66個良性循環推動超線性知識創造
有關管道計劃的其他信息67
臨牀:CCM REC-994用於CCM·首個候選療法進入行業贊助的CCM第二階段試驗(Sycamore)·與羅切斯特大學領先的KOL合作開發用於臨牀試驗的CCM PRO儀器·可能的MOA降低ROS和氧化應激以挽救病理性內皮功能障礙計劃概述臨牀更新·第二階段安全終點符合在安慰劑和REC-994組中看到的相似的AE特徵·服用400 mg與安慰劑的患者基於MRI的趨勢是病變體積和含鐵血黃素環大小減少·完成12個月治療的參與者中有80%進入LTE部分近期催化劑·規劃在醫學會議上發表數據並在同行評審的科學雜誌上發表結果·預計儘快與FDA會面,討論另一項臨牀研究的計劃·商業機會·居住在美國和EU5的約360,000名有症狀的CCM患者,沒有獲得批准的藥物·有利的競爭格局,REC-994在開發IP和排他性方面估計領先2年以上·美國和歐盟的ODD提供7年和10年·使用方法專利提供到2035年的保護(不包括延期),正在尋求額外的保護,通過口服生物可用小分子超氧化物清除劑68在CCM中具有首發疾病的潛力
69非腫瘤學孤兒適應症產品美國+EU5患病率腦海綿狀畸形(CCM)REC-994(遞歸)>1,800,000(症狀:~360,000)特發性肺纖維化(IPF)Esbriet(吡非尼酮)>160,000囊性纖維化(CF)VX-669/VX-445+Tezacaftor+IVAVAFtor-Vertex>55,000脊柱肌肉萎縮症(SMA)SPINRAZA(Nusinesen)>65,000來源:血管瘤聯盟;Flemming KD等老年人中基於人羣的腦海綿狀血管畸形患病率:關於老齡化的梅奧臨牀研究。JAMA Neurol2017年7月1日;74(7):801-805。DOI:10.1001/JAMANEUR.2017.0439.PMID:28492932;PMC5647645;斯皮格勒·S等人:腦海綿狀血管畸形的流行、分子遺傳分析和遺傳諮詢的最新進展。摩爾綜合徵。2018年2月;9(2):60-69。10.1159/000486292。EPub 2018年1月25日PMID:29593473;PMCID:PMC5836221;Maher t等人:特發性肺纖維化的全球發病率和流行率。答覆。2021年7月7日;22(197)。DOI:10.1186/s12931-021-01791-z.34233665。DRG 2022解決方案,報告:流行病學,囊性纖維化。CDC:SMA臨牀:CCM疾病概述:CCM是一種被低估的孤兒疾病69
SiCTRL siCCM2 siCCM2+辛伐他汀siCCM2+Cholecalciferol siCCM2+REC-994使用我們的遞歸OS的早期版本在學術環境中,我們從2,100個分子中確定了大約39個分子,根據機器學習分類器拯救了與CCM2功能喪失相關的複雜的無偏見的表型。通過一系列日益複雜的後續驗證性試驗,REC-994脱穎而出,成為我們在為期5個月的慢性CCM動物模型中測試的兩種化合物之一,這兩種化合物都顯示出顯著的益處。臨牀:CCM CCM-Recursion OS 70的應用原型,Gibson等人。確定治療腦海綿狀血管畸形的再利用藥物的策略。《發行量》,2015
臨牀:CCM來源:以上數據來自Gibson等人。確定治療腦海綿狀血管畸形的再利用藥物的策略。循環,2015或遞歸內部數據(Ccm1小鼠模型)·REC-994針對通透性挑戰穩定血管完整性·血管通透性改變是CCM病變的臨牀相關特徵減少Ccm1和CCM2 LOF小鼠模型中的病變數量和大小1恢復乙酰膽鹼誘導的血管擴張缺陷2病變大小(Mm2)Ccm1 LOF模型ECKO+REC-994Wt ECKO%V As d atio n乙酰膽鹼
日誌M
病變大小(mm~2)CCM2 LOF模型***修復CCM2小鼠的真皮滲透性缺陷3 DMSO對照REC-994 CCM2 Wt CCM2 ECKO D e RM al P e rm e ab tity(A b so RP ti on n,A U)*臨牀前研究:Rec-994減少CCM 71遺傳小鼠模型的病變負擔並改善血管缺陷
[健康的REC-994影響CCM·內皮細胞激活·平滑肌增殖·白細胞黏附·通過調節SOD2、CCM1(KRIT1)和CCM2抑制血小板聚集:CCM1或CCM2功能喪失導致激活的內皮:·細胞-細胞連接完整性降低和單層通透性增加·血管擴張受損·海綿狀血管瘤形成劑量REC-994恢復正常功能:·正常化ROS平衡·恢復靜止的內皮細胞狀態·穩定根據REC-994研究手冊改編的內皮屏障功能臨牀:CCM REC-994:作用機制]REC-994階段1研究-耐受性良好,在SAD和MAD研究中沒有劑量依賴性的不良反應研究安慰劑50 mg 200 mg 400 mg 800 mg TEAE總數≥One TEAE 5 4 0 0 10 3 4 3 15 4嚴重程度輕中重度3 1 0 0 0 3 0 0 3 0 3 0 0 3 1 0藥物研究不太可能肯定3 1 0 0 0 1 0 2 1 0 0 0 1 2 0 0 1 0 0 1 2 0 0≥One TEAE中止藥物研究AE0 0 0 0來源:REC-994用於治療症狀性腦海綿狀血管畸形(CCM)1期SAD和MAD研究結果。在治療聯盟科學會議上的口頭陳述。2022年11月17日臨牀:CCM進一步信心:臨牀研究表明良好的安全性73
[計劃概述在NF2使用HDAC抑制劑臨牀更新近期催化劑商業機會IP和排他性·2/3期(楊樹)試驗中口服可用I類和IIb類HDAC小分子抑制劑·獨特的MOA擾亂PP1-HDAC接口,在不影響總AKT的情況下減弱病理生理學P-AKT·FDA於2021年批准對NF2突變腦膜瘤的快速追蹤指定·A部分(第二階段)完全登記24名成人蔘與者·早期1期研究顯示CNS腫瘤患者的MPFS為9.1個月,包括5名NF2患者·REC-2282在血漿和中樞神經系統腫瘤早期第一階段研究中達到的治療濃度·第二階段成人讀數(安全性和初步療效)預計2024年第四季度美國和EU5有資格接受治療的NF2相關腦膜瘤患者~33,000人·有可能擴展到更多的NF2突變人羣,包括間皮瘤、MPNST和EHE·美國和歐盟的ODD在批准後分別提供7年和10年的市場排他性·物質專利的成分提供到2030年的保護(不包括擴展)臨牀:NF2 REC-2282用於治療神經纖維瘤病2型(NF2)74]75·威脅死亡;如果可行,手術切除是主要幹預措施·許多患者患有多發性腦膜瘤,表現出異質性和不同步生長·腫瘤的停滯或縮小可改善預後~27,000名具有NF2突變的腦膜瘤患者(零星)~6,000名NF2患者腦膜瘤(家族性)>66,000名患者腦膜瘤可治療US+EU5患者~33,000名顱內腦膜瘤來源:Pemov等。神經纖維瘤病2型相關顱腦和脊髓腦膜瘤的臨牀和基因組對比分析。大自然。2020年7月28;10(12563)。DOI:https://doi.org/10.1038/s41598-020-69074-z;Nord臨牀:NF2疾病概述:神經纖維瘤病2型腦膜瘤75·大多數腫瘤是良性的,生長緩慢,但位於中樞神經系統會導致嚴重的發病率或死亡率·發病年齡早,腦膜瘤數量多,有截斷突變,對預後有不利影響
