysis Experience of clinical study design planning and execution

OUR SOLUTIONS 16S rRNA microbiome profiling and analysis stand alone or in

combination with metabolomics (mass spectrometry) Gut permeability measurements (zonulin calprotectin

lactulosemannitol)

Assoc Prof Harald Sourij MD Area Leader Metab amp Inflamm

Clnical Endocrinologist

Assessment of neurochemical biomarkers by cerebral open flow microperfusion Non-invasive PET imaging methods for angiogenesis and inflammation in liver diseases Rodent models for various diseases (diabetes hepatocellular) Human glucose triple tracer techniques with tracers in accordance with GMP GLP and GCP

guidelines for meticulous characterization of glucose metabolism Glycerol tracer techniques for determination of lipid fluxes Lipidomics techniques for biomarker research in cardiovascular disease

28

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 18: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

BBMRI-ERIC Expert Centre

bull Expert centres are key intermediaries between public and private sectors performing the analysis of biological samples under internationally standardized conditions

bull Their main goals are to

Provide access to primary data that can easily be shared in contrast to biological samples and

Provide high-quality information from biological samples to industry for further product development

Quoted from bdquoBBMRI-ERIC-Associated Expert Centres Trusted Partners V20ldquo

18

CONFIDENTIAL Property of CBmed

Retrospective Cohort Assembly ndash An Example

Colon Cancer Cohort with Early and Late Relapse

bull A project was identified for validation of immune infiltration as a biomarker for colon cancer relapse

bull Inclusion and exclusion criteria were defined in an eCRF bull Feasibility request sent to the Biobank Graz for FFPE

biospecimens from 100 stage II amp III colon cancer patients

bull In collaboration with the Oncology Department of the Medical University of Graz the cohorts were further refined with data regarding clinical outcome

bull An application for ethics approval was submitted to the Ethics Department of the medical university of Graz The Ethics approval was successfullly granted

bull Tissue samples were pseudonymised and sent to CBmed for analysis

Immune Cell Biomarkers in Colon Cancer

19

CONFIDENTIAL Property of CBmed

Clinical Researchers amp Prospective Cohorts

Prospective cohorts have many benefits

bull control sampling time points to observed patient response to therapy

bull access to biospecimens not normally collected as routine

bull control of sampling procedures

bull collection of fresh cells and tissues required for analysis by eg flow cytometry MALDI-MS imaging and development of PDX models

CBmed has built strong collaborations with clinical researchers from the Medical Universities of Graz amp Vienna enabling the initiation of a wide range of prospective collections

20

CONFIDENTIAL Property of CBmed

Prospective Cohorts

bull CBmed Prospectively collects Biospecimens in the following indications Type 1 amp 2 diabetes inflammatory bowel disease cardiovascular disease liver disease

(NAFLD NASH alcoholic liver disease hepatitis C cirrhosis) chronic kidney disease obesity metabolic bone disease fertility disorders (polycystic ovarian) sepsis

Cancer ndash breast prostate colorectal cancer lung endometrial ovarian hepatocellular melanoma urothelial renal cell pancreatic head amp neck bladder AML lymphoma

Healthy controls

bull Diverse biospecimen types Blood (serum plasma) tissue circulating tumor

cells circulating immune cells urine stool saliva cultures

bull Ethical Guidelines - Collected following the ethical guidelines of the Biobank Graz an international standard for Biobanking

bull Clinical Data Management - Clinical data collected in a clinical data management system in accordance with good clinical practice (GCP) CBmed has access to specimens with meticulous clinical characterization follow-up data and biomarker results

21

CONFIDENTIAL Property of CBmed

Close cooperation with large hospital organisations

22

CONFIDENTIAL Property of CBmed

Innovative use of Clinical Information for Biomarker Research

bull Access to biospecimens alone is worthless without associated high quality in-depth clinical data

bull CBmed works together with KAGes one of the largest hospital companies in Europe with a catchment area of 12 million people with the aim of developing IT solutions for extracting the relevant clinical data from structured and unstructured sources with a view to selecting the appropriate patients for biomarker research

Our Strengths

bull Expertise in

Data semantics

Biomedical Terminologies

Natural Language processing

Big data management (eg SAP HANA)

Predictive content analytics

23

CONFIDENTIAL Property of CBmed

Wide scope of RampD

Internal Biomarker Research Programmes

24

CONFIDENTIAL Property of CBmed

RampD Project Overview

Core Labs

NGS

Metabolomics

Immunology

Digital Pathology

MALDI-MS

Proteomics amp In-vivo Imaging

Disease Models (PDX ADX)

Technology Development eg electrochemical chip-based diagnostics

Patient Cohorts

AREA 1

Data amp Technology

Multi-omics

Clinical Data Management

Software

development ndash semantic

searching of clinical data

AREA 2

Cancer

AREA 3

Metabolism amp

Inflammation

bull Early Diagnostics including bull Tracking the Trace (CTCs in Urologic

Cancer) bull Metabolomics (Idiopathic Pulmonary

Arterial Hypertension) bull Sepsis amp Fungal Infection

bull Prognostic amp Predictive Markers (Patient Stratification) including bull Minimal Residual Disease in AML bull Immune Cell Characterisation as a

Biomarker in CRC bull Eukaryotic Initiation Factors in eg

Glioblastoma bull Biosensors for short-lived biomarkers

in diabetes bull Diabesity amp Cardiovascular disease

including microbiome analysis

bull Translation to Market bull Health Technology Assessment

25

CONFIDENTIAL Property of CBmed

Internal RampD Projects

bull Health technology assessment

Area 3 Metabolism

amp Inflammation

Area 1 Data

amp Technologies

Area 2 Cancer

bull Metabolomics bull Clinical information system bull Semantic data management

bull Next generation sequencing

bull Tracking the trace bull Minimal residual disease

and CAR T-cells

bull Diabesity

bull Cardiovascular disease bull Biosensors

bull Bone metabolism

bull Fertility bull Electrochemical biomarker detection

bull Liver function

bull Microbiome-gut-brain

bull Sepsis

bull Fungal infections

bull ADX models bull Eukaryotic initiation factors

bull Core Lab for Target Identify-cation and Probe Development

bull Clinical MALDI Applications bull Digital Pathology

bull Immunology bull Knowledge discovery amp data mining)

26

CONFIDENTIAL Property of CBmed

Disease Area Stronghold CANCER

OUR EXPERTISE Experts in Clinical Oncology and Pathology Deep clinical phenotyping through access to standardised clinical

documentation Pre-exisiting network of clinicians and researchers (basic amp

translational) Experience at clinical research including clinical trials

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

OUR SOLUTIONS Isolation amp analysis of circulating tumour cells (PARSORTIX amp Mobile Diagnostic System ndash blood

and other boldy fluids) Detection analysis and validation of circulating tumour DNA Development of discriminative multimarker panels for serum proteins and immune cell gene

expression signatures Highly sensitive method for detection of minimal residual disease in haematological malignancies Drug validation and development programmes (eg antibodies viral vector-based and anti-eIFs) Access to tumour tissue (patient amp autopsy derived) for generation of xenograft models (PDX amp

ADX)

27

CONFIDENTIAL Property of CBmed

Disease Area Stronghold METABOLISM amp INFLAMMATION

OUR EXPERTISE Experts in Clinical Endocrinology amp Metabolic Diseases In-vitro amp In-vivo analysis Experience of clinical study design planning and execution

OUR SOLUTIONS 16S rRNA microbiome profiling and analysis stand alone or in

combination with metabolomics (mass spectrometry) Gut permeability measurements (zonulin calprotectin

lactulosemannitol)

Assoc Prof Harald Sourij MD Area Leader Metab amp Inflamm

Clnical Endocrinologist

Assessment of neurochemical biomarkers by cerebral open flow microperfusion Non-invasive PET imaging methods for angiogenesis and inflammation in liver diseases Rodent models for various diseases (diabetes hepatocellular) Human glucose triple tracer techniques with tracers in accordance with GMP GLP and GCP

guidelines for meticulous characterization of glucose metabolism Glycerol tracer techniques for determination of lipid fluxes Lipidomics techniques for biomarker research in cardiovascular disease

