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Exhibit 10.24    
    

 
 

SYNAGRO TECHNOLOGIES, INC.
  2005 RESTRICTED STOCK PLAN    
    

1.    Purpose.    

        This
plan shall be known as the Synagro Technologies, Inc. 2005 Restricted Stock Plan (the "Plan"). The purpose of the Plan shall be to promote the long-term growth
and profitability of Synagro Technologies, Inc. (the "Company") and its Subsidiaries by (i) providing certain directors, officers and employees of, and certain other individuals who
perform services for, the Company and its Subsidiaries with incentives to maximize stockholder value and otherwise contribute to the success of the Company and (ii) enabling the Company to
attract, retain and reward the best available persons for positions of responsibility. Grants of restricted stock may be made under the Plan. 

2.    Definitions.    

        (a)   "Board
of Directors" and "Board" mean the board of directors of the Company. 

        (b)   "Cause"
means the occurrence of one or more of the following events: 

        (i)    Conviction
of a felony or any crime or offense lesser than a felony involving the property of the Company or a Subsidiary; or 

        (ii)   Conduct
that has caused demonstrable and serious injury to the Company or a Subsidiary, monetary or otherwise; or 

        (iii)  Willful
refusal to perform or substantial disregard of duties properly assigned, as determined by the Company or a Subsidiary, as the case may be; or 

        (iv)  Breach
of duty of loyalty to the Company or a Subsidiary or other act of fraud or dishonesty with respect to the Company or a Subsidiary. 

        (c)   "Change
in Control" means the occurrence of one of the following events: 

        (i)    if
any "person" or "group" as those terms are used in Sections 13(d) and 14(d) of the Exchange Act or any successors thereto, other than an Exempt Person, is or becomes
the "beneficial owner" (as defined in Rule 13d-3 under the Exchange Act or any successor thereto), directly or indirectly, of securities of the Company representing 50% or more of
the combined voting power of the Company's then outstanding securities; or 

        (ii)   during
any period of two consecutive years, individuals who at the beginning of such period constitute the Board and any new directors whose election by the Board or
nomination for election by the Company's stockholders was approved by at least two-thirds of the directors then still in office who either were directors at the beginning of the period or
whose election was previously so approved, cease for any reason to constitute a majority thereof; or 

        (iii)  consummation
of a merger or consolidation of the Company with any other corporation, other than a merger or consolidation (A) which would result in all or a
portion of the voting securities of the Company outstanding immediately prior thereto continuing to represent (either by remaining outstanding or by being converted into voting securities of the
surviving entity) more than 50% of the combined voting power of the voting securities of the Company or such surviving entity outstanding immediately after such merger or consolidation or
(B) by which the corporate existence of the Company is not affected and following which the Company's chief executive officer and directors retain their positions with the Company (and
constitute at least a majority of the Board); or 

        (iv)  consummation
of a plan of complete liquidation of the Company or a sale or disposition by the Company of all or substantially all the Company's assets, other than a
sale to an Exempt Person. 

 

        (d)   "Code"
means the Internal Revenue Code of 1986, as amended. 

        (e)   "Committee"
means the Compensation Committee of the Board, which shall consist solely of two or more members of the Board. 

        (f)    "Common
Stock" means the Common Stock, par value $0.002 per share, of the Company, and any other shares into which such stock may be changed by reason of a
recapitalization, reorganization, merger, consolidation or any other change in the corporate structure or capital stock of the Company. 

        (g)   "Disability"
means a disability that would entitle an eligible participant to payment of monthly disability payments under any Company disability plan or as otherwise
determined by the Committee. 

        (h)   "Exchange
Act" means the Securities Exchange Act of 1934, as amended. 

        (i)    "Exempt
Person" means (i) GTCR Golder Rauner, L.L.C., GTCR Golder Rauner II, L.L.C. or any of their respective affiliates, (ii) any person, entity or group
under the control of any party included in clause (i), or (iii) any employee benefit plan of the Company or a trustee or other administrator or fiduciary holding securities under an
employee benefit plan of the Company. 

