David Mazzo
Analyst · H.C. Wainwright
Thanks Joe. I will begin by reiterating my comments from our last call and provide a high level description of what we are doing at Caladrius and why our development programs are increasingly relevant and attractive investment opportunities today. As many of you may be aware, the majority of companies in the cell and gene therapy space are focused on treating cancers and/or rare diseases. Though there's clearly a need for advances in these areas, heart disease continues to be overlooked despite being the leading cause of death in the United States and most of the developed world. One of the factors that differentiate Caladrius from other biopharmaceutical companies is that we are focused on developing cell therapies that reverse as opposed to manage cardiovascular diseases and we have late-stage clinical programs underway with a large database of human clinical data. Our therapies to-date have been shown to be well tolerated, effective, durable, economical and pharmacoeconomically justified. Most importantly, we are working on products with the goal of providing patients with a single administration curative therapy rather than one that requires chronic readministration. With that said, let me provide a summary of the basis for our CD34+ cell therapy platform. Our CD34+ cell technology has led to the development of therapeutic product candidates designed to address diseases and conditions caused by ischemia, a condition in which the supply of oxygenated blood to healthy tissue is restricted. Previously published animal and human studies have demonstrated that the administration of CD34+ cells induces angiogenesis of the microvasculature that is that these cells prompt the development of new blood capillaries, thereby contributing to the prevention of tissue death by facilitating blood flow to the area of ischemic insult. We believe several conditions caused by underlying ischemic injury can be improved through the application of our CD34+ cell technology, including but not limited to critical limb ischemia, coronary microvascular dysfunction and refractory angina. Now I'll speak to the specifics of our CD34+ technology-based clinical programs beginning with our product nearest to commercialization CLBS12 in Japan. Among others, our CD34+ cell technology has spawned the development of our product candidate for the treatment of critical limb ischemia CLBS12, which is currently in an ongoing registration eligible clinical study in Japan. CLI is characterized by a severe obstruction of the arteries that significantly reduces blood flow to the lower extremities principally the feet and legs and represents the end-stage of peripheral arterial disease. CLI patients often experience severe rest pain, limited mobility, non-healing skin ulcers, and if not successfully treated eventual amputation. Please note, that it is well documented, but not well-known that CLI patients have a higher mortality rate than patients with most cancers. CLBS12 was awarded a SAKIGAKE designation from the Japan Ministry of Health Labor and Welfare for the treatment of CLI. The SAKIGAKE designation is a regulatory designation akin to an RMAT designation in the United States and affords the recipient prioritized regulatory consultation a dedicated review system to support the development and review process as well as reduced time of six months for the CLBS12 registration application once filed. CLBS12 is also eligible for early conditional approval and possibly full approval based on the compelling nature of the complete data from our ongoing prospective randomized controlled open-label multicenter study in CLI patients in Japan. In addition, European Medicines Agency granted CLBS12 advanced therapy medicinal product or ATMP classification for the treatment of CLI. ATMP are defined as medical treatments that are based on genes or cells and are intended as long-term or permanent therapeutic solutions to acute or chronic human diseases at a genetic cellular or tissue level. This regulatory achievement sets the stage for us to work closely with European regulators to define the most expeditious path and regulatory plan to registration for CLBS12 in the EU. The ongoing study in Japan comprises subjects divided into two cohorts a 30-subject group with traditional arterial sclerotic CLI and seven subjects group with Buerger's disease a type of CLI often associated with heavy smoking. Those subjects were randomized to treatment are dosed with CLBS12 in a single treatment through a series of intramuscular injections in addition to receiving standard of care pharmacotherapy. Subjects randomized to the control arm only received standard of care with drugs approved in Japan including antiplatelet agent, anticoagulants and vasodilators the choice of which is made by the investigators according to the protocol. The study allows for the rescue subjects in the control arm by indicating crossover to treatment if their CLI is deemed to be progressing. The primary objective of this study is to show that CLBS12 can prevent the serious consequences of CLI by reverting the patients to a CLI-free condition through improved blood flow in the afflicted limb. Dictates is defined as two consecutive monthly visits in, which rest pain is absent and previous non-healing skin ulcers are completely healed as determined by an independent adjudication committee. As previously reported, and as you can review in our corporate presentation on our company website, the responses observed to date in the Buerger's disease cohort are very positive and consistent with the beneficial therapeutic effect and safety profile as previously reported in published clinical trials in Japan and the United States. For patients with Buerger's disease, amputation and even death are likely outcomes and no available pharmacotherapies prevent amputation. However, subjects in the fully enrolled Buerger's disease cohort in our study have achieved a remarkable remission rate of 57% meaning that four of seven subjects have now met the primary endpoint in our CLI-free. It is worth repeating that the natural history of Buerger's disease patients its continued disease progression leading to likely amputation. So our data are extraordinarily positive. We are very encouraged by the study results to date and believe that they suggest a positive outcome for the overall trial recognizing, however, that the final conclusions of the trial will be dependent on all data from all subjects. We continue to anticipate complete enrollment in the study during the first half of this year with top line data for the full study in early 2021, leading to an earliest possible approval in Japan in late 2021 or early 2022. That said, it is too early to tell if the recent outbreak of COVID-19 coronavirus in Japan will have a negative impact on enrollment rate for the remaining subjects needed to complete the trial. Regarding commercialization, our strategy remains to license or partner CLBS12 in Japan. And to that end, our conversations continue with prospective partners and we continue to see to consummate a deal in transfer with the completion of the study if not before. Turning now to CLBS16, our promising CD34 product candidate for the treatment of coronary microvascular dysfunction. Like all our CD34-positive cell therapy product candidates, CLBS16 uses a proprietary and patented formulation of CD34-positive cells, specifically designed for an injection at/or near the site of ischemic insult, which in the case of CMD is an infusion into a coronary artery. CLBS16 is the subject of the recently completed ESCaPE-CMD trial, a 20-patient proof-of-concept clinical trial evaluating CLBS16 as a treatment for coronary microvascular dysfunction, a plaqueless heart disease and involving damage to the interlining of the tiny arterial blood vessels in the heart with no discernible large vessel blockages. Despite the absence of large vessel disease, CMD patients have an equally poor prognosis related to major adverse cardiac events and death as to patients who have identifiable large vessel blockages. But because obvious large artery blockages aren't seen CMD is often under diagnosed, misdiagnosed or untreated. It should also be noted that CMD is more frequently encountered in females making this an emerging – excuse me, an important emerging women's health care issue. CLBS16 is designed to address the symptoms and physiology of CMD by employing the CD34-positive cells innate ability to increase microcirculation. In November 2019, at the American Heart Association scientific sessions we reported the data for those patients that is 17 of 20 who at the time had completed their six month follow-up visit in our ESCaPE-CMD trial. The data showed highly statistically significant improvement in coronary flow reserve correlating with symptom relief for patients with CMD after a single administration of CLBS16. And the results of the ESCaPE-CMD trial are not only important for defining the next development step for CLBS16, but they provide the first direct quantitative evidence in humans, corroborating the mechanism of action of CD34 cells something which is supportive of all of our programs. The initial results were outstanding and we look forward to reporting complete results in the first half of 2020 the timing of which is dependent upon acceptance for publication or presentation of the complete data set in the scientific journal, or at a noteworthy scientific conference. We are planning to advance the CLBS16 program to its next clinical development step a Phase IIb study as expeditiously as possible with a target for first in patient sometime around midyear. And now moving on to our Phase III-ready CD34 cell therapy product candidate in the United States CLBS14. CLBS14 is being developed to address no-option refractory disabling angina or NORDA by stimulating the growth of new microvasculature in an oxygen-deprived heart and those patients who have had large vessel disease treated with all available therapies but still have debilitating angina, likely due to microvasculature deficiency. Our confidence in this program is based on a series of published Phase 1, 2 and 3 study results that indicate a consistency of therapeutic effect of CD34-positive cells to increase exercise tolerance improve heart function and decrease long-term mortality associated with the condition. As discussed on our last quarterly call, we finalized with FDA the protocol design for a confirmatory Phase 3 trial to support the registration of CLBS14 for NORDA in the U.S. But due to the projected cost of the study, we have deferred its initiation in the U.S. pending confidence that would require sufficient capital to fund the study to completion. Among the possible sources of capital are non-dilutive grants and/or partnerships both of which we are pursuing vigorously. So in closing, we are very pleased with the corporate and development achievements made throughout 2019 and believe that these accomplishments form the foundation from which we expect to attain a number of key milestones throughout 2020. Our experienced, dedicated and passionate team remains committed to the efficient and effective advancement of our programs as we work to bring innovative treatment options to patients in need and restore human health. And with that overview, operator we're ready to now take questions.