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Cytori Therapeutics
7th International Conference on Cell Therapy for Cardiovascular Disease
                   Focus on Acute Injury Technologies
                            25 January 2012

                           Alex Milstein, M.D.
                       VP, Clinical Development
Real-Time Access to Autologous Regenerative Cells




                                                              Cardiovascular
                                                                 Disease
                         < 2 hours



      Cytori Celution®           Regenerative cells

                                                              Soft Tissue Repair

Versatile technology; focus on cardiac & soft tissue repair
CE Mark approval in Europe for soft tissue; Seeking CMI in 1H 2012
36+ patents, 100 + filed on device & cells

                Celution™ System is not available in the US
Acute Myocardial Infarction – The APOLLO Trial


  APOLLO TRIAL
  •   Prospective European Multicenter Trial
  •   Randomized (3:1)
  •   Double Blind
  •   Placebo controlled
  •   Blinded independent core labs
  •   Safety & Feasibility Trial
  •   n = 14 (4 placebo, 10 treated)
  •   Co-Principal Investigators: Drs. H.J. Duckers
      and P.W. Serruys
Cell Treated: Better Perfusion of the Heart
                                                                      6 & 18 month follow-up
           Perfusion defect in LAD territory:
                     Reduction in perfusion defect in patients treated with ADRC compared
                     to placebo patients as analyzed by MIBI SPECT (TSS scores)
                        MIBI SPECT TSS change (matched pairs)




                                                                     10x               9x
                                                                improvement       improvement




p=NS
                                                                                                Slide: Courtesy
All SPECT images were assessed by an independent, blinded core lab (CCL, Boston, MA)            HJ Duckers, MD, PhD
Reduction of > 50% in Infarct Size seen with ADRCs
                                                                   6 & 18 month follow-up
  Percent of Left Ventricle Infarcted (%LVI):
         Greater improvement in %LVI in ADRC patients vs. to Placebo control patients (late
         enhancement cMRI)
           change in rel.infarct size (I/LV) (matched pairs)




                                                                                            all pts    baseline 6 mo

                                                                                            Placebo     24,7%       24,7%

                                                                                            ADRC        31,6%       15,4%
                                                                                                 Means for treatment groups




p=NS                                                           Matched-pair analysis
                                                                                                        Slide: Courtesy
All MRI images were assessed by an independent, blinded core lab (CCL, Boston, MA)                      HJ Duckers, MD, PhD
Preservation of End-Systolic Volume with ADRCs
                                               6 & 18 month follow-up
  Change in ESV
        ESV was markedly reduced in ADRC patients as compared to placebo control patients
                  change in ESV (cc, 2D TTE)




                                                                                       24,4 cc
                                                                                     improvement
                                                                                       (-72,2%)




                                                                                         Slide: Courtesy
All TTE images were assessed by an independent, blinded core lab (CCL, Boston, MA)       HJ Duckers, MD, PhD
APOLLO: Arrhythmias
                 Percent of Pa ents with Signific nt
                                      a                                                         More ventricular arrhythmias observed in
                      Ventricular Arrhythmias                                                                Control patients
60%                                                                                            More Significant Ventricular Arrhythmias in
50%
                         50%                                                                    control patients
                                                                                               Higher frequency of recordings with
40%
                                                           30%                                  Ventricular Premature Bits (VPB) in Controls
                                                                                                Higher number of VPBs per recording
30%
                                                                                     
20%                                                                                             in Controls
10%

 0%
                        Placebo                        Group 1



            Premature Ventricular Contrac ons - Mean Count per Pa ent                                 Premature Ventricular Contrac ons - Mean Cumula ve Count
700                                                                                      3000


600
                                                                                         2500


500
                                                                                         2000

400
                                                                           control       1500                                                                    control

300                                                                        ADRC                                                                                  ADRC


                                                                                         1000
200


                                                                                          500
100



 0                                                                                          0
      0.5    1      2        3    4   8   12    16    25         52   77                        0.5     1    2     3     4    8     12   16    25    52    77
APOLLO: Summary
   ADRCs are safe in the treatment of STEMI
        No safety concerns
        Cell administration is safe
        No new MACE/SAEs
        No Deaths


   Feasibility
        Concordant improvement in infarct and ischemia:
           Mean reduction in Infarct Size is maintained to 18 months
           Improvement in cardiac perfusion is maintained to 18 months
        May have positive impact on arrhythmia in cell-treatment patents
Cytori Cardiac Program: Present and Future


Celution™ System is CE Marked in the EU

Acute Myocardial Infarction:
   • European APOLLO Trial – completing 36-mo FU
   • Pivotal European ADVANCE Trial – ramping up
   • US trial in AMI – to follow ADVANCE

Chronic Myocardial Ischemia:
   • European PRECISE Trial – completing 36-mo FU
   • US ATHENA Trial – IDE filed
AMI - THE ADVANCE TRIAL

