Investor Presentation · 2019-03-29 · GKT831 - Liver Fibrosis (NOX1/4 inhibitor) Primary Biliary...

Investor Presentation

April 2019

Inhibiting NOX enzymes to treat multiple diseases with high medical need

Euronext: GKTX

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Positive PBC interim efficacy data released on November 5 2018 - Full data expected in Spring 2019

Genkyotex: Establishing NOX inhibition as a new therapeutic class

We discover and develop oral small molecule NOX inhibitors— NOX enzymes are important since they control multiple stress responses pathways simultaneously — Activation of NOX enzymes is key in many multifactorial diseases

Lead asset GKT831: a potent anti fibrotic oral small molecule currently in Phase 2 testing— Two Phase 2 trials ongoing in liver fibrosis (PBC) and kidney fibrosis (DKD)— NIH sponsored Phase 2 trial in idiopathic pulmonary fibrosis (IPF) to be launched in H1 2019— Further potential in NASH and immuno-oncology

PBC trial: Positive interim efficacy results released November 5th, final results expected in Spring 2019 – 100% of patients have completed the full 24 week treatment

Partnership with Serum Institute of India Private Ltd (SIIPL) valued at up to €150 million plus royalties

Trading on Euronext as GKTX since March 2017— Cash and cash equivalents of €10.2 million as of December 31 2018, cash runway to end Q1 2020


Seasoned management team with international life sciences experience


Elias Papatheodorou Chief Executive Officer

25 years of experience in biotechnology and multinational companies

Ex- Philip Morris International, The Coca Cola Company, Novosom AG, MedigeneAG and Covagen AG

Covagen was acquired by Janssen Pharmaceuticals, a J&J Company.

Strong track record in fundraising, business and corporate development andlicensing transactions

Philippe WieselChief Medical Officer & EVP

Lead clinical research programs at Serono’s EU and US offices, including the phase3 program (ex-US) for Raptiva in psoriasis, leading to the first EMA approval of abiologic agent for psoriasis

Conducted basic research in the laboratories of Professor Edgar Haber at HarvardMedical School, and of Professor Hans Brunner at the Division of Hypertension inLausanne

Alexandre GrassinVP Finance & Administration

Diverse experiences in Finance with Novartis from 2007-2010 and Alexion from2010 to 2012

Financial Auditor with KPMG


Discovery platform delivers broad pipeline in diseases with high medical needPositive PBC interim efficacy data released on November 5 2018 - Full data in Spring 2019

GKT831 - Liver Fibrosis(NOX1/4 inhibitor)

Primary Biliary Cholangitis (PBC)(Positive interim efficacy data released November 5 2018)

GKT831 - Kidney Fibrosis(NOX1/4 inhibitor)

Diabetic Kidney Disease (DKD) in T1D(IIT1 funded by JDRF2 - Trial launched in H2 2017)

GKT831 - Lung Fibrosis(NOX1/4 inhibitor)

Idiopathic Pulmonary Fibrosis (IPF)(IIT funded by US NIH3 - Trial launch H1 2019)

NOX1 inhibitors Preclinical

Novel NOX inhibitors

Vaxiclase Pertussis vaccine (Licensed to SIIPL)

Preclinical Phase 1 Phase 2 Phase 3Program

Discovery

1Investigator initiated trial2 Juvenile Diabetes Research Foundation3 National Institutes of Health


NOX inhibitors: pathway based medicine addressing validated disease targets

NOX stands for a group of enzymes called NADPH Oxidases

NOX NOX1 NOX2 NOX3 NOX4 NOX5 DUOX1 DUOX2

VALIDATED DISEASE

PATHWAYS

DISEASE PROCESSES

Inflammation Angiogenesis Fibrosis Proliferation

A family of 7 enzymes that amplify multiple signaling pathways

VEGF PI3K TRPV1 NF-κB

NMDA(CNS)

TRPV1 (hearing loss)

TGFβ RAS RANKL TLR4 NA Thyroid hormone iodination


We focus on fibrotic diseases by targeting NOX1 and NOX4 with GKT831


NOX 1 & 4 are major drivers of fibrogenesis in multiple organsNOXs act upstream of targets such as TGF-β, MCP-1 and ASK1

