Thierry Legon CEO, ASIT biotech - Paris May 03 2018

 
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Thierry Legon CEO, ASIT biotech - Paris May 03 2018
Paris May 03 2018   Leader in Allergenic Peptide Immunotherapy

                           Thierry Legon
                           CEO, ASIT biotech

   1
Thierry Legon CEO, ASIT biotech - Paris May 03 2018
About ASIT biotech
Mission
    To improve acceptance and compliance of allergy immunotherapy by developing
    short course treatments based on innovative allergenic peptides

Main achievements
    • Clinical efficacy of lead product in Grass Pollen Rhinitis confirmed in Phase 3
      clinical study
    • Validated technology platform to design, characterize, screen and produce
      novel product candidates
    • Ongoing design and screening of product candidates in House Dust Mite
      Rhinitis and food allergy (peanuts, cow’s milk and egg white)

2
Thierry Legon CEO, ASIT biotech - Paris May 03 2018
About ASIT biotech
• ASIT biotech has dual market listing in Brussels (Belgium) and Paris (France) since
  May 2016
• Raised €73 million since inception (€23.4 million by IPO (2016) and €13.9 million
  by a private placement (2018))
• 26 active and motivated collaborators
• Partnership with public and private internationally renowned institutions

3
Thierry Legon CEO, ASIT biotech - Paris May 03 2018
Ever increasing number of allergic patients

4
Thierry Legon CEO, ASIT biotech - Paris May 03 2018
Over 1 billion patients suffer today from Allergy and
over 4 billion in 2050
• Steadily increasing prevalence of allergic diseases

• More complex allergies with high morbidity leading to a heavy burden for
  health care system

• 30 to 40% of the world population would be affected by one or more allergic
  conditions

      ✓    Over 400 million patients suffer from Allergic Rhinitis
      ✓    Over 200 million patients suffer from Food allergies
      ✓    Over 300 million patients suffer from Asthma

    World Allergy Week April 2011
    EAACI

5
Thierry Legon CEO, ASIT biotech - Paris May 03 2018
Allergic Rhinitis:
up to 400 million people worldwide
    USA                                                      CHINA
                                    EUROPE                   1,6-43%
    12-30%
                                    23-30%

                                                                       JAPAN                                              USA   Europe   China   Japan
                                                                       9,1-37,5%
                                          MIDDLE EAST
                                          7,4-45,2%                                                 Population (M)        320   320      1379    127

                                                                                                    Population with       43    73       TBD     38
                                                                                                    Rhinitis (M)

                                                                                                    Population with       24    25       TBD     9
                                                                                                    severe Rhinitis (M)

                 LATIN              AFRICA                          AUSRALIA
                 AMERICA            7,2-54,1%                       12-41,3%
                 5,5-45,1%
    Bauchau V & Durham SR Eur Respir J 2004; 24: 758-764
    Katelaris, C.H. et al., 2012. Clinical and experimental allergy 42(2), pp.186–207
6   C.F., M. & Tong Janice S.C. Lin, 2015. European Academy of Allergy and Clinical Immunology, pp. 62–63.
Thierry Legon CEO, ASIT biotech - Paris May 03 2018
Food Allergy:
more than 200 millions people worldwide

    • 15 million of American, 17 million of
      Europeans suffer from food allergy1
    • Increasing prevalence in both
      developed and developing countries2
    • Peanut, cow’s milk and egg white
      concern >74% children3
    • Total annual food allergy management
      cost estimate/child in the US: $ 4,184

    1. Commins et al. 2016 and World Allergy Organization
    2. Prescott et al. 2013
    3. Scott et al. 2011
    4. Gupta et al 2013
7
Thierry Legon CEO, ASIT biotech - Paris May 03 2018
Allergy leads to symptoms
impairing quality of life

                                 Reduced work
                                   productivity

    Eye symptoms
                                                           Asthma
                 Nasal                                                Angiodema
             symptoms
                                                  Sleep deprivation