28

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 19: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Retrospective Cohort Assembly ndash An Example

Colon Cancer Cohort with Early and Late Relapse

bull A project was identified for validation of immune infiltration as a biomarker for colon cancer relapse

bull Inclusion and exclusion criteria were defined in an eCRF bull Feasibility request sent to the Biobank Graz for FFPE

biospecimens from 100 stage II amp III colon cancer patients

bull In collaboration with the Oncology Department of the Medical University of Graz the cohorts were further refined with data regarding clinical outcome

bull An application for ethics approval was submitted to the Ethics Department of the medical university of Graz The Ethics approval was successfullly granted

bull Tissue samples were pseudonymised and sent to CBmed for analysis

Immune Cell Biomarkers in Colon Cancer

19

CONFIDENTIAL Property of CBmed

Clinical Researchers amp Prospective Cohorts

Prospective cohorts have many benefits

bull control sampling time points to observed patient response to therapy

bull access to biospecimens not normally collected as routine

bull control of sampling procedures

bull collection of fresh cells and tissues required for analysis by eg flow cytometry MALDI-MS imaging and development of PDX models

CBmed has built strong collaborations with clinical researchers from the Medical Universities of Graz amp Vienna enabling the initiation of a wide range of prospective collections

20

CONFIDENTIAL Property of CBmed

Prospective Cohorts

bull CBmed Prospectively collects Biospecimens in the following indications Type 1 amp 2 diabetes inflammatory bowel disease cardiovascular disease liver disease

(NAFLD NASH alcoholic liver disease hepatitis C cirrhosis) chronic kidney disease obesity metabolic bone disease fertility disorders (polycystic ovarian) sepsis

Cancer ndash breast prostate colorectal cancer lung endometrial ovarian hepatocellular melanoma urothelial renal cell pancreatic head amp neck bladder AML lymphoma

Healthy controls

bull Diverse biospecimen types Blood (serum plasma) tissue circulating tumor

cells circulating immune cells urine stool saliva cultures

bull Ethical Guidelines - Collected following the ethical guidelines of the Biobank Graz an international standard for Biobanking

bull Clinical Data Management - Clinical data collected in a clinical data management system in accordance with good clinical practice (GCP) CBmed has access to specimens with meticulous clinical characterization follow-up data and biomarker results

21

CONFIDENTIAL Property of CBmed

Close cooperation with large hospital organisations

22

CONFIDENTIAL Property of CBmed

Innovative use of Clinical Information for Biomarker Research

bull Access to biospecimens alone is worthless without associated high quality in-depth clinical data

bull CBmed works together with KAGes one of the largest hospital companies in Europe with a catchment area of 12 million people with the aim of developing IT solutions for extracting the relevant clinical data from structured and unstructured sources with a view to selecting the appropriate patients for biomarker research

Our Strengths

bull Expertise in

Data semantics

Biomedical Terminologies

Natural Language processing

Big data management (eg SAP HANA)

Predictive content analytics

23

CONFIDENTIAL Property of CBmed

Wide scope of RampD

Internal Biomarker Research Programmes

24

CONFIDENTIAL Property of CBmed

RampD Project Overview

Core Labs

NGS

Metabolomics

Immunology

Digital Pathology

MALDI-MS

Proteomics amp In-vivo Imaging

Disease Models (PDX ADX)

Technology Development eg electrochemical chip-based diagnostics

Patient Cohorts

AREA 1

Data amp Technology

Multi-omics

Clinical Data Management

Software

development ndash semantic

searching of clinical data

AREA 2

Cancer

AREA 3

Metabolism amp

Inflammation

bull Early Diagnostics including bull Tracking the Trace (CTCs in Urologic

Cancer) bull Metabolomics (Idiopathic Pulmonary

Arterial Hypertension) bull Sepsis amp Fungal Infection

bull Prognostic amp Predictive Markers (Patient Stratification) including bull Minimal Residual Disease in AML bull Immune Cell Characterisation as a

Biomarker in CRC bull Eukaryotic Initiation Factors in eg

Glioblastoma bull Biosensors for short-lived biomarkers

in diabetes bull Diabesity amp Cardiovascular disease

including microbiome analysis

bull Translation to Market bull Health Technology Assessment

25

CONFIDENTIAL Property of CBmed

Internal RampD Projects

bull Health technology assessment

Area 3 Metabolism

amp Inflammation

Area 1 Data

amp Technologies

Area 2 Cancer

bull Metabolomics bull Clinical information system bull Semantic data management

bull Next generation sequencing

bull Tracking the trace bull Minimal residual disease

and CAR T-cells

bull Diabesity

bull Cardiovascular disease bull Biosensors

bull Bone metabolism

bull Fertility bull Electrochemical biomarker detection

bull Liver function

bull Microbiome-gut-brain

bull Sepsis

bull Fungal infections

bull ADX models bull Eukaryotic initiation factors

bull Core Lab for Target Identify-cation and Probe Development

bull Clinical MALDI Applications bull Digital Pathology

bull Immunology bull Knowledge discovery amp data mining)

26

CONFIDENTIAL Property of CBmed

Disease Area Stronghold CANCER

OUR EXPERTISE Experts in Clinical Oncology and Pathology Deep clinical phenotyping through access to standardised clinical

documentation Pre-exisiting network of clinicians and researchers (basic amp

translational) Experience at clinical research including clinical trials

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

OUR SOLUTIONS Isolation amp analysis of circulating tumour cells (PARSORTIX amp Mobile Diagnostic System ndash blood

and other boldy fluids) Detection analysis and validation of circulating tumour DNA Development of discriminative multimarker panels for serum proteins and immune cell gene

expression signatures Highly sensitive method for detection of minimal residual disease in haematological malignancies Drug validation and development programmes (eg antibodies viral vector-based and anti-eIFs) Access to tumour tissue (patient amp autopsy derived) for generation of xenograft models (PDX amp

ADX)

27

CONFIDENTIAL Property of CBmed

Disease Area Stronghold METABOLISM amp INFLAMMATION

OUR EXPERTISE Experts in Clinical Endocrinology amp Metabolic Diseases In-vitro amp In-vivo analysis Experience of clinical study design planning and execution

OUR SOLUTIONS 16S rRNA microbiome profiling and analysis stand alone or in

combination with metabolomics (mass spectrometry) Gut permeability measurements (zonulin calprotectin

lactulosemannitol)

Assoc Prof Harald Sourij MD Area Leader Metab amp Inflamm

Clnical Endocrinologist

Assessment of neurochemical biomarkers by cerebral open flow microperfusion Non-invasive PET imaging methods for angiogenesis and inflammation in liver diseases Rodent models for various diseases (diabetes hepatocellular) Human glucose triple tracer techniques with tracers in accordance with GMP GLP and GCP

guidelines for meticulous characterization of glucose metabolism Glycerol tracer techniques for determination of lipid fluxes Lipidomics techniques for biomarker research in cardiovascular disease

28

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 20: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Clinical Researchers amp Prospective Cohorts

Prospective cohorts have many benefits

bull control sampling time points to observed patient response to therapy

bull access to biospecimens not normally collected as routine

bull control of sampling procedures

bull collection of fresh cells and tissues required for analysis by eg flow cytometry MALDI-MS imaging and development of PDX models

CBmed has built strong collaborations with clinical researchers from the Medical Universities of Graz amp Vienna enabling the initiation of a wide range of prospective collections

20

CONFIDENTIAL Property of CBmed

Prospective Cohorts

bull CBmed Prospectively collects Biospecimens in the following indications Type 1 amp 2 diabetes inflammatory bowel disease cardiovascular disease liver disease

(NAFLD NASH alcoholic liver disease hepatitis C cirrhosis) chronic kidney disease obesity metabolic bone disease fertility disorders (polycystic ovarian) sepsis

