4D Molecular Therapeutics, Inc. · NASDAQ:FDMT
4D Molecular Therapeutics — Investor Presentation (August 2024)
77 slides from 4D Molecular Therapeutics's investor presentation, August 2024
Slide 1: Harnessing the Power of Directed Evolution for Genetic Medicines
Harnessing the Power of Directed Evolution for Targeted, Next-Generation Genetic Medicines Corporate Presentation | August 2024 © 2024 4D Molecular © 2024 4DTherapeutics. Molecular Therapeutics. All Rights Reserved. All Rights Reserved.
Slide 2: Legal Disclaimer
Legal Disclaimer This Presentation contains forward looking statements that involve substantial risks and uncertainties. All statements, other than statements of historical facts, contained in this Presentation, including statements regarding our clinical development plans, strategy, future operatio
Slide 3: Leading Clinical Stage Next Generation AAV Company
Leading Clinical Stage Next Generation AAV Company Mission: Become a Fully Integrated Biopharma Company Boldly Innovating to Unlock the Full Potential of Genetic Medicines for Millions of Patients DIRECTED MODULAR ~1 BILLION PLATFORM EVOLUTION Proprietary Capsid Sequences Customized & Evolved Vector
Slide 4: Platform Solution: Therapeutic Vector Evolution
Platform Solution: Therapeutic Vector Evolution Innovation Through Nobel Prize-Winning Technology for Biologics “…the most powerful biological design process…” – Frances Arnold, 2018 Nobel Prize in Chemistry* THERAPEUTIC DIRECTED AAV GENE VECTOR EVOLUTION THERAPY EVOLUTION *Dr. Arnold and the other
Slide 5: Successes & Limitations of Conventional AAV
Successes & Limitations of Conventional AAV Opportunity For Targeted Genetic Medicine Vectors & Products SUCCESSES LIMITATIONS ▪ Limited Delivery ▪ Limited Transduction ▪ Increased Inflammation Narrow Focus on Niche and Toxicity Diseases ▪ Vulnerability to Neutralizing Antibodies OPPORTUNITY: UNLOCK
Slide 6: Platform Solution: ~1 Billion Synthetic Capsid Sequences
Platform Solution: ~1 Billion Synthetic Capsid Sequences Step 1: Create Massive Diversity in Highly Diverse and Distinct Libraries CONVENTIONAL CREATE ~1 BILLION SYNTHETIC AAV CAPSID HIGHLY DIVERSE AND NATURALLY OCCURRING SEQUENCES BY DIVERSIFYING THE CAP GENE DISTINCT 4DMT AAV CAPSIDS CAPSID LIBRAR
Slide 7: Platform Solution: Target Vector Profile Fitness Competition
Platform Solution: Target Vector Profile Fitness Competition Steps 2 & 3: Therapeutic Vector Evolution IDENTIFY DESIGN PACKAGE ADMINISTER COMPETITIVE SELECTION* LEAD DISEASE ORGAN(S)-SPECIFIC 4DMT AAV 4DMT AAV TARGET VECTOR PROFILE FITNESS VECTORS TARGET(S) TARGET VECTOR LIBRARIES LIBRARIES PROFILE
Slide 8: Unlocking the Full Potential of Genetic Medicines: Multiple Large Market Opportunities
Unlocking the Full Potential of Genetic Medicines: Multiple Large Market Opportunities VECTOR / PRODUCT ESTIMATED RESEARCH IND- PRODUCT DELIVERY CANDIDATE INDICATION PREVALENCE CANDIDATE ENABLING P HA S E 1/ 2 P HA S E 3 R I G HT S Wet AMD ~3M U.S./EUMM 4D-150 DME ~5M U.S./EUMM OPHTHALMOLOGY 4D-125
Slide 9: Large Market Ophthalmology
Large Market Ophthalmology Modular Vector: R100 ▪ 4D-150: Wet AMD & DME ▪ 4D-175: Geographic Atrophy © 2024 4D Molecular © 2024 4DTherapeutics. Molecular Therapeutics. All Rights Reserved. All Rights Reserved.