                                        Reduced
                             school performance

8
                         …if not threathening life…
Thierry Legon CEO, ASIT biotech - Paris May 03 2018
Allergy: inappropriate immune response against
       harmless substance
                                                                                 Th2
                                                                                 cell                   Allergens

                                                        B cell

                                                                      2                     1

1. First contact between allergen and       IgE                                                      Antigen
   mucosa                                synthesis                                                  Presenting
2. Allergen specific IgE antibody                                3                                     cell
   production
           ‒ Uptake & processing by
               APC
           ‒ T- cell activation
           ‒ allergen specific IgE         Mast cell   Basophil
                                                                                 4              5
               antibody production
3. Loading of allergen specific IgE on
   mast cells                                                                                         Degranulation leading to
4. Bridging of the IgE by allergens                                                                     histamine release
5. Allergic reaction
                                                                                                                Eosinophils
                                                                     Mast cell   Basophil
                                                                                                         recruitment and activation
       9
Thierry Legon CEO, ASIT biotech - Paris May 03 2018
Therapeutic options: Symptomatic vs Curative

10
Symptomatic drugs for allergic rhinitis
                                     Interleukin specific                                               Nonspecific immunosuppressors
                                       blockers (mAb)                                                         Intranasal steroids
Allergic rhinitis &                  Mepolizumab (GSK)
                                                                                                               Inhaled steriods
                                                                                                            Leukotriene modifiers
                                                                                       Th2
                                      Reslizumab (Teva)
asthma                                Benralizumab (AZ)
                                                                                       cell

• >95% of the market                     Dupilumab                   B cell                                Allergen
                                     (Regeneron/Sanofi)
• daily intake during allergen
  exposure (seasonal/perennial)                                         IgE
                                                                     synthesis
• no long-term effect             IgE-specific blockers
                                         (mAb)                                                         Antigen
                                                                                                                            Antihistamines
                                                                                                                                Zyrtec
• poor effectiveness in case of                                                                       Presenting
                                                                                                         cell                    Xyzal
  low compliance                      Omalizumab                                                                                Allegra
                                  (Novartis/Genentech)
• $20 billion/year for                                                                                                          Claritin
                                                            Mast cell Basophil
  respiratory allergies                                                                                     Degranulation
                                                                                                             leading to
                                                                                                             histamines
                                                                                                               release
Food allergy                                                                     Mast cell Basophil
                                                                                                              Eosinophils
• no registered drugs available                                                                               recruitment
                                                                                                                  and
• food avoidance                                                                                               activation

• epinephrine injection

    11
Curative treatment: Allergy Immunotherapy

     Sub-cutaneous               Sublingual

12
Allergy immunotherapy induces natural regulation of the
   immune system and provides better symptoms reduction
                                                                             Th2
                                                                             cell
                                                                                                                         Allergen
                                                                                           -

                                                                             IL-10 IL-35
1. Regulatory T and B cells                                  IgG4 & IgA
                                                B cell
2. Prevention of the seasonal                                 synthesis                        2
   increase of IgE
                                                             +        3
3. Induction of IgG4-associated
   blocking antibodies leading
                                    IgE synthesis
   to clinical benefit during the                                                                                  Antigen
                                                                          Treg                 Breg       +   1
   pollen season.                                                                                                 Presenting
                                                         -                cell                 cell                                 Whole Allergens
4. Suppression of grass pollen-                                  2
                                                                                                                     cell
   induced basophil activation
   responsible for immediate
   allergic response
                                                                                                   4
                                                                                           -
                                                                                                                               Degranulation leading to
                                    Mast cell      Basophil                                                                      histamine release

                                                                                                                                 Eosinophils
                                                                           Mast cell                   Basophil
                                                                                                                               recruitment and
                                                                                                                                  activation
   13
Allergy immunotherapy market less than €1billion today

                Year 1           Year 2           Year 3
                                                                              COMPLIANCE

     SCIT
                                                               SCIT 40-60
 Subcutaneous
immunotherapy
                                                              Doctor visits    < 25%

                                                                 Daily
     SLIT                                                    administration
  Sublingual
immunotherapy
                                                               180 to 360     < 12.5%
                                                               days/year