Cancer ndash breast prostate colorectal cancer lung endometrial ovarian hepatocellular melanoma urothelial renal cell pancreatic head amp neck bladder AML lymphoma

Healthy controls

bull Diverse biospecimen types Blood (serum plasma) tissue circulating tumor

cells circulating immune cells urine stool saliva cultures

bull Ethical Guidelines - Collected following the ethical guidelines of the Biobank Graz an international standard for Biobanking

bull Clinical Data Management - Clinical data collected in a clinical data management system in accordance with good clinical practice (GCP) CBmed has access to specimens with meticulous clinical characterization follow-up data and biomarker results

21

CONFIDENTIAL Property of CBmed

Close cooperation with large hospital organisations

22

CONFIDENTIAL Property of CBmed

Innovative use of Clinical Information for Biomarker Research

bull Access to biospecimens alone is worthless without associated high quality in-depth clinical data

bull CBmed works together with KAGes one of the largest hospital companies in Europe with a catchment area of 12 million people with the aim of developing IT solutions for extracting the relevant clinical data from structured and unstructured sources with a view to selecting the appropriate patients for biomarker research

Our Strengths

bull Expertise in

Data semantics

Biomedical Terminologies

Natural Language processing

Big data management (eg SAP HANA)

Predictive content analytics

23

CONFIDENTIAL Property of CBmed

Wide scope of RampD

Internal Biomarker Research Programmes

24

CONFIDENTIAL Property of CBmed

RampD Project Overview

Core Labs

NGS

Metabolomics

Immunology

Digital Pathology

MALDI-MS

Proteomics amp In-vivo Imaging

Disease Models (PDX ADX)

Technology Development eg electrochemical chip-based diagnostics

Patient Cohorts

AREA 1

Data amp Technology

Multi-omics

Clinical Data Management

Software

development ndash semantic

searching of clinical data

AREA 2

Cancer

AREA 3

Metabolism amp

Inflammation

bull Early Diagnostics including bull Tracking the Trace (CTCs in Urologic

Cancer) bull Metabolomics (Idiopathic Pulmonary

Arterial Hypertension) bull Sepsis amp Fungal Infection

bull Prognostic amp Predictive Markers (Patient Stratification) including bull Minimal Residual Disease in AML bull Immune Cell Characterisation as a

Biomarker in CRC bull Eukaryotic Initiation Factors in eg

Glioblastoma bull Biosensors for short-lived biomarkers

in diabetes bull Diabesity amp Cardiovascular disease

including microbiome analysis

bull Translation to Market bull Health Technology Assessment

25

CONFIDENTIAL Property of CBmed

Internal RampD Projects

bull Health technology assessment

Area 3 Metabolism

amp Inflammation

Area 1 Data

amp Technologies

Area 2 Cancer

bull Metabolomics bull Clinical information system bull Semantic data management

bull Next generation sequencing

bull Tracking the trace bull Minimal residual disease

and CAR T-cells

bull Diabesity

bull Cardiovascular disease bull Biosensors

bull Bone metabolism

bull Fertility bull Electrochemical biomarker detection

bull Liver function

bull Microbiome-gut-brain

bull Sepsis

bull Fungal infections

bull ADX models bull Eukaryotic initiation factors

bull Core Lab for Target Identify-cation and Probe Development

bull Clinical MALDI Applications bull Digital Pathology

bull Immunology bull Knowledge discovery amp data mining)

26

CONFIDENTIAL Property of CBmed

Disease Area Stronghold CANCER

OUR EXPERTISE Experts in Clinical Oncology and Pathology Deep clinical phenotyping through access to standardised clinical

documentation Pre-exisiting network of clinicians and researchers (basic amp

translational) Experience at clinical research including clinical trials

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

OUR SOLUTIONS Isolation amp analysis of circulating tumour cells (PARSORTIX amp Mobile Diagnostic System ndash blood

and other boldy fluids) Detection analysis and validation of circulating tumour DNA Development of discriminative multimarker panels for serum proteins and immune cell gene

expression signatures Highly sensitive method for detection of minimal residual disease in haematological malignancies Drug validation and development programmes (eg antibodies viral vector-based and anti-eIFs) Access to tumour tissue (patient amp autopsy derived) for generation of xenograft models (PDX amp

ADX)

27

CONFIDENTIAL Property of CBmed

Disease Area Stronghold METABOLISM amp INFLAMMATION

OUR EXPERTISE Experts in Clinical Endocrinology amp Metabolic Diseases In-vitro amp In-vivo analysis Experience of clinical study design planning and execution

OUR SOLUTIONS 16S rRNA microbiome profiling and analysis stand alone or in

combination with metabolomics (mass spectrometry) Gut permeability measurements (zonulin calprotectin

lactulosemannitol)

Assoc Prof Harald Sourij MD Area Leader Metab amp Inflamm

Clnical Endocrinologist

Assessment of neurochemical biomarkers by cerebral open flow microperfusion Non-invasive PET imaging methods for angiogenesis and inflammation in liver diseases Rodent models for various diseases (diabetes hepatocellular) Human glucose triple tracer techniques with tracers in accordance with GMP GLP and GCP

guidelines for meticulous characterization of glucose metabolism Glycerol tracer techniques for determination of lipid fluxes Lipidomics techniques for biomarker research in cardiovascular disease

28

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 21: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Prospective Cohorts

bull CBmed Prospectively collects Biospecimens in the following indications Type 1 amp 2 diabetes inflammatory bowel disease cardiovascular disease liver disease

(NAFLD NASH alcoholic liver disease hepatitis C cirrhosis) chronic kidney disease obesity metabolic bone disease fertility disorders (polycystic ovarian) sepsis

Cancer ndash breast prostate colorectal cancer lung endometrial ovarian hepatocellular melanoma urothelial renal cell pancreatic head amp neck bladder AML lymphoma

Healthy controls

bull Diverse biospecimen types Blood (serum plasma) tissue circulating tumor

cells circulating immune cells urine stool saliva cultures

bull Ethical Guidelines - Collected following the ethical guidelines of the Biobank Graz an international standard for Biobanking

bull Clinical Data Management - Clinical data collected in a clinical data management system in accordance with good clinical practice (GCP) CBmed has access to specimens with meticulous clinical characterization follow-up data and biomarker results

21

CONFIDENTIAL Property of CBmed

Close cooperation with large hospital organisations

22

CONFIDENTIAL Property of CBmed

Innovative use of Clinical Information for Biomarker Research

bull Access to biospecimens alone is worthless without associated high quality in-depth clinical data

bull CBmed works together with KAGes one of the largest hospital companies in Europe with a catchment area of 12 million people with the aim of developing IT solutions for extracting the relevant clinical data from structured and unstructured sources with a view to selecting the appropriate patients for biomarker research

Our Strengths

bull Expertise in

Data semantics

Biomedical Terminologies

Natural Language processing

Big data management (eg SAP HANA)

Predictive content analytics

23

CONFIDENTIAL Property of CBmed

Wide scope of RampD

Internal Biomarker Research Programmes

24

CONFIDENTIAL Property of CBmed

RampD Project Overview

Core Labs

NGS

Metabolomics

Immunology

Digital Pathology

MALDI-MS

Proteomics amp In-vivo Imaging

Disease Models (PDX ADX)

Technology Development eg electrochemical chip-based diagnostics

Patient Cohorts

AREA 1

Data amp Technology

Multi-omics

Clinical Data Management

Software

development ndash semantic

searching of clinical data

AREA 2

Cancer

AREA 3

Metabolism amp

Inflammation

bull Early Diagnostics including bull Tracking the Trace (CTCs in Urologic

Cancer) bull Metabolomics (Idiopathic Pulmonary

Arterial Hypertension) bull Sepsis amp Fungal Infection

bull Prognostic amp Predictive Markers (Patient Stratification) including bull Minimal Residual Disease in AML bull Immune Cell Characterisation as a