Slide 10: R100 is Designed for Low Dose Intravitreal Delivery for Retinal Diseases
R100 is Designed for Low Dose Intravitreal Delivery for Retinal Diseases R100 Capsid Efficient Intravitreal Delivery to the Retina Overcome Enhanced retinal barrier (e.g., ILM) transduction Capsid base Peptide insertions Point mutations (internal) Modular Vector Platform for Genetic Medicines to Tre
Slide 11: Wet AMD is the First of Four Large Market Retina Indications
Wet AMD is the First of Four Large Market Retina Indications for 4DMT ~7.6 Million Patients in U.S. Ongoing 4D-150 Trials Future opportunities 3.4M 4.2M 2024 U.S. Prevalence ~2.6M* ~1.7M ~1.7M ~1.6M wet AMD DME Moderate-Severe NPDR GA Lead Program 4D-150 4D-175 Market Scope 2023 Retinal Pharmaceutic
Slide 12: Current Bolus Anti-VEGF Therapies for Wet AMD Do Not Preserve Vision
Current Bolus Anti-VEGF Therapies for Wet AMD Do Not Preserve Vision Long-Term Vision Loss Over Time in the Real World with Current Standard of Care1 +4 +3.0 Therapeutic Objective: Long-term Vision Preservation Change in VA,ETDRS Letters +2 +1.2 Change from Baseline 0 -0.4 -1.8 -2 -3.1 -4 -4.6 Initi
Slide 13: 4D-150 Solution: Designed to Preserve Vision
4D-150 Solution: Designed to Preserve Vision by Addressing the Limitations of Current Wet AMD Therapeutic Regimens Aqueous Concentrations Following Bevacizumab Injections1* Vision Loss Over Time 166% VEGF-A Due to Limitations of Limited durability & 91% VEGF-C Current Standard of high treatment burd
Slide 14: Goal of Continuous Retinal Expression of Anti-VEGF is to Reduce Retinal Anatomy Variability
Goal of Continuous Retinal Expression of Anti-VEGF is to Reduce Retinal Anatomy Variability Oscillating Peak-Trough Anti-VEGF Concentrations Can Central Subfield Thickness (CST) Variability Lead to Variability in CST Predicts Legal Blindness in Wet AMD1 100 HR 2.90 (p=0.002) 0 reservation vision pre
Slide 15: Products with Incremental Improvements in Durability Have Become Commercial Blockbusters
Products with Incremental Improvements in Durability & Reduction in Treatment Burden Have Become Commercial Blockbusters Reduction in Injections Peak WW Annual Sales In-Office IVT “Treat & Extend” Landscape in Wet AMD vs. (All Indications, Eylea Q8W* Consensus6) 4D-150 Designed to provide continuous
Slide 16: Potential Multi-billion Annual Revenue Opportunity for 4D-150 in Wet AMD
Potential Multi-billion Annual Revenue Opportunity for 4D-150 in Broad Wet AMD Patient Population in the U.S. if Approved Market Unlocked Through Potential Wet AMD U.S. Opportunity Adoption Across Key Patient Segments Estimated in 2035 ~$10B annual* Logistically and/or compliance 1% share High burde
Slide 17: Strong & Accelerating Enrollment Rates
Significant Investigator & Patient Interest Following Clinical Data Drove Strong & Accelerating Enrollment Rates 139 Patients Treated with 4D-150 Patients 4D-150 To-Date Enrolled per Month ~14 ~9 ~2 Phase Phase 1 1 Phase 2Phase 2 Dose Expansion Phase Phase 2 Population 2 & Alternate Extension Dose E
Slide 18: Key Highlights from 4D-150 Interim Data Presented at ASRS
Key Highlights from 4D-150 Interim Data Presented at ASRS 1.1 STRONG CLINICAL ACTIVITY DEMONSTRATED IN BROAD WET AMD DISEASE ACTIVITY POPULATION: Planned Phase 3 Population 2.2 DEMONSTRATED DURABLE CLINICAL ACTIVITY 3.3 CONTINUES TO BE SAFE & WELL-TOLERATED: In Both Wet AMD & DME 4.4 PROVIDES FURTHE