                   3 year long cumbersome treatment
                 due to the use of whole allergen extracts
   14
Whole allergen extract limitations
Safety concerns: induction of histamine and proinflammatory substances

Efficacy concerns: delay in reaching the optimal balance between IgG4 and IgE
                         Allergen injectionsAllergen Injections
                         Symptoms

                                                                                   IgG and IgG4

                                                                                   IgE
                                                                                   Lymphocyte responses

                                                6 months          2 years   Time
15
ASIT™ Innovative technology

16
ASIT+™ allergenic peptides allow short-course
treatment improving patient adherence and
compliance

ASIT biotech’s
    Offer
                   4 visits

         4 doctor visits in 3 weeks before each pollen season

17
ASIT+TM unique safe and efficient active ingredients
Current Immunotherapy                                          ASIT+TM Immunotherapy

                                                                    Optimally-sized
     Whole Allergens
                                                               natural allergenic peptides
Advantages
                                                                       (1 – 10 kDa)
✓ Clinically effective
✓ Safety: SLIT > SCIT            ASIT+TM Technology Platform    ✓   Short course SCIT
✓ Include all the necessary
    immunological information                                   ✓   Real-life clinical efficacy during
✓ IgG4 and blocking antibodies                                      grass pollen season confirmed
✓ Applicable to all allergies                                   ✓   Fast onset of optimal
                                                                    immunoregulation with blocking
Disadvantages                                                       antibodies induction
 Increased AEs                                                 ✓   Applicable to all allergies
 3 year treatment                                              ✓   No need of adjuvant
 Poor patient compliance                                       ✓   Probable high patient adherence
 Need of adjuvants                                                 and compliance

18
ASIT+TM technology platform to design, characterize,
screen and produce novel product candidates

        Extraction of              Large proteins do not enter into the gel
       allergens from              particles
       natural source              => shorter pathway through the column.

                                   ASIT+TM allergenic peptides enter into
                                   the gel particles
         Enzymatic                 => longer pathway through the column.
         hydrolysis

         Selection of
     allergenic peptides
      according to size
          (1-10kDa)

19
ASIT™ Clinical Development

20
ASIT biotech pipeline: achieved milestones
                                      Pre-clinical              Phase I                      Phase II                 Phase III

                                                                                                        Q1 2017 - Positive phase III
      Grass pollen
                                  gp-ASIT+™

                                                                       Q2 2017 - Positive Phase I/II
  House dust mite
                                  hdm-ASIT+™
                                     Preclinical development program
             Food
Peanut - Egg white - Cow’s milk
                                  food-ASIT+™

        21
gp-ASIT+™ Positive Phase III clinical study (BTT009)

 TRIAL              # PATIENTS                     PRIMARY OBJECTIVE                      DESIGN

                ‒    2:1 (active : placebo)    ‒    Clinical efficacy during pollen   ‒   Double-blind
                ‒    93% retention rate: 512        season based on reduction in      ‒   Placebo controlled
 Phase III           patients attended the          the combined symptom-             ‒   67 centers in Europe
                     last visit                     medication score (CSMS)

• symptom and drug intake reduction statistically significant -15.5% during the peak and -17.9% over the
  pollen season (p
ASIT™ mechanistic aspects
                            Prof. Mohamed Shamji

23
Short Course treatment of Subcutaneous Peptide Hydrolysate from Lolium
 Perenne suppresses Basophil Responses and induces IgG-associated
                    Blocking Antibodies: A RDPCT

                               Mohamed Shamji, PhD. CS. FAAAAI

                                   Head, Immunomodulation and Tolerance Group
          Director, Immune Tolerance Network Distributed Centre of Excellence for Allergy & Asthma, UK
            Chair, Scientific Program Committee, European Academy, Allergy and Clinical Immunology
                                   Associate Professor in Immunology and Allergy,
                             Allergy & Clinical Immunology, Imperial College London, UK

                                          Media & Analyst Conference, Paris, France
                                                  Thursday, 3rd May, 2018
    24
Pathophysiology of Allergic Rhinitis and Mechanisms of AIT