*Sources: Brenner DA, Hepatology 2012, Brenner DA, PLoS One, 2015, Torok N, Free Radic Biol Med, 2012. Torok N, Gastroenterology, 2015; Thannickal V, Science Trans Med, 2014; Gray SP, Circulation, 2013

Quiescentfibroblast

LIVER INJURY

NOX/ROS

Proliferation

Contractility

Fibrogenesis

Matrix degradationMMP-2

Chemotaxis

Retinoid loss

WBC chemoattraction

FIBROSIS

Pathways amplified by NOX1/4

Activated myofibroblast

SteatosisCholestasis

Hep C/HepBAlcohol

FIBROGENIC PATHWAYS

GKT831 downregulates the activation of multiple clinically validated fibrogenic and apoptotic pathways*

LUNG INJURYSmoking

Toxic chemicalsInflammation

RENAL INJURYHyperglycemia

High blood pressureInflammation

LIVER

FIBROSISKIDNEY

FIBROSISLUNG


We focus on key fibrosis markets with GKT831

Fibrosis: ~45% of all deaths in the developed world1

Source 1: The Journal of Clinical Investigation; Common and unique mechanisms regulate fibrosis in various fibroproliferative diseases; March 2007. Source 2: The global impact of hepatic fibrosis and end-stage liver disease ; Lim YS1,Kim WR.ClinLiver Dis.2008 Nov;12(4):733-46, vii. doi: 10.1016/j.cld.2008.07.007. Source 3: Nalysnyk L., et al. Incidence and Prevalence of Idiopathic Pulmonary Fibrosis: Review of the Literature. Eur Respir Rev. 2012;21(126):355-361. Source 4: HovindP, Tarnow L, Rossing K, et al. Diabetes care 2003;26:1258-64. Source 5: Groop PH, Thomas MC, Moran JL, et al. Diabetes 2009;58:1651-8. Source 6: Diabetes Care, American Diabetes Association, 2014 Jan;37 Suppl 1:S14-80. doi: 10.2337/dc14-S014.

GKT831

Liver fibrosis impacts 300 to 700 million people worldwide2

Primary Biliary Cholangitis (PBC)│Orphan disease Non-alcoholic steatohepatitis (NASH) Primary biliary sclerosis (PSC) │Orphan disease Viral hepatitis Alcoholic steatohepatitis

Idiopathic Pulmonary Fibrosis (IPF) affects 3 million people

worldwide3

Idiopathic Pulmonary Fibrosis│Orphan disease Cystic fibrosis│ Orphan disease Systemic sclerosis│ Orphan disease Refractory asthma and Chronic Obstructive

Pulmonary Disease (COPD)

Diabetic Kidney Disease develops in 20% to 40% of all

diabetics6


Immuno-oncology therapies not as effective in highly

fibrotic tumors

Cancer associated fibroblasts (CAFs) oppose immunotherapies by shielding tumors from T-cells

Targeting CAFs with GKT831 restores response to immunotherapies


Diabetic Kidney Disease (DKD) is the leading cause of end-stage renal disease4

Affects 14% to 31% of people with type 1 diabetes after 20 years of diabetes5

GKT831 – A Phase 2 asset with therapeutic potential in multiple fibrotic diseases

Orally available small molecule (NCE) with nanomolar potency— NOX1 and NOX4 Ki ~ 100nM in membrane based assays— 10-12 hour half life in humans— Solid patent protection in key countries till 2028/2029 without any extension

Favorable clinical safety profile in healthy subjects and susceptible patients— No safety signal and no dose limiting toxicity in 5 Phase 1 clinical studies— No safety signal in patients with long-term type 2 diabetes and multiple diabetic complications— 100% of patients have completed the full 24-week treatment period of the PBC trial

2 SAEs : one case of multiple bone fractures due to a traffic accident and one case of urinary tract infection. Both cases unrelated to study drug.