Slide 19: 4D-150 Continues to be Safe and Well Tolerated in Wet AMD & DME
4D-150 Continues to be Safe and Well Tolerated in Wet AMD & DME (N=139) No Significant Inflammation in Patients Treated with Planned Phase 3 Dose & Durezol Regimen Highest SUN/NEI Score Observed (4D-150–Related)* All Doses & Steroid Regimens Planned Phase 3 Dose & Range of Maximum Follow-up† Tested†
Slide 20: Phase 2 Cohorts Designed to Evaluate 4D-150 in Wet AMD
Phase 2 Cohorts Designed to Evaluate 4D-150 in Wet AMD Patients With Severe or Broad Disease Activity Population: Severe & High Treatment Burden Broad Disease Activity Cohort: Dose Expansion Population Extension 3E10 vg/eye 3E10 vg/eye (n=20) (n=30) 2:2:1 Sequential 1E10 vg/eye 1E10 vg/eye Randomize
Slide 21: Phase 2 Cohorts Enrolled Wet AMD Patients With Severe or Broad Disease Activity
Phase 2 Cohorts Enrolled Wet AMD Patients With Severe or Broad Disease Activity 10 + Phase 2 Dose Expansion 8 Actual Anti-VEGF Injections Mean CST: ~440 μm Actual Injections*: ~10 (prior 12 months) 6 4 Phase 2 Population Extension Mean CST: ~330 μm 2 Actual Injections*: ~4.4 0 200 225 250 275 300 32
Slide 22: Wet AMD is a Heterogenous Patient Population
Wet AMD is a Heterogenous Patient Population with a Wide Range of Anti- VEGF Need Real World Injection Frequency1 Moderate to High burden: ~20% to ~60% 14% 14% 13% 11% 9% 10% % of eyes treated 7% 6% 5% 4% 3% 3% 2% 1 2 3 4 5 6 7 8 9 10 11 12 13 Real World Number of Injections (Yr 1) 1. Adapted from C
Slide 23: Phase 2 Population Extension Cohort Treatment Schema & Endpoints
Phase 2 Population Extension Cohort Treatment Schema & Endpoints Design Finalized ~Mid-2023: Population Extension Cohort Study Schema 1) Patient safety during gene expression ramp-up (maximizes by week 8-12) 2) Similar to expected Phase 3 design (and precedents) Landmark Local Corticosteroid* Analys
Slide 24: Baseline Characteristics Showed Dose Arms are Well Balanced
Baseline Characteristics Showed Dose Arms are Well Balanced 3E10 vg/eye 1E10 vg/eye Total (N=30) (N=15) (N=45) Mean ±SD age, years 77 ±7.7 78 ±8.6 77 ±7.9 Mean ±SD BCVA, ETDRS letters 71 ±9.9 73 ±8.8 72 ±9.5 Mean ±SD CST (central subfield thickness), m 336 ±135.0 314 ±70.8 329 ±117.1 Mean ±SD time
Slide 25: Robust Anti-VEGF Treatment Burden Reduction Observed through 24 Weeks
Robust Anti-VEGF Treatment Burden Reduction Observed through 24 Weeks Patients Receiving Planned Phase 3 Dose of 3E10: 77% Injection-Free & 93% Had 0–1 Injection Aflibercept Ranibizumb Bevacizumab Faricimab Suppl. Aflibercept Overall: 4D-150 89% reduction in annualized 3E10 vg/eye anti-VEGF injectio
Slide 26: Planned Phase 3 Dose Demonstrated Higher BCVA Gains
Planned Phase 3 Dose Demonstrated Higher BCVA Gains That Were Maintained Over Time, Including in Injection-Free Patients Mean Change Mean Absolute Average (95% CI): Baseline Weeks 20/24 Week 24 3E10 vg/eye: Total 71 +3.5 (1.1, 5.8) 75 4D-150 3E10 (n=30) 3E10 vg/eye: Total (n=30) 3E10 vg/eye: Injecti
Slide 27: Planned Phase 3 Dose Demonstrated Sustained Anatomic Control
Planned Phase 3 Dose Demonstrated Sustained & Greater Anatomic Control Without Fluctuations, Including in Injection-Free Patients 200 (n=30) Total (n=30) 4D-150 3E10 vg/eye: Adjusted mean (95% CI) change in CST Mean Change Mean Absolute 150 4D-150 4D-150 3E10 3E10 inj-free vg/eye: (n=23) Injection-f
Slide 28: Patient Case Highlighting the Benefit of a Single Injection of 4D-150 3E10