        (j)    "Family
Member" has the meaning given to such term in General Instructions A.1(a)(5) to Form S-8 under the Securities Act of 1933, as amended, and any
successor thereto. 

        (k)   "Fair
Market Value" of a share of Common Stock of the Company means, as of the date in question, the officially-quoted closing selling price of the stock (or if no
selling price is quoted, the bid price) on the principal securities exchange on which the Common Stock is then listed for trading (including for this purpose the Nasdaq Market or the Pacific Exchange)
(the "Market") for the applicable trading day or, if the Common Stock is not then listed or quoted in the Market, the Fair Market Value shall be the fair value of the Common Stock determined in good
faith by the Board. 

        (l)    "Non-Employee
Director" has the meaning given to such term in Rule 16b-3 under the Exchange Act and any successor thereto. 

        (m)  "Retirement"
means retirement as defined under any Company pension plan or retirement program or termination of one's employment on retirement with the approval of the
Committee. 

        (n)   "Subsidiary"
means a corporation or other entity of which outstanding shares or ownership interests representing 50% or more of the combined voting power of such
corporation or other entity entitled to elect the management thereof, or such lesser percentage as may be approved by the Committee, are owned directly or indirectly by the Company. 

3.    Administration.    

        The
Plan shall be administered by the Committee; provided that the Board may, in its discretion, at any time and from time to time, resolve to administer the Plan, in which case the term
"Committee" shall be deemed to mean the Board for all purposes herein. Subject to the provisions of the Plan, the Committee shall be authorized to (i) select persons to participate in the Plan,
(ii) determine the form and substance of grants made under the Plan to each participant, and the conditions and restrictions, if any, subject to which such grants will be made,
(iii) certify that the conditions and restrictions applicable to any grant have been met, (iv) modify the terms of grants made under the Plan, (v) interpret the Plan and grants
made thereunder, (vi) make any adjustments necessary or desirable in connection with grants made under the Plan to eligible participants located outside the United States and
(vii) adopt, amend, or rescind such rules and regulations, and make such other determinations, for carrying out the Plan as it may deem appropriate. Decisions of the Committee on all matters
relating to the Plan shall be in the Committee's sole discretion and shall be conclusive and binding on all parties. The validity, construction, and effect of the Plan and any rules and regulations
relating to the Plan shall be determined in accordance with applicable federal and state laws and rules and regulations promulgated pursuant thereto and the rules and regulations of the principal
securities exchange on 

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which
the Common Stock is then listed for trading. No member of the Committee and no officer of the Company shall be liable for any action taken or omitted to be taken by such member, by any other
member of the Committee or by any officer of the Company in connection with the performance of duties under the Plan, except for such person's own willful misconduct or as expressly provided by
statute. 

        The
expenses of the Plan shall be borne by the Company. The Plan shall not be required to establish any special or separate fund or make any other segregation of assets to assume the
payment of any award under the Plan, and rights to the payment of such awards shall be no greater than the rights of the Company's general creditors. 

4.    Shares Available for the Plan.    

        Subject
to adjustments as provided in Section 12 hereof, an aggregate of 3,500,000 shares of Common Stock (the "Shares") may be issued pursuant to the Plan. Such Shares may be in
whole or in part authorized and unissued or held by the Company as treasury shares. If any grant under the Plan is forfeited as to any Shares, then such forfeited Shares shall thereafter be available
for further grants under the Plan. 

5.    Participation.    

        Participation
in the Plan shall be limited to those directors (including Non-Employee Directors), officers (including non-employee officers) and employees of, and
other individuals performing services for, the Company and its Subsidiaries as selected by the Committee. Nothing in the Plan or in any grant thereunder shall confer any right on a participant to
continue in the service or employ as a director or officer of or in the performance of services for the Company or a Subsidiary or shall interfere in any way with the right of the Company or a
Subsidiary to terminate the employment or performance of services or to reduce the compensation or responsibilities of a participant at any time. By accepting any award under the Plan, each
participant and each person claiming under or through him or her shall be conclusively deemed to have indicated his or her acceptance and ratification of, and consent to, any action taken under the
Plan by the Company, the Board or the Committee. 

