![Tcelna in Secondary Progressive Multiple Sclerosis
•
Patients initially experience a relapsingremitting course then transition to SPMS
•
SPMS patients experience worsening QOL /
disability with or without relapses
•
Over 450,000 patients in North America
and 2 million world wide have MS
•
Approximately 30-45% of MS patients can be classified as Secondary Progressive
•
Tcelna is being pursued for this SPMS indication
•
Potential SPMS market in the North America alone could exceed $7 billion [150,000
SPMS patients at average cost of $50,000 per year of treatment]
•
No SPMS treatment approved by EMA; only one approved by FDA with limited use
due to toxicity
•
Upon successful clinical development, Tcelna has the potential to be the treatment of
choice in SPMS
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Opexa therapeutics corporate presentation november 21
- 1. Precision Immunotherapy TM Precision Immunotherapy Opexa Therapeutics, Inc. NASDAQ: OPXA November 2013 The Woodlands, TX
- 2. Forward-Looking Statements • This investor presentation contains forward-looking statements which are made pursuant to the safe harbor provisions of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended. Statements contained in this presentation, other than statements of historical fact, constitute “forward-looking statements.” The words “expects,” “believes,” “anticipates,” “estimates,” “may,” “could,” “intends,” and similar expressions are intended to identify forward-looking statements. Forward-looking statements do not constitute guarantees of future performance. Investors are cautioned that statements which are not strictly historical statements, including, without limitation, statements regarding the development of our product candidate, Tcelna (imilecleucel-T), constitute forward-looking statements. • Such forward-looking statements are subject to a number of risks and uncertainties that could cause actual results to differ materially from those anticipated. These risks and uncertainties include, but are not limited to, risks associated with: market conditions; our capital position; our ability to compete with larger, better financed pharmaceutical and biotechnology companies; new approaches to the treatment of our targeted diseases; our expectation of incurring continued losses; our uncertainty of developing a marketable product; our ability to raise additional capital to continue our development programs (including to undertake and complete any ongoing or further clinical studies for Tcelna); our ability to satisfy various conditions required to access the financing potentially available under the purchase agreements with Lincoln Park Capital Fund, LLC (“Lincoln Park”) or sell shares of our common stock to Lincoln Park or under our at-the-market (ATM) facility; our ability to maintain compliance with NASDAQ listing standards; the success of our clinical trials (including the Phase IIb trial for Tcelna in Secondary Progressive Multiple Sclerosis which, depending upon results, may determine whether Ares Trading SA (“Merck”) elects to exercise its option for an exclusive license to Tcelna for the treatment of multiple sclerosis (the “Option”)); whether Merck exercises the Option and, if so, whether we receive any development or commercialization milestone payments or royalties from Merck pursuant to the Option; our dependence (if Merck exercises the Option) on the resources and abilities of Merck for the further development of Tcelna; the efficacy of Tcelna for any particular indication; our ability to develop and commercialize products; our ability to obtain required regulatory approvals; our compliance with all FDA regulations; our ability to obtain, maintain and protect intellectual property rights; the risk of litigation regarding our intellectual