RJ Tesi
Analyst · ROTH Capital Partners
Thank you, David, and thank you, everyone, for joining the call. I will arrange my remarks to highlight key takeaways for the third quarter, year-to-date and provide updates of our two platform programs, before I pass it back to David to discuss our financial results and upcoming milestones. Then we will move to Q&A. I'll start with our DN-TNF program, beginning with XPro1595, which we are developing for Alzheimer's disease and other CNS indications where a neuroinflammation plays an important role. A significant highlight since our last quarterly update was the announcement in September that we were awarded a $2.9 million SBIR grant from the NIH to support a Phase II study in XPro1595 in patients with treatment-resistant depression. In rough numbers, we expect to receive $0.75 million this year, $1.2 million in 2021 and the balance in 2022. Importantly, we will conduct this trial in collaboration with 2 of the world's pioneers in this field, Professor Andrew Miller, MD; and Associate Professor, Jennifer Felger, both at Emory University. Treatment resistant depression is an indication with a significant unmet need. An estimated 7 million patients in the U.S. with major depressive disorder are resistant to current therapies. The definition of treatment resistant depression is simple. The patient must fail 2 lines of treatment for their depression to be labeled treatment resistant. There are two surprises hidden in that simple statement. The diagnosis is one - that one comes to by trial and error of treatment. There are no biomarkers that predict which patients are going to be successful or fail or which drug you should use. Imagine a disease with 7 million patients is treated with the diagnostic precision of some ancient time, namely hit and miss. I find that remarkable. This trial hopes to change that, at least to begin the process of changing that. The trial will use biomarkers of inflammation to enroll patients and will use biomarkers to determine responsive therapy with XPro, a strategy that is rarely, if ever used in the development of psychiatric drugs. Based on our work using XPro to treat patients with neuroinflammation in Alzheimer's disease, we believe treatment with XPro will decrease neuroinflammation in the patients with treatment resistant depression. We restore functional connectivity in a reward-related brain circuitry, an MRI neuroimaging biomarker that can be seen and will improve anhedonia, an important symptom of major depression, which is sort of apathy, and they just can't get excited about anything. A more detailed discussion of this biology in the trial are beyond the scope of this call. I refer you to our September 29 KOL webinar that is posted on our website. Needless to say, we are excited about expansion of our neuroinflammation franchise beyond Alzheimer's disease and look forward to commencing enrollment of this trial in 2021. Turning to our flagship program in Alzheimer's disease. In July, we presented interim data from a Phase I trial using XPro1595 to treat neuroinflammation in patients with Alzheimer's disease. XPro reduced neuroinflammation by an average of 40.6% in a white matter pathway, important for language and memory in patients with Alzheimer's disease. In this study, neuroinflammation is assessed in many ways. But as part of this preliminary data snapshot, we focused on MRI measures of white matter free water, a validated biomarker of neuroinflammation. In the admittedly small preliminary data set, we had 6 patients, half in a low dose and half in a high dose cohort - excuse me, that were treated for 12 weeks. As a reminder, this trial is a neuroinflammation trial in Alzheimer's disease - in patients with Alzheimer's disease. The primary endpoint is decreasing neuroinflammation. We are measuring cognitive changes as in a 12-week trial, the expectation for significant changes is tempered. There were several important findings in this preliminary data set. First, neuroinflammation was decreased over the 12-week period, as measured by white matter free water. White matter free water was measured in 2 ways, a whole brain measure using a safe - white net of mask, and we look at neuroinflammation and specific white matter tracks, the super highway of the connecting parts of the brain. Using the safe white matter mask, we saw a clear dose response with an increase of 1.7% of neuroinflammation over a 3-month period in the low dose group, but a decrease of neuroinflammation of 2.3% in the high dose group. In a more detailed analysis of white matter tract pathology, we showed the 40% reduction of neuroinflammation in the arcuate fasciculus in patients treated with XPro. Every patient had a decrease, and the range was between 20% and 50%. Why do we believe a decrease in neuroinflammation in the arcuate fasciculus is important? The arcuate fasciculus is a major white matter tract that connects regions of the brain important for language and short-term memory. Language, more specifically, the deterioration of language skills, is a sensitive clinical sign used by clinicians in Alzheimer's disease. Language skills or the deterioration of language skills are helpful in the diagnosis of MCI and to monitor the progression of MCI to Alzheimer's disease and to measure the worsening of cognitive decline. We acknowledge these are preliminary data in a small number of patients. Regardless, we are encouraged by these results for 3 reasons. First, the results are predicted by preclinical studies. Second, we treated Alzheimer's patients with a novel therapeutic protein by subcutaneous injection in thigh or the abdomen like an insulin shot to decrease neuroinflammation in a specific nerve anatomic structure that is important in one of the most sensitive clinical science of Alzheimer's disease, language. We believe this gives us considerable optimism. Finally, we - in measuring white matter free water using a sensitive, and I stress, noninvasive biomarker, that we will increase the precision and decrease the risk of drug development in Alzheimer's disease and the other neurodegenerative diseases we will be looking to in the future. We look forward to expanding the data set in the patients of the Phase I trial and studying patients who have entered the extension trial. The extension trial is patients who reached their 3-month deadline or treatment end of study and want to stay on the drug, they get treated once a week for long term. I encourage you to review the July 13 webinar, Cash on the INmune Bio YouTube channel to gain further insight into the data. This data give us confidence in our plans to initiate 2 phase trials in 2021, one in treatment-resistant depression that I've already mentioned, supported by the NIH and one will be a Phase II trial in Alzheimer's disease. We are no longer alone in believing that neuroinflammation is an important pathology associated with CNS diseases. Our approach of targeting neuroinflammation caused by the dysregulated anhedonia system has received votes of confidence in the form of funding from the National Institute of Mental Health, the Alzheimer's Association and the ALS Foundation. We remain confident that our focus on targeting real activation combined with the use of biomarkers in patient selection and functional provides a path forward. On to Quellor, the name of our program for treating hospitalized patients with COVID-19. We have a simple hypothesis related to the pathology of the disease in this pandemic. First, patients are hospitalized because COVID-19 - because of COVID-19-related cytokine storm. Second, we believe blending, suppressing, eliminating, curtailing, you choose the word, that cytokine storm will benefit the patient, decrease symptoms and decrease pathology. Finally, we are - we believe how you attack the cytokine storm matters. We believe TNF is the master cytokine of a cytokine storm, and that's what Quellor targets. We're testing these principles in a Phase II clinical trial in patients with respiratory compromise COVID-19 infection. Why do we think blocking TNF will be important? TNF decreases the expression of IL-1 and IL-6, the other major cytokines of the cytokine storm. So that is if you cut the knees out of the TNF, IL-1 and IL-6 don't get up regulated. There are 3 additional, what we call TNF pathology is important to the progression of symptoms in these hospitalized patients. First, as I mentioned, TNF causes activation of the innate immune system, the driving force of the hyperimmune response. TNF also causes activation of endothelial cells. Endothelial cells are the cells that line the blood vessels. Activated endothelial cells express ICAM, VCAM and tissue factor. The first 2, ICAM and VCAM, direct transmigration of activated immune cells from the blood to the tissue. They have - these activated cells have to be in the tissue to cause damage, and they need to be directed to go there. That's what ICAM and VCAM do. Tissue factor causes blood clots. You've all heard that aberrant blood clots seem to get stepped in the blood vessels of the lungs, the kidneys, the heart, the brain and beyond and contribute to the catastrophic complications of C-19. We believe that the blood clots are one of the major problems associated with the vexing viral disease. On September 1, we announced the FDA accepted our IND application, paving the way for the initiation of the Phase II clinical trial, evaluating Quellor to treat patients who have respiratory compromise and are hospitalized before C-19. We aim to enroll 366 patients in a randomized trial with a 1:1 randomization. One, the control group get standard of care, and the treatment group with standard of care plus Quellor as a single injection on admission to the hospital. Last quarter, we announced that our INB03 oncology program was delayed due to the pandemic. We hope to initiate the Phase II trial in MUC4 positive cancers next year, actually, the pandemic has been controlled. Although this clinical program is - the clinical part of this program is dormant, the laboratory research continues. We're looking at the combination of INB03 with TKIs in MUC4 expressing tumors. Similarly, our LIVNate program in NASH will not begin a Phase II trial until the pandemic has been controlled. We hope to have more clarity on these 2 programs by the end of the year. Update in March. In the meantime, however, we are all in, in progressing our neuroinflammation programs and the cytokine storm program focused on COVID-19. So that's what I have to say about the dominant negative TNF platform. I'll now move to INKmune, which is our NK cell priming platform. NK cells play a critical role in cancer outcomes, given their importance in targeting residual disease, one of the primary causes of cancer relapse. INKmune restores the function of patients' own NK cells to attack residual disease. And we believe that by eliminating residual disease, INKmune should prolong survival. We have 2 therapeutic programs in the queue, high-risk myelodysplastic syndrome or MDS, a precursor to acute myeloid leukemia that predominantly affects elderly patients. The second program is ovarian cancer, a heretofore uncurable malignancy. We plan to initiate a single-center Phase I trial in high-risk MDS, a first-in-man study using the product in the very near future. The company is ready to go, but the U.K. is suffering from a resurgence of COVID-19 like we are in the U.S. So the development time lines in the U.K. are being compromised. We plan to - for when the clinical site is ready, we will be able to support admission of patients to the clinical trial. The high-risk MDS trial will include at least 9 patients. And the ability to expand both the number of centers and the number of patients will depend on ongoing results, both in the treatment as well as control the pandemic. Likewise, the ovarian cancer program is delayed because of the pandemic. We are hopeful to start enrolling patients in 2021. We remain aggressive in pursuit of new IP and expansion of existing IP. In August, we were granted a European patent covering the peripheral administration of XPro1595 for treatment of Alzheimer's disease and other diseases of the CNS. This is part of the foundational patent suite supporting our all-important neuroinflammation franchise. The patent runs through 2033. In September, we will announce the issuance of the U.S. patent covering INKmune as primes NK cells and in the role in combating the malignancy. This patent runs through 2036. I can promise you we have much more IP in the ring - in the wings, and we will announce those as they are made public. I now turn it back to David Moss, INmune Bio's CFO, to discuss financial results and upcoming announcements.