76臨牀:NF2,NF2基因敲除細胞,健康細胞,REC-2282,HUVEC,人臍靜脈內皮細胞;NF2,神經纖維瘤病2型;siRNA,小幹擾RNA。防止小鼠NF2缺陷腦膜瘤模型的生長和再生長+REC-2282(月)+正常飲食(月)來自OS的啟示:REC-2282挽救了NF2 76的損失
77AKT,蛋白激酶B;eIF4F,真核細胞起始因子4F;HDAC,組蛋白脱乙酰酶;mTOR,雷帕黴素的哺乳動物靶點;mTORC1,雷帕黴素複合體的哺乳動物靶點;NF2,2型神經纖維瘤病;PI0.3萬,磷脂酰肌醇3-激酶;PP1,蛋白磷酸1;RAS,網狀激活系統。NF2編碼蛋白Merlin並負調節mTOR信號1 2 3失去Merlin導致PI3K/AKT/mTOR通路中信號增加致癌的mTOR信號被HDAC抑制劑阻斷細胞增殖和存活正常細胞增殖和存活細胞增殖和存活組織激活獨立於細胞外因素,不對正常調節活性的生化信號做出反應臨牀:NF2 REC-2282:作用機制77口服生物利用度,中樞神經系統穿透,小分子HDAC抑制劑
78 1 Sborov DW等人。HDAC抑制劑AR-42在多發性骨髓瘤和t細胞和b細胞淋巴瘤患者中的1期試驗。Leuk淋巴瘤。2017年10月;58(10):2310-2318。2 Collier Ka等人。組蛋白去乙酰酶抑制劑AR-42在神經纖維瘤病2型相關腫瘤和晚期實體惡性腫瘤患者中的1期試驗。抗癌化學藥物。2021年5月;87(5):599-611。3 Vorinostat/Belinostat/Romidessin各自的信息臨牀:與其他HDAC抑制劑相比,NF2 REC-2282似乎更適合於NF2。78 REC-2282將是治療NF2腦膜瘤的首發HDAC抑制劑。
使用MEK 1/2抑制劑的FAP的首個疾病機會·口服生物利用度,1b/2期MEK 1/2的小分子非ATP競爭性變構抑制劑(Tupelo)·在疾病相關的臨牀前模型中,REC-4881似乎比批准的MEK抑制劑更活躍·FDA於2022年批准FAP快速通道指定·第一部分完成,4 mg qd大致耐受性良好,安全性與其他MEK抑制劑一致·早期PD數據表明4 mg具有藥理活性-第二部分方案更新為劑量遞增/擴展·療效將評估12周時息肉負擔相對於基線的變化·第二部分在2024年第二季度獲得初步讀數(安全性、初步療效、第二階段初步讀數)藥代動力學)預計2025年上半年美國和EU5有資格接受治療的FAP患者約50,000人·有機會治療中到重度人羣,潛在地推遲或防止手術幹預·美國和歐盟的ODD在批准後分別提供7年和10年的市場排他性·無已知市場準入障礙計劃概述臨牀更新近期催化劑商業機會IP和排他性臨牀:FAP REC-4881用於家族性腺瘤性息肉病(FAP)79
80名患者羣體約50,000名確診US+EU5名患者·由APC基因突變引起的常染色體顯性腫瘤易感綜合徵·經典FAP(胚系突變):·結腸和上消化道成百上千的息肉·腸外表現(例如,硬纖維瘤)·40歲前發展為結直腸癌(CRC)的100%可能性,如果不治療·護理標準:青春期結腸切除術·結腸切除術後,息肉進展為上消化道息肉的高風險患者在結腸和上消化道發現息肉臨牀:https://www.hopkinsmedicine.org/health/conditions-and-diseases/familial-adenomatous-polyposis疾病概述:家族性腺瘤性息肉病80
臨牀:FAP在相關FAP模型中對新OS Insight的臨牀前驗證81
82 Jon,WJ等人。(2018)。Wnt/β-catenin和RAS-ERK途徑之間的相互作用以及通過靶向β/β-catenin途徑降解Ras-catenin和RAS的抗癌策略。NPJ精準腫瘤學,2(5)。3REC-4881通過β-連環蛋白破壞複合體抑制MEK1/2並恢復RAS的不穩定,使細胞恢復到失控狀態1 1疾病狀態REC-4881影響臨牀:FAPMOA:REC-4881阻斷WNT突變誘導的MAPK信號轉導82口服生物利用度,小分子MEK抑制劑
計劃概述臨牀更新近期催化劑商業機會IP和排他性臨牀:使用MEK 1/2抑制劑的AXIN1或APC突變癌症的AXIN1或APC首病機會·口服生物利用度,2期小分子非ATP競爭性MEK 1/2變構抑制劑(LILAC)·第一個進入AXIN1或APC突變癌症第二期信號發現研究的候選治療藥物·Recursion在腫瘤學上的第一個臨牀試驗,也是第一個使用推論搜索生成假設的臨牀試驗·REC-4881的安全磨合,以在分配之前識別RP2D·旨在評估AXIN1或APC突變腫瘤兩個獨立隊列中的活性的方案·有效性將評估RECIST 1.1測量的ORR·2024年第一季度實現的FPI(安全性、初步療效、第二階段讀數和PK)預計2025年上半年·在美國和EU5中有AXIN1或APC突變的可藥物治療患者的確診發病率約為104,000人·AXIN1和APC基因被商業可用的NGS面板和液體活檢檢測方法覆蓋·使用方法正在申請專利,保護期限至2043年(不包括延期)·市場準入沒有已知障礙83 REC-4881用於AXIN1或APC突變癌症
84·AXIN1和APC基因被市售NGS面板和液體活檢檢測分析覆蓋·FDA指南支持將ctDNA用作患者選擇,以檢測資格標準的改變,並作為招募標記陽性和標記陰性人羣的試驗的分層因素4·多種腫瘤類型將為研究設計和患者選擇提供信息靈活的患者選擇策略和研究設計如果存在,AXIN1或APC突變可能是多個實體腫瘤1AXIN1和APC改變頻率的可操作驅動因素,從AACR Genie門户網站獲得。2高級人口估計,使用美國每年的死亡人數和腫瘤中的EU5,摘自ACS和ECIS。3結直腸癌羣體僅限於RAS/RAF野生型。4個https://www.fda.gov/media/158072/download.每年約104,000例可治療的AXIN1/APC突變病例(美國和EU5)1,2結直腸癌3 42%上消化道18%SCCHN 15%泌尿系統13%婦科7%乳腺4%臨牀:AXIN1或APC疾病概述:AXIN1或APC突變癌84
85臨牀:AXIN1或APC REC-4881的表型與APC和AXIN1的遺傳KO相反,提供了一種新的機制,可以恢復由這些基因丟失所模擬的疾病狀態AXIN1 APC 2.5微米1.0微米0.25微米0.1微米REC 4881在突變模型中顯着更強的抗腫瘤活性導致顯著的PFS益處遞歸OS確定AXIN1和APC生物學的新見解85
計劃概述臨牀更新近期催化劑商業機會IP和排他性潛力用於預防RCDI的一流小分子·口服生物可用小分子艱難梭菌毒素抑制劑和由Recursion開發的首個NCE·差異化MOA選擇性地針對細菌毒素,同時保留宿主,將不良事件降至最低·在黃金標準倉鼠模型中,強勁的臨牀前活性證明優於貝洛昔單抗·在第一階段劑量遞增中具有良好的安全性和耐受性,沒有DLTS和SAE·在第一階段出現的最小不良事件,所有被認為是1級·Bid劑量的劑量提供了治療暴露,預計將達到目標低谷濃度·第二階段概念驗證研究計劃於2024年第四季度啟動·初步讀數預計為2025年·美國和歐盟有100,000名高危RCDI患者,治療選擇有限,以防止疾病復發·有能力解決因共病而不符合FMT或基於微生物組治療的人羣·2042年前允許獲得專利的物質的組成(不包括延期)·市場準入未知障礙REC-3964用於預防復發艱難梭菌感染(RCDI)臨牀:艱難梭菌86