property rights or the rights of third parties; the success of third party development and commercialization efforts with respect to products covered by intellectual property rights that we may license or transfer; our limited manufacturing capabilities; our dependence on third-party manufacturers; our ability to hire and retain skilled personnel; our volatile stock price; and other risks detailed in our filings with the SEC. • These forward-looking statements speak only as of the date made. We assume no obligation or undertaking to update any forwardlooking statements to reflect any changes in expectations with regard thereto or any change in events, conditions or circumstances on which any such statement is based. You should, however, review additional disclosures we make in our Annual Reports on Form 10-K, Quarterly Reports on Form 10-Q, and Current Reports on Form 8-K filed with the SEC. 2
- 3. Introduction to Opexa • Antigen specific T-cell immunotherapy platform with potential in multiple autoimmune diseases • Strong Patent Estate: 50 patents issued on T-cell platform (US and ROW, collectively) • Precision Immunotherapy potentially optimizes benefit-risk profile • Lead product, Tcelna®, under development for Multiple Sclerosis • Currently conducting a Phase IIb clinical trial in Secondary Progressive MS (SPMS) • Limited treatment options currently available for SPMS • Potential SPMS market in North America alone could exceed $7 Billion • Fast Track designation from the U. S. Food and Drug Administration (FDA) for the treatment of SPMS • Option Agreement with Merck Serono, a strong commercial partner 3
- 4. Experienced Management Team and Board of Directors Neil Warma, President & CEO, Director › 19+ years international healthcare experience with large Pharma and emerging biotechnology companies › Former Senior Management, Novartis Pharmaceuticals, Basel, Switzerland › Former CEO, Viron Therapeutics, Inc. › Co-founder and President of MedExact Inc., a company subsequently acquired Karthik Radhakrishnan, Chief Financial Officer › 10+ years of health care capital markets experience › Formerly, Vice President at ING Investment Management › MBA, MS in Engineering, CFA charter holder Don Healey, Ph.D., Chief Scientific Officer › Former Director of Immunology, Argos Therapeutics Gail J. Maderis CEO, BayBio, Former CEO of Five Prime Therapeutics, Founder of Genzyme Molecular Oncology Michael S. Richman CEO, Amplimmune 25+ years of experience in cellular immunology and immune regulation › Board of Directors Donna Rill, Chief Development Officer › Designed and validated cGMP Cell & Gene Therapy Laboratories, Vector Production facilities, and Translational Research Labs Executive Director, Alkek Foundation 30 years in cell and gene therapy research and clinical application › Scott B. Seaman Neil K. Warma CEO, Opexa Kenny Frazier, VP of Clinical Dev. and Regulatory Affairs › 24 years of extensive clinical and regulatory experience › Formerly, Head of Clinical Operations, Lexicon Pharmaceuticals and Tanox, Inc. 4
- 5. SPMS Scientific Advisory Board Dawn McGuire, M.D., FAAN (Chair) Advisory Council of the Gill Heart Institute Former Vice President of Clinical Research at Elan Pharmaceuticals • • Hans-Peter Hartung, M.D • Chair of Neurology at Heinrich-Heine University, Düsseldorf • President ECTRIMS, World Health Organization Advisory Board on MS Mark S. Freedman, M.D. • • • Director of the Multiple Sclerosis Research Unit at Ottawa Hospital Multiple Sclerosis Society of Canada, National MS Society (USA) ACTRIMS committee member Clyde Markowitz, M.D. • Director of MS Center at the University of Pennsylvania Doug Arnold, M.D. • James McGill Professor Neurology and Neurosurgery at the Montreal Neurological Institute Edward Fox, M.D., Ph.D. • • Director of Multiple Sclerosis Clinic of Central Texas Advisory Committee, Lone Star Chapter of the National Multiple Sclerosis Society 5