                                     ILC2
             Natural exposure        Cell         CRTH2+ T cells
            (Low-dose allergen)                                                                      Allergen-
                                                        Th2        IL-         Mast Cell   Basoph   specific IgE
                                                        Cell        9                         il
                                            Th
                                                                         IL-
                                             0
                                                         Tfh              5
                                                         Cell                  Eosinophi
                   Dendritic cells                                 IL-4            l                  Plasma
                   (nasal                        CXCR5+ T cells    IL-21           B                    Cell
                   mucosa)                                         IL-13          Cel
                                                                                    l

                                                                                                                   Shamji et al., JACI
25
Year 1   Year 2             Year 3                            Compliance
             SCIT
          Subcutaneous
         immunotherapy                                                 SCIT 40-60
Characterisation of Peptide Hydrolysate from Lolium Perenne
(gpASIT+TM) and its ability to bind to IgE compared to Grass Pollen
                                extract
                                                       Reproducibility                                                                                                 Basophil activation
                                                                                                  Graph#8

                                                                                                                                                 CD63+ basophils [%]
                                             80

                     IgE binding (%)
                                             60

                                             40

                                             20

                                               0
                                               1e-4          0,001          0,01          0,1              1           10       100       1000

                                                                                        Concentration [µg/ml]
                                                            Concentration [µg/ml]                                                                                         Concentration [ng/mL]
                                                      4-P Fit: y = (A - D)/( 1 + (x/C)^B ) + D:      A           B        C      D      R^2
                                         Plot#2 (PROT 08J20 (1/3): Concentration vs %IN...         -0.72       0.973   0.0861   95.7   0.999
                                         Plot#4 (PROT 00597 (1/3): Concentration vs %IN...          4.86       0.835   0.0905   97.9     1                                                  *p ≤ 0.05
                                                                     Pollen proteins - batch 1
                                         Plot#6 (PEP 00597 (1/3): Concentration vs %INHIB)         -8.18       0.269    136     143    0.999
                                         Plot#10 (PEP 08K05 (1/3): Concentration vs %INH...        -12.8       0.227    497     170    0.998
                                                                                                                                                                                            **p ≤ 0.05
                                       __________                    Pollen proteins - batch 2                                                                                              ***p ≤ 0.05
                                       Weighting: Fixed

                                                                     Pollen peptides - batch 1
                                                                     Pollen peptides - batch 2                                                                                 Shamji et al., JACI 2017
27
Characterisation of Peptide Hydrolysate from Lolium Perenne
(gpASIT+TM) and its ability to bind to IgE compared to Grass Pollen
                                extract
                                                       Reproducibility                                                                                                 Basophil activation
                                                                                                  Graph#8

                                                                                                                                                 CD63+ basophils [%]
                                             80

                     IgE binding (%)
                                             60

                                             40

                                             20

                                               0
                                               1e-4          0,001          0,01          0,1              1           10       100       1000

                                                                                        Concentration [µg/ml]
                                                            Concentration [µg/ml]                                                                                         Concentration [ng/mL]
                                                      4-P Fit: y = (A - D)/( 1 + (x/C)^B ) + D:      A           B        C      D      R^2
                                         Plot#2 (PROT 08J20 (1/3): Concentration vs %IN...         -0.72       0.973   0.0861   95.7   0.999
                                         Plot#4 (PROT 00597 (1/3): Concentration vs %IN...          4.86       0.835   0.0905   97.9     1                                                  *p ≤ 0.05
                                                                     Pollen proteins - batch 1
                                         Plot#6 (PEP 00597 (1/3): Concentration vs %INHIB)         -8.18       0.269    136     143    0.999
                                         Plot#10 (PEP 08K05 (1/3): Concentration vs %INH...        -12.8       0.227    497     170    0.998
                                                                                                                                                                                            **p ≤ 0.05
                                       __________                    Pollen proteins - batch 2                                                                                              ***p ≤ 0.05
                                       Weighting: Fixed