Over 96% of subjects have completed the full 24-week treatment period - no drop outs or treatment interruptions related to pruritus

— Over 270 subjects exposed to GKT831

Broad therapeutic potential in fibrotic disorders and immuno-oncology— Efficacy in multiple models of fibrotic and inflammatory diseases and in immuno-oncology— Two Phase 2 trials ongoing in liver (PBC) and kidney fibrosis (DKD)— Lung fibrosis (IPF) IIT trial to be initiated in H1 2019


PBC: A gateway to the large fibrosis market

Primary Biliary Cholangitis (PBC):an orphan disease in the large liver fibrosis area

A quicker proof of concept (PoC) in smaller and shorter trial


Source 1 : In Europe, USA and Japan. Boonstra K. et al. Epidemiology of primary sclerosing cholangitis and primary biliary cirrhosis: a systematic review. J Hepatol. 2012 May;56(5):1181-8

Description— Chronic autoimmune liver disease leading to the progressive destruction

of the bile ducts

— Bile, a fluid produced in the liver, plays a role in digesting food but is toxic when it accumulates in the bile ducts and liver cells

Prevalence — Prevalence of between 2 - 40 cases per hundred thousand-population 1

— Women make up about 90% of PBC cases The disease most often develops during middle age and is usually

diagnosed in people between the ages of about 30 to 60 years There appears to be a genetic component to developing PBC

Current treatments— Current medications only slow disease progression and manage

symptoms

GKT831

Primary Biliary Cholangitis

Inflammed Bile DuctsNormal Bile Ducts


Phase 2 trial of GKT831 in patients with PBC – Interim analysis results


Phase 2 trial in PBC conducted in 62 centers / 9 countries including U.S.A.

GKT831

111 PBC patients Confirmed PBC UDCA non responder Baseline ALP & GGT ≥1.5ULN Normal bilirubin

Randomized, double blind, placebo controlled, parallel group

24-week treatment with interim analysis on week 6 data

UDCA plus placebo or one of 2 doses of GKT831 (400 mg once-daily (OD) and 400 mg twice daily (BID)) – randomization ratio 1:1:1

Trial Patients Design

Markers of liver fibrosis (ELF score, collagen fragments, transient elastography)

Markers of cholestasis (ALP, bilirubin)

Markers of liver injury (AST, ALT, CK-18)

Markers of inflammation (hsCRP, fibrinogen, IL-6)

Quality of life and itching (PBC40 questionnaire and VAS score)

Phase 2

Secondary endpoint

A marker of liver injury (Change in serum Gamma Glutamyl Transferase - GGT)

Primary endpoint

Positive interim analysis conducted when 92 patients completed their week 6 visit and published on November 5th 2018

Sources: 1ALP: alkaline phosphatase; AST: aspartate aminotransferase; ALT: alanine aminotransferase; CK-18: cytokeratin-18; hsCRP: high sensitivity C-reactive protein; IL-6: interleukin-6)


Baseline characteristics in line with targeted population of active PBC patients

GKT831

Well balanced patient characteristics, and active disease at baseline

Placebo GKT831400mg OD1

GKT831400mg BID2 ALL

N 31 31 30 92

Age (years) 56 (10) 56 (10) 55 (9) 56 (9)

Females (%) 97 84 93 91

ALP (IU/L) 304 (151) 282 (89) 350 (177) 312 (145)

GGT (IU/L) 224 (212) 215 (154) 237 (193) 225 (187)

ALT (IU/L) 44 (18) 44 (22) 55 (34) 47 (26)

AST (IU/L) 44 (19) 43 (20) 50 (33) 46 (24)

Total bilirubin (µmol/L) 11 (5) 11 (5) 10 (4) 11 (4)

hsCRP (mg/L) 5.0 (4.9) 5.8 (5.7) 4.7 (5.1) 5.2 (5.2)

Values expressed as mean (SD). Baseline: Day 1 1 Once daily; 2 Twice daily


Dose dependent and statistically significant reductions in GGT

GKT831

p<0.01

p=0.52

Perc

ent c

hang

e in

GGT

from

Bas

elin

e

-7%

-12%

-23%

-30

-25

-20

-15

-10

-5

00 1 2 3 4 5 6

Mean ± SEM

PlaceboGKT831 400mg ODGKT831 400mg BIDTreatment duration (week)

-7%

-12%

-23%

The progressive reductions from baseline to week 2 and to week 6 suggest that further improvements can be achieved with continued treatment


Greater GGT reductions in patients with higher baseline GGT (≥2.5XULN, n=68)

GKT831

Placebo400mg

OD400mg

BID

GKT831

Mean ± SEM

Perc

ent c

hang

e in

GGT

from

Ba

selin

e to

Wee

k 6

-8%

-11%

-29%

These results suggest that GKT831 may also benefit patients with more advanced disease