疾病狀態健康細胞REC-3964 0.1微米臨牀:艱難梭菌·REC-3964有效地抑制毒素b,對毒素A有殘留活性,而苯洛毒素單抗是針對毒素b的。·治療結束時存活概率與單獨使用苯洛毒素單抗有顯著差異(p
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臨牀:艱難梭菌CDI毒素與細胞表面受體結合並觸發內源性事件1自催化裂解事件將CDI毒素的糖基轉移酶酶域釋放到感染細胞的胞漿中2葡萄糖轉移酶將Rho家族GTP酶鎖定在失活狀態3 Rho GTP酶失活改變細胞骨架動力學,誘導細胞凋亡,並損害屏障功能,從而驅動改編自Awad,mm的CDI 4 3 1 2 4的病理效應。等人的研究。(2014)。艱難梭菌毒力因素:對厭氧芽胞形成病原體的洞察。腸道微生物。5(5),579-593REC-3964是Recursion的第一個小分子NCE,進入臨牀:艱難梭菌毒素88的選擇性抑制劑REC-3964
改編自阿瓦德,嗯。等人的研究。(2014)。艱難梭菌毒力因素:對厭氧芽胞形成病原體的洞察。腸道微生物。5(5),579-5933 1 2 4臨牀:艱難梭菌REC-3964:艱難梭菌毒素的選擇性抑制劑89 REC-3964結合並阻斷毒素固有的葡萄糖轉移酶的催化活性,但不是宿主的5 5 REC-3964是Recursion進入臨牀的第一個小分子NCE[90個試驗設計·隨機化、雙盲試驗人羣·健康受試者·SAD(n=48)·接受REC3964治療的36名參與者·接受安慰劑·MAD治療的12名受試者·接受安慰劑治療的34名受試者·接受安慰劑治療的34名受試者主要目標✓評估REC3964和REC3964的安全性和耐受性✓評估單劑和多劑TOPLINE後REC3964的PK譜·REC-3964口服給藥在所有受試者中耐受性良好✓為3%(n=1)患有藥物相關不良反應的受試者✓為12%(n=4)在有藥物相關性AEs的MAD參與者✓中,所有AEs被認為是1級✓,沒有觀察到SAEs,✓沒有與治療相關的中斷·✓-3964表現出良好的PK曲線,✓暴露(AUC)在所測試的劑量範圍(50 mg-1200 mg)內呈近似劑量比例增加,半衰期為~7-10小時;BID劑量有望達到目標低谷濃度臨牀:艱難梭菌REC-3964用於艱難梭菌1期研究完成90]MAD研究安慰劑(N=8)n(%)100 mg(N=10)n(%)300 mg(N=8)n(%)500 mg(N=8)n(%)900 mg(N=8)n(%)REC-3964總體(N=34)n(%)MAD總體(N=42)n(%)≥患者總數17 24 5 9 7 45 62(62.5)4(50.0)21(61.8)27(64.3)與研究毒品無關的關係4(50.0)6(60.0)3(37.5)4(50.0)4(50.0)17(50.0)21(50.0)關係2(25.0)2(20.0)1(12.5)1(12.5)0 4(11.8)6(14.3)腹脹2(25.0)1(10.0)1(12.5)1(12.5)03(8.8)5(11.9)腹脹0 1(10.0)00 01(2.9)1(2.4)嚴重程度1級6(75.0)8(80.0)4(50.0)5(62.5)4(50.0)21(2級2 0 0 0級≥3 0 0 0-0 0 0-0 0 0-0-01級=輕度,2級=中度,3級=重度,4級=生命危險,5級=致命,REC-3964耐受性良好,沒有治療相關的SAE臨牀:艱難梭菌進一步信心:臨牀研究證實安全91
計劃概述臨牀更新近期催化劑商業機會IP&排他性潛力生物標記物選定種羣的一流分子膠降解劑·遞歸OS將RBM39確定為能夠模擬CDK12生物學的新靶點,獨立於CDK13·鉛分子在HRP和HRD細胞系和患者來源的異種移植中顯示出持久的迴歸·計劃在18個月內從靶標識別進入IND使能階段·在相關動物模型中沒有重大的體外安全性問題和良好的耐受性·靶標接觸分析表明RBM39的降解與體內腫瘤減少之間存在很強的相關性·出色的物理化學性質和合理的人類計劃劑量支持成本效益CMC活動·預計在2024年第三季度提交IND,預計2024年第四季度啟動1/2階段·2025年預計劑量遞增部分的第一階段數據·美國和歐盟5國中約220,000名患有沒有HRR突變且在一線治療方面取得進展的癌症患者·作為單一藥物或與其他藥物聯合使用的潛力(PARP,IO、化療等)·2043年前正在申請保護的物質成分專利(不包括延期)·臨牀前市場準入無已知障礙:REC-1245 REC-1245:RBM39抑制晚期人力資源熟練癌症92
REC-994 Phase 1 Studies - well-tolerated with no dose-dependent adverse events in SAD and MAD MAD Study Placebo 50 mg 200 mg 400 mg 800 mg Total Number of TEAEs Total Subjects with ≥ one TEAE 5 4 0 0 10 3 4 3 15 4 Severity Mild Moderate Severe 3 1 0 0 0 0 3 0 0 3 0 0 3 1 0 Relationship to Study Drug None Unlikely Possibly Likely Definitely 3 1 0 0 0 0 0 0 0 0 0 1 0 2 0 2 1 0 0 0 1 2 0 1 0 Total Number of SAEs Total Subject with ≥ one TEAE Discontinued Study Drug Due to AE 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Source: REC-994 for the Treatment of Symptomatic Cerebral Cavernous Malformation (CCM) Phase 1 SAD and MAD Study Results. Oral Presentation at Alliance to Cure Scientific Meeting. 2022 Nov 17 Clinical: CCM Further Confidence : Clinical Studies Indicate Favorable Safety Profile 73