        Restricted
stock awards may be granted to such persons and for such number of Shares as the Committee shall determine (such individuals to whom grants are made being sometimes herein
called "grantees"). Determinations made by the Committee under the Plan need not be uniform and may be made selectively among eligible individuals under the Plan, whether or not such individuals are
similarly situated. A grant made hereunder in any one year to an eligible participant shall neither guarantee nor preclude a further grant to such participant in that year or subsequent years. 

6.    Restricted Stock.    

        The
Committee may, in its sole discretion and without limitation, grant Shares of restricted stock under the Plan to participants. Each grant of Shares of restricted stock shall specify
the applicable restrictions on such Shares, the duration of such restrictions (as determined by the Committee in its discretion or provided in this Section 6), and the time or times at which
such restrictions shall lapse with respect to all or a specified number of Shares that are part of the grant. 

        The
participant will be required to pay the Company the aggregate par value of any Shares of restricted stock (or such larger amount as the Board may determine to constitute capital
under Section 154 of the Delaware General Corporation Law, as amended, or any successor thereto) within ten days of the date of grant, unless such Shares of restricted stock are treasury
shares. Unless otherwise determined by the Committee, certificates representing Shares of restricted stock granted under the Plan will be held in escrow by the Company on the participant's behalf
during any period of restriction thereon and will bear an appropriate legend specifying the applicable restrictions thereon, and the participant will be required to execute a blank stock power
therefor. Except as otherwise 

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provided
by the Committee, during such period of restriction the participant shall have all of the rights of a holder of Common Stock, including but not limited to the rights to receive dividends and
to vote, and any stock or other securities received as a distribution with respect to such participant's restricted stock shall be subject to the same restrictions as then in effect for the restricted
stock. 

        If
a participant ceases to be a director, officer or employee of, or to otherwise perform services for, the Company or any Subsidiary due to death, Disability or Retirement during any
period of restriction, all Shares of restricted stock granted to such participant on which the restrictions have not lapsed shall be immediately forfeited to the Company; provided, however, in its
sole discretion, the Committee may provide that all restrictions on such Shares that have not lapsed shall lapse. Subject to the immediately following paragraph, at such time as a participant ceases
to be a director, officer or employee of, or otherwise performing services for, the Company or its Subsidiaries for any other reason, all Shares of restricted stock granted to such participant on
which the restrictions have not lapsed shall be immediately forfeited to the Company; provided, however, in its sole discretion, the Committee may provide that all restrictions on such Shares that
have not lapsed shall lapse. 

        If
there is a Change in Control of the Company and a participant is terminated (other than for Cause, in which case all Shares of restricted stock granted to such participant on which
the restrictions have not lapsed shall be immediately forfeited to the Company) from being a director, officer or employee of, or from performing other services for, the Company or a Subsidiary within
one year after such Change in Control, all restrictions on Shares of restricted stock granted to such participant shall lapse. In addition, the Committee shall have the authority to grant shares of
restricted stock with respect to which all restrictions shall lapse automatically upon a Change in Control, whether or not the grantee is subsequently terminated. 

7.    Withholding Taxes.    

        (a)   Participant Election. Unless otherwise determined by the Committee, a participant may elect to deliver shares of Common
Stock (or have the Company withhold shares deliverable upon grant or vesting of restricted stock) to satisfy, in whole or in part, the amount the Company is required to withhold for taxes in
connection with the delivery of restricted stock upon the grant thereof. Such election must be made on or before the date the amount of tax to be withheld is determined. Once made, the election shall
be irrevocable. The fair market value of the shares to be withheld or delivered will be the Fair Market Value as of the date the amount of tax to be withheld is determined. 

        (b)   Company Requirement. The Company may require, as a condition to any grant under the Plan or to the delivery of
certificates for Shares issued hereunder, that the grantee make provision for the payment to the Company of federal, state or local taxes of any kind required by law to be withheld with respect to any
grant or delivery of Shares. The Company, to the extent permitted or required by law, shall have the right to deduct from any payment of any kind (including salary or bonus) otherwise due to a
grantee, an amount equal to any federal, state or local taxes of any kind required by law to be withheld with respect to any grant or delivery of Shares under the Plan. 

8.    Written Agreement.    

        Unless
the Committee determines otherwise, each employee to whom a grant is made under the Plan shall enter into a written agreement with the Company that shall contain such provisions
consistent with the provisions of the Plan, as may be approved by the Committee. 

9.    Transferability.    

        Unless
the Committee determines otherwise, no award granted under the Plan shall be transferable by a participant other than by will or the laws of descent and distribution or to a
participant's Family Member by gift or a qualified domestic relations order as defined by the Code. All provisions of this Plan shall in any event continue to apply to any award granted under the Plan
and 

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transferred
as permitted by this Section 9, and any transferee of any such award shall be bound by all provisions of this Plan as and to the same extent as the applicable original grantee. 

10.    Listing, Registration and Qualification.    

        If
the Committee determines that the listing, registration or qualification upon any securities exchange or under any law of Shares is necessary or desirable as a condition of, or in
connection with, the
granting of same or the issue of Shares thereunder, no Shares of restricted stock may be issued, unless such listing, registration or qualification is effected free of any conditions not acceptable to
the Committee. 

11.    Transfer of Employee.    

        The
transfer of an employee from the Company to a Subsidiary, from a Subsidiary to the Company, or from one Subsidiary to another shall not be considered a termination of employment; nor
shall it be considered a termination of employment if an employee is placed on military or sick leave or such other leave of absence which is considered by the Committee as continuing intact the
employment relationship. 

12.    Adjustments.    

        In
the event of a reorganization, recapitalization, stock split, stock dividend, combination of shares, merger, consolidation, distribution of assets, or any other change in the
corporate structure or shares of the Company, the Committee shall make such adjustment as it deems appropriate in the number and kind of Shares available for issuance under the Plan (including,
without limitation, the total number of Shares available for issuance under the Plan pursuant to Section 4), in the number and kind of restricted stock; provided, however, that the Committee
shall not be required to make any adjustment that would (i) require the inclusion of any compensation deferred pursuant to provisions of the Plan (or an award thereunder) in a participant's
gross income pursuant to Section 409A of the Code and the regulations issued thereunder from time to time and/or (ii) cause any award made pursuant to the Plan to be treated as providing
for the deferral of compensation pursuant to such Code section and regulations. Any such adjustment shall be final, conclusive and binding for all purposes of the Plan. In the event of any merger,
consolidation or other reorganization in which the Company is not the surviving or continuing corporation or in which a Change in Control is to occur, all of the Company's obligations regarding awards
that were granted hereunder and that are outstanding on the date of such event shall, on such terms as may be approved by the Committee prior to such event, be (a) canceled in exchange for cash
or other property or (b) assumed by the surviving or continuing corporation. 

13.    Amendment and Termination of the Plan.    

        The
Board of Directors or the Committee, without approval of the stockholders, may amend or terminate the Plan, except that no amendment shall become effective without prior approval of
the stockholders of the Company if stockholder approval would be required by applicable law or regulations or by any listing requirement of the principal stock exchange on which the Common Stock is
then listed. 

        Notwithstanding
any other provisions of the Plan, and in addition to the powers of amendment set forth in this Section 13 and Section 14 hereof or otherwise, the provisions
hereof and the provisions of any award made hereunder may be amended unilaterally by the Committee from time to time to the extent necessary (and only to the extent necessary) to prevent the
implementation, application or existence (as the case may be) of any such provision from (i) requiring the inclusion of any compensation deferred pursuant to the provisions of the Plan (or an
award thereunder) in a participant's gross income pursuant to section 409A of the Code, and the regulations issued thereunder from time to time and/or (ii) inadvertently causing any
award hereunder to be treated as providing for the deferral of compensation pursuant to such Code section and regulations. 

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14.    Amendment or Substitution of Awards under the Plan.    

        The
terms of any outstanding award under the Plan may be amended from time to time by the Committee in its discretion in any manner that it deems appropriate, provided that, except as
otherwise provided in Section 12, no such amendment shall adversely affect in a material manner any right of a participant under the award without his or her written consent. The Committee may,
in its discretion, permit holders of awards under the Plan to surrender outstanding awards in order to exercise or realize rights under other awards, or in exchange for the grant of new awards, or
require holders of awards to surrender outstanding awards as a condition precedent to the grant of new awards under the Plan, but only if such surrender, exercise, realization, exchange, or grant
(a) would not constitute a distribution of deferred compensation for purposes of Section 409A(a)(3) of the Code or (b) constitutes a distribution of deferred compensation that is
permitted under regulations issued pursuant to Section 409A(a)(3) of the Code. 

15.    Commencement Date; Termination Date.    

        The
date of commencement of the Plan shall be the later of: (i) the date on which the Company's Registration Statement on Form S-1
(No. 333-122351) is declared effective by the Securities and Exchange Commission; and (ii) 20 calendar days after an Information Statement pursuant to Section 14C of
the Exchange Act relating to the Plan has been sent or given to the Company's stockholders. 

        Unless
previously terminated upon the adoption of a resolution of the Board terminating the Plan, the Plan shall terminate at the close of business on the ten year anniversary of the
date on which the Plan commenced. No termination of the Plan shall materially and adversely affect any of the rights or obligations of any person, without his or her written consent, under any grant
of restricted stock theretofore granted under the Plan. 

16.    Severability.    

        Whenever
possible, each provision of the Plan shall be interpreted in such manner as to be effective and valid under applicable law, but if any provision of the Plan is held to be
prohibited by or invalid under applicable law, such provision shall be ineffective only to the extent of such prohibition or invalidity, without invalidating the remainder of the Plan. 

17.    Governing Law.    

        The
Plan shall be governed by the corporate laws of the State of Delaware, without giving effect to any choice of law provisions that might otherwise refer construction or interpretation
of the Plan to the substantive law of another jurisdiction. 

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Exhibit 10.24

SYNAGRO TECHNOLOGIES, INC. 2005 RESTRICTED STOCK PLANQuickLinks
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EXHIBIT 4.2.6    
    

 
 

AMENDMENT NO. 1 TO GENTIUM S.P.A.    
    

 
 

SERIES A SENIOR CONVERTIBLE PROMISSORY NOTES, WARRANTS,
  SUBSCRIPTION AGREEMENTS AND INVESTOR RIGHTS AGREEMENTS    
    

        This Amendment No. 1 (this "Amendment") is dated as of May 27, 2005 among Gentium S.p.A.
("Gentium") and a majority-in-interest of the Holders (as defined below). 

 
 

RECITALS    
    

        WHEREAS, Gentium issued Series A senior convertible promissory notes in the aggregate principal amount of
$8,010,000 (the "Notes") and warrants to purchase common stock, par value €1 per share, of Gentium (the
"Warrants") to certain purchasers (the "Holders") pursuant to subscription agreements between the
Holders and Gentium (the "Subscription Agreements"), and in connection therewith entered into investor rights agreements with each of the Holders (the
"Investor Rights Agreements"); 

        WHEREAS, Gentium entered into a letter agreement (the "Undertaking Letter"), dated
January 10, 2005, with Alexandra Global Master Fund Ltd., a Holder, whereby Gentium agreed to use its reasonable best efforts to cause the holders of a
majority-in-interest of the Notes and the Warrants to agree to amend certain provisions of the Notes, the Warrants, the Subscription Agreements and the Investor Rights
Agreements; 

        NOW,
THEREFORE, Gentium and a majority-in-interest of the Holders hereby agree as follows. 

1.
Amendments to Notes. 

        1.1   Section 9. Section 9 of each Note is hereby amended and restated to read as follows: 

        Section 9.  Remedies on Default. Upon the occurrence or existence of an Event of Default, Noteholders representing a
majority-in-interest of the then outstanding Notes, which Noteholders shall include Generation Capital Associates and Alexandra Global Master Fund Ltd., by notice in
writing to Issuer (the "Acceleration Notice"), may declare the principal amount of the Notes and all accrued and unpaid interest to be due and payable
immediately, without presentment, demand, protest or any notice of any kind, all of which are hereby expressly waived, in the event that Issuer shall not have cured such Event of Default within ten
(10) business days after receipt of such notice, except in the case of any Event of Default under Sections (8)(c) and (d) above, in which
event acceleration shall be automatic, become immediately due and payable. Upon the occurrence of any Event of Default, the Noteholder may, in addition to declaring all amounts due hereunder to be
immediately due and payable, pursue any available remedy, whether at law or in equity. If an Event of Default occurs, Issuer shall pay to the Noteholder the reasonable attorneys' fees and
disbursements and all other out-of-pocket costs incurred by the Noteholder in order to collect amounts due and owing under this Note or otherwise to enforce the Noteholder's
rights and remedies hereunder. 

        1.2   Section 10. The first sentence of Section 10 of each Note is hereby amended and restated to read as
follows: 

        Section 10.  Issuer Redemption. Pursuant to the terms of this Section 10, Issuer (x) shall redeem all but not less
than all of the unpaid Principal Amount of this Note, together with all unpaid accrued interest hereon and all other amounts due hereunder through such redemption date (the "Redemption Amount"), if
any of the following events occurs: 

        (i)    any
dissolution, liquidation or winding up of Issuer ("Dissolution Event"); or 

 

        (ii)   (A)
a merger in which the Issuer is not the surviving entity and pursuant to which the Issuer's shareholders prior to the merger hold less than a majority of the
outstanding equity securities of the surviving entity following the merger or (B) sale of all of substantially all of the assets of Issuer; 

        and
(y) at any time prior to the Maturity Date (except as set forth in clause (x) above), with the written consent of Noteholders representing a
majority-in-interest of the then outstanding Notes, which Noteholders shall include Generation Capital Associates and Alexandra Global Master Fund Ltd., Issuer may
redeem all or any portion of the unpaid Principal Amount of this Note, together with all unpaid accrued interest hereon and all amounts due hereunder through such redemption date, 

        which
Redemption Amount, in the cases of clauses (x) and (y) of this Section 10, shall be distributed ratably among each holder of the Notes so that each Noteholder
receives that portion of the Redemption Amount available for distribution as the Principal Amount of this Note bears to the aggregate principal amount of all Notes then outstanding. 

        1.3   Section 13. Section 13 of each Note is hereby amended and restated to read as follows: 

        Section 13.  Amendments. This Note may not be changed orally, but only, in the case of an amendment or modification by an
agreement
in writing and signed by Issuer and Noteholders representing a majority-in-interest of the then outstanding Notes, which Noteholders shall include Generation Capital Associates
and Alexandra Global Master Fund Ltd., and in the case of a waiver, by the party (or in the case of Noteholder, by Noteholders representing a majority-in-interest of the
then outstanding Notes, which Noteholders shall include Generation Capital Associates and Alexandra Global Master Fund Ltd.) against whom enforcement of any waiver is sought; provided, that no
such amendment, modification or waiver shall be binding on a Noteholder without such Noteholder's consent in the event that the amendment, modification or waiver (i) reduces the rate, or
extends the time of payment, of any interest on any Note; (ii) reduces the amount, or extends the time of payment of any installment or other payment of principal on any Note;
(iii) decreases or forgives the principal amount of any Note; or (iv) releases all or any portion of the shares of Common Stock of Issuer pledged pursuant to the Pledge Agreement. 

2.
Amendments to Warrants. 

        2.1   Antidilution. Each Warrant is hereby amended to add the following as Section 8(f): 

        (f)  Adjustments for stock dividends, stock splits and stock combinations. If, at any time after the Issue Date, the number of shares of
Common Stock outstanding is increased by a stock dividend payable in shares of Common Stock or by a subdivision or split-up of shares of Common Stock, then, following the record date fixed
for the determination of holders of Common Stock entitled to receive such stock dividend, subdivision or split-up, the Exercise Price shall be appropriately decreased and the number of
shares of Common Stock issuable upon exercise of this Warrant shall be appropriately increased, in each case in proportion to such increase in outstanding shares. If, at any time after the Issue Date,
the number of shares of Common Stock outstanding is decreased by a combination of the outstanding shares of Common Stock, then, following the record date for such combination, the Exercise Price shall
be appropriately increased and the number of shares of Common Stock issuable upon exercise of this Warrant shall be appropriately decreased, in each case, in proportion to such decrease in outstanding
shares. 

        2.2   Section 17. Section 17 of each Warrant is hereby amended and restated to read as follows: 

        SECTION
17. Amendments; Modifications. This Warrant Certificate may be amended or modified only with the written consent of the Company
and the holders representing a 

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majority-in-interest
of the then outstanding Investor Warrants which holders shall include Generation Capital Associates and Alexandra Global Master Fund Ltd., and any
provision of this Warrant Certificate may be waived only by the party (or in the case of the Holder, by holders representing a majority-in-interest of the
then-outstanding Investor Warrants, which holders shall include Generation Capital Associates and Alexandra Global Master Fund Ltd.) against whom enforcement of any waiver is
sought; provided, that no such amendment, modification or waiver shall be binding on a Holder without such Holder's consent in the event that the amendment, modification or waiver (i) increases
the Exercise Price of any Investor Warrant; or (ii) reduces the amount of Shares covered by any Investor Warrant. 

3.
Amendments to Subscription Agreements. 

        3.1   Section 1.10. Section 1.10 of each Subscription Agreement is hereby amended and restated to read as
follows: 

        1.10.
The Subscriber understands that Rule 144 promulgated under the Act ("Rule 144") requires, among other conditions, a
one-year holding period prior to the resale (in limited amounts) of securities acquired in a non-public offering without having to satisfy the registration requirements under
the Act. The Subscriber understands and hereby acknowledges that the Company is under no obligation to register any of the Securities under the Act or any state securities or "blue sky"
laws or assist the Subscriber in obtaining an exemption from various registration requirements, other than as set forth in the Investors' Rights Agreement. 

        3.2   Section 1.12. Section 1.12 of each Subscription Agreement is hereby amended and restated to read as
follows: 

        1.12.
[Intentionally Omitted.] 

        3.3   Section 1.22. Section 1.22 of each Subscription Agreement is hereby amended and restated to read as
follows: 

        1.22.
The Subscriber understands that all information regarding the Offering is confidential and represents that, until the consummation of an initial public offering of the Company's
securities, it will not be used for any purpose other than in connection with his or her consideration of a purchase of the Units and agrees to treat it in a confidential manner. 

        3.4   Section 5.2. Section 5.2 of each Subscription Agreement is hereby amended and restated to read as follows: 

        5.2.
Any term of this Agreement may be amended and the observance of any term of this Agreement may be waived (either generally or in a particular instance and either retroactively or
prospectively), only with the written consent of the Company and the holders of a majority in interest of the Securities sold pursuant to the Offering, which holders shall include Generation Capital
Associates and Alexandra Global Master Fund Ltd. Any amendment or waiver effected in accordance with this paragraph shall be binding upon each holder of any Securities purchased pursuant to the
Offering at the time outstanding, each future holder of all such securities and the Company. 

4.
Amendments to Investor Rights Agreements. 

        4.1   Section 1.14(b). Section 1.14(b) of each Investor Rights Agreement is hereby amended and restated to read
as follows: 

        (b)
such market stand-off time period shall not exceed 270 days for an initial public offering of the Company's securities and for ninety (90) days for a
follow-on offering of the Company's securities; except that such provision shall not apply to the shares of Common Stock of the 

3

 

Company
purchased by Generation Capital Associates and Alexandra Global Master Fund Ltd. purchase from FinSirton S.p.A., which shall be governed by a separate agreement. 

        4.2   Section 2.5. Section 2.5 of each Investor Rights Agreement is hereby amended to add the following at the
end of such section: 

Notwithstanding
the foregoing, the provisions of this Section 2.5 shall not apply to shares of Common Stock of the Company purchased by Generation Capital Associates and Alexandra Global Master
Fund Ltd. purchase from FinSirton S.p.A., which shall be governed by a separate agreement. 

        4.3   Section 3.7. Section 3.7 of each Investor Rights Agreement is hereby amended and restated to read as
follows: 

        3.7.
Amendments and Waivers. Any term of this Agreement may be amended and the observance of any term of this Agreement may be waived
(either generally or in a particular instance and either retroactively or prospectively), only with the written consent of the Company and the holders of a majority-in-interest
of the Registrable Securities then outstanding, which holders shall include Generation Capital Associates and Alexandra Global Master Fund Ltd. Any amendment or waiver effected in accordance
with this paragraph shall be binding upon each holder of any Registrable Securities then outstanding, each future holder of all such Registrable Securities, and the Company. 

5.
Miscellaneous. 

        5.1   Governing Law. This Amendment shall be construed in accordance with and governed by the laws of the State of New York
without regard to principles of conflicts of laws. In the event that a judicial proceeding is necessary, the exclusive forums for resolving disputes arising out of or relating to this Amendment are
either the Supreme Court of the State of New York in and for the County of New York or the federal courts for such State and County, and all related appellate courts, the parties hereby irrevocably
consent to the jurisdiction of such courts and agree to said venue. 

        5.2   Counterparts. This Amendment may be executed in two or more counterparts, each of which shall be deemed an original, but
all of which together shall constitute one and the same instrument. 

        5.3   Titles and Subtitles. The titles and subtitles used in this Amendment are used for convenience only and are not to be
considered in construing or interpreting this Amendment. 

        5.4   Severability. The holding of any provision of this Amendment to be invalid or unenforceable by a court of competent
jurisdiction shall not affect any other provision of this Amendment, which shall remain in full force and effect. If any provision of this Amendment shall be declared by a court of competent
jurisdiction to be invalid, illegal or incapable of being enforced in whole or in part, such provision shall be interpreted so as to remain enforceable to the maximum extent permissible consistent
with applicable law and the remaining conditions and provisions or portions thereof shall nevertheless remain in full force and effect and enforceable to the extent that they are valid, legal and
enforceable, and no provisions shall be deemed dependent upon any other covenant or provision unless so expressed herein. 

        [Remainder
of page intentionally left blank] 

4

        IN
WITNESS WHEREOF, the parties have executed this Amendment as of the date first set forth above. 

	 	 	GENTIUM S.P.A.
	

 	
 	
By:	

/s/  LAURA FERRO      
 Name: Laura Ferro
 Title: Chief Executive Officer and President
	

 	
 	
MAJORITY-IN-INTEREST OF THE HOLDERS:
	

 	
 	
By:	

/s/  ALESSANDRO FALCONI      
 Name: Alessandro Falconi
 Title: Attorney-in-Fact
	

 	
 	

By:	

/s/  ANTONIO FIGERIO      
 Name: Antonio Figerio
 Title: Attorney-in-Fact
	

 	
 	

By:	

/s/  MAURIZIO PIGLIA      
 Name: Maurizio Piglia
 Title: Attorney-in-Fact

Acknowledged and Agreed

as satisfaction of Gentium's

obligations under the Undertaking Letter:

ALEXANDRA
GLOBAL MASTER FUND LTD. 

	By:
	ALEXANDRA
INVESTMENT MANAGEMENT, LLC

as Investment Advisor

	

By:	
 	

/s/  MIKHAIL FILIMONOV      
 Name: Mikhail Filimonov
 Title: Chairman and Chief Executive
Officer	
 	

 	
 	

 

QuickLinks

EXHIBIT 4.2.6

AMENDMENT NO. 1 TO GENTIUM S.P.A.

SERIES A SENIOR CONVERTIBLE PROMISSORY NOTES, WARRANTS, SUBSCRIPTION AGREEMENTS AND INVESTOR RIGHTS AGREEMENTS

RECITALS

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