David Mazzo
Analyst · WBB. Your line is open sir
Thank you Joe. We are excited to be moving forward with this new chapter in our corporate development and believe that we will enhance our prospects for positive returns for our shareholders based on an improved risk profile that is diversified across technology platforms and medication indication. Allow me to begin with an update on our landmark U.S. Phase II study of CLBS03 as a treatment for recent onset Type 1 Diabetes. We continue to make steady progress according to plan with the Sanford project T-Rex study which is due conducted in partnership with Sanford Research, a non-profit research organization that is part of Sanford Health and that supports an emerging translational research center focused on finding cure for Type 1 Diabetes or T1D. As a recap, CLBS03 is the personalized autologous cell therapy consisting of each patient’s own regulatory T-cells or T-Reg, which have been expanded in number and functionally enhanced by proprietary method developed through a collaboration with Dr. Jeffrey Bluestone and renowned researchers at UCSF and for which Caladrius has exclusive rights to international portfolio have issued and pending patents for T1D and other indications. The T-Reg study is a perspective randomized placebo-controlled double-blind Phase II clinical trial to evaluate the safety and efficacy of CLBS03 and 111 adolescence aged eight to 17 with recent onset Type 1 diabetes. Patients are randomized into one of three groups to receive a single administration of either high dose of CLBS03 or low dose of CLBS03 or placebo. The key end points for the trial are the standard medical and regulatory end points for T1D trial and include preservation of C-peptide which is an accepted measure for pancreatic beta cell function as well as insulin use, severe hypoglycemic episodes, and glucose and hemoglobin A1c levels. The study is 80% powered to detect the 0.2 picomol per mL difference and area under the curve mean C-Peptide between the active and placebo arms. This landmark study is novel and that it’s also includes work involve extensive and immune profile and participates to better elucidate the mechanism of action of CLBS03. Enrollment of the first 19 patients was completed in August 2016 and the evaluation produced favorable safety data, which allowed us to continue enrollment of the second cohort of subject last fall. The study has been conductive at the leading clinical centers throughout the United States including Joslin Diabetes Center and strong interest in its innovative program has allowed to us enroll and treat patients rapidly. Recently we were pleased to announce the achievement of the 50% enrollment milestone in the study with achievement of the 56 patient. There is a specified interim analysis of safety and potential early therapeutic effect that will occur after the six month post treatment follow-up visit of this group of patients and we expect to announce those results in early 2018. As a remainder, our research partner in T-Rex study, Sanford Research continues to provide support to the study by the covering the operational costs at their two clinical sites in addition to having made a $5 million equity investment in Caladrius in September of 2016. The study is also subsidized by two noteworthy grant, first the Juvenile Diabetes Research Foundation granted Benaroya Research Institute at Virginia Mason in Seattle a $620,000 grant to support Benaroya scientist and their collaborators in their analysis of the impact of CLBS03 therapy on the immune system of treated participants in the T-Rex Study to better understand the therapies mechanism of action. This grant to Benaroya directly offsets costs that Caladrius otherwise would have been incurred as part of our clinical trial. Second, we are particularly pleased that the T-Rex Study supported by a grant of up to $12.2 million from the California Institute for Regenerative Medicine. As Joe mentioned, we received an initial $5.7 million payment during the second quarter and we expect to receive our first milestone payment of approximately $2 million when we enroll our 10th patient in California into the T-Rex study, which is anticipated before the end of this year. Our confidence in the program is supported by several published studies including early clinical work conducted by Dr. Stephen Gitelman, a leading pediatric endocrinologist at UCSF and Chairman of the Executive Theory Committee for the T‑Reg Study. Dr. Gitelman, along with Dr. Kevan Herold at Yale University, conducted a Phase I study funded by the Juvenile Diabetes Research Foundation on what is now known as CLBS03 that demonstrated T-Reg therapy to be well tolerated, durable and preserving of beta cell function in children. Their study was published in clinical immunology. In addition a study in Diabetic Adults published in Science Translational Medicine in November 2016 provided supplementary evidence for safety and tolerability of otologists expanded polyclonal T-Reg cell therapy while showing that the T-Regs retained to T-cell receptor diversity and demonstrated enhanced functional activity. And finally a European study in children published in Clinical Immunology and the Journal of Translational Medicine provided a preliminary indication of therapeutic effect to T-Regulatory cells as the treatment for patients with Type 1 diabetes. On the regulatory front, our CLBS03 program is the recipient of a number of important international regulatory designations including FDA Orphan Drug status, EU Advanced Therapeutic Medicinal Product Classification and FDU First Track designation which represents the first Type 1 diabetes program ever to receive this distinction. This regulatory recognition taking in combination with the cited results from previous clinical studies continues to feel our enthusiasm for advancing this novel T1D therapeutic approach. We reported the completing of the six month interim analysis that may inform us as to the continued safety and potential early therapeutic signal of CLBS03 and early onset T1D noting that the primary efficacy endpoint is planned to be evaluated if all patients have completed the one year follow-up visit of their treatment. Results from this Phase II study are expected to provide critical therapy performance information that will help us and/or potential partner decide whether and how to design and execute the most efficient economical and rapid registration study or studies to culminate development and achieve registration of the therapy. Let’s turn now to other pipeline opportunities. We continue to carefully and rigorously evaluate additional clinical development indication based on our T-Regulatory cell and CD34 platforms and will invest in other promising pipeline technologies into our programs based on an ongoing thorough data driven evaluation process. Our