Darrin Uecker
Analyst · Medical Hope Productions. Please go ahead
Thank you, Kevin. I think it will be helpful today to reiterate the underlying capability of our technology to better understand why it has great potential to improve the present state of cardiac tissue ablation for the treatment of AF among other applications. At Pulse Biosciences, we have developed a novel and proprietary tissue treatment platform based on nsPFA where ultrafast electrical energy pulses at nanosecond pulse durations from billions up to millionth of a second are used to stimulate cellular effects that can lead to positive therapeutic outcomes. nsPFA is broadly considered a pulse field technology, but the use of nanosecond duration pulses leads to a highly differentiated cellular mechanism of action that can be applied to a number of important clinical applications with distinct and unique benefits to patients treating MDs and post-care trained staff. We have demonstrated that when these incredibly fast energy pulses are applied to cells, they penetrate the cell and disrupt the function of the internal organelles of the cell by creating small holes in the organelle membranes, known as poration. These organelles include the mitochondria, which is the cells power plant and the endoplasmic reticulum, which plays an important role in protein synthesis. When the function of these organelles is disrupted, the cell goes through a natural regulated cell death process. This ability to get inside the cell with nontoxic application of electrical energy, while preserving the integrity of the outer cell membrane to initiate regulated cell death is a cornerstone of our nsPFA technology. This regulated cell death process leads to a more natural healing response as the body’s immune system is accustomed to dealing with cell death through this natural and regulated mechanism as opposed to sudden necrotic cell death caused by other energy-based therapies, which can lead to a significant inflammatory response that slows the return to normal tissue function. We believe it is this ability to initiate regulated cell death through the temporary formation of pores in intracellular organelle membranes that importantly differentiates nsPFA from other energy-based therapies, such as standard PFA and radio frequency ablation. Another important and unique feature of Pulse Biosciences nsPFA is the lack of impact it has on acellular structures, such as the extracellular tissue that provides the tissue architecture in support of cellular and organ healing. While thermal energy modalities will destroy all tissue indiscriminately, nsPFA has a selective mechanism that impacts cells that leaves the acellular structure, which typically is made of collagen, intact, allowing the tissue to heal in a more natural way. nsPFA also has been shown to spare nerve fibers or those parts of the nerve that carry electrical impulses as well as blood vessel architecture and tissue. Another significant benefit when the therapeutic intent is to clear on one itself and promote healing and a return to normal tissue function. This novel mechanism of action has been demonstrated in human clinical and preclinical studies across a large number of organs and tissue types. Evidence supporting this has been published in a number of peer-reviewed publications such as the Journal of Lasers in Surgery and Medicine, the Journal of Cosmetic and Laser Surgery and the Journal of Dermatologic Surgery. We have determined that the underlying nsPFA mechanism of action is uniquely suited to address the current challenges of cardiac tissue ablation. Today, the treatment of AF requires the precise and safe ablation of heart tissue to block, inhibit or otherwise prevent faulty electrical signals from causing in irregular heartbeat. We believe nsPFA technology will prove to be highly differentiated from standard thermal energy modalities in use today. nsPFA should be able to deliver faster ablation through thicker tissue than thermal modalities because it is not impacted by heat sinks, such as the blood in the heart. Thermal modalities experienced charring on electrode surfaces, which prevent adequate ablations and can add undesired time and challenges to procedures. This has not happened with nsPFA because of the earlier mentioned attributes and its non-thermal nature. Because nsPFA ablation does not impact acellular tissue, such as collagen or cartilage, our technology has the potential to offer significant safety advantages over thermal modalities by allowing surgeons to ablate near and into vessels and valves without safety concerns of permanent damage. And finally, nsPFA ablation has been shown to spare nerves of any permanent damage even when treated directly, which is another concern with thermal modalities. With nsPFA, we believe physicians can provide a more focused thorough treatment and thereby reduce their procedure times with the end goal to improve clinical outcomes and patient experience. In recent years, pulse field ablation has gained attention in electrophysiology for the treatment of AF as a result of its safety profile and potential to improve efficacy. nsPFA differs from standard PFA in that the pulse durations for nsPFA are much shorter, typically 10 times [ph] to 10,000 times shorter, which translates to appropriate energy and a more energy-efficient mechanism. In turn, less energy per nsPFA pulse allows us to design larger footprint electrodes that can treat more tissue faster with reduced concern of thermal damage that can be an issue with standard PFA. Appropriate controlled energy and shorter duration pulses will stimulate less muscle contraction than nerve stimulation during treatment. And as such, reduces the need for stronger sedation and paralytics that are often used with standard PFA. For these reasons, we believe nsPFA will provide meaningful benefits in both efficacy and safety over standard PFA. On the product development side, we are working with top KOLs and to develop AF treatment solutions to be used in the catheter lab and in the operating room. The differentiated benefits of our nsPFA technology will be incorporated in the design of both a surgical clamp for the treatment of AF in the operating room by cardiac surgeons and a catheter that is navigated into the heart through the vascular system for the treatment of AF by electrophysiologists in EP lab. While these devices serve different physician specialties, they are both providing a highly differentiated solution for the treatment of AF and both make use of the core nsPFA technology, so the development of these devices is highly leveraged. Both devices are currently being tested in preclinical models. Over the last several years, we have been researching and developing nsPFA cardiac ablation surgical tools, and we now have achieved what we believe is an on-target initial commercial design for a cardiac ablation clamp. The cardiac ablation clamp is designed to be used and what is commonly referred to as the Cox-Maze procedure, a procedure performed by cardiac surgeons specifically for the treatment of AF. During this procedure, cardiac surgeons create lines of ablation in the heart in order to block aberrant electrical signals and cure the patient of AF. Today, this has done with thermal modalities, and we believe nsPFA can offer a faster, more precise, safer and easier to perform ablation procedure. In 2023, we plan to perform the necessary device testing, including continued preclinical testing to prepare for regulatory clearance and human clinical use. In parallel with the continued device testing, we expect to meet with the U.S. Food and Drug Administration, or FDA, to discuss the regulatory requirements for a potential FDA clearance in order to market our cardiac clamp in the United States. This will be done as part of the FDA’s standard Q submission process, also known as a pre-submission meeting. We expect that our first meeting on this topic with the FDA will take place in the second quarter of 2023. After meeting with FDA, we expect to have better clarity on time lines to regulatory clearance and first-in-human clinical use. Turning to our second product in development, the cardiac catheter ablation device. Just like the clamp, our catheter delivers an electric field as opposed to thermal energy to destroy heart muscle cells and should provide many of the same safety and efficacy benefits. The catheter design is unique and enables a circumferential or circular ablation in the single treatment. This feature should expedite treatment times compared to thermal modalities, especially when performing the common, but challenging treatment approach of ablating around the pulmonary veins. The catheter has also been in development for several years, and we have accrued substantial learning while working with leaders in the electrophysiology field to optimize its design and evaluate performance in preclinical studies. We believe our current design is suitable to pursue a first-in-human clinical study following currently planned additional preclinical safety studies. In the U.S., we expect the catheter will require an FDA premarket approval or PMA submission to achieve approval to market and sell the device. The process to complete these trials will take several years. We strive to have a solid understanding of the devices performance as we go forward, and we look forward to providing updates along the way. We have accomplished a great deal with both of our nsPFA devices and the preclinical data we continue to produce is very encouraging. Notably, last month, the company highlighted a poster presentation at the prestigious 2023 AF Symposium in Boston. The poster was titled Novel Nanosecond Pulse Field Ablation Compatible with 3D Mapping & Navigation System. The poster highlighted the integration of our nsPFA system with a compatible 3D mapping and navigation system. The preclinical study demonstrated the ability to navigate the catheter for accurate ablation integrate pre and post ablation voltage maps with the same catheter. To further increase awareness for our technology among the cardiology community, we have submitted multiple abstracts highlighting nsPFA for presentation at the upcoming Heart Rhythm Society Meeting in May. We look forward to sharing more updates on our progress in the future as we accomplish the next important milestones. Now, I’ll turn the call back to Kevin for an update on our financial results.