-40

-35

-30

-25

-20

-15

-10

-5

0

p=0.64

p<0.01

-29%

-11%-8%


GKT831 also achieves statistically significant reductions in ALP GKT831

Placebo GKT831400mg OD

GKT831400mg BID

Proportion of patients with ≥15%reduction in ALP at Week 6 16.1% 25.8% 53.3%

p<0.001

p=0.06

-2%

-2%

-17%

-25

-20

-15

-10

-5

0

50 1 2 3 4 5 6

Perc

ent c

hang

e in

ALP

from

Bas

elin

e

Mean ± SEM

PlaceboGKT831 400mg ODGKT831 400mg BID

Treatment duration (week)

-8%


Dose dependent reductions in liver transaminases at week 6

GKT831

-12

-10

-8

-6

-4

-2

0

-12

-10

-8

-6

-4

-2

0

Placebo400mg

OD400mg

BID

GKT831

Change in AST Change in ALT

Placebo400mg

OD400mg

BID

GKT831

Med

ian

% c

hang

e in

AST

fr

om B

asel

ine

to W

eek

6

Med

ian

% c

hang

e in

ALT

from

Ba

selin

e to

Wee

k 6

Although enrolled patients had relatively low levels of liver transaminases, dose dependent reductions were observed


Changes in inflammatory marker hsCRP at week 6

GKT831

-30

-25

-20

-15

-10

-5

0

5M

edia

n %

cha

nge

in h

sCRP

fr

om B

asel

ine

to W

eek

6

Change in hsCRP

Placebo400mg

OD400mg

BID

GKT831

Although enrolled patients had relatively low levels of high sensitivity C-reactive protein, dose dependent reductions were observed


Dose dependent reductions in FIB-4 and APRI

-25

-20

-15

-10

-5

0

5

-25

-20

-15

-10

-5

0

5

Placebo400mg

OD400mg

BID

GKT831

FIB-4 score APRI score

Med

ian

% c

hang

e in

FIB

-4 sc

ore

from

Bas

elin

e to

Wee

k 6

Med

ian

% c

hang

e in

APR

I sco

re

from

Bas

elin

e to

Wee

k 6

Placebo400mg

OD400mg

BID

GKT831

At weeks 12 and 24, assessments of liver fibrosis will include collagen fragments (e.g. Pro-C3), the Enhanced Liver Fibrosis (ELF) score. Transient elastography (i.e. Fibroscan®) will be done at week 24

GKT831


Other Pipeline and Conclusions


Phase 2 trial in type 1 diabetes-induced kidney disease (DKD)


GKT831

142 T1D DKD patients 48-week treatment in up to 15 centers in Australia. Trials

conducted by Baker Heart and Diabetes Institute in Melbourne

GKT831 200mg BID against matching placebo, twice daily

Trial # patients Design

Renal function: estimated glomerular filtration rate (eGFR), and cystatin C

Renal injury: NGAL, KIM-1

Inflammation: hsCRP, fibrinogen, IL-6

Metabolomics and lipidomics profiles

Exploratory epigenetics and transcriptomics studies

Phase 2

Secondary endpoint

Change in urinary albumin to creatinine ratio (UACR), adjusted for baseline

Primary endpoint

The IIT DKD phase 2 trial funded by JDRF is currently recruiting

Sources 1NGAL: neutrophil gelatinase-associated lipocalin; KIM-1: kidney injury marker 1; hsCRP: high sensitivity C-reactive protein; IL-6: interleukin-6; T1D: type 1 diabetes