Biomarker in CRC bull Eukaryotic Initiation Factors in eg

Glioblastoma bull Biosensors for short-lived biomarkers

in diabetes bull Diabesity amp Cardiovascular disease

including microbiome analysis

bull Translation to Market bull Health Technology Assessment

25

CONFIDENTIAL Property of CBmed

Internal RampD Projects

bull Health technology assessment

Area 3 Metabolism

amp Inflammation

Area 1 Data

amp Technologies

Area 2 Cancer

bull Metabolomics bull Clinical information system bull Semantic data management

bull Next generation sequencing

bull Tracking the trace bull Minimal residual disease

and CAR T-cells

bull Diabesity

bull Cardiovascular disease bull Biosensors

bull Bone metabolism

bull Fertility bull Electrochemical biomarker detection

bull Liver function

bull Microbiome-gut-brain

bull Sepsis

bull Fungal infections

bull ADX models bull Eukaryotic initiation factors

bull Core Lab for Target Identify-cation and Probe Development

bull Clinical MALDI Applications bull Digital Pathology

bull Immunology bull Knowledge discovery amp data mining)

26

CONFIDENTIAL Property of CBmed

Disease Area Stronghold CANCER

OUR EXPERTISE Experts in Clinical Oncology and Pathology Deep clinical phenotyping through access to standardised clinical

documentation Pre-exisiting network of clinicians and researchers (basic amp

translational) Experience at clinical research including clinical trials

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

OUR SOLUTIONS Isolation amp analysis of circulating tumour cells (PARSORTIX amp Mobile Diagnostic System ndash blood

and other boldy fluids) Detection analysis and validation of circulating tumour DNA Development of discriminative multimarker panels for serum proteins and immune cell gene

expression signatures Highly sensitive method for detection of minimal residual disease in haematological malignancies Drug validation and development programmes (eg antibodies viral vector-based and anti-eIFs) Access to tumour tissue (patient amp autopsy derived) for generation of xenograft models (PDX amp

ADX)

27

CONFIDENTIAL Property of CBmed

Disease Area Stronghold METABOLISM amp INFLAMMATION

OUR EXPERTISE Experts in Clinical Endocrinology amp Metabolic Diseases In-vitro amp In-vivo analysis Experience of clinical study design planning and execution

OUR SOLUTIONS 16S rRNA microbiome profiling and analysis stand alone or in

combination with metabolomics (mass spectrometry) Gut permeability measurements (zonulin calprotectin

lactulosemannitol)

Assoc Prof Harald Sourij MD Area Leader Metab amp Inflamm

Clnical Endocrinologist

Assessment of neurochemical biomarkers by cerebral open flow microperfusion Non-invasive PET imaging methods for angiogenesis and inflammation in liver diseases Rodent models for various diseases (diabetes hepatocellular) Human glucose triple tracer techniques with tracers in accordance with GMP GLP and GCP

guidelines for meticulous characterization of glucose metabolism Glycerol tracer techniques for determination of lipid fluxes Lipidomics techniques for biomarker research in cardiovascular disease

28

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 22: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Close cooperation with large hospital organisations

22

CONFIDENTIAL Property of CBmed

Innovative use of Clinical Information for Biomarker Research

bull Access to biospecimens alone is worthless without associated high quality in-depth clinical data

bull CBmed works together with KAGes one of the largest hospital companies in Europe with a catchment area of 12 million people with the aim of developing IT solutions for extracting the relevant clinical data from structured and unstructured sources with a view to selecting the appropriate patients for biomarker research

Our Strengths

bull Expertise in

Data semantics

Biomedical Terminologies

Natural Language processing

Big data management (eg SAP HANA)

Predictive content analytics

23

CONFIDENTIAL Property of CBmed

Wide scope of RampD

Internal Biomarker Research Programmes

24

CONFIDENTIAL Property of CBmed

RampD Project Overview

Core Labs

NGS

Metabolomics

Immunology

Digital Pathology

MALDI-MS

Proteomics amp In-vivo Imaging

Disease Models (PDX ADX)

Technology Development eg electrochemical chip-based diagnostics

Patient Cohorts

AREA 1

Data amp Technology

Multi-omics

Clinical Data Management

Software

development ndash semantic

searching of clinical data

AREA 2

Cancer

AREA 3

Metabolism amp

Inflammation

bull Early Diagnostics including bull Tracking the Trace (CTCs in Urologic

Cancer) bull Metabolomics (Idiopathic Pulmonary

Arterial Hypertension) bull Sepsis amp Fungal Infection

bull Prognostic amp Predictive Markers (Patient Stratification) including bull Minimal Residual Disease in AML bull Immune Cell Characterisation as a

Biomarker in CRC bull Eukaryotic Initiation Factors in eg

Glioblastoma bull Biosensors for short-lived biomarkers

in diabetes bull Diabesity amp Cardiovascular disease

including microbiome analysis

bull Translation to Market bull Health Technology Assessment

25

CONFIDENTIAL Property of CBmed

Internal RampD Projects

bull Health technology assessment

Area 3 Metabolism

amp Inflammation

Area 1 Data

amp Technologies

Area 2 Cancer

bull Metabolomics bull Clinical information system bull Semantic data management

bull Next generation sequencing

bull Tracking the trace bull Minimal residual disease

and CAR T-cells

bull Diabesity

bull Cardiovascular disease bull Biosensors

bull Bone metabolism

bull Fertility bull Electrochemical biomarker detection

bull Liver function

bull Microbiome-gut-brain

bull Sepsis

bull Fungal infections

bull ADX models bull Eukaryotic initiation factors

bull Core Lab for Target Identify-cation and Probe Development

bull Clinical MALDI Applications bull Digital Pathology

bull Immunology bull Knowledge discovery amp data mining)

26

CONFIDENTIAL Property of CBmed

Disease Area Stronghold CANCER

OUR EXPERTISE Experts in Clinical Oncology and Pathology Deep clinical phenotyping through access to standardised clinical

documentation Pre-exisiting network of clinicians and researchers (basic amp

translational) Experience at clinical research including clinical trials

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

OUR SOLUTIONS Isolation amp analysis of circulating tumour cells (PARSORTIX amp Mobile Diagnostic System ndash blood

and other boldy fluids) Detection analysis and validation of circulating tumour DNA Development of discriminative multimarker panels for serum proteins and immune cell gene

expression signatures Highly sensitive method for detection of minimal residual disease in haematological malignancies Drug validation and development programmes (eg antibodies viral vector-based and anti-eIFs) Access to tumour tissue (patient amp autopsy derived) for generation of xenograft models (PDX amp

ADX)

27

CONFIDENTIAL Property of CBmed

Disease Area Stronghold METABOLISM amp INFLAMMATION

OUR EXPERTISE Experts in Clinical Endocrinology amp Metabolic Diseases In-vitro amp In-vivo analysis Experience of clinical study design planning and execution

OUR SOLUTIONS 16S rRNA microbiome profiling and analysis stand alone or in

combination with metabolomics (mass spectrometry) Gut permeability measurements (zonulin calprotectin

lactulosemannitol)

Assoc Prof Harald Sourij MD Area Leader Metab amp Inflamm

Clnical Endocrinologist

Assessment of neurochemical biomarkers by cerebral open flow microperfusion Non-invasive PET imaging methods for angiogenesis and inflammation in liver diseases Rodent models for various diseases (diabetes hepatocellular) Human glucose triple tracer techniques with tracers in accordance with GMP GLP and GCP

guidelines for meticulous characterization of glucose metabolism Glycerol tracer techniques for determination of lipid fluxes Lipidomics techniques for biomarker research in cardiovascular disease

28

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 23: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Innovative use of Clinical Information for Biomarker Research

bull Access to biospecimens alone is worthless without associated high quality in-depth clinical data

bull CBmed works together with KAGes one of the largest hospital companies in Europe with a catchment area of 12 million people with the aim of developing IT solutions for extracting the relevant clinical data from structured and unstructured sources with a view to selecting the appropriate patients for biomarker research

Our Strengths

bull Expertise in

Data semantics

Biomedical Terminologies

Natural Language processing

Big data management (eg SAP HANA)