Patient Case Highlighting the Benefit of a Single Injection of 4D-150 3E10: BCVA & CST Improved and Maintained Over Time and Injection-free Patient received 4 prior anti-VEGF injections (bevacizumab) in last 6 months CST (m) 200 0 -2 0 2 4 6 8 10 12 14 16 18 20 22 24 4D-150 100 4D-150 500 BCVA (ETD
Slide 29: Randomized Phase 2 Dose Expansion Treatment Schema & Endpoints
Randomized Phase 2 Dose Expansion Treatment Schema & Endpoints: 4D-150 at Doses of 3E10 & 1E10 vg/eye vs. Aflibercept Q8 Week Control Topical corticosteroid taper† Landmark Analysis Aflibercept 4D-150 (Day -7) (Day 1) 4D-150 3E10 vg/eye (n=20) 4D-150 1E10 vg/eye (n=21) Aflibercept 2 mg (n=10) 0 4 8
Slide 30: Baseline Characteristics: Severe Disease Activity & High Treatment Burden
Baseline Characteristics: Wet AMD Patients with Severe Disease Activity & High Treatment Burden 3E10 vg/eye 1E10 vg/eye Aflibercept Total (n=20) (n=21) (n=10) (N=51) 77 ± 7.7 Mean ±SD age, years 77 ± 8.0 77 ± 8.6 80 ± 4.1 (range: 57–92) Mean ±SD time since diagnosis, years 4.0 ± 3.0 2.9 ± 2.2 1.9 ±
Slide 31: PRISM Met All Objectives Through 24 Weeks
PRISM Met All Objectives in Wet AMD Patients with Severe Disease Activity & High Treatment Burden Through 24 Weeks Anti-VEGF Long Term Retinal Treatment Burden Durability Administration Safety Anatomical Reduction (3E10 vg/eye Control (3E10 vg/eye) from Phase 1) intravitreal Single, routine injecti
Slide 32: Robust Reduction in Treatment: 89% Reduction with High Dose 4D-150
Robust Reduction in Treatment for Severe Disease Activity & High Treatment Burden Patients: 89% Reduction with High Dose 4D-150 Aflibercept Ranibizumb Bevacizumab 4D-150 Brolucizumab Faricimab Suppl. Aflibercept Overall: 4D-150 89% reduction in annualized 3E10 vg/eye anti-VEGF injection rate (n=20)
Slide 33: Stable Visual Acuity Equivalent to Standard Aflibercept
Stable Visual Acuity Equivalent to Standard Aflibercept 30 Average difference (95% CI) vs. Aflibercept Total Aflibercept(n=10) Aflibercept 2 mg Q8W (n=10) Adjusted mean (95% CI) change in ETDRS letters 20 4D-150 (3E10 vg/eye) –1.8 (–1.0, 4.1) Population 4D-1503E10 4D-150 3E10vg/eye vg/eye(n=20) (n=2
Slide 34: Stable Visual Acuity With and Without Supplemental Injections
Stable Visual Acuity Equivalent to Standard Aflibercept With and Without Supplemental Injections 30 Average difference (95% CI) vs. Aflibercept Injection-free Aflibercept (n=10) Aflibercept 2 mg Q8W (n=10) Adjusted mean (95% CI) change in ETDRS letters 4D-150 (3E10 vg/eye) +0.4 (–5.2, 6.1) 20 4D-150
Slide 35: Sustained Reduction in CST and Anatomic Control Compared to Aflibercept
Sustained Reduction in CST and Anatomic Control Compared to Aflibercept Average difference (95% CI) vs. Aflibercept 200 Total 150 Aflibercept(n=10) Aflibercept 2 mg Q8W (n=10) 4D-150 (3E10 vg/eye) –8.3 (–92.6, 76.0) Adjusted mean (95% CI) Population change in CST (µm) 100 4D-1503E10 4D-150 3E10vg/ey
Slide 36: Sustained Reduction in CST With and Without Supplemental Injections
Sustained Reduction in CST and Anatomic Control Compared to Aflibercept With and Without Supplemental Injections 200 Average difference (95% CI) vs. Aflibercept Injection-free Aflibercept Aflibercept 2(n=10) mg Q8W (n=10) 4D-150 (3E10 vg/eye) –30.8 (–125, 63.2) 150 Adjusted mean (95% CI) change in C
Slide 37: Outcomes Under Preliminary Phase 3 Eligibility Criteria