                                                                     Pollen peptides - batch 1
                                                                     Pollen peptides - batch 2                                                                                 Shamji et al., JACI 2017
28
Characterisation of Peptide Hydrolysate from Lolium Perenne
(gpASIT+TM) and its ability to bind to IgE compared to Grass Pollen
                                extract
                                                       Reproducibility                                                                                                 Basophil activation
                                                                                                  Graph#8

                                                                                                                                                 CD63+ basophils [%]
                                             80

                     IgE binding (%)
                                             60

                                             40

                                             20

                                               0
                                               1e-4          0,001          0,01          0,1              1           10       100       1000

                                                                                        Concentration [µg/ml]
                                                            Concentration [µg/ml]                                                                                         Concentration [ng/mL]
                                                      4-P Fit: y = (A - D)/( 1 + (x/C)^B ) + D:      A           B        C      D      R^2
                                         Plot#2 (PROT 08J20 (1/3): Concentration vs %IN...         -0.72       0.973   0.0861   95.7   0.999
                                         Plot#4 (PROT 00597 (1/3): Concentration vs %IN...          4.86       0.835   0.0905   97.9     1                                                  *p ≤ 0.05
                                                                     Pollen proteins - batch 1
                                         Plot#6 (PEP 00597 (1/3): Concentration vs %INHIB)         -8.18       0.269    136     143    0.999
                                         Plot#10 (PEP 08K05 (1/3): Concentration vs %INH...        -12.8       0.227    497     170    0.998
                                                                                                                                                                                            **p ≤ 0.05
                                       __________                    Pollen proteins - batch 2                                                                                              ***p ≤ 0.05
                                       Weighting: Fixed

                                                                     Pollen peptides - batch 1
                                                                     Pollen peptides - batch 2                                                                                 Shamji et al., JACI 2017
29
Hypotheses

- 3-week treatment with subcutaneous peptide hydrolysates from Lolium perenne
  (LPP, gpASIT+TM) is associated with reduction in CSMS and RTSS during the
  peak and throughout the entire pollen season.

- gpASIT+TM immunotherapy but not placebo blunts the seasonal increases of
  sIgE

- gpASIT+TM immunotherapy but not placebo treatment suppresses grass pollen-
  induced basophil hyperesponsivess and basophil reactivity.

- A short-course of gpASIT+TM immunotherapy induces IgG4-associated
  blocking antibodies that conferred clinical benefit during the pollen season and
  supresses pathogenic T cell responses.

  30
Hypotheses

- 3-week treatment with subcutaneous peptide hydrolysates from Lolium
  perenne (LPP, gpASIT+TM) is associated with reduction in CSMS and
  RTSS during the peak and throughout the entire pollen season.

- gpASIT+TM immunotherapy but not placebo blunts the seasonal increases of
  sIgE

- gpASIT+TM immunotherapy but not placebo treatment suppresses grass pollen-
  induced basophil hyperesponsivess and basophil reactivity.

- A short-course of gpASIT+TM immunotherapy induces IgG4-associated blocking
  antibodies that conferred clinical benefit during the pollen season and
  supresses pathogenic T cell responses.

  31
Study design – RDBCT
Immune mechanisms analyses on participant from a single site - (Ghent, Belgium).

          Mechanistic analyses
                                                                         CSMS

  32
CSMS during the peak pollen and the entire pollen season
                        following LPP and Placebo

            CSMS –
            CSMS – Peak
                   Peak season
                        season            CSMS – Entire season

Mösges and Shamji, Allergy 2018
    33
3-week treatment with subcutaneous peptide hydrolysates
      from Lolium perenne (LPP, gpASIT+TM) supresses CSMS and
                                 RTSS

                   CSMS                  RTSS

CSMS reduction in Belgium                 RTSS reduction in Belgium
Peak period : -35.1%; P=0.03.             Peak period: -27.4%, P=0.04
Entire pollen season : -53,7%; P=0.03     Entire pollen season: -56.9%, P=0.01
      34   Shamji MH et al, EAACI 2017
Hypotheses

- 3-week treatment with subcutaneous peptide hydrolysates from Lolium
  perenne (LPP, gpASIT+TM) is associated with reduction in CSMS and
  RTSS during the peak and throughout the entire pollen season.