Program Overview First-in-disease opportunity in NF2 with HDAC inhibitor Clinical Updates Near-term Catalysts Commercial Opportunity IP & Exclusivity • Orally bioavailable small molecule inhibitor of class I and class IIB HDACs in Phase 2/3 (POPLAR) trial • Unique MOA that disrupts PP1-HDAC interface, attenuating pathophysiologic p-AKT without affecting total AKT • Fast Track Designation in NF2 mutant meningioma granted by FDA in 2021 • Part A (Phase 2) fully enrolled with 24 adult participants • Early Phase 1 study demonstrated mPFS of 9.1 months in patients with CNS tumors, including 5 NF2 patients • Therapeutic concentrations of REC-2282 achieved in plasma and CNS tumors in early Phase 1 studies • Phase 2 readout in adults (safety and preliminary efficacy) expected Q4 2024 • ~ 33,000 NF2-associated meningioma patients in US and EU5 eligible for treatment with no approved therapies • Potential to expand into additional NF2 mutant populations including mesothelioma, MPNST and EHE • ODD in US and EU provides 7 and 10 years, respectively, of market exclusivity following approval • Composition of matter patent provides protection until 2030 (excluding extensions) Clinical: NF2 REC-2282 for Neurofibromatosis Type 2 (NF2) 74
75 • Threatens mortality; if amenable, surgical excision is primary intervention • Many patients have multiple meningiomas that exhibit heterogenous behavior and asynchronous growth • Stasis or shrinkage of tumor could improve prognosis ~27,000 Patients who have Meningiomas that Harbor NF2 Mutations (Sporadic) ~6,000 NF2 Patients have Meningiomas (Familial) >66,000 Patients have Meningiomas Treatable US + EU5 patients ~33,000 Intracranial Meningioma Source: Pemov, et al. Comparative clinical and genomic analysis of neurofibromatosis type 2-associated cranial and spinal meningiomas. Nature. 2020 Jul 28;10(12563). Doi: https://doi.org/10.1038/s41598-020-69074-z; NORD Clinical: NF2 Disease Overview : Neurofibromatosis Type 2 (NF2) Meningiomas 75 • Most tumors are benign and slow growing but location in CNS leads to serious morbidity or mortality • Prognosis is adversely affected by early age at onset, a higher number of meningiomas and having a truncating mutation
76 Clinical: NF2 NF2 knockdown cells Healthy Cells REC-2282 HUVEC, human umbilical vein endothelial cells; NF2, neurofibromatosis type 2; siRNA, small interfering RNA. Prevents growth & regrowth of NF2- deficient meningioma model in mice + REC-2282 (months) + Normal diet (months) Insight from OS : REC-2282 Rescued Loss of NF2 76
77 AKT, protein kinase B; eIF4F, eukaryotic initiation factor 4F; HDAC, histone deacetylase; mTor, mammalian target of rapamycin; mTORC1; mammalian target of rapamycin complex 1; NF2, neurofibromatosis type 2; PI3K, phosphoinositide 3-kinase; PP1, protein phosphate 1; Ras, reticular activating system. NF2 encodes for the protein Merlin and negatively regulates mTOR signaling 1 2 3 Loss of Merlin leads to increased signaling in the PI3K/AKT/mTOR pathway Oncogenic mTOR signaling arrested with HDAC inhibitors Cell proliferation and survival Normal cell proliferation and survival Cell proliferation and survival Constitutive activation is independent of extracellular factors and does not respond to biochemical signals that would normally regulate activity 1 2 3 2 3 Clinical: NF2 REC-2282 : Mechanism of Action 77 Orally Bioavailable, CNS-penetrating, Small Molecule HDAC Inhibitor