Vision and CST Outcomes Under Preliminary Phase 3 Eligibility Criteria* Supports Advancement to Phase 3 25 Aflibercept (n=6) Average 20 Anti-VEGF Injections Adjusted 15 4D-150 3E10 vg/eye (n=16) (Weeks 20 & 24) ∆ vs A L B mean 10 +3.3 ±95% CI 5 10 0 change in -5 9.6 BCVA 90% -10 Preliminary Phase 3
Slide 38: Phase 1 Patients Remain Injection-free Through ~2 to 2.5 Years
3 Patients from Phase 1 Treated with 4D-150 3E10 vg/eye Remain Injection- free Through ~2 to 2.5 Years with Strong Disease Control 4D-150 Anti-VEGF Injections (3E10 vg/eye) Aflibercept Ranibizumb Visits Supplemental Aflibercept Participant 1 Participant 3 Participant 4 -52 -48 -44 -40 -36 -32 -28 -2
Slide 39: Planned 4D-150 Phase 3 Registrational Trials in Wet AMD
Planned 4D-150 Phase 3 Registrational Trials in Wet AMD ▪ Primary Endpoint: Noninferiority (BCVA) 4D-150 3E10 vg/eye vs. aflibercept Preliminary 2mg Q8 weeks Phase 3 Design ▪ Study Size: ~450 patients per study, two studies ▪ Target Population: broad wet AMD disease activity ▪ Increased collaboratio
Slide 40: Phase 2 Study Evaluating 4D-150 in Diabetic Macular Edema
Phase 2 Study Evaluating 4D-150 in Diabetic Macular Edema, a 2nd Large Market Indication Randomized, Active-Controlled, Double-Masked Phase 2 Key Inclusion Criteria Part 1 – Dose Confirmation Part 2 – Expansion ▪ Type I or II diabetes mellitus with macular thickening secondary to DME involving the c
Slide 41: Geographic Atrophy is a Large and Growing Retinal Disease
Geographic Atrophy is a Large and Growing Retinal Disease, CFH Dysfunction & Activation of the Complement Pathway Implicated Classical Lectin Alternative pathway pathway pathway Geographic Atrophy (GA) Antibody-antigen Serum lectin binding Spontaneous hydrolysis complex to mannose residues of C3 on
Slide 42: 4D-175 Solution: Intravitreal Gene Therapy for Geographic Atrophy
4D-175 Solution: Intravitreal Gene Therapy for Geographic Atrophy Biological Rationale 4D-175: sCFH-Transgene Payload ▪ Clinically validated retinotropic AAV vector (R100) ▪ Codon-optimized sequence encoding a highly Promoter (Ubiquitous) Transgene (sCFH) functional, shortened form of human compleme
Slide 43: Short-form Complement Factor H is Highly Functional Compared to Full-Length
Short-form Complement Factor H (sCFH) is Highly Functional Compared to Full-Length Transgene Design Pharmacological Activity Heparin Binding C3b Cleavage Full-length Human CFH1 3 sCFH NT Control Heparin binding CFH Heparin C3b binding CFH + + + - + - Supernatant sCFH C3b binding binding C3d binding
Slide 44: Target sCFH Levels Reached in Non-Human Primate Study
Target sCFH Concentration Levels Reached in Non-Human Primate Ocular Pharmacodynamics and Tolerability Study 4D-175 sCFH Ocular Biodistribution 4D-175 Safety and Tolerability Aqueous Humor* Ocular Distribution‡ Fluorescein Angiography Intraocular Pressure (IOP) 40 Vehicle (n=3) NHP 2502 (1.5x1011 vg
Slide 45: Rapidly Advancing Development in Large Market Ophthalmology
Rapidly Advancing Development in Large Market Ophthalmology VECTOR PRODUCT EPIDEMIOLOGY DELIVERY CANDIDATE INDICATION (PREVALENCE) PHASE 1 PHASE 2 PHASE 3 MILESTONES ✓ 24-week Ph 2 Dose Expansion (N=51) ✓ 24-week Ph 2 Pop. Extension (N=45) ▪ Sep 24 4D-150 Development Day: Interim longest available f
Slide 46: Pulmonology
PULMONOLOGY Modular Vector: A101 ▪ 4D-710: Cystic Fibrosis Lung Disease ▪ 4D-725: Alpha-1 Antitrypsin Deficiency Lung Disease © 2024 4D Molecular © 2024 4DTherapeutics. Molecular Therapeutics. All Rights Reserved. All Rights Reserved.