- gpASIT+TM immunotherapy but not placebo blunts the seasonal increases of
  sIgE

- gpASIT+TM immunotherapy but not placebo treatment suppresses grass pollen-
  induced basophil hyperesponsivess and basophil reactivity.

- A short-course of gpASIT+TM immunotherapy induces IgG4-associated blocking
  antibodies that conferred clinical benefit during the pollen season and
  supresses pathogenic T cell responses.

  35
Hypotheses

- 3-week treatment with subcutaneous peptide hydrolysates from Lolium perenne
  (LPP, gpASIT+TM) is associated with reduction in CSMS and RTSS during the
  peak and throughout the entire pollen season.

- gpASIT+TM immunotherapy but not placebo blunts the seasonal increases
  of sIgE

- gpASIT+TM immunotherapy but not placebo treatment suppresses grass pollen-
  induced basophil hyperesponsivess and basophil reactivity.

- A short-course of gpASIT+TM immunotherapy induces IgG4-associated blocking
  antibodies that conferred clinical benefit during the pollen season and
  supresses pathogenic T cell responses.

  36
Effect of LPP (gpASIT+TM) immunotherapy on sIgE levels

                                             V8-V6

V2 = Before treatment
V6 = After treatment
V8 = After the grass pollen season

        37     Shamji MH et al, EAACI 2017
Effect of LPP (gpASIT+TM) immunotherapy on sIgE levels

                                             V8-V6

V2 = Before treatment
V6 = After treatment
V8 = After the grass pollen season

        38     Shamji MH et al, EAACI 2017
Hypotheses

- 3-week treatment with subcutaneous peptide hydrolysates from Lolium perenne
  (LPP, gpASIT+TM) is associated with reduction in CSMS and RTSS during the
  peak and throughout the entire pollen season.

- gpASIT+TM immunotherapy but not placebo blunts the seasonal increases
  of sIgE

- gpASIT+TM immunotherapy but not placebo treatment suppresses grass pollen-
  induced basophil hyperesponsivess and basophil reactivity.

- A short-course of gpASIT+TM immunotherapy induces IgG4-associated blocking
  antibodies that conferred clinical benefit during the pollen season and
  supresses pathogenic T cell responses.

  39
Hypotheses

- 3-week treatment with subcutaneous peptide hydrolysates from Lolium perenne
  (LPP, gpASIT+TM) is associated with reduction in CSMS and RTSS during the
  peak and throughout the entire pollen season.

- gpASIT+TM immunotherapy but not placebo blunts the seasonal increases of
  sIgE

- gpASIT+TM immunotherapy but not placebo treatment suppresses grass
  pollen-induced basophil hyperesponsivess and basophil reactivity.

- A short-course of gpASIT+TM immunotherapy induces IgG4-associated blocking
  antibodies that conferred clinical benefit during the pollen season and
  supresses pathogenic T cell responses.

  40
Effect of gpASIT+TM and Placebo on CD203chighCRTH2+
 Basophils

                                           * ** *         ** **
                                       *                *
                                   *                *

41   Shamji MH et al, EAACI 2017
Hypotheses

- 3-week treatment with subcutaneous peptide hydrolysates from Lolium perenne
  (LPP, gpASIT+TM) is associated with reduction in CSMS and RTSS during the
  peak and throughout the entire pollen season.

- gpASIT+TM immunotherapy but not placebo blunts the seasonal increases of
  sIgE

- gpASIT+TM immunotherapy but not placebo treatment suppresses grass
  pollen-induced basophil hyperesponsivess and basophil reactivity.

- A short-course of gpASIT+TM immunotherapy induces IgG4-associated blocking
  antibodies that conferred clinical benefit during the pollen season and
  supresses pathogenic T cell responses.

  42
Hypotheses

- 3-week treatment with subcutaneous peptide hydrolysates from Lolium perenne
  (LPP, gpASIT+TM) is associated with reduction in CSMS and RTSS during the
  peak and throughout the entire pollen season.