78 1 Sborov DW, et al. A phase 1 trial of the HDAC inhibitor AR-42 in patients with multiple myeloma and T- and B-cell lymphomas. Leuk Lymphoma. 2017 Oct;58(10):2310-2318. 2 Collier KA, et al. A phase 1 trial of the histone deacetylase inhibitor AR-42 in patients with neurofibromatosis type 2-associated tumors and advanced solid malignancies. Cancer Chemother Pharmacol. 2021 May;87(5):599-611. 3 Prescribing Information of Vorinostat/Belinostat/Romidepsin respectively Clinical: NF2 REC-2282 Appears Well Suited for NF2 vs Other HDAC Inhibitors 78 REC-2282 Would be First-In-Disease HDAC Inhibitor for Treatment of NF2 Meningiomas
First-in-disease opportunity in FAP with a MEK 1/2 inhibitor • Orally bioavailable, small molecule non-ATP competitive allosteric inhibitor of MEK 1/2 in Phase 1b/2 (TUPELO) • REC-4881 appears more active versus approved MEK inhibitors in disease relevant preclinical models • Fast Track Designation in FAP granted by FDA in 2022 • Part 1 completed with 4 mg QD generally well-tolerated and safety profile consistent with other MEK inhibitors • Early PD data indicates 4 mg is pharmacologically active – Part 2 protocol updated to dose escalation / expansion • Efficacy will evaluate change in polyp burden relative to baseline at 12 weeks • FPI for Part 2 achieved in Q2 2024 • Phase 2 initial readout (safety, preliminary efficacy, pharmacokinetics) anticipated H1 2025 • ~ 50,000 FAP patients in US and EU5 eligible for treatment with no approved therapies • Opportunity to treat moderate-to-severe population to potentially delay or prevent surgical intervention • ODD in US and EU provides 7 and 10 years, respectively, of market exclusivity following approval • No known barriers to market access Program Overview Clinical Updates Near-term Catalysts Commercial Opportunity IP & Exclusivity Clinical: FAP REC-4881 for Familial Adenomatous Polyposis (FAP) 79
80 Patient Population ~50,000 Diagnosed US + EU5 patients • Autosomal dominant tumor predisposition syndrome caused by a mutation in the APC gene • Classic FAP (germline mutation) : • Hundreds to thousands of polyps in colon and upper GI tract • Extraintestinal manifestations (e.g., desmoid tumors) • 100% likelihood of developing colorectal cancer (CRC) before age 40, if untreated • Standard of care: colectomy during adolescence • Post-colectomy, patients at significant risk of polyps progressing to GI cancer Polyps Found in Colon and Upper GI Tract https://www.hopkinsmedicine.org/health/conditions-and-diseases/familial-adenomatous-polyposis Clinical: FAP Disease Overview : Familial Adenomatous Polyposis 80
Clinical: FAP Preclinical Validation of Novel OS Insight in Relevant FAP Models 81