Slide 47: A101: Next-Gen Aerosolized Genetic Medicine Vector for Pulmonology
A101: Next-Gen Aerosolized Genetic Medicine Vector for Pulmonology Prior aerosol gene therapy trials failed to achieve Aerosolized A101-Based Genetic Medicines transgene expression in lung1,2; potential limitations: Poor mucus penetration Overcome Potential Barriers Enhanced Transduction of Airway
Slide 48: CF Lung Disease Has High Unmet Medical Need Despite Modulators
CF Lung Disease Has High Unmet Medical Need Despite Modulators Disease Burden Epidemiology ▪ Dysfunctional cystic fibrosis transmembrane ▪ ~105,0004,5 prevalence worldwide: conductance regulator (CFTR) protein → o ~40,000 prevalence in U.S. alone inability to transport chloride at the apical membran
Slide 49: Highest Unmet Need in ~35K People with Cystic Fibrosis
Highest Unmet Need in ~35K People with Cystic Fibrosis 4D-710 has the Potential to Treat Cystic Fibrosis Lung Disease Regardless of Genetic Variant Cystic Fibrosis Population WW Population Segment Estimated People Ineligible for CFTR modulators ~10k study population 10% Intolerant to CFTR modulators
Slide 50: Phase 1/2 Designed to Identify Doses for Late-Stage Development
Phase 1/2 Designed to Identify Doses for Late-Stage Development Generate Safety, Biomarker & Clinical Activity Data to Inform Selection of Phase 2 & 3 Dose Phase 1 (Dose Exploration) Phase 2 (Dose Expansion) Primary Objectives: ppFEV1 Eligibility Criteria: 50% to 100% ppFEV1 Eligibility Criteria: ▪
Slide 51: AEROW Enrolled Participants Baseline Characteristics
AEROW To-Date Enrolled pwCF Ineligible or Intolerant to Modulators with a Broad Range of Disease Activity, 5 with Pre-Existing Immunity to A101 2E15 vg 1E15 vg 5E14 vg 2.5E14 vg Participant # 1 2 3 4 1 2 3 1 2 1 Age, y 37 27 32 69 36 24 20 42 39 25 Sex Female Male Female Female Male Male Female Fema
Slide 52: Aerosolized 4D-710 Was Well Tolerated
Aerosolized 4D-710 (Up to 1E15 vg) Was Well Tolerated 4D-710-Related Adverse Events None Grade 1 Grade 2 Grade 3 Grade 4 1E15 vg 1 2 3 5E14 vg 1 2 2.5E14 vg 1 Month (post dose): 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 ▪ Administration of aerosolized 4D-710 well tolerated o
Slide 53: Dose-dependent CFTRΔR RNA Expression Following 4D-710
Dose-dependent CFTR∆R RNA Expression Following 4D-710 Administration CFTRR RNA (ISH): mean % (+) airway epithelial cells 80 ▪ Dose-dependent CFTRR mRNA Mean % (+) epithelial cells 60 expression in bronchial epithelial 53 cells 40 40 ▪ No CFTRR mRNA expression 27 observed in commercial non-CF and
Slide 54: Widespread 4D-710–Mediated CFTR Protein Expression
Widespread 4D-710–Mediated CFTR Protein Expression at All Doses and in All Participants CFTR (+) Epithelial Cells (IHC) CFTR Staining Intensity (IHC)* 99.3 98.3 100 300 277 100 94 Mean % (+) epithelial cells 250 224.9 Mean intensity score* 80 204.9 200 60 150 44.2 150 40 100 18.4 47 20 50 19 0 0 2E1
Slide 55: Widespread & Consistent CFTR Protein Expression: 100% of Samples
Widespread & Consistent CFTR Protein Expression: 100% of Samples 4D-710 Treated 2E15 vg 1E15 vg 5E14 vg 2.5E14 vg Participant 1 Participant 2† Participant 3 Participant 4 Participant 1 Participant 2† Participant 3 Participant 1 Participant 1 Pending Not sampled Not sampled Pending Interstitial stain
Slide 56: CFTR Protein Expression Observed in Multiple Airway Cell Types
CFTR Protein Expression Observed in Multiple Airway Cell Types CFTR Protein Expression (IHC) Following Administration of 4D-710: Secretory, Ciliated & Basal Cells CFTR Protein Expressed in Multiple Cell Types* Localization to Apical Region† Cross section Longitudinal (1) Basal cells (2) Goblet cells