Solid IP portfolio with potential of term extensions in the US, Europe and Japan

Solid patent protection in key countries


GKT831 (per se) and its derivatives in treating NADPH related disorders

GKT831

Country Application No. Patent No. Anticipated expiry Type of protection

USA 12/532,336 8,389,518 12.04.2028 Pharmaceutical formulations/use

USA 13/734,205 9,073,919 20.03.2028 Pharmaceutical formulations/use

Europe 08718102.0 2139477 20.03.2028 Pharmaceutical formulations/use

Europe 12187254.3 2545918 20.03.2028 Pharmaceutical formulations/use

Japan 2009-554036 5715340 20.03.2028 Pharmaceutical formulations/use

Japan 2015-050104 6047189 20.03.2028 Pharmaceutical formulations/use

Country Application No. Patent No. Anticipated expiry Type of protection

USA 13/120,440 9,096,588 22.09.2029 NCE/use

USA 14/750,019 Pending - NCE/use

Europe 9787271.7 2344492 22.09.2029 NCE/use

Europe 14190340.1 Pending - NCE/use

Japan 2011-527466 5700837 22.09.2029 NCE/use

Japan 2014-254651 5932008 22.09.2029 NCE/use

GKT831 (generically) and its derivatives in treating NADPH related disorders


Stock information


Stock market information– Markets: Euronext Paris and Euronext Brussels– Number of shares: 7,934,762 (as of Dec. 2018)

Cash Position– €10.2m in Cash & Cash equivalent (31 Dec. 2018)– Cash runway to Q1.2020– €5m gross financing in form of convertible notes

with warrants (Aug. 2018)

Stock codes– Name: GENKYOTEX– Mnemonic: GKTX– ISIN code: FR0011790542

Contacts Genkyotex– Elias Papatheodorou – CEO– Alexandre Grassin – VP Finance and

Administration

Tel.: +33 4 80 16 06 07E-mail: [email protected]: www.genkyotex.com

Shareholding structure (as at April 27, 2018):


mailto:[email protected]

http://www.genkyotex.com/

Appendix – Additional Analysis on Phase 2 PBC Interim Results


Pharmacokinetics analysis indicates good exposure and a dose effect

Drug levels were measured at weeks 2 (n=44), 12 (n=29), and 18 (n=17)

The main findings are:

All patients allocated to GKT831 had detectable drug levels indicating good compliance

As expected, patients receiving GKT831 400mg BID had higher plasma levels compared to patients receiving 400mg OD

As anticipated in PBC patients with cholestasis and reduced biliary elimination, drug levels were higher than in healthy subjects or diabetic patients

GKT831


Appendix – Additional Information on Genkyotex


A selective NOX1 inhibitor with broad therapeutic potential

GKT771: potential to address multiple pain processing , inflammatory, and angiogenic pathways


GKT771

Analgesic

Anti-inflammatory

Anti-angiogenic

Potent, highly selective NOX1 inhibitor

NOX1 plays key roles in angiogenesis, inflammation, and inflammatory pain

GKT771 targets the NGF / TrkA / TRPV1 pain processing pathway: a clinically validated target for pain therapies

GKT771 blocks angiogenesis through the VEGF1 pathway, a clinically validated anti-angiogenic target

GKT771 shows potent activity in vitro and in vivo models of angiogenesis and inflammatory pain

Combined mechanism of action (MoA) consistent with therapeutic potential in inflammatory pain and chronic inflammatory diseases

Further therapeutic potential in eye diseases and itching

Excellent ADME2 profile

IP protection with NCE3/use patent running until 2035

GKT771

1. VGEF: Vascular endothelial growth factor 2. ADME: Absorption, distribution, metabolism, and excretion3. NCE: New chemical entity


Preclinical studies: over 50 publications in leading peer-reviewed journals


GKT831

“Inhibition of NOX4 by GKT831 improves inflammation and fibrosis in fast food diet-fed mice. […]”

Hepatocyte NADPH Oxidase 4 Regulates Stress Signaling, Fibrosis, and Insulin Sensitivity During Development of Steatohepatitis in MiceGastroenterology. 2015 Aug;149(2):468-80

“GKT831 treatment led to a reversal of age-associated persistent fibrosis and reduced mortality. […]” in an IPF model

Reversal of Persistent Fibrosis in Aging by Targeting Nox4-Nrf2 Redox ImbalanceSci Transl Med. 2014 Apr 9;6(231):231ra47

“[…] our results demonstrate the potential of the NOX1 and NOX4 inhibitor GKT831, which is currently in phase 2human clinical trials, as an NLRP3 inflammasome inhibitor […]”

NOX4-dependent fatty acid oxidation promotes NLRP3 inflammasome activation in macrophages Nat Med. 2016 Sep;22(9):1002-12

“GKT831 treatment prevented skeletal muscle oxidation and nitrosylation of RyR1, restored calstabin1 binding andimproved EDL muscle–specific force. […]”