Predictive content analytics

23

CONFIDENTIAL Property of CBmed

Wide scope of RampD

Internal Biomarker Research Programmes

24

CONFIDENTIAL Property of CBmed

RampD Project Overview

Core Labs

NGS

Metabolomics

Immunology

Digital Pathology

MALDI-MS

Proteomics amp In-vivo Imaging

Disease Models (PDX ADX)

Technology Development eg electrochemical chip-based diagnostics

Patient Cohorts

AREA 1

Data amp Technology

Multi-omics

Clinical Data Management

Software

development ndash semantic

searching of clinical data

AREA 2

Cancer

AREA 3

Metabolism amp

Inflammation

bull Early Diagnostics including bull Tracking the Trace (CTCs in Urologic

Cancer) bull Metabolomics (Idiopathic Pulmonary

Arterial Hypertension) bull Sepsis amp Fungal Infection

bull Prognostic amp Predictive Markers (Patient Stratification) including bull Minimal Residual Disease in AML bull Immune Cell Characterisation as a

Biomarker in CRC bull Eukaryotic Initiation Factors in eg

Glioblastoma bull Biosensors for short-lived biomarkers

in diabetes bull Diabesity amp Cardiovascular disease

including microbiome analysis

bull Translation to Market bull Health Technology Assessment

25

CONFIDENTIAL Property of CBmed

Internal RampD Projects

bull Health technology assessment

Area 3 Metabolism

amp Inflammation

Area 1 Data

amp Technologies

Area 2 Cancer

bull Metabolomics bull Clinical information system bull Semantic data management

bull Next generation sequencing

bull Tracking the trace bull Minimal residual disease

and CAR T-cells

bull Diabesity

bull Cardiovascular disease bull Biosensors

bull Bone metabolism

bull Fertility bull Electrochemical biomarker detection

bull Liver function

bull Microbiome-gut-brain

bull Sepsis

bull Fungal infections

bull ADX models bull Eukaryotic initiation factors

bull Core Lab for Target Identify-cation and Probe Development

bull Clinical MALDI Applications bull Digital Pathology

bull Immunology bull Knowledge discovery amp data mining)

26

CONFIDENTIAL Property of CBmed

Disease Area Stronghold CANCER

OUR EXPERTISE Experts in Clinical Oncology and Pathology Deep clinical phenotyping through access to standardised clinical

documentation Pre-exisiting network of clinicians and researchers (basic amp

translational) Experience at clinical research including clinical trials

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

OUR SOLUTIONS Isolation amp analysis of circulating tumour cells (PARSORTIX amp Mobile Diagnostic System ndash blood

and other boldy fluids) Detection analysis and validation of circulating tumour DNA Development of discriminative multimarker panels for serum proteins and immune cell gene

expression signatures Highly sensitive method for detection of minimal residual disease in haematological malignancies Drug validation and development programmes (eg antibodies viral vector-based and anti-eIFs) Access to tumour tissue (patient amp autopsy derived) for generation of xenograft models (PDX amp

ADX)

27

CONFIDENTIAL Property of CBmed

Disease Area Stronghold METABOLISM amp INFLAMMATION

OUR EXPERTISE Experts in Clinical Endocrinology amp Metabolic Diseases In-vitro amp In-vivo analysis Experience of clinical study design planning and execution

OUR SOLUTIONS 16S rRNA microbiome profiling and analysis stand alone or in

combination with metabolomics (mass spectrometry) Gut permeability measurements (zonulin calprotectin

lactulosemannitol)

Assoc Prof Harald Sourij MD Area Leader Metab amp Inflamm

Clnical Endocrinologist

Assessment of neurochemical biomarkers by cerebral open flow microperfusion Non-invasive PET imaging methods for angiogenesis and inflammation in liver diseases Rodent models for various diseases (diabetes hepatocellular) Human glucose triple tracer techniques with tracers in accordance with GMP GLP and GCP

guidelines for meticulous characterization of glucose metabolism Glycerol tracer techniques for determination of lipid fluxes Lipidomics techniques for biomarker research in cardiovascular disease

28

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 24: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Wide scope of RampD

Internal Biomarker Research Programmes

24

CONFIDENTIAL Property of CBmed

RampD Project Overview

Core Labs

NGS

Metabolomics

Immunology

Digital Pathology

MALDI-MS

Proteomics amp In-vivo Imaging

Disease Models (PDX ADX)

Technology Development eg electrochemical chip-based diagnostics

Patient Cohorts

AREA 1

Data amp Technology

Multi-omics

Clinical Data Management

Software

development ndash semantic

searching of clinical data

AREA 2

Cancer

AREA 3

Metabolism amp

Inflammation

bull Early Diagnostics including bull Tracking the Trace (CTCs in Urologic

Cancer) bull Metabolomics (Idiopathic Pulmonary

Arterial Hypertension) bull Sepsis amp Fungal Infection

bull Prognostic amp Predictive Markers (Patient Stratification) including bull Minimal Residual Disease in AML bull Immune Cell Characterisation as a

Biomarker in CRC bull Eukaryotic Initiation Factors in eg

Glioblastoma bull Biosensors for short-lived biomarkers

in diabetes bull Diabesity amp Cardiovascular disease

including microbiome analysis

bull Translation to Market bull Health Technology Assessment

25

CONFIDENTIAL Property of CBmed

Internal RampD Projects

bull Health technology assessment

Area 3 Metabolism

amp Inflammation

Area 1 Data

amp Technologies

Area 2 Cancer

bull Metabolomics bull Clinical information system bull Semantic data management

bull Next generation sequencing

bull Tracking the trace bull Minimal residual disease

and CAR T-cells

bull Diabesity

bull Cardiovascular disease bull Biosensors

bull Bone metabolism

bull Fertility bull Electrochemical biomarker detection

bull Liver function

bull Microbiome-gut-brain

bull Sepsis

bull Fungal infections

bull ADX models bull Eukaryotic initiation factors

bull Core Lab for Target Identify-cation and Probe Development

bull Clinical MALDI Applications bull Digital Pathology

bull Immunology bull Knowledge discovery amp data mining)

26

CONFIDENTIAL Property of CBmed

Disease Area Stronghold CANCER

OUR EXPERTISE Experts in Clinical Oncology and Pathology Deep clinical phenotyping through access to standardised clinical

documentation Pre-exisiting network of clinicians and researchers (basic amp

translational) Experience at clinical research including clinical trials

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

OUR SOLUTIONS Isolation amp analysis of circulating tumour cells (PARSORTIX amp Mobile Diagnostic System ndash blood

and other boldy fluids) Detection analysis and validation of circulating tumour DNA Development of discriminative multimarker panels for serum proteins and immune cell gene

expression signatures Highly sensitive method for detection of minimal residual disease in haematological malignancies Drug validation and development programmes (eg antibodies viral vector-based and anti-eIFs) Access to tumour tissue (patient amp autopsy derived) for generation of xenograft models (PDX amp

ADX)

27

CONFIDENTIAL Property of CBmed

Disease Area Stronghold METABOLISM amp INFLAMMATION

OUR EXPERTISE Experts in Clinical Endocrinology amp Metabolic Diseases In-vitro amp In-vivo analysis Experience of clinical study design planning and execution

OUR SOLUTIONS 16S rRNA microbiome profiling and analysis stand alone or in

combination with metabolomics (mass spectrometry) Gut permeability measurements (zonulin calprotectin

lactulosemannitol)

Assoc Prof Harald Sourij MD Area Leader Metab amp Inflamm

Clnical Endocrinologist

Assessment of neurochemical biomarkers by cerebral open flow microperfusion Non-invasive PET imaging methods for angiogenesis and inflammation in liver diseases Rodent models for various diseases (diabetes hepatocellular) Human glucose triple tracer techniques with tracers in accordance with GMP GLP and GCP

guidelines for meticulous characterization of glucose metabolism Glycerol tracer techniques for determination of lipid fluxes Lipidomics techniques for biomarker research in cardiovascular disease

28

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 25: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