82 Jeon, WJ, et al. (2018). Interaction between Wnt/β-catenin and RAS-ERK pathways and an anti-cancer strategy via degradations of β-catenin and RAS by targeting the Wnt/β-catenin pathway. npj Precision Oncology, 2(5). 3 3 REC-4881 inhibits MEK 1/2 and recovers the destabilization of RAS by the β-Catenin destruction complex, restoring the cell back to a Wnt-off like state 2 1 Disease State REC-4881 Impact Clinical: FAP MoA : REC-4881 Blocks Wnt Mutation Induced MAPK Signaling 82 Orally Bioavailable, Small Molecule MEK Inhibitor
Program Overview Clinical Updates Near-term Catalysts Commercial Opportunity IP & Exclusivity Clinical: AXIN1 or APC First-in-disease opportunity in AXIN1 or APC mutant cancers with a MEK 1/2 inhibitor • Orally bioavailable, small molecule non-ATP competitive allosteric inhibitor of MEK 1/2 in Phase 2 (LILAC) • First therapeutic candidate advanced to a Phase 2 signal finding study in AXIN1 or APC mutant cancers • Recursion’s first clinical trial in oncology and the first that used inferential search for hypothesis generation • Safety run-in of REC-4881 to identify RP2D prior to allocation • Protocol designed to assess activity in two independent cohorts of AXIN1 or APC mutant tumors • Efficacy will evaluate ORR as measured by RECIST 1.1 • FPI achieved in Q1 2024 • Phase 2 readout (safety, preliminary efficacy, and PK) anticipated H1 2025 • Diagnosed incidence of ~ 104,000 2L+ drug-treatable patients harboring AXIN1 or APC mutations in US and EU5 • AXIN1 and APC genes covered by commercially available NGS panels and liquid biopsy detection assays • Method of use patent pending with protection until 2043 (excluding extensions) • No known barriers to market access 83 REC-4881 for AXIN1 or APC Mutant Cancers
84 • AXIN1 and APC genes covered by commercially available NGS panels and liquid biopsy detection assays • FDA guidance supports utility of ctDNA as patient selection for the detection of alterations for eligibility criteria and as a stratification factor for trials enrolling marker-positive and marker-negative populations4 • Multiple tumor types will inform study design and patient selection Flexible Patient Selection Strategy and Study Design When present, AXIN1 or APC mutations may be actionable drivers across multiple solid tumors 1AXIN1 and APC alteration frequencies obtained from AACR Genie Portal. 2 Advanced population estimates using number of deaths per year in US and EU5 across tumors, extracted from ACS and ECIS. 3 CRC population restricted to RAS/RAF wildtype. 4 https://www.fda.gov/media/158072/download. ~104,000 2L+ drug-treatable AXIN1/APC-mutant cases each year (US & EU5)1,2 Colorectal3 42% Upper GI 18% SCCHN 15% Urological 13% Gynecological 7% Breast 4% Clinical: AXIN1 or APC Disease Overview : AXIN1 or APC Mutant Cancers 84
85 Clinical: AXIN1 or APC REC-4881 is phenotypically opposite to the genetic KO of APC and AXIN1 providing a novel mechanism that may restore the disease state modeled by the loss of these genes AXIN1 APC 2.5 µm 1.0 µm 0.25 µm 0.1 µm REC 4881 Significantly greater antitumor activity in mutant models led to significant PFS benefit Recursion OS Identified Novel Insight of AXIN1 & APC biology 85