- gpASIT+TM immunotherapy but not placebo blunts the seasonal increases of
  sIgE

- gpASIT+TM immunotherapy but not placebo treatment suppresses grass pollen-
  induced basophil hyperesponsivess and basophil reactivity.

- A short-course of gpASIT+TM immunotherapy induces IgG4-associated
  blocking antibodies that conferred clinical benefit during the pollen
  season and supresses pathogenic T cell responses.

  43
Induction of Blocking antibodies following gpASIT+TM and Placebo

                    Phleum Pratense        Lolium Perenne

                                       *                    *

    44   Shamji MH et al, EAACI 2017
Induction of blocking antibodies is associated with the induction
       of regulatory B cells in gpASIT+TM treated group.

                                      *         *    *
                                          *

   45   Shamji MH et al, EAACI 2018
gpASIT+TM is associated with reduction of IL-4+Tfh cells induction
            of IFN-g+ Tfh cells and FoxP3+ Tfh cells

                        *        *                        *   *
                                                  *   *

    46   Sharif and Shamji MH et al, AAAAI 2017
Summary/Conclusions

- 3-week treatment with subcutaneous peptide hydrolysates from Lolium perenne
  (LPP, gpASIT+TM) is associated with reduction in CSMS and RTSS during the
  peak and throughout the entire pollen season.

- gpASIT+TM immunotherapy but not placebo blunts the seasonal increases of
  sIgE

- gpASIT+TM immunotherapy but not placebo treatment suppresses grass pollen-
  induced basophil hyperesponsivess and basophil reactivity.

- A short-course of gpASIT+TM immunotherapy induces IgG4-associated
  blocking antibodies that conferred clinical benefit during the pollen season and
  supresses pathogenic T cell responses.

  47
Proposed Mechanisms of gpASIT+TM

                                                  ILC2
                      Natural exposure            Cell            CRTH2+ T cells
                     (Low-dose allergen)                                                                                             Allergen-
                                                                           Th2            IL-9      Mast Cell   Basophil            specific IgE
                                                                           Cell
                                                          Th                               IL-5
                                                           0
                                                                           Tfh
                                                                           Cell                     Eosinophi
                            Dendritic cells                                               IL-4          l                             Plasma Cell
                            (nasal                               CXCR5+ T cells           IL-21          B
                            mucosa)                                                       IL-13        Cell

                       Immunotherapy                             CTL-4               IL-10
                     (High-dose allergen)

                                                         Th                Tfr
                                                          0                cell
                                                                                                                      Plasma Cell
                                              IL-27                                   IL-10/IL-35     Bregs                                    Allergen-specific
                                                                           iTreg                                                                  IgG4 & IgA
                          Dendritic cells                                  IL-10+         TGF-β        cell
                        (under skin or oral
                            mucosa)                      Th         iTre           nTre
                                                          1          g +
                                                                   TGF-β            g +
                                                                                  Foxp3
                                                         Cel
                                                          l

                                                         IFN-γ                                                                                 IgG4 and IgA
                                                                                                                                             competes with
                                                                                                                                             IgE for allergen
                                                                                                                                                 binding

48   Shamji MH et al, JACI 2017
Acknowledgments

                                                               Ralph Mösges, MD, PhD,
                                                               Elena M. Kasche, MD,
Stephen Durham, MD.FRCP                                        Esther Raskopf, PhD,
Oleksandra (Sasha) Fedina,                                     Jaswinder Singh, MSc,
                                                               Lea Sohlich
Angeliki Karamani, BSc                                         Anatoli Astvatsatourov, PhDa, Kija
Rebecca Parkin, BSc                                            Shah-Hosseini
Aliya Datoo
Iesha Singh, MSc
Lubna Kousar, PhD
Hanisah Sharif, MSc          Jean Ceupens, MD
Abigail Rob, Bsc             Peter Helings, MD,                             Ludo Haazen, MD
                                                                            Sabine Pirotton, PhD
                                                                            Nathalie Wathelet, PhD
                                                                            Marie-Alix Bonny
                                                                            Nicolas Bovy, PhD
                                   Claus Bachert, MD, PhD
                                                                            Julie Halkein, PhD
                                   Philip Gaevert, MD, PhD
                                                                            Valeria Karusinova
                                   Lara Derycke, MD
                                                                            Gael Placier, PhD
                                   Gabrielle Holtapples, MSc
                                                                            Jean Duchateau, MD, PhD
                                                                            Thierry Legon, MBA
     49
hdm-ASIT+™ for house dust mite rhinitis
first in man clinical study: safety of ASIT+TM confirmed