RampD Project Overview

Core Labs

NGS

Metabolomics

Immunology

Digital Pathology

MALDI-MS

Proteomics amp In-vivo Imaging

Disease Models (PDX ADX)

Technology Development eg electrochemical chip-based diagnostics

Patient Cohorts

AREA 1

Data amp Technology

Multi-omics

Clinical Data Management

Software

development ndash semantic

searching of clinical data

AREA 2

Cancer

AREA 3

Metabolism amp

Inflammation

bull Early Diagnostics including bull Tracking the Trace (CTCs in Urologic

Cancer) bull Metabolomics (Idiopathic Pulmonary

Arterial Hypertension) bull Sepsis amp Fungal Infection

bull Prognostic amp Predictive Markers (Patient Stratification) including bull Minimal Residual Disease in AML bull Immune Cell Characterisation as a

Biomarker in CRC bull Eukaryotic Initiation Factors in eg

Glioblastoma bull Biosensors for short-lived biomarkers

in diabetes bull Diabesity amp Cardiovascular disease

including microbiome analysis

bull Translation to Market bull Health Technology Assessment

25

CONFIDENTIAL Property of CBmed

Internal RampD Projects

bull Health technology assessment

Area 3 Metabolism

amp Inflammation

Area 1 Data

amp Technologies

Area 2 Cancer

bull Metabolomics bull Clinical information system bull Semantic data management

bull Next generation sequencing

bull Tracking the trace bull Minimal residual disease

and CAR T-cells

bull Diabesity

bull Cardiovascular disease bull Biosensors

bull Bone metabolism

bull Fertility bull Electrochemical biomarker detection

bull Liver function

bull Microbiome-gut-brain

bull Sepsis

bull Fungal infections

bull ADX models bull Eukaryotic initiation factors

bull Core Lab for Target Identify-cation and Probe Development

bull Clinical MALDI Applications bull Digital Pathology

bull Immunology bull Knowledge discovery amp data mining)

26

CONFIDENTIAL Property of CBmed

Disease Area Stronghold CANCER

OUR EXPERTISE Experts in Clinical Oncology and Pathology Deep clinical phenotyping through access to standardised clinical

documentation Pre-exisiting network of clinicians and researchers (basic amp

translational) Experience at clinical research including clinical trials

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

OUR SOLUTIONS Isolation amp analysis of circulating tumour cells (PARSORTIX amp Mobile Diagnostic System ndash blood

and other boldy fluids) Detection analysis and validation of circulating tumour DNA Development of discriminative multimarker panels for serum proteins and immune cell gene

expression signatures Highly sensitive method for detection of minimal residual disease in haematological malignancies Drug validation and development programmes (eg antibodies viral vector-based and anti-eIFs) Access to tumour tissue (patient amp autopsy derived) for generation of xenograft models (PDX amp

ADX)

27

CONFIDENTIAL Property of CBmed

Disease Area Stronghold METABOLISM amp INFLAMMATION

OUR EXPERTISE Experts in Clinical Endocrinology amp Metabolic Diseases In-vitro amp In-vivo analysis Experience of clinical study design planning and execution

OUR SOLUTIONS 16S rRNA microbiome profiling and analysis stand alone or in

combination with metabolomics (mass spectrometry) Gut permeability measurements (zonulin calprotectin

lactulosemannitol)

Assoc Prof Harald Sourij MD Area Leader Metab amp Inflamm

Clnical Endocrinologist

Assessment of neurochemical biomarkers by cerebral open flow microperfusion Non-invasive PET imaging methods for angiogenesis and inflammation in liver diseases Rodent models for various diseases (diabetes hepatocellular) Human glucose triple tracer techniques with tracers in accordance with GMP GLP and GCP

guidelines for meticulous characterization of glucose metabolism Glycerol tracer techniques for determination of lipid fluxes Lipidomics techniques for biomarker research in cardiovascular disease

28

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 26: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Internal RampD Projects

bull Health technology assessment

Area 3 Metabolism

amp Inflammation

Area 1 Data

amp Technologies

Area 2 Cancer

bull Metabolomics bull Clinical information system bull Semantic data management

bull Next generation sequencing

bull Tracking the trace bull Minimal residual disease

and CAR T-cells

bull Diabesity

bull Cardiovascular disease bull Biosensors

bull Bone metabolism

bull Fertility bull Electrochemical biomarker detection

bull Liver function

bull Microbiome-gut-brain

bull Sepsis

bull Fungal infections

bull ADX models bull Eukaryotic initiation factors

bull Core Lab for Target Identify-cation and Probe Development

bull Clinical MALDI Applications bull Digital Pathology

bull Immunology bull Knowledge discovery amp data mining)

26

CONFIDENTIAL Property of CBmed

Disease Area Stronghold CANCER

OUR EXPERTISE Experts in Clinical Oncology and Pathology Deep clinical phenotyping through access to standardised clinical

documentation Pre-exisiting network of clinicians and researchers (basic amp

translational) Experience at clinical research including clinical trials

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

OUR SOLUTIONS Isolation amp analysis of circulating tumour cells (PARSORTIX amp Mobile Diagnostic System ndash blood

and other boldy fluids) Detection analysis and validation of circulating tumour DNA Development of discriminative multimarker panels for serum proteins and immune cell gene

expression signatures Highly sensitive method for detection of minimal residual disease in haematological malignancies Drug validation and development programmes (eg antibodies viral vector-based and anti-eIFs) Access to tumour tissue (patient amp autopsy derived) for generation of xenograft models (PDX amp

ADX)

27

CONFIDENTIAL Property of CBmed

Disease Area Stronghold METABOLISM amp INFLAMMATION

OUR EXPERTISE Experts in Clinical Endocrinology amp Metabolic Diseases In-vitro amp In-vivo analysis Experience of clinical study design planning and execution

OUR SOLUTIONS 16S rRNA microbiome profiling and analysis stand alone or in

combination with metabolomics (mass spectrometry) Gut permeability measurements (zonulin calprotectin

lactulosemannitol)

Assoc Prof Harald Sourij MD Area Leader Metab amp Inflamm

Clnical Endocrinologist

Assessment of neurochemical biomarkers by cerebral open flow microperfusion Non-invasive PET imaging methods for angiogenesis and inflammation in liver diseases Rodent models for various diseases (diabetes hepatocellular) Human glucose triple tracer techniques with tracers in accordance with GMP GLP and GCP

guidelines for meticulous characterization of glucose metabolism Glycerol tracer techniques for determination of lipid fluxes Lipidomics techniques for biomarker research in cardiovascular disease

28

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 27: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Disease Area Stronghold CANCER

OUR EXPERTISE Experts in Clinical Oncology and Pathology Deep clinical phenotyping through access to standardised clinical

documentation Pre-exisiting network of clinicians and researchers (basic amp

translational) Experience at clinical research including clinical trials

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

OUR SOLUTIONS Isolation amp analysis of circulating tumour cells (PARSORTIX amp Mobile Diagnostic System ndash blood

and other boldy fluids) Detection analysis and validation of circulating tumour DNA Development of discriminative multimarker panels for serum proteins and immune cell gene

expression signatures Highly sensitive method for detection of minimal residual disease in haematological malignancies Drug validation and development programmes (eg antibodies viral vector-based and anti-eIFs) Access to tumour tissue (patient amp autopsy derived) for generation of xenograft models (PDX amp

ADX)

27

CONFIDENTIAL Property of CBmed

Disease Area Stronghold METABOLISM amp INFLAMMATION

OUR EXPERTISE Experts in Clinical Endocrinology amp Metabolic Diseases In-vitro amp In-vivo analysis Experience of clinical study design planning and execution

OUR SOLUTIONS 16S rRNA microbiome profiling and analysis stand alone or in

combination with metabolomics (mass spectrometry) Gut permeability measurements (zonulin calprotectin

lactulosemannitol)