Program Overview Clinical Updates Near-term Catalysts Commercial Opportunity IP & Exclusivity Potential first-in-class small molecule for prevention of rCDI • Orally bioavailable, small molecule C. difficile toxin inhibitor and the first NCE developed by Recursion • Differentiated MOA selectively targets bacterial toxin while sparing the host to minimize adverse events • Robust preclinical activity demonstrating superiority vs bezlotoxumab in the gold standard hamster model • Favorable safety and tolerability profile in Phase 1 dose-escalation with no DLTs and no SAEs • Minimal adverse events seen in Phase 1, and all deemed Grade 1 • BID dosing provides therapeutic exposures expected to reach targeted trough concentrations • Phase 2 proof-of-concept study planned for initiation in Q4 2024 • Preliminary readout expected YE 2025 • > 100,000 high-risk rCDI patients in US and EU5 with limited treatment options to prevent recurrent disease • Ability to address populations not eligible for FMT or microbiome-based therapies due to comorbidities • Composition of matter patent allowed with protection until 2042 (excluding extensions) • No known barriers to market access REC-3964 for Prevention of recurrent C. difficile infection (rCDI) Clinical: C. difficile 86
Disease State Healthy Cells REC-3964 0.1 µM Clinical: C. difficile • REC-3964 potently inhibits toxin B with residual activity against toxin A, while bezlotoxumab is specific to toxin B. • Significant difference in probability of survival vs bezlotoxumab alone at the end of treatment (p
Clinical: C. difficile CDI toxins bind to cell surface receptors and trigger endocytic event 1 Autocatalytic cleavage event releases CDI toxin's glucosyltransferase enzymatic domain into the cytosol of the infected cell 2 The glucosyltransferase locks Rho family GTPases in the inactive state 3 Inactivation of Rho GTPases alters cytoskeletal dynamics, induces apoptosis, and impairs barrier function which drives the pathological effects of CDI 4 3 1 2 4 Adapted from Awad, MM. et al. (2014). Clostridium difficile virulence factors: Insights into an anaerobic spore-forming pathogen. Gut Microbes. 5(5), 579-593. REC-3964 is Recursion’s 1st Small Molecule NCE to Reach the Clinic REC-3964 : Selective Inhibitor of C. difficile Toxins 88
Adapted from Awad, MM. et al. (2014). Clostridium difficile virulence factors: Insights into an anaerobic spore-forming pathogen. Gut Microbes. 5(5), 579-593. 3 1 2 4 Clinical: C. difficile REC-3964 : Selective Inhibitor of C. difficile Toxins 89 REC-3964 binds and blocks catalytic activity of the toxin’s innate glucosyltransferase, but not the host's 5 5 REC-3964 is Recursion’s 1st Small Molecule NCE to Reach the Clinic
90 Trial Design • Randomized, Double-blind Trial Population • Healthy Participants • SAD (n = 48) • 36 participants treated with REC-3964 • 12 participants treated with placebo • MAD (n = 42) • 34 participants treated with REC-3964 • 8 participants treated with placebo Primary Objectives ✓ Assess the safety & tolerability of SAD and MAD of REC-3964 ✓ Evaluate the PK profile of REC-3964 after single and multiple doses Phase 1 Topline • REC-3964 oral administration was well