 TRIAL              # PATIENTS                   AIM                                            COMPLETED

                                                 ‒   Assessment of the maximum tolerated         ‒   Q2 2017
                   ‒   36 patients randomized
                                                     dose
Phase I/IIa
                                                 ‒   Safety and clinical tolerability
                                                 ‒   Immunogenicity
                                                 ‒   Impact on reactivity to a challenge test

• 27 patients treated with hdm-ASIT+™ - 9 placebo.
• safety and tolerability of hdm-ASIT+™ confirmed
• slight positive immunological and clinical impact in a limited number of treated patients
• new product prototypes in development to be tested by Prof. M. Shamji at ICL to optimize the product candidates
  immunogenicity

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food-ASIT+™ for food allergy
product prototypes screening on-going

  PRE-CLINICAL DEVELOPMENT                                    AIM                                   COMPLETED

                                                              ‒   Selection of product candidate
   Product                                                        peanut, cow’s milk & egg white    ‒   Q2 2018
 prototype ex
vivo screening
                                                              ‒   ex vivo safety and tolerability
                                                              ‒   ex vivo immunogenicity

• non-dilutive funding from the Walloon Region to co-finance 55% 1
• collaboration with Prof. M. Shamji (ICL), and Dr. S. Till (King’s)
• first-in-man Phase I/II trial in peanut allergy expected to be conducted from H1 2018 to end-2019

     1   a recoverable cash advance granted in January 2017
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ASIT biotech pipeline: next milestones
                                     Pre-clinical   Phase I                    Phase II                     Phase III

                                  gp-ASIT+™                                                       FDA meeting - H2 2018
      Grass pollen                                                                     Second Phase III Q4 2018 - Q4 2019

                                                                 Selection of a new ASIT+TM active ingredient - Q2 2018
                                  hdm-ASIT+™            Second Phase I/II clinical trial with improved prototype - Q1 2019
  House dust mite

                                  food-ASIT+™                 Selection of ASIT+TM active ingredient for peanut - Q2 2018
             Food                                                            First Phase I/II clinical trial in food - H2 2018
Peanut - Egg white - Cow’s milk

        52
Summary

53
Short course immunotherapy with ASIT biotech’s
    allergenic peptides addresses the unmet needs of
    all stakeholders

                                                 4 visits/year

                 Patient                 Healthcare systems                                Allergists

•        Efficient: Reduction of         •   Documented safety and             •   New therapeutic option
         symptoms and rescue                 efficacy                          •   More patient accepting AIT
         medication in the real life &
                                         •   Improved acceptance               •   Patients more compliant
         Improved quality of life
                                         •   Improved compliance               •   Fast onset of action
•        4 doctor visits
                                         •   Improved real-life efficacy       •   Better patient follow-up
•        Time & Money saving
                                         •   Reduced direct & indirect costs   •   Higher patient satisfaction

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Paris May 03 2018   Leader in Allergenic Peptide Immunotherapy

                    Merci pour votre attention !

   55
Disclaimer

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•   This presentation includes forward-looking statements that reflect the Company's intentions, beliefs or current expectations concerning, among other things, the
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•   In this presentation, references are made to the Company’s product candidates, for which marketing authorisation has not yet been obtained. These product
    candidates are designated throughout this presentation by their internal project names at the Company. The names used are not meant to refer to these products (if
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         56
CONTACTS

           ASIT Biotech

        Thierry Legon – CEO
        Tel.: +32 2 264 03 90
     investors@asitbiotech.com

       www.asitbiotech.com

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