Peter Altman
Analyst · H.C. Wainwright. Please go ahead
Thank you, Miranda, and good afternoon to everyone on the call. This morning, we announced the primary outcome data from the CardiAMP Heart Failure trial, which was presented yesterday at the American College of Cardiology late-breaking Clinical Trial sessions in Chicago by Dr. Amish Raval of the University of Wisconsin at Medicine, co-national principal investigator for the study. The slides for this presentation are now publicly available on our website. This data from 115 randomized ischemic heart failure patients treated with our lead therapeutic candidate, autologous CardiAMP Cell Therapy or BCD-01, is excellent and truly remarkable. To appreciate this, I would like to explain the outcome measure on this call. The endpoints in the CardiAMP-HF clinical trial are composite endpoints in which patients are evaluated by outcome tiers in order of most important to least importance, and each patient is compared with every other patient to assess whether a patient is better than another in that tier. In the first tier of cardiac death equivalents, which includes all-cause death, heart transplantation and implantation of a left ventricular assist device, the results demonstrated a greatly reduced mortality rate. This is wonderful to see in a clinical indication where no therapy today appears to be reducing mortality. In the second tier of major adverse cardiac cardiovascular events, which includes hospitalization for heart failure, stroke and myocardial infarction, the results demonstrated meaningful reductions here as well. This is also excellent news as these events are the drivers for the enormous cost of heart failure care to society and to payers. In the third tier of the 6-minute walk distance, we were not successful, and this offset the benefits in the first 2 tiers, resulting in the primary endpoint not being met. An alternative third tier component of quality of life as measured by the Minnesota Living with Heart Failure Questionnaire, which has been used as the third tier component in other similar interventional heart failure therapies with this type of efficacy analysis also favored therapy and showed meaningful trends approaching statistical significance with a p-value of 0.14. The FDA was aware we were doing this analysis before we looked at this final data. In clinical studies of heart failure of reduced ejection fraction, most, if not all, other trials use elevated markers of heart stress, such as NTproBNP as an inclusion criteria. When we apply this simple screen to our results, CardiAMP cell therapy has superior results on all 3 tiers for both outcome measures, reaching a p-value of 0.07 with 6-minute walk in the third tier component and a p-value of 0.02 with quality of life in the third tier of the composite endpoint, reaching statistical significance. We are able to see these low p-values in this data because the changes in heart death equivalent and major adverse cardiac events are large. Results show a 47% relative risk reduction in heart death equivalents a 16% relative risk reduction in major adverse cardiac events, a clinically meaningful 10.5-point improvement in quality of life score and a 13.9-meter improvement in the 6-minute walk distance test, all of this out to 2-year follow-up. Although we have not yet fully analyzed the echocardiography data, results are showing improved left ventricular ejection fraction and perhaps more importantly, reduced heart volumes, both at the end of contraction and the end of relaxation of the heart, suggesting positive heart remodeling. Lastly, we also noted reductions in cardiac arrhythmias in these patients that were treated. As the primary safety concern with cell therapy has historically been increased life-threatening arrhythmias, the strong trends toward reducing arrhythmias is a valuable signal for safety at minimum. When these results were presented at the American College of Cardiology, the discussant, Dr. Mary Walsh, a former President of the American College of Cardiology and a heart failure physician congratulated Dr. Raval and shared her perspective that the very patients being treated in the CardiAMP Heart Failure study are in great need for therapies such as cell therapy and that these patients have an interest in these therapies in her own practice. She congratulated Dr. Raval on the level of compliance shown to guideline-directed medical therapy in CardiAMP-HF. Dr. Walsh challenged Dr. Raval on how rigorous the blinding of the patients was in this study that resulted in the quality of life benefit noted, Dr. Raval made clear that a very rigorous blind had been implemented in CardiAMP-HF, which satisfied Dr. Walsh and which was also supported by the blinding questionnaire in the study whose results you can see in the presentation on our website. The market reaction this morning to these results is a bit of a surprise. If you review our previous reports and earnings calls, you will see that these results are exactly what we hoped we would have. We have long known that this trial would not meet its primary endpoint, potentially due to the 6-minute walk test distance in the healthier patients who did not have elevated markers of heart stress in this study, and are delighted actually that the 2-year outcomes are so strong across all patients and able to reach statistical significance in the patients having elevated markers of heart stress or NTproBNP elevation. The win ratio is greater than 2.0, where we clearly win on the most important Tier 1 and Tier 2 assessments show that 2 patients in the treated group are doing better for every patient, which may be the same or worse than in the control group. This data is meaningful for BioCardia on 2 critical levels. First, we have a very rigorous data set for the CardiAMP cell therapy now that strongly supports the ongoing CardiAMP Heart Failure II trial, which utilizes quality of life in the third tier of the composite endpoint and requires patients to have elevated markers of heart stress. The p-value of 0.02 seen in this group says the CardiAMP-HF2 trial is well overpowered and likely to be successful. Second, the benefits observed for patients on guideline-directed medical therapy seen in this study are compelling, particularly for patients with elevated markers of heart stress, where there was statistical significance. This outcome is in line with our hopes for this data as discussed with regulatory authorities. We look forward to sharing the CardiAMP-HF 2-year data with the Food and Drug Administration and Japan's Pharmaceutical and Medical Device Agency soon to align on the pathways that could make it available for physicians and their patients. These regulatory leaders, similar to the distinguished Dr. Mary Walsh are aware that these patients with ischemic heart failure of reduced ejection fraction are in great need, which is one of the reasons FDA granted CardiAMP cell therapy a breakthrough device designation intended for indications in great need of new therapies. Knowing of this great need, these agencies approve therapies based on risk-benefit analysis from rigorous good clinical practice studies such as CardiAMP-HF. These agencies know that for medical device implants, safety results over time can arise due to a host of issues related to fatigue, device erosion and immunological response, among many others. These agencies also know that safety issues such as drug toxicities can present over time due to drug compartmentalization and the long history of difficult patient compliance to medication. These agencies will also know that these potential long-term medical device implant and drug safety issues do not exist for CardiAMP cell therapy for heart failure. After the onetime CardiAMP cell therapy procedure, there is nothing left behind other than high concentrations of a patient's own cells in their heart tissue, where these cells naturally home when there is an injury to the heart. Our discussions with the regulatory agencies will be around the evidence we have for safety and efficacy of the CardiAMP cell therapy from this very rigorous clinical study in light of the very real patient need that exists and in light of other therapies that may be approved for these patients. The regulatory authorities are also aware that CardiAMP cell processing system has been previously approved in the United States and Japan for other indications, and our Helix delivery system has been approved previously in Europe. The CardiAMP Heart Failure II trial is active and consenting patients. We expect significant news flow ahead as we progress in this study in parallel to the ongoing regulatory discussions. Beyond this lead therapeutic autologous cell therapy program in heart failure, we have also made progress this quarter in other programs. This quarter, final data from the last rolling cohort patient in the CardiAMP cell therapy and chronic myocardial ischemia trial or VC-02 is being collected and will be prepared for scientific presentation and publication. This entire program benefits from the scientific support from CardiAMP-HF. We have also completed enrollment in the low-dose cohort in our CardiALLO allogeneic mesenchymal stem cell therapy in ischemic heart failure or BCDA-03 and are actively scheduling the Data Safety Monitoring Board review of the safety outcomes for this off-the-shelf therapy. On the Helix Biotherapeutic delivery partnering front, we have no updates to share at this time on current and future partners. We continue to be focused on partnerships where our contributions to the success of partners will reward our shareholders. One element of the Helix delivery system is our proprietary FDA-approved Morph DNA steerable introducer platform. We are continuing to detail its advantages to physicians and partners who may benefit from these products. We do not expect significant revenues in the near term, but do expect to have news here as we make progress. On the business development front, we understand that partnering can create meaningful value for shareholders with respect to each of our 4 platforms: CardiAMP, CardiALLO, Helix and Morph DNA. For CardiAMP cell therapy business development, we expect the final data from CardiAMP Heart Failure I trial, which we now have will enhance interest by distribution partners and strategics. It is noteworthy that interventional therapies for heart failure are receiving more and more attention because there are many patients who remain symptomatic even on state-of-the-art guideline-directed medical therapy. For CardiALLO cell therapy business development, our allogeneic cell therapy, we have had discussions around partnering these cells for other clinical indications beyond our current plans in cardiac and pulmonary disease. I note that FDA has approved a first mesenchymal stem cell therapy by a peer company in 2025, which has a treatment price of $800,000 for a course of 4 treatments. And another peer company appears to soon expect conditional approval for mesenchymal stem cell therapy in Japan to treat acute respiratory distress, where we also have an approved IND at BioCardia. These peer company successes may enhance our partnering discussions around our clinical stage allogeneic mesenchymal stem cell therapy platform. For our Helix Biotherapeutic delivery platform, potential biotherapeutic delivery partners who wish to have access to our delivery experience, products and support capabilities remain active in discussions. Current partners realize that minimally invasive delivery not only enhances future commercialization, but is also seen as a critical means for clinical development, enabling much faster enrollment, thus significantly reducing their operational costs by shortening time lines for their therapeutic development. Lastly, partner therapeutics are expected to benefit enormously from our threefold efficiency of delivery and the enhanced pharmacokinetics with our Helix system supported by data from many groups. We believe this advantage underlies our positive CardiAMP-HF data and is due to the stability of the Helix in the beating heart and the self-sealing helical pathway into the tissue. On the Morph front, the recent FDA approval has us open for business in a competitive but real market. Physician usage is the first step toward any distribution or commercial partnership. Morph DNA was used in the - as the steerable platform in the recent CardiALLO low-dose cohort patient and more procedures are expected ahead. Looking forward, we are working to complete the following important efforts for our therapeutic programs. First, to submit CardiAMP-HF results and request consultation with FDA and Japan PMDA. Second, to activate multiple sites in CardiAMP-HF2 and drive enrollment. Third, for BCD-02 to deliver top line data in the rolling cohort and for BCD-03, complete the DSMB review in the CardiALLO-HF low-dose cohort. I will now pass the call to David McClung, our CFO, who will review our fourth quarter 2024 financial results. David?