Assoc Prof Harald Sourij MD Area Leader Metab amp Inflamm

Clnical Endocrinologist

Assessment of neurochemical biomarkers by cerebral open flow microperfusion Non-invasive PET imaging methods for angiogenesis and inflammation in liver diseases Rodent models for various diseases (diabetes hepatocellular) Human glucose triple tracer techniques with tracers in accordance with GMP GLP and GCP

guidelines for meticulous characterization of glucose metabolism Glycerol tracer techniques for determination of lipid fluxes Lipidomics techniques for biomarker research in cardiovascular disease

28

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 28: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Disease Area Stronghold METABOLISM amp INFLAMMATION

OUR EXPERTISE Experts in Clinical Endocrinology amp Metabolic Diseases In-vitro amp In-vivo analysis Experience of clinical study design planning and execution

OUR SOLUTIONS 16S rRNA microbiome profiling and analysis stand alone or in

combination with metabolomics (mass spectrometry) Gut permeability measurements (zonulin calprotectin

lactulosemannitol)

Assoc Prof Harald Sourij MD Area Leader Metab amp Inflamm

Clnical Endocrinologist

Assessment of neurochemical biomarkers by cerebral open flow microperfusion Non-invasive PET imaging methods for angiogenesis and inflammation in liver diseases Rodent models for various diseases (diabetes hepatocellular) Human glucose triple tracer techniques with tracers in accordance with GMP GLP and GCP

guidelines for meticulous characterization of glucose metabolism Glycerol tracer techniques for determination of lipid fluxes Lipidomics techniques for biomarker research in cardiovascular disease

28

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 29: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

CBmed Publications excerpt

29

PLoS One 2016 Jul 2511(7)e0159448 doi 101371journalpone0159448 eCollection 2016 Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection Stotz M12 Liegl-Atzwanger B3 Posch F1 Mrsic E1 Thalhammer M4 Stojakovic T5 Bezan A12 Pichler M167 Gerger A128 Szkandera J12

Curr Fungal Infect Rep 20161043-50 Epub 2016 Apr 7 Point of Care Testing for the Diagnosis of Fungal Infections Are We There Yet Prattes J1 Heldt S2 Eigl S2 Hoenigl M3

Brain Behav Immun 2016 Aug56140-55 doi 101016jbbi201602020 Epub 2016 Feb 23 Cognitive impairment by antibiotic-induced gut dysbiosis Analysis of gut microbiota-brain communication Froumlhlich EE1 Farzi A2 Mayerhofer R2 Reichmann F2 Jačan A2 Wagner B3 Zinser E3 Bordag N4 Magnes C5 Froumlhlich E6 Kashofer K7 Gorkiewicz G8 Holzer P9

PLoS One 2015 Oct 2810(10)e0141399 doi 101371journalpone0141399 eCollection 2015 Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome A Randomized Pilot Study Stadlbauer V1 Leber B2 Lemesch S1 Trajanoski S3 Bashir M4 Horvath A1 Tawdrous M1 Stojakovic T5 Fauler G5 Fickert P1 Houmlgenauer C1 Klymiuk I3 Stiegler P2 Lamprecht M6 Pieber TR7 Tripolt NJ4 Sourij H7

Atherosclerosis 2015 Sep242(1)141-4 doi 101016jatherosclerosis201505005 Epub 2015 Jul 8 Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome An open-label randomized study Tripolt NJ1 Leber B2 Triebl A3 Koumlfeler H4 Stadlbauer V5 Sourij H6

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 30: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Core Labs

30

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 31: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

CBmed Core Labs

31

Vienna

Graz

Core Lab Complete NGS Workflow

Core Lab Metabolomics

Core Lab Immunology

Core Lab Digital Pathology

Core Lab MALDI

Core Lab Proteomics amp

In-vivo Imaging

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 32: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Core Lab Metabolomics EXPERTISE AND TECHNOLOGY

The earliest available signs of any disease onset are alterations of the individuals metabolome often resulting from compensatory mechanisms which start long before clinical symptoms manifest Therefore the study of metabolomics is core to CBmed

EQUIPMENT PARK CBmed amp Joanneum Research bull Agilent 6495 UHPLC TrMSMS bull LC Triple Quad MSMS (Thermo TSQ) bull GC Triple Quad MSMS bull GCMS bull LC LTQ Orbitrap XL bull LC Exactive Plus bull UHPLC Q Exactive Robotic Liquid Handling Workstation

OUR SOLUTIONS GLP certified Metabolomics laboratories Several targeted metabolomics platforms (glycolysis TCA pentose phosphate

pathway AcylCoAs Polyamines) enabling absolute quantification Detection of novel unknown markers by untargeted MS

OUR EXPERTISE study design data generation analysis interpretation amp knowledge generation

In collaboration with the Joanneum Research

32

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 33: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Core Lab Application EARLY DETECTION OF IPAH

33

bull Novel minimally invasive biomarkers detected in blood

bull correlation of several fatty acids sums and ratios were found to correlate well with mPAP

disease severity (mean PAP in mmHg)

healthy

PH

Patent application submitted

Idiopathic Pulmonary Arterial Hypertension

severe disease

overall mortality 50 in 28 years life expectancy ~4 years

frequent psychiatric comorbidities panic disorder depression anxiety

therapy

PH care is very expensive - up to euro 300000 patient year

but currently no curative therapy

diagnosis

challenging with high numbers of unreported cases and late detection

gold standard is right heart catheterization

For more info regarding our methods see Froumlhlich et al 2016 Brain Behav Immun 56140-55

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 34: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Core Lab Immunology EXPERTISE AND TECHNOLOGY

34

Based on cutting edge Flow Cytometry phenotyping capabilities with detection of up to 18 markers simultaneously

CBmedrsquos key research interest in immunology revolves around the role of Regulatory T-cells in autoimmune disease (eg diabetes irritable bowel disease rheumatoid arthritis) and cancer (eg colorectal cancer)

OUR EXPERTISE High Quality Workflow (to Euroflow guidelines) Extensive experience of analysis from clinical trials Prospective collection of blood specimens from a variety of disease

areas Other methods include ELISA ELISpot Chemotaxis assay co-culture

assays proliferation and cell stimulation tests amp immortalized cultures

EQUIPMENT PARK bull LSR Fortessa cell analyzer BD bull FACS ARIA II BD (cell sorting)

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 35: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Core Lab Application CROSS DISEASE ANALYSIS OF T- AND B CELL SUBTYPES

35

FACS quantification of T- and B-cell subtypes in different diseases

bull More than 50 subtypes defined by surface and intracellular markers

bull 5 different panels with 12 fluorochromes per panel

bull Study cohort B cell subpopulation

in healthy control B cell subpopulation

in RA patient Healthy participants

Type 1 diabetes patients

Rheumatoid arthritis patients

Systemic lupus erythematodes patients

Systemic sclerosis patients

Colorectal cancer patients

Patients who receive renal transplantation

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 36: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Core Lab Digital Pathology EXPERTISE AND TECHNOLOGY

36

CBmedrsquos Digital Pathology workflow enables the addressing of key issues in biomarker research including heterogeneity and spatial relationship of the immune system with tumour and tumour microenvironment

Vectra System (PerkinElmer) is a cutting edge digital pathology system allowing indepth cell phenotyping through spectral unmixing technology and quantitative spatial analysis through image analysis and bioinformatics software (InForm amp Sportfire)

EQUIPMENT PARK bull Vectra System PerkinElmer bull Ventana Classic XT Ultra bull Dako Labvision Classic bull Further autostainers Sanovo amp Menarini bull Automated TMA robot

OUR METHODS Multiplex IHC Insitu RNA hybridization Histology from Cryo amp FFPE

tissue

OUR EXPERTISE Tumour Immunology Image Analysis Close collaboration with

Pathology department of the Medical Uni Graz

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 37: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Core Lab Application TUMOUR IMMUNOLOGY IN CRC

37

Investigation of distance measurements between specific immune cell subtypes and tumor cells as prognostic markers in colon cancer

Comparison of early relapse vs late relapse in stage II colon cancer

Above CD4 CD8 CD45R0 FoxP3 Cytokeratin DAPI Left Spatial distance between Cytotoxic T cells and nearest tumour cell