consideration of new indications in autoimmune disease and/or cardiovascular disease based on our existing technology platforms will be strongly influenced by the availability of funding grants or collaborations to support the proposed work. We look forward to the completion and data read out from studies T conducted by Jeff Bluestone in collaboration with Dr. Flavio Vincenti at UCSF that are evaluating autologous T-Reg as a treatment for subclinical rejection following kidney transplant in the study sponsored by the National Institute Allergy and Infectious Diseases as well as the study evaluating autologous T-Reg as a treatment for dermal lupus. Caladrius owns intellectual property rights for both of these indications and those data will inform our decision of whether to pursue further development in these indications. Turning now to our CD34 plus technology. CD34 cell therapy is supported by a robust body of clinical evidence having been investigated in clinical studies encompassing over 700 patients with more 400 of them receiving CD34 cell therapy exposure. Significant opportunities exist across multiple underserved cardiovascular indications such as critical limb ischemia, a coronary macro vascular dysfunction and refractory angina. The potential of CD34 cell therapy is also supported by preclinical data demonstrating improved micro circulation and by Phase II studies that consistent show benefits in safety and function. We are actively pursuing our CD34 technology as the treatment for no option CLI in Japan as there is early supportive data in this indication and we can leverage Japan’s new Regenerative Medicine Law that provides a regular path to early condition approval. CLI or critical limb ischemia is a severe obstruction of the arteries that markedly reduces blood flow to the extremities principally the feet and legs. CLI can lead to pain, skin ulcers and dermal sores and if not successfully addressed eventually amputation. No option CLI means the pharmacotherapy is no longer working and that amputation of a limb or limbs is the next step in treatment of these patients. CLBS12 is our CD34 cell therapy for CLI and its is based on previous studies of autologous CD34 cell therapy for no option CLI patients in both Japan and the U.S. in which researchers found that CD34 cell injection at comparable doses are safe, led to improvement in CLI free status and improved amputation free survival. Our Phase II clinical program and CMC strategy were designed in constant with the Japanese PMDA and we reached in the agreement that positive results from the study should qualify CLBS12 for early conditional commercial approval in Japan for this indication. The agreed trial is a 35 patient pivotal Phase II prospective, randomized controlled, open-label multicenter study and no option CLI patients to be conducted in Japan. Those randomized to treatment will be dosed with CLBS12 through intramuscular injection in addition to receiving standard of care. Patients randomized with the control arm will receive standard of care pharmacotherapy alone. It was agreed that the primary endpoint of this study is prime to continuous with CLI free status, which is defined as two consecutive monthly visits without disease progression. This is a highly clinically relevant endpoint and encompasses the broader spectrum of improvement when time to amputation or amputation free survival which are the typical end points in these studies. Also because this is an open-label study, we will be able to monitor patients and evaluate progress in real time. Based on the substantial clinical data from four prior trials in CLI and claudication, we believe that CD34 cell therapy is not only safe, but it can help improve quality of life and potentially treat patients with this life-threatening condition and this is what we intend to demonstrate through this pivotal Phase II trial. The study as expected the cost between $7 and $8 million of approximately three years with initial investment of about $2.5 million in the first year. We expect to initiate this study in late 2017 or early 2018 and with favorable outcomes we would seek to out license this product candidate in Japan. In addition to CLI, we plan to explore the broader aspect of our CD34 cell therapy platform, which has the potential to be effective in the treatment of other cardiovascular diseases. We have submitted an SBIR grant application to the NIH for our CD34 cell therapy to treat coronary micro vascular dysfunction. A disease that results in reduced blood flow to the heart muscle resulting in pain and dysfunction. We expect the decision on this funding in the coming months and if positive, our goal will be to initiate a 20 patient Phase II study before the end of the year or early in 2018. Moving forward, our strategy will emphasize the advancement of our clinical pipeline and diversification of our product candidate portfolio. We expect to achieve value creating milestones that position us for significant growth throughout the balance of the year and beyond. These milestones include reporting enrollment of the 10th patients in California in the T-Reg study, which involvement triggers at $2 million milestone payment. Reporting during early 2018 top line data from the interim analysis of the Phase II T-Rex study accepting the early therapeutic effect of CLBS03 in Type 1 Diabetes. Initiating the planned 35 patients Phase II trial in Japan in no option critical limb ischemia. Receiving additional grants for our CLBS03 and CD34 platforms in multiple indications and pursuing licensing opportunities for CLI in Japan and for other pipeline programs globally. So in closing, as I said earlier, we are excited to be turning our full attention to our mission of advancing Caladrius as a development focused biopharmaceutical Company, we have two compelling technology platform on which to build and we are well on our way to fully implementing a number of important clinical programs in the areas of unmet need. And while we are committed to executing our clinical programs and advancing them through to their next development milestone and decision point, we remain opportunistic about integrating other assets into our pipeline to potentially create both near and long-term value for our shareholders. Before we now move to questions, I will take this opportunity to thank you our loyal shareholders for your continued interest and support as we transition Caladrius to a development focused biopharmaceutical Company. Additionally, I also expand our gratitude to the patient, their families and the physicians who participate in our clinical programs with the hope of improving not only their own outcome, but also the outcomes of future patients. None of the progress we have made would have been possible without all of your support. And with overview operator, we are now ready to take questions.