- 6. Pipeline and Potential Areas of Investigation Stage of Development Indication Evaluation Preclinical Phase I Phase II Phase III Commercial T-CELL PLATFORM Multiple Sclerosis (Tcelna)* Secondary Progressive MS* Phase IIb ongoing Relapsing Remitting MS* Phase III not yet initiated STEM CELL PLATFORM Type 1 Diabetes * Rights granted to Merck Serono under option and license agreement (Feb. 5, 2013) 6
- 7. Tcelna in Secondary Progressive Multiple Sclerosis • Patients initially experience a relapsingremitting course then transition to SPMS • SPMS patients experience worsening QOL / disability with or without relapses • Over 450,000 patients in North America and 2 million world wide have MS • Approximately 30-45% of MS patients can be classified as Secondary Progressive • Tcelna is being pursued for this SPMS indication • Potential SPMS market in the North America alone could exceed $7 billion [150,000 SPMS patients at average cost of $50,000 per year of treatment] • No SPMS treatment approved by EMA; only one approved by FDA with limited use due to toxicity • Upon successful clinical development, Tcelna has the potential to be the treatment of choice in SPMS 7
- 8. Tcelna Addressing the Root Cause of Multiple Sclerosis Preventing Demyelination and Enabling Remyelination • Myelin Reactive T-cells (MRTC) cross the blood brain barrier, enter the brain, bind to antigen presenting cells (APC) causing release of pro-inflammatory cytokines which lead to a two pronged attack through: i. Activation of microglial cells leading to destruction of myelin sheath, the protective coating of nerve fibers ii. Destruction of oligodendroglial cells which are responsible for producing myelin Result Destruction of the myelin sheath with barriers to prevent remyelination • T cells play a vital role in our immune system. Only a very small proportion develop into MRTC. Most competing therapies non-specifically suppress all T-cells (including beneficial T cells) and/or focus on preventing their entry into the central nervous system, which may lead to serious side effects. Opexa’s Strategy Adapted by permission from Macmillan Publishers Ltd: NATURE REVIEWS IMMUNOLOGY 3, 483-492 (June 2003), copyright (2003) Tcelna programs the immune system to specifically recognize MRTCs as pathogenic thereby inhibiting further destruction of the myelin sheath and potentially enabling remyelination 8
- 9. Single Cycle Manufacturing Process: Annual course of treatment (5 doses) from one blood draw 14 days Epitope Profiling 35 days 1 day Manufacturing and QC Dispensation - Red Cross - Blood Group Alliance Cryopreservation Epitope Profiling Expansion of antigen specific T-cells Formulation/ Irradiation of each dose as required Administration: 5 subcutaneous injections/year 9
- 10. Mechanism of Action Reduction in Myelin Reactive T-Cells Tcelna Demonstrated a Reduction in Myelin Reactive T-cells (MRTC) Week 0 Week 5 Week 13 Week 21 Dose 1 Dose 2 Dose 3 Dose 4 Week 28 Week 52 0% Reduction in MRTC -10% -20% -30% -40% -50% -60% -70% -80% -90% -100% Each dose consisting of 30-45 x 106 cells Results from Tcelna dose ranging studies: Published in Clinical Immunology (2009) 131, 202-215 10
- 11. Merck Serono Agreement for MS indication • February 2013 option and license agreement with Merck Serono – Up to $220 million in additional payments • Option exercise $25 million for starting Phase III/ or $15 million if another Phase II • $35 million FDA filing, approval and commercialized in US • $30 million for EU filing, approval and commercialization in at least three countries • RRMS development and commercialization of up to $40 million – One time commercial milestones of up to $85 million • Royalties ranging from 8% to 15% of annual net sales with step-ups occurring when net sales exceed $500 million, $1 B & $2 B • Opexa maintains key rights: – Development and commercialization rights to Tcelna in Japan – Certain manufacturing rights – Co-development funding option in exchange for increased royalties – Rights to all other disease indications 11