Excess TGF-β mediates muscle weakness associated with bone metastases in miceNat Med. 2015 Nov;21(11):1262-1271


“[…] pharmacological inhibition of NOX4 may have broad applicability for stromal targeting across cancer types. […]”

Targeting the Myofibroblastic Cancer-Associated Fibroblast Phenotype Through Inhibition of NOX4 J Natl Cancer Inst. 2018 Jan 1;110(1)

GKT831 markedly reduces fibrosis and inflammation in diet-induced NASH modelRobust anti-fibrotic activity despite sustained steatosis


Reduced inflammation and fibrosis despite sustained steatosis

Fast food diet model of NASH

831 831

831 831

Source: Torok N et al, Gastroenterology 2015

Source: Victor Thannickal et al., University of Alabama. Science Translational Medicine, 2014

GKT831 reverses fibrosis & improves survival in a model of irreversible lung fibrosisThe bleomycin model conducted in aged mice induces irreversible lung fibrosis

n = 21-23/group

Start of treatment

Weeks post injury

Body

wei

ght (

g)

Days post injury

p = 0.043

6 weeks post injury

Hyd

roxy

prol

ine

(µg/

lung

)

Perc

ent s

urvi

val

Control Vehicle GKT831

GKTVehicle

GKTVehicle


Four Phase 1 studies: very good safety and pharmacodynamics (PD) profile


No dose limiting toxicity

No safety signal

Dose proportional PK up to 900mg/day

GKT831 is rapidly absorbed after oral dosing(median tmax ~ 1h)

Mean half-life of parent compound is 8-15 hours

Minimal renal elimination (<2%)

Multiple dosing does not affect PK parameters

Very low probability of DDI* through CYP3A4

Low variability in PK parameters when taken with meals

GKT831

Pharmacodynamics

0

2

4

6

8

10

Placebo 100mg OD2

300mg OD

400mg BID3

GKT831900mg

OD

Med

ian

chan

ge in

Min

ima

Eryt

hem

a Do

se (m

J/cm

2 )

ROS

(rel

ativ

e flu

ores

cenc

e)

Time after UV (minutes)

UV + GKT831 2 uM

UV + GKT831 0.2 uM

UV + GKT831 20 uM

No UV

UV + vehicle

UV + Trolox

UV + DPI

120000

100000

80000

60000

40000

20000

0 10 20 30 40 50 60 700

GKT831 reduces ROS production induced by UVB4 in vitro1

GKT831 is pharmacologically active in healthy subjects

Safety and PK

Single and multiple doses of GKT831 were well-tolerated and pharmacologically active in healthy subjects

• Drug-drug interactions studies• Sources: 1 In vitro studies conducted at StratiCELL for Genkyotex, unpublished; 2 Once-daily; 3 Twice a day; 4Ultra-violet


Initial phase 2 results in diabetic kidney disease (DKD)

Excellent safety profile up to 200mg BID for 12 weeks— Well tolerated with fewer adverse events than placebo : moderate

to severe AEs 57 vs 15 (p<0.001) n=68/arm

Primary endpoint: no significant difference on renal outcomes— Possible reasons:

Duration of treatment: 12 weeks sufficient for drugs acting on intra-renal hemodynamics, but not to demonstrate direct anti-inflammatory or anti-fibrotic effects

Dose

Secondary endpoints: pharmacological activity demonstrated— Statistically significant reduction in liver enzymes – GGT (p<0.05)— Strong trend for reduction in triglycerides (p=0.066)— Statistically significant reduction in inflammation - hsCRP (p<0.05)— Strong trend for reduction in additional inflammatory markers –

serum amyloid protein A (p<0.08), IL-6 (p=0.2)


GKT831

GKT831 significantly reduces the incidence of adverse events

Adverse events

Severity Placebo GKT831 Diff.

All 119 69 -42%Mild 62 54 -12%Moderate 44 14 -68%Severe 13 1 -93%

p < 0.001 (CMH analysis)

GKT831 significantly improved multiple predefined secondary efficacy endpoints of liver inflammation and injury. Importantly, the study confirmed the favourable safety profile of GKT831.


Investor Presentation · 2019-03-29 · GKT831 - Liver Fibrosis (NOX1/4 inhibitor) Primary Biliary...

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