Slide 57: Pre-existing A101 Immunity and Transgene-mediated Protein Expression
Pre-existing A101 Immunity and Transgene-mediated Protein Expression Pre-existing A101 Immunity Did NOT Affect CFTRR RNA or CFTR Protein Expression CFTR Expression According to Baseline Anti-A101 Antibodies ns ns Pre-existing Anti-A101 Capsid Antibodies 80 ns 150 300 CFTRdR ISH % Positive Positive
Slide 58: ppFEV1 Improvement at 12 Months in Two of Three Participants
Two of Three Participants with Mild to Moderate ppFEV1 Impairment at Baseline Showed Improvement at 12 Months 2E15 vg 2x1015 vg (Pt 2) Participant 2 2E15 vg 2x1015 (Pt 3) vg Participant 3 1E15 vg 1x1015 vg Participant (Pt 2) 2 90 86 +6 ▪ Three participants had a 80 80 4D-710 (2x1015 vg) 74 baseline
Slide 59: 4D-710 (1E15 vg): Durable Improvement in CFQ-R-R Score
4D-710 (1E15 vg): Durable Improvement in CFQ-R-R Score CFQ-R Respiratory Symptom Score Mean Change in CFQ-R-R Score 100 14 * 89 89 CFQ-R Respiratory Symptom Score 90 * 12 11.1 83 83 83 * 83 Respiratory Symptom Score 80 78 78 78 Mean change in CFQ-R 72 72 72 72 10 70 8.4 8.4 8.4 61 8 7.4 * 60 56 6 50
Slide 60: Totality of Data Supports 1E15 vg as Intended Phase 2 Dose
Totality of Clinical & Biomarker Data To-date Supports 1E15 vg as Intended Phase 2 Expansion Dose, 5E14 vg Dose Pending Additional Follow-Up 2E15 vg 1E15 vg 5E14 vg 2.5E14 vg Dose Selection Criteria: Target Profile (n=4) (n=3) (n=1) (n=1) CFTR∆R RNA expression (ISH) ≥15% cells1,2 CFTR protei
Slide 61: Preliminary Registration Path for 4D-710
Preliminary Registration Path for 4D-710 for Treatment of People with CF Who are Modulator-Ineligible/-Intolerant Preliminary Phase 3 Design Accelerated Approval N= ~60-80 Additional FDA/EMA discussions to follow pwCF with low baseline ppFEV1 Population additional AEROW clinical and lung (planned ~4
Slide 62: Pulmonology Pipeline Key Expected Milestones
Pulmonology Pipeline Key Expected Milestones VECTOR PRODUCT EPIDEMIOLOGY IND- EXPECTED UPCOMING DELIVERY CANDIDATE INDICATION (PREVALENCE) ENABLING PHASE 1/2 PHASE 3 MILESTONES Cystic Fibrosis Lung Disease ✓ Phase 1 interim update (N=10) ~15K (modulator ▪ Mid-2025 Interim data update WW ineligible /
Slide 63: Cardiology
CARDIOLOGY Vector: C102 ▪ 4D-310: Fabry Disease Cardiomyopathy © 2024 4D Molecular © 2024 4DTherapeutics. Molecular Therapeutics. All Rights Reserved. All Rights Reserved.
Slide 64: C102 & 4D-310 Designed for Low Dose IV Delivery to the Heart
C102 & 4D-310 Designed for Low Dose IV Delivery to the Heart Cardiac disease is the most common cause of Intravenous C102-Based Genetic Medicines death (75%)1 in Fabry disease 4D-310 C102 Vector: C102 (cardiac Current therapies do not adequately address targeting evolved AAV) Fabry-related cardiovas
Slide 65: 4D-310 Unique MOA Well-Differentiated Versus ERT & Genetic Medicines
4D-310 Unique MOA Well-Differentiated Versus ERT & Genetic Medicines for Fabry Disease Cardiomyopathy ERT (Blood) Genetic Medicine AGA Enzyme PEGylated AGA AAV-mediated 4D-310 MOA Product Design Infusions Liver-directed Normal Pharmacokinetics Time of dose AGA Delivery Lifelong Through the Bloodstre
Slide 66: Phase 1/2 Open Label Clinical Trials: 4D-310 for Fabry Disease Cardiomyopathy
Phase 1/2 Open Label Clinical Trials: 4D-310 for Fabry Disease Cardiomyopathy Geography U.S. multicenter (Currently on Clinical Hold) Taiwan & Australia multicenter Patient Population Male or female adults; classic or late onset Fabry disease; cardiac involvement* (on or off ERT) 4D-310 Dose 1E13 vg
Slide 67: Cardiac Assessments: Multiple Diverse Endpoints