- 12. Tcelna Development Program Broad Spectrum of MS patients treated Phase Completion Dates Population Total N Treatment Duration (months) Tcelna Baylor Placebo 1998 RRMS, PPMS, SPMS (26) 114 Up to 24 months 114 Phase I dose escalation 2006 RRMS (5) SPMS (6) 16 12 16 - Phase I/II Open label retreatment 2007 RRMS (9) SPMS (4) 13 12 13 - Phase IIb TERMS 2008 RRMS, CIS 150 12 100 50 Phase IIb extension OLTERMS 2008 RRMS, CIS 38 At least one dose post TERMS 15 from placebo arm Phase IIb Abili-T 1st Half 2016* SPMS 180* 24* 90* 90* * Expected upon completion of ongoing SPMS Abili-T trial 12
- 13. TERMS Study A Completed Phase IIb Clinical Trial in RRMS • Completed Phase IIb clinical trial in 150 RRMS patients; 33 sites in U.S. • 37% reduction in ARR vs. placebo • ARR 0.214 vs. 0.339 • Superior safety and promising efficacy trend demonstrated • Two End-of-Phase II meetings with FDA successfully completed Relapses/patient/year • mITT population (n=142) 0.4 0.35 0.3 0.25 0.2 0.15 0.1 0.05 0 0.339 37% Tcelna 0.214 n=94 Placebo n=48 13
- 14. TERMS Study - Prospective Analysis in More Active or Progressive Patients Sub-population of patients (n=50) with more progressed/active disease profile (baseline ARR >1) Percent Brain Volume Change at Week 52 n=32 n=18 -0.1 -0.2 Tcelna 88% Placebo -0.25 -0.3 -0.32 2.4 88% Reduction in Brain Atrophy 2.4 2.39 2.35 2.3 2.25 2.2 2.23 2.2 (p=0.045) Tcelna Placebo 2.15 2.1 -0.35 0.7 Baseline Week 52 Statistically Significant Improvement in Disability (p=0.045) ARR (relapses/patient/yr) -0.05 Annualized Relapse Rate (ARR) at Week 52 2.45 -0.04 EDSS Score (Mean) Brain volume change (%) 0 -0.15 Change in Disability (EDSS) at Week 52 0.6 0.5 0.4 0.63 55% Tcelna 0.3 0.2 Placebo 0.28 0.1 0 n=32 n=18 55% Reduction in ARR These Data Support Phase IIb Program in SPMS 14
- 15. TERMS Study - Subgroup Analysis in Patients Naïve to DMT Annualized Relapse Rate (ARR) 1.4 73% Reduction p=0.009 1.2 1.18 1 64% Reduction p=0.046 0.8 0.6 56% Reduction p=0.060 0.4 0.2 0 Tcelna Placebo 0.5 0.48 0.31 0.21 n=53 0.18 n=28 mITT n=45 n=25 ARR > 1 n=16 n=8 ARR>1 Annualized relapse rate in DMT naïve populations. ARR in placebo subjects without previous disease modifying treatment (DMT) experience reflects relapse rates commonly seen in other placebo controlled trials in MS. In this subpopulation, treatment with Tcelna resulted in a 56–73% reduction in ARR compared with placebo. 15
- 16. Secondary Progressive MS: Overview of Phase I/II Patients treated with Tcelna • 36 SPMS patients treated in three clinical studies – – • 35 of these patients were treated with Tcelna for two years 26 patients treated at Baylor; 10 patients treated by Opexa Promising efficacy observed – – 10 patients in Opexa sponsored study showed significant reduction in relapse rates from a baseline ARR of 0.5 to an ARR of 0.1 at two years – • Disease stabilization as measured by EDSS was observed in 80% of patients at two years (compared to a historical control data that shows progression rate of 40%) No worsening in key Quality of Life Indicators (physical and psychological condition) at two years Well-tolerated with a favorable safety profile – No Serious Adverse Events 16