•   Primary endpoint: cMRI infarct size at 6 months
•   Randomized, Double-blind, Placebo-controlled
•   N ≤ 360, at up to 35 sites in the EU
•   23 sites selected & committed
•   Various states of regulatory process by country
•   Co-PIs Drs. H.J. Duckers and G. Pompilio
•   Independent blinded core labs will evaluate all imaging data
•   Independent DMC provides safety oversight
•   Independent CEC will adjudicate all germane events
•   Currently enrolling & treating patients

18-mo data from Apollo support trial design for ADVANCE
Thank you

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CYTX Conference on Cell Therapy for Cardiovascular Disease

  • 1. Cytori Therapeutics 7th International Conference on Cell Therapy for Cardiovascular Disease Focus on Acute Injury Technologies 25 January 2012 Alex Milstein, M.D. VP, Clinical Development
  • 2. Real-Time Access to Autologous Regenerative Cells Cardiovascular Disease < 2 hours Cytori Celution® Regenerative cells Soft Tissue Repair Versatile technology; focus on cardiac & soft tissue repair CE Mark approval in Europe for soft tissue; Seeking CMI in 1H 2012 36+ patents, 100 + filed on device & cells Celution™ System is not available in the US
  • 3. Acute Myocardial Infarction – The APOLLO Trial APOLLO TRIAL • Prospective European Multicenter Trial • Randomized (3:1) • Double Blind • Placebo controlled • Blinded independent core labs • Safety & Feasibility Trial • n = 14 (4 placebo, 10 treated) • Co-Principal Investigators: Drs. H.J. Duckers and P.W. Serruys
  • 4. Cell Treated: Better Perfusion of the Heart 6 & 18 month follow-up Perfusion defect in LAD territory: Reduction in perfusion defect in patients treated with ADRC compared to placebo patients as analyzed by MIBI SPECT (TSS scores) MIBI SPECT TSS change (matched pairs) 10x 9x improvement improvement p=NS Slide: Courtesy All SPECT images were assessed by an independent, blinded core lab (CCL, Boston, MA) HJ Duckers, MD, PhD
  • 5. Reduction of > 50% in Infarct Size seen with ADRCs 6 & 18 month follow-up Percent of Left Ventricle Infarcted (%LVI): Greater improvement in %LVI in ADRC patients vs. to Placebo control patients (late enhancement cMRI) change in rel.infarct size (I/LV) (matched pairs) all pts baseline 6 mo Placebo 24,7% 24,7% ADRC 31,6% 15,4% Means for treatment groups p=NS Matched-pair analysis Slide: Courtesy All MRI images were assessed by an independent, blinded core lab (CCL, Boston, MA) HJ Duckers, MD, PhD
  • 6. Preservation of End-Systolic Volume with ADRCs 6 & 18 month follow-up Change in ESV ESV was markedly reduced in ADRC patients as compared to placebo control patients change in ESV (cc, 2D TTE) 24,4 cc improvement (-72,2%) Slide: Courtesy All TTE images were assessed by an independent, blinded core lab (CCL, Boston, MA) HJ Duckers, MD, PhD
  • 7. APOLLO: Arrhythmias Percent of Pa ents with Signific nt a More ventricular arrhythmias observed in Ventricular Arrhythmias Control patients 60%  More Significant Ventricular Arrhythmias in 50% 50% control patients  Higher frequency of recordings with 40% 30% Ventricular Premature Bits (VPB) in Controls Higher number of VPBs per recording 30%  20% in Controls 10% 0% Placebo Group 1 Premature Ventricular Contrac ons - Mean Count per Pa ent Premature Ventricular Contrac ons - Mean Cumula ve Count 700 3000 600 2500 500 2000 400 control 1500 control 300 ADRC ADRC 1000 200 500 100 0 0 0.5 1 2 3 4 8 12 16 25 52 77 0.5 1 2 3 4 8 12 16 25 52 77
  • 8. APOLLO: Summary  ADRCs are safe in the treatment of STEMI  No safety concerns  Cell administration is safe  No new MACE/SAEs  No Deaths  Feasibility  Concordant improvement in infarct and ischemia:  Mean reduction in Infarct Size is maintained to 18 months  Improvement in cardiac perfusion is maintained to 18 months  May have positive impact on arrhythmia in cell-treatment patents
  • 9. Cytori Cardiac Program: Present and Future Celution™ System is CE Marked in the EU Acute Myocardial Infarction: • European APOLLO Trial – completing 36-mo FU • Pivotal European ADVANCE Trial – ramping up • US trial in AMI – to follow ADVANCE Chronic Myocardial Ischemia: • European PRECISE Trial – completing 36-mo FU • US ATHENA Trial – IDE filed
  • 10. AMI - THE ADVANCE TRIAL • Primary endpoint: cMRI infarct size at 6 months • Randomized, Double-blind, Placebo-controlled • N ≤ 360, at up to 35 sites in the EU • 23 sites selected & committed • Various states of regulatory process by country • Co-PIs Drs. H.J. Duckers and G. Pompilio • Independent blinded core labs will evaluate all imaging data • Independent DMC provides safety oversight • Independent CEC will adjudicate all germane events • Currently enrolling & treating patients 18-mo data from Apollo support trial design for ADVANCE