tolerated by all subjects tested ✓ 3% (n=1) of participants in SAD with drug-related AEs ✓ 12% (n=4) of participants in MAD with drug-related AEs ✓ All AEs were deemed Grade 1 ✓ No SAEs were observed ✓ No discontinuations related to treatment • REC-3964 exhibited a favorable PK profile ✓ Exposures (AUC) increased approximately dose-proportionally across the dose ranges tested (50 mg – 1200 mg) ✓ Half-life ranged from ~7-10 hours; BID dosing expected to reach targeted trough concentrations Clinical: C. difficile REC-3964 for C. difficile Phase 1 Study Complete 90
MAD Study Placebo (N=8) n ( %) 100 mg (N=10) n ( %) 300 mg (N=8) n ( %) 500 mg (N=8) n ( %) 900 mg (N=8) n ( %) REC-3964 Overall (N=34) n ( %) MAD Overall (N=42) n ( %) Total Number of TEAEs 17 24 5 9 7 45 62 Total Participants with ≥ 1 TEAE 6 ( 75.0) 8 ( 80.0) 4 ( 50.0) 5 ( 62.5) 4 ( 50.0) 21 ( 61.8) 27 ( 64.3) Relationship to Study Drug Not Related 4 ( 50.0) 6 ( 60.0) 3 ( 37.5) 4 ( 50.0) 4 ( 50.0) 17 ( 50.0) 21 ( 50.0) Related 2 ( 25.0) 2 ( 20.0) 1 ( 12.5) 1 ( 12.5) 0 4 ( 11.8) 6 ( 14.3) Abdominal Distension 2 ( 25.0) 1 ( 10.0) 1 ( 12.5) 1 ( 12.5) 0 3 ( 8.8) 5 ( 11.9) Flatulence 0 1 ( 10.0) 0 0 0 1 ( 2.9) 1 ( 2.4) Severity Grade 1 6 ( 75.0) 8 ( 80.0) 4 ( 50.0) 5 ( 62.5) 4 ( 50.0) 21 ( 61.8) 27 ( 64.3) Grade 2 0 0 0 0 0 0 0 Grade ≥ 3 0 0 0 0 0 0 0 Total Number of SAEs 0 0 0 0 0 0 0 Discontinued Study Drug Due to AE 0 0 0 0 0 0 0 TEAEs = treatment emergent adverse events; Grade 1 = Mild, Grade 2 = Moderate, Grade 3 = Severe, Grade 4 = Life Threatening, Grade 5 = Fatal REC-3964 was well-tolerated with no treatment-related SAEs Clinical: C. difficile Further Confidence : Clinical Studies Confirming Safety 91
Program Overview Clinical Updates Near-term Catalysts Commercial Opportunity IP & Exclusivity Potential first-in-class molecular glue degrader for biomarker selected population • Recursion OS identified RBM39 as a novel target capable of mimicking CDK12 biology independent of CDK13 • Lead molecule has demonstrated durable regressions across HRP and HRD cell line and patient derived xenografts • Program advanced from target identification to IND-enabling stages in under 18 months • No significant in vitro safety concerns with favorable tolerability in disease relevant animal models • Target engagement assays demonstrate strong correlation between RBM39 degradation and tumor reduction in vivo • Excellent physiochemical properties and reasonable human projected doses support cost-effective CMC campaign • IND submission expected in Q3 2024 with Phase 1/2 initiation expected in Q4 2024 • Phase 1 data from the dose-escalation portion expected by YE 2025 • ~220,000 patients in US and EU5 harbor cancers that lack HRR mutations and have progressed on frontline therapies • Potential as a single agent or in combination with other agents (PARP, IO, chemo, etc.) • Composition of matter patent pending with protection until 2043 (excluding extensions) • No known barriers to market access Preclinical: REC-1245 REC-1245: RBM39 Inhibition for Advanced HR-Proficient Cancers 92