- 17. Tcelna Stabilizes Disease in SPMS at 2 Years 80% of subjects treated with Tcelna showed no further disease progression by EDSS at 2 years Percent of Patients Showing Disease Stabilization 100% Stabilization vs. Historical Progression 80% 80% Stable Progressed 60% 40% 20% 40% 20% 0% Tcelna Open Label (n=35) *A small percentage of patients in pooled analysis showed an improvement (i.e. decrease in progression) Historical Disease Progression **Historical control: ESIMS Study, published Hommes Lancet 2004 17
- 18. Tcelna Reduces Annualized Relapse Rate (ARR) in SPMS at 2 years Annualized Relapse Rate (ARR) 0.60 Tcelna treated SPMS patients (n=10) 0.50 In 21.8 years of cumulative 0.40 patient follow up, only 1 patient experienced 1 relapse 0.30 0.20 0.10 0.00 Baseline 12 Months 24 Months One relapse observed in 21 years of cumulative patient follow up 18
- 19. Percentage Change in Multiple Sclerosis Impact Scale Tcelna Stabilizes Quality of Life Scores in SPMS at 2 years 4.0% 2.0% Tcelna treated (n=10) 2.1% 0.9% 0.0% Tcelna treated (n=7) 12 Month 1.2% Physical 18-24 Month Psychological -2.0% -4.0% -5.1% -6.0% Negative percent change indicates improvement from baseline Following two years of treatment, no worsening of physical condition and improvement in psychological condition 19
- 20. Abili-T : Landmark trial in SPMS • Abili-T Phase IIb clinical trial in SPMS is ongoing – Double-blind, 1:1 randomized, placebo-controlled – Inclusion criteria: Secondary Progressive MS with EDSS of 3 to 6 – Immune Monitoring program conducted on a blinded basis • Fast Track designation granted by FDA for Tcelna in SPMS • 180 Patients expected to be enrolled – SPMS population – Approximately 33 sites in USA and Canada • 2 annual courses of personalized therapy 20
- 21. Efficacy Assessments • Primary Endpoint – Whole-brain atrophy • Secondary Endpoints – – – – – – – Sustained progression measured by EDSS Time to sustained progression T2 lesions progressing to hypointense lesions (black holes) Change in EDSS Annualized Relapse Rate (ARR) Change in MSFC Assessment of disability Change in Symbol Digit Modality Test (SDMT) • Exploratory Endpoints – – – – – Quality of life assessment by MSQLI Gd-enhancing lesion volume with increasing MTR Gd-enhancing lesion volume with decreasing MTR Change in MTR in normal-appearing white matter Changes in T-regulatory cell repertoire and function 21
- 22. Immune Monitoring Program Trial initiation 2012 40 patients at dose 5 Whole blood analysis: Absolute frequency of Tcells, B-cells, Dendritic cells and Monocytes • Goal is to show no systemic impact on immune response, i.e. Tcelna is a Precision Immunotherapy • Tcelna differentiates by not depleting a broad spectrum of T-cells 180 patients at 10 doses 2014 2013 Immuno vigilance 90 patients at dose 5 2015 Phenotypical Analysis (CD4 and CD8) End of Study 2016 Plausible indicators of Tcelna efficacy • Reduction in Th1/TH17 Pro-inflammatory Anti-inflammatory TH1 TH17 Treg Tr1 TH2 IL-2 IL-6 IL-12 IL-17E, IL-17F IL-23 TNFα IFNϒ IL-4 IL-5 IL-10 IL-27 TGFβ BDNF • Increase in Treg/Tr1 cells • Reduction in proinflammatory cytokines (IL-12, IL-23, IFNϒ, TNFα) • Increase in anti-inflammatory cytokines (IL-10, IL-27) • Loss of proinflammatory monocyte markers (CD16/HLADR, CCR5) • Gain in anti-inflammatory monocyte markers (PDL-1, HLAG, ICOS) 22
- 23. Financials Cash and Cash Equivalents (MM) as of September 30, 2013 $20.2 Shares outstanding (MM) ~22.7 Warrants (MM) (1) ~3.1 Stock Options (MM) (2) ~1.1 (1) Weighted average exercise price =$4.12 as of September 30, 2013 (2) Weighted average exercise price = $4.45 as of September 30, 2013 23
- 24. Goals and Milestones • Present Immune Monitoring base line data at ACTRIMS Conference (2013) • Activate Canadian sites and initiate enrollment in Canada (2013) • Activate and initiate all Abili-T clinical sites in U.S. (2013) • Advance and complete enrollment in Phase IIb Abili-T study in SPMS (2013-14) • Evaluate and present interim immune monitoring data (2013-15) • Evaluate potential of T-cell platform in additional autoimmune diseases (2013-14) 24
