Christopher Twitty
Analyst · Scotiabank
Thank you, Punit. I'm pleased to share our thoughts on a few recent preclinical studies with Nimacimab, a novel antibody-based peripherally restricted CB1 inhibitor. These studies were designed to not only address the hypothesis that a truly peripherally restricted CB1 inhibitor, such as Nimacimab, can effectively drive weight loss, but to also generate mechanistic data to support Skye's differentiated approach to CB1 inhibition. Recent biomarker analyses from our initial mouse DIO study have further extended the impact of the dose-dependent weight loss observed with Nimacimab treatment. Specifically, now we can report Nimacimab-dependent reduction in fasting insulin levels that complement significant glycemic control as well as productive modulation of key appetite-regulating hormones, including GLP-1 and leptin. Additional data sets also highlighted significant reduction of inflammation in adipose tissue as well as liver steatosis. We are also happy to report that this initial study has now been repeated by an independent lab with very reproducible results, not only in terms of the magnitude of weight loss and body composition that is preservation of lean mass with significant reduction of fat mass, but also with positive changes in glycemic control. This repeat study also looked carefully at food consumption and noted a significant reduction in cumulative caloric intake, slightly less but in line with Semaglutide. Collectively, these studies highlight that Nimacimab-dependent efficacy is driven by multiple peripheral pathways coordinated through different organ systems. Building on our Monotherapy studies, we compared Nimacimab, Monlunabant, a small molecule CB1 inhibitor and the dual GLP-1 GIP agonist tirzepatide, both alone and in combination with Nimacimab using our DIO model. We chose to use higher yet clinically translatable doses of CB1 inhibitors with Nimacimab having a similar level of exposure as the current Phase 2 dose and Monlunabant being slightly higher than its 20-day daily Phase 2 dose. Both CB1 inhibitors demonstrated significant weight loss over 23%, driven by reduced fat mass with lean mass preservation. We are encouraged that Skye's highly restricted Nimacimab drove similar efficacy compared to less peripherally restricted CB1 inhibitor, Monlunabant in a DIO model at clinically relevant doses. This study further highlighted that while an active yet suboptimal dose of tirzepatide could yield a similar level of weight loss as Nimacimab, the combination with Nimacimab produced 31.5% weight loss. These results, combined with our mechanistic data strongly support the potential for Nimacimab to be effective as both a Monotherapy and as part of a combination approach to address the growing obesity epidemic. These in vivo studies continue to support our belief that our differentiated antibody approach can provide meaningful efficacy without the challenge that current small molecule inhibitors face, which is brain exposure that can cause unwanted neuropsychiatric side effects. To address this potential advantage, we ran a series of in vitro potency experiments designed to leverage a critical mechanistic difference between Nimacimab and small molecule inhibitors. Unlike small-molecule CB1 inhibitors such as Monlunabant that bind to the CB1 receptor at the orthosteric site, that is the same site as the endogenous agonist, primarily endocannabinoids AEA and 2AG, Nimacimab binds to the allosteric site to inhibit CB1 in a noncompetitive manner. We modeled a low concentration of CