Peter Altman
Analyst · H.C. Wainwright
Thanks, Jules, and good afternoon to everyone on the call. We have had a great quarter. But before I get into the details, let's take a few moments to review what we are doing and why we are doing it. BioCardia's efforts are focused on advancing 2 cell therapy platforms to treat significant unmet cardiovascular and pulmonary diseases. Specifically, ischemic heart failure, chronic myocardial ischemia and acute respiratory distress. All of our cell-based therapies involve local delivery of the therapeutic cells to the heart or lungs, where we intend them to act locally. In the heart, our own proprietary Helix minimally invasive delivery system, a third platform, is used to deliver the cells to target regions of damage. For the lungs, we intend to use intravenous delivery which will result in the investigational cells being localized in the small blood vessels of the lungs. Local delivery of therapeutics to the target location where their action is desired maximizes their effective dosage within the tissues where delivered, and minimizes potential negative effects remote from target tissues. Heart failure is the first problem we are going after. It is an enormous unmet need that affects more than 26 million people worldwide. The latest blockbuster drugs and pretty much the same indication we are going after don't have much of an impact on mortality. Patients in the published results of the pivotal trials for these new drugs have a cardiac mortality of roughly 7% and an all-cause mortality of 10% per year, regardless of whether they were treated or controlled patients. This data makes clear that heart failure is still a problem in great need of new therapeutic solutions. Our autologous mononuclear cell therapy platform, which we call CardiAMP cell therapy, is being advanced in 2 cardiac clinical indications. In preclinical studies, cardiac mononuclear cell therapy has been shown to release proteins locally within the tissue to facilitate cardiac recovery after heart damage, with improvements in heart perfusion and contractile function. All known previous clinical studies similar to the approach we are taking, and our 2 lead CardiAMP Cell Therapy programs have shown patient benefits on average. In some of these studies, including our own, the benefits have been remarkable. Our FDA breakthrough designation in ischemic heart failure validates this perspective. In granting this designation, the FDA looked through all of our clinical results patient by patient, and agreed that CardiAMP cell therapy data to date shows it has promise to provide the more effective treatment for ischemic heart failure. Advancing this and our other therapeutic candidates is what we are all about. Our efforts to complete the CardiAMP Autologous Cell Therapy pivotal clinical trials for the indications of heart failure, or BCA-01, and chronic myocardial ischemia or BCA-02, remain our primary focus with an estimated combined 1.6 million patients in a reachable U.S. market. The CardiAMP Cell Therapy heart failure trial, or BCDA-01, is a Phase III 260-patient randomized controlled clinical study intended to provide the primary data to support safety and efficacy in pursuit of market clearance. We have enrolled 115 patients in this trial, with a number of additional crossover patients. In August of 2022, the independent Data Safety Monitoring Board completed a prespecified data review, including a risk-benefit assessment. Following this review, the Data Safety Monitoring Board indicated that it had no significant concerns and recommended the study continue as designed. As part of this review, we looked at blinded results across more than 100 patients past the 1-year primary endpoint, including treated and controlled patients in the trial. We were impressed that the survival rate at 1 year follow-up was greater than that observed in recent similar large pivotal trials in patients with heart failure with reduced ejection fraction. For study subjects followed through the key visit dates in this study, mean health outcomes across both treated and controlled patients was improved across multiple endpoints at all time points, including 6-minute walk distance, which contributes to the primary composite endpoint. The Data Safety Monitoring Board recommended that the company as sponsor consider implementing an adaptive statistical analysis plan, which could enable an early readout for study treatment efficacy. An adaptive statistical analysis plan is 1 which attempts to determine the appropriate number of patients needed in a clinical study based on the data within the trial itself, as opposed to from a previous trial. This has the significant advantage of derisking the trial from changes that have occurred in the current trial relative to previous trials. In reviewing the data during a Data Safety Monitoring Board meeting under an adaptive statistical analysis plan, the data monitoring board may be able to assess at certain points in the clinical trial how many patients should be enrolled in the trial to meet the primary endpoint in the trial. If a trial has already enrolled the number of patients expected to be required to show efficacy, then there is potential that the Data Safety Monitoring Board informs the sponsor that the trial enrollment might be stopped for expected success. Efforts are now underway to complete an adaptive statistical analysis plan for the CardiAMP heart failure trial, executive steering committee and the FDA to review and comment on. In parallel, our clinical operations team, under the leadership of Debby Holmes-Higgin, is working to ensure the clinical data that the Data Safety Monitoring Board would use in such an adaptive review of the study statistics is correct, through extensive monitoring of the clinical data in collaboration with our clinical partners. This is often referred to as cleaning the data and is a significant effort. The next prespecified formal data safety monitoring board review is anticipated in March 2023. And based on conversations the company has had with the intended developers of the Adaptive statistical analysis plan and its respected regulatory consultants and our own efforts cleaning the data, the company believes it is likely to be able to have the Adaptive statistical analysis plan in place for the next Data Safety Monitoring Board meeting. The specific details of any potential adaptive statistical analysis plan, in combination with any modifications to the data safety monitoring board charter, will dictate what happens at this next and subsequent data safety monitoring board reviews. As the CardiAMP Cell Therapy trial in heart failure was over 90% powered for success based on the previous Phase II data, there is potential that the trial could meet its primary efficacy endpoint on the patients that have already been enrolled to date. However, when the Data Safety Monitoring Board next meets, they may recommend that the trial continue per plan, be stopped for safety or be stopped for futility if the data does not support that achieving the primary endpoint is possible. This October, additional data came out at the Heart Failure Society of America Annual Meeting in the form of 2-year data on the 10-patient rolling cohort. The data showed 100% survival and trends towards benefit across multiple endpoints, and further enhances our enthusiasm for this program. This October, we also updated our patient-facing website www.cardiamp.com. This includes the elegant animation that details the trial overview discussed in our last quarterly call. I encourage everyone to view this website and watch the trial overview and the patient testimonials there. If you have friends or relatives suffering from heart failure, please pass along the website to them for them to learn about the CardiAMP Cell Therapy and opportunities to participate in the trial. Our second therapeutic program is for the same therapy for the treatment of chronic myocardial ischemia with refractory angina or BCDA-02. The CardiAMP chronic myocardial ischemia trial is a Phase III multicenter, randomized, double-blinded controlled study of up to 343 patients at up to 40 clinical sites. The Phase III pivotal trial is also designed to provide the primary support for the safety and efficacy of the CardiAMP cell therapy system for this indication. It uses many of the same novel aspects of the CardiAMP heart failure trial and is expected to leverage our experience and investment in the heart failure trial. This program benefits from the 2022 Center for Medicaid and Medicare Services, or CMS, reimbursement at up to $20,000 for treatment and control patients. The trial has been activated at 2 centers and the company is working to activate additional centers. Early clinical data from the rolling cohort is showing safety with remarkable benefits in the primary endpoint of exercise tolerance time, and we are working to deliver data on this cohort in advance to the randomized cohort. As we have shared in July, we had our second consultation with Japan Pharmaceutical and Medical Device Agency regarding registration of CardiAMP Cell Therapy for ischemic heart failure. We are substantially ready, today, to submit the dossier with all details as requested, but may delay in order to obtain the support of 1 or more Japanese medical societies for CardiAMP Cell Therapy, to support its approval and its reimbursement. This is under active discussion today with our regulatory and scientific advisers and 1 of our potential distribution partners. Japanese researchers established the building blocks for this therapy many years ago. The therapeutic approach we are pursuing was first studied in a preclinical model by physician scientists in Yokohama. This early work was performed in parallel to other Japanese vascular biology scientists who identified important aspects of bone marrow-derived mononuclear cells and tissue repair. Their early efforts underlie our CardiAMP Cell Therapy, and we hope to be able to provide this therapy to the many in Japan who could benefit from it. Now I'd like to move to our 2 allogeneic cell therapy product candidates based on our allogeneic neurokinin-1 receptor positive mesenchymal stem cell platform, which has also progressed in the past quarters. Our allogeneic MSC program in heart failure, which we have designated BCDA-03, is intended to include the patients who have been excluded from our autologous program due to the nature of their cells. We have completed the manufacturing validation runs and stability testing for the chemistry manufacturing and control section of the IND. We have completed the preclinical pharmacology, toxicology animal testing with no safety issues and with trends towards therapeutic benefit. It is my pleasure to share that the IND application for this program was filed with FDA SBR in early November 2022. The company anticipates FDA approval of the IND in December. Our allogeneic MSC program in patients recovering from acute respiratory distress syndrome, which we have designated BCDA-04, was approved by FDA in April 2022 to treat patients. A first clinical study manufacturing run from our Sunnyvale facility has been completed. Cells are cryopreserved awaiting final longer lead time test data for lot release hopefully this month, after which they may be shipped to centers for patients in the clinical study. This manufacturing run has potential to have sufficient cells to complete the entire Phase I portion of the Phase I/II trial, as we achieved many doses with each batch. We are in late-stage onboarding of world-class clinical centers to perform the trial ahead. We are optimistic due to the long-standing promise of mesenchymal stem cells in lung repair and the unique clinical indication we have defined. We aim to address the need to reduce local and systemic inflammation after a patient is taken off respirator support with goals of accelerating recovery, enhancing survival and reducing both relapse and rehospitalization. In summary, we are advancing 4 therapeutic product candidates that address important unmet cardiac and pulmonary diseases based on our autologous and our allogeneic cell therapy platforms. From these therapeutic development efforts, we now have 4 active business development initiatives. First is partnering our CardiAMP Cell Therapy platform internationally. Second is licensing out our clinical stage NK1R-positive mesenchymal stem cell program for other clinical indications which have shown promise with other mesenchymal stem cell preparations. Third is licensing our catheter-based biotherapeutic delivery systems for cell, gene and protein therapy candidates to the heart, such as in the Bluerock relationship we began last quarter. And fourth is monetizing our Avance transseptal introducer sheath product. I will now pass the call to David McClung, our CFO, who will provide some financial perspective. David?