- 25. Investment Thesis • T-cell platform company with Fast Track designation in SPMS • Strong Intellectual property with 50 issued patents • Esteemed Scientific Advisory Board • Precision Immunotherapy potentially optimizes benefit-risk profile • Targeting an unmet medical need in a potentially substantial market • Option Agreement with Merck Serono, a strong commercial partner • Replacement value of company is multiples of present market cap • Attractive potential risk-reward profile for long term/value investors • Goal-oriented management team focused on value creation 25
- 26. APPENDIX 26
- 27. Tcelna® Highlights • Clinical studies conducted in Relapsing Remitting and Secondary Progressive MS • Progress made on manufacturing with focus on commercially viable process ─ Over 850 Tcelna preparations have been successfully manufactured, reproducible and consistent • Safety demonstrated and trends in clinical efficacy across broad spectrum of patients for relapsing remitting and secondary progressive MS • Dose and regimen for ongoing clinical development has been selected based on dose ranging studies • Commercial opportunities in MS: – Secondary Progressive MS • Abili-T Phase II SPMS trial ongoing with 180 patients expected in U.S. and Canada • Fast track designation – Relapsing Remitting MS • Formal End of Phase II meetings have been conducted • FDA feedback obtained for potential Phase III studies 27
- 28. Tcelna Manufacturing: Personalization followed by Expansion Step The Epitope Profiling Assay (EPA) • Screen peripheral blood for Myelin-Reactive T-cells (MRTCs), and mapping of immunodominant epitopes to MBP, MOG and PLP – 109 overlapping peptides encompassing MBP, MOG and PLP – Interferon gamma response to individual peptide pools defines positive response in 7 day assay ImmPathTM Process • Procure unit of blood from which up to six T-cell lines reactive with immunodominant myelin peptides are generated and pooled as a patient-specific Tcelna product – Manufacturing performed under GMP/GTPs in functionally closed system – Process generates a year of Tcelna doses from a single unit of blood 28
- 29. Tcelna Manufacturing: Precision Medicine Proprietary Assay Enables Annual Personalized Treatments Year 1 Conduct analysis of 109 peptides from all three key myelin proteins (MBP, MOG, PLP) Year 2 • Re-assess epitope profile annually to identify epitope shift Year 3 • Develop newly personalized formulation annually based on evolved epitope profile 29
- 30. TERMS Study: Safety Overview Safety Summary Deaths • No deaths occurred Serious Adverse Events (SAEs) • No treatment-related SAEs Most common adverse events • Mild to moderate injection site reaction 30
- 31. Abili-T Annual Treatment and Efficacy Assessment Schedule Screen Screen E P Baseline Wk 4 Wk 8 IM1 T1 Wk 12 IM2 T2 T3 Wk 24 Wk 36 Wk 52 IM3 T4 IM4 T5 EDSS EDSS EDSS EDSS EDSS EDSS Neuro Neuro Neuro Neuro Neuro Neuro SDMT SDMT SDMT SDMT SDMT MSFC MSFC MSFC MSQLI MRI MSQLI MRI Efficacy Assessments EDSS: NEURO: SDMT: MSFC: MSQLI: MRI: Expanded Disability Status Scale Neurological Examination Symbol Digit Modalities Test MS Functional Composite MS Quality of Life Indicator Magnetic Resonance Imaging MRI T IM Tcelna dose Immune Monitoring E P Epitope Profile Assay 500 mL Procurement 31 31
- 32. Mechanism of Action • Attenuated, patient-specific (autologous) myelin reactive Tcells (MRTC) – MRTC expanded ex vivo in response to immunodominant peptides of MBP, MOG and PLP • Therapeutic sc dosing (30-45 x 106 cells) stimulates host reactivity to the ‘over-represented’ MRTC inducing a dominant negative ‘regulatory T-cell’ response leading to: – Down-regulation of similar endogenous disease-causing myelin reactive T-cells – Potential to induce up-regulation of regulatory cells (Foxp3+ and Tr1 cells) to reduce inflammation and provide possible neuroprotection, should these gain entry to the CNS • Phase I/II studies conducted with Tcelna in RRMS and SPMS showed a substantial reduction in MRTC, and improved clinical outcomes – lower relapse rates and stabilization of disease as defined by EDSS 32
- 33. Mechanism of Action Tcelna increases Tr1 cells in SPMS Patients Observations • Increase in Tr1 cells from non-detectable to detectable levels in Tcelna treated patients (n=3) • Increase in Tr1 cells to a level similar to those observed in healthy controls (n=4) • p=0.971 (i.e. no statistical difference between healthy donor and post-treatment TR1 dose levels) Pre-Tcelna (non-detectable) Post -Tcelna Clinical findings in Tcelna treated patients • All three patients (who had experienced relapse in preceding 12-24 month) remained relapse free during the 52-week assessment • Showed stabilization of disease progression • Showed a 57%-67% reduction in myelin reactive T-cell counts from baseline 33
- 34. Mechanism of Action The Immunopathology of SPMS • SPMS is associated with compartmentalized CNS inflammatory cells - • Microglia activation suggests ongoing chronic innate immune responses SPMS is associated with inflammatory processes localized within the central nervous system - In SPMS, it is believed that the Blood Brain Barrier (BBB) remains closed enabling only those products that are able to cross the BBB to be potentially effective - • Mechanisms responsible for continued neurodegeneration in SPMS are distinct from those of RRMS SPMS is characterized by a chronic inflammatory process (vs. acute episodes for RRMS) Immunological defects associated with progression to SPMS - Levels of the anti-inflammatory cytokine IL-10 are reduced in patients with SPMS - A therapeutic that has the potential to restore local production of IL-10 would be expected to alleviate chronic inflammation, and thereby reduce neurodegeneration 34
- 35. Baseline Abili-T patients versus Healthy Individuals SPMS subjects have a reduced frequency of IL-10 secreting TR1 cells CD4+ TR1: CD4+CD45RA-LAG3+CD49b+ CD4+ TR1: CD4+CD18bright CD49b+ 4 * % of CD4+ T cells % of CD4+ T cells 15 10 5 3 2 1 0 0 Healthy Donors * ** (p=0.02) Healthy Donors SPMS Patients ** SPMS Patients (p=0.01) ACTRIMS 2013 Poster: Profiling of Secondary Progressive MS by Multicolor Flow Cytometry Lauren W Collison, Ph.D; Chris L Ayers, Ph.D., Jordan L Harrell, MBE; Don Healey, Ph.D. 35
- 36. SPMS subjects have reduced nTReg cells (another type of CD4 cells) Frequency of nTregs may be reduced in SPMS, although the level of Foxp3 expression is equivalent to that of healthy donors. Therefore, function of Tregs cells is equivalent between the populations, unlike in RRMS where reduction in Tregs may play a greater role in the persistence of autoimmunity. Foxp3+ nTregs: CD4+CD127-CD25bright Foxp3+ 25000 * 0.8 20000 0.6 15000 MFI % of CD4+ T cells 1.0 Foxp3+ nTregs: CD4+CD127-CD25bright Foxp3+ 0.4 10000 0.2 5000 0.0 0 Healthy Donors * (p=0.06) SPMS Patients Healthy Donors SPMS Patients (p=0.56) (p= 0.56) ACTRIMS 2013 Poster: Profiling of Secondary Progressive MS by Multicolor Flow Cytometry Lauren W Collison, Ph.D; Chris L Ayers, Ph.D., Jordan L Harrell, MBE; Don Healey, Ph.D. 36
- 37. SPMS patients have fewer Anti-inflammatory monocytes (PDL1 and HLA-G) HLA-G+ Monocytes: CD14+CD16-ICOS+HLA-G+ 6 % of Conv Monocytes % of Conv Monocytes PD-L1+ Monocytes: CD14+CD16-ICOS+PD-L1+ ** 4 2 0 Healthy Donors ** (p=0.004) SPMS Patients 2.0 1.5 1.0 0.5 0.0 Healthy Donors SPMS Patients (p=0.164) ACTRIMS 2013 Poster: Profiling of Secondary Progressive MS by Multicolor Flow Cytometry Lauren W Collison, Ph.D; Chris L Ayers, Ph.D., Jordan L Harrell, MBE; Don Healey, Ph.D. 37