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 38: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Core Lab Genetics amp Genomics EXPERTISE AND TECHNOLOGY

38

EQUIPMENT PARK CBmed amp Medical Univ Graz bull Qiagen GeneReader bull Thermo Fisher Ion Torrent PGM and Proton bull Illumina MiSeq

Fast large-scale gene mutation analysis for molecular diagnostics in cancer

Elucidation of biological pathways by gene expression profiling

Microbiome diversity analysis in digestive system Identification of bacteria and fungi in infection and sepsis

OUR EXPERTISE Experience of clinical amp routine genetic sequencing analysis Biospecimen Quality - Working to relevant Molecular Diagnostics

Regulations eg ISO15189 Involved in working groups of the EU regarding quality regulations for

Companion Diagnositics Close collaboration with Pathology department of the Medical Univ Graz

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 39: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Core Lab Application LIQUID BIOPSY FOR FcNA BY NGS

39

bull Comparison of gene mutations between primary tumors distant metastases and blood with the aim of validating biomarkers from liquid biopsies

bull Cohorts from lung cancer colon cancer melanoma amp steatohepatitis

bull Investigation of the mutational spectra of primary tumor fcNA and metastases including prospective follow up studies

QIAGEN NGS complete workflow

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 40: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Core Lab MALDI-Mass Spectrometry

EXPERTISE AND TECHNOLOGY

40

MALDI MS is a sensitive and rapid technique for biomarker discovery in both tissues and liquids

CBmed aims to develop a MALDI-based technology platform for high throughput analysis of clinical samples

OUR EXPERTISE Biomarker discovery in tissue ndash tumor-infiltrating immune cells by MALDI-

MS imaging coupled with immunohistochemistry and micromanipulation Biomarker discovery in liquids ndash protein and lipid biomarkers in blood

from cardiovascular disease patients Close cooperation with Medical University of Vienna

EQUIPMENT PARK bull MALDI MS imaging bull LC-ESI bull MALDI-MS Kratos bull Micromanipulator TissueGnostics

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 41: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Core Lab Application DETECTION OF EXOSOMES IN CRC

41

Tumor cells release excessive amounts of exosomes which are suggested to influence tumor growth progression metastasis and drug resistance

Due to their easy accessability and representation of the parental (tumor) cells exosomes are promising biomarkers for diagnosis and prognosis

Hierarchical clustering analysis of 5 colon cancer cell lines by MALDI-MS

MALDI-MS for characterization of tumor exosomes MALDI-TOF-MS screening was developed on

exosomes isolated from colon cancer cell lines with different degrees of drug resistance

Screening detects molecule types in the mass range of mz 300-18000

Exosome screening will be applied to colon cancer patients with the view of developing novel prognostic biomarkers

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 42: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Core Lab Proteomics amp Invivo Imaging

EXPERTISE AND TECHNOLOGY

42

A complete and integrated workflow from target identification to probe development and correlation of in-vivo location with histopathological analysis Tumor biomarkers are investigated by whole proteome platforms for development of Imaging probes that visualize the individual tumor situation Our expertise Biomarker discovery through IHC-guided mass spectrometry-based

proteomics on huge archives of FFPE tissue Studies - strong research background in prostate and colorectal cancer Application - open for any input of novel target testing or stratification of

known targets by above listed methods Incorporation of tissue samples biomarker discovery from other CBmed

core labs Close cooperation with Medical University of Vienna

In-vivo probe production and imaging

TECHNOLOGIES CBmed amp Medical University of Vienna bull TissueFAXSSORT guided micro-digestion bull Mass Spectrometry based Proteomics bull In-vivo Probe Development bull In-vivo Imaging by PET or SPECT

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 43: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Core Lab Application WORK FLOW FROM DISCOVERY TO IMAGING

43

Biomarker discovery via mass spectrometry-based proteomics in FFPE tissue

Use of novel biomarkers for in-vivo probe design

Imaging of new biomarkers in-vivo and comparison with ex-vivo histology

Imaging of in-vivo probe in prostate cancer correlated with histology

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 44: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Fusion Technology

44

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 45: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

disease without relapse

disease with relapse

Digital Pathology

NGS

Proteomics

Metabol-omics

MALDI-MS Integrated Analysis

Flow Cytometry

Fusion Technology

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 46: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Fusion Technology

46

bull Proper use of biomarkers in clinical research increases the likelihood of approval by three times [1]

[1] Clinical Development Sucess Rates 2006-2015 BIO Industry Analysis June 2016

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 47: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Fusion Technology

47

Fuse CBmed Core Lab Technologies to increase the likelihood of

identifying relevant prognostic predictive biomarkers in

specific clinical settings

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 48: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Fusion Technology ndash Show case Colon cancer

48

bull Clinical need Colon cancer (CC) is the 3rd most common cancer worldwide In stage II CC surgical resection is the treatment of choice The clinical benefit of postoperative chemotherapy is unproven for stage II patients The existence of prognostic and predictive biomarkers would provide a strategy for stratifying patients for risk of tumor relapse which in turn would allow treatment options to be tailored to the individual

bull Aim Identifying a biomarker panel using a multi-OMICS approach to predict tumor recurrence in stage II colon cancer

bull Results are expected in mid 2017

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 49: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Fusion Technology - Advantages

49

bull Integrated approach to biomarker discovery by

Using modern CBmed Core Lab technologies

Combining the complimentary advantages of both targeted and untargeted methods for biomarker discovery

Integration of heterogeneous data through data management system and biostatistics

Standardising the workflow from feasibility check to cohort assembly Core Lab analysis and integrated data interpretation

bull Fast identification of biomarkers through parallel analysis

bull Novel insights into disease mechanisms through detection of biomarker patterns on a multibiomics level

bull Multiple site ndash single contact point ndash complete solution

bull Applicable and easily transferable for different research questions (various diseases identification of prognostic predictive and drugable biomarkers)

bull Network of Medical Universities and European biobanks

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 50: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed 50

AREA 1 Data + Technologies (incl CORE Labs) acting Armin Gerger MD12

AREA 2 Cancer Armin Gerger MD12

AREA 3 Metabolism amp Inflammation Harald Sourij MD12

Areas

CSO CFO Prof Thomas Pieber12 Ing Robert Fasching12

Assistance of CFO and HQ Assistance Marlies Friess MA Scientific Affairs Selma Mautner PhD1

HR Finance amp Controlling Petra Majcen1

Controlling Elke Pacher Mag (FH) Purchasing and PM Isabell Dolznig MSc1

EFQM Coordinator Nina Krisper MSc CBmed Coordinator Vienna Wolfgang Wadsak PhD1 IT Responsible Christian Peitler

CBmed HQ functions

Organization CBmed GmbH Valid as of October 04th 2016

Director Business Development Mag Thomas Weber1

Release Thomas Pieber Robert Fasching

1 CBmed Science Board members 2 CBmed Program Committee members

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 51: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed 51

Management Team

Prof Thomas Pieber MD

CSO

Ing Robert Fasching

CFO

Assoc Prof Armin Gerger MD Area Leader Cancer Clinical Oncologist

Assoc Prof Harald Sourij MD

Area Leader Metab amp Inflamm Clinical Endocrinologist

Selma Mautner PhD Scientific Affairs

Isabell Dolznig MSc Purchasing and PM

Petra Majcen Finance amp Controlling

and HR

Wolfgang Wadsak CBmed Coordinator

Vienna

Mag Thomas Weber Director Business Development

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 52: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism

CONFIDENTIAL Property of CBmed

Contact

52

For all queries please contact Thomas Weber Director Business Development Email thomaswebercbmedat Tel +43 (0)316 385 28813 Center for Biomarker Research in Medicine Stiftingtalstraszlige 5 8010 Graz Austria wwwcbmedat

Page 53: Center for Biomarker Research in Medicinecbmed.at/CBmed_Basis-Presentation.pdf · technologies with international and interdisciplinary expertise in the fields of cancer, metabolism