Cardiac Assessments: Multiple Diverse Endpoints Study Assessment Method Time Points Transgene delivery & expression, Gb3 accumulation Cardiac Biopsy* Weeks 6, 26 Exploratory endpoint (INGLAXA 2) Cardiac contractility (global longitudinal strain) Echocardiogram† Months 6, 9, 12, 18, 24 FDA-recommende
Slide 68: Baseline Patient Characteristics
Baseline Patient Characteristics INGLAXA 1 INGLAXA 2 Characteristic Patient 1 Patient 2 Patient 3 Patient 4 Patient 5 Patient 6 Disease classification Classic Classic Classic Late onset Late onset Late onset GLA variant c.1023A>C c.708G>T c.974G>A c.671A>G IVS4+919 G>A c.644 A>G Serum AGA activity,
Slide 69: Cardiac Biopsy: Robust & Durable Transgene Expression in Cardiomyocytes
Cardiac Biopsy: Robust & Durable Transgene Expression in Cardiomyocytes ▪ Single participant with repeated cardiac biopsy 25 Week 6 (Weeks 6 & 26)* mRNA expression 20 Week 26 16.2 15 ▪ No inflammation 9.8 10 ▪ Paired analysis of biopsies demonstrated 5 4.3 2.6 widespread transduction & durable trans
Slide 70: Cardiac Biopsy: Reduction in Gb3 Substrate Accumulation
Cardiac Biopsy: Reduction in Gb3 Substrate Accumulation in Cardiomyocytes Mean Gb3 Inclusion Body Ultra-high resolution electron microscopy & Volume per Cardiomyocyte image analysis used to identify cardiomyocytes & quantify the volume of Gb3 inclusions1 1200 1000 1058 Mean volume (m3) 800 15% Redu
Slide 71: Global Longitudinal Strain: Ventricular Function Improved or Stable
Global Longitudinal Strain: Ventricular Function Improved or Stable in All Evaluable Participants Change from Baseline (%) Patient Baseline (Screening) Month 6 Month 12 Month 24 1 ‒17.10 Borderline ‒1.1 ‒2.5 ‒2.9 3 ‒18.83 Low normal ‒0.5 ‒3.3 ‒2.8 2* ‒22.17 Normal na ‒1.1 na MCID=1.5%2 5 ‒21.95‡ Nor
Slide 72: Cardiopulmonary Exercise Testing: Durable Improvement in Peak VO2
Cardiopulmonary Exercise Testing: Durable Improvement in Peak VO2 in 3 of 4 Evaluable Participants Change from Baseline Patient Measurement Baseline Month 6 Month 12 Month 24 mL/kg/min +2.0† +7.8† 1 na nc* (% predicted) (+6.3)† (+24.6)† mL/kg/min 14.0 +7.0 2‡ na na (% predicted) (33.0) (+17.0) MCID=
Slide 73: KCCQ: Improved or Stable QoL in All Evaluable Participants
Kansas City Cardiomyopathy Questionnaire (KCCQ): Improved or Stable QoL in All Evaluable Participants +10.4 +12.5 +5.2 Clinical 100 100 100 100 98.4 +4.7 97.9 100 100 100 100 97.9 +1.1 93.8 92.2 92.7 Summary Absolute Score 80 +5.7 87.5 Baseline Month 9 Score 60 59.9 65.6 Month 12 Month 24 40 20 0 Pa
Slide 74: Variability in Serum Biomarkers, No Correlation with Cardiac Outcomes
Considerable Inter- and Intrasubject Variability in Serum Biomarkers, No Correlation with Cardiac Outcomes Serum AGA 4 Activity 3 Cardiac Outcomes (Patient 2) Log serum AGA activity (nmol/hr/mL) 2 Outcome Baseline Month 12 Change 1 Peak VO2 (mL/kg/min) 14.0 21.0 +7.0 Patient 1 0 Patient 2 * Peak VO2
Slide 75: Program Expectations & Cash Position
Program Expectations & Cash Position ©© 2024 4D4D 2024 Molecular Therapeutics. Molecular AllAll Therapeutics. Rights Reserved. Rights Reserved. 75
Slide 76: Strong Cash Balance to Execute Through Key Near-Term Expected Milestones
Strong Cash Balance to Execute Through Key Near-Term Expected Milestones Large Market 4D-150 1) Interim longest available follow up data through up to 2.5 years from PRISM Phase 1/2 cohorts Ophthalmology DEVELOPMENT DAY (September 2024) 2) Final wet AMD Phase 3 clinical trial design update 24-week
Slide 77: Thank You
THANK YOU 5858 Horton Street, Suite 455 | Emeryville, California 94608 (510) 505-2680 | Investor.Relations@4DMT.com IR.4DMT.com | LinkedIn © 2024 4D Molecular © 2024 4DTherapeutics. Molecular Therapeutics. All Rights Reserved. All Rights Reserved.
4D Molecular Therapeutics — Investor Presentation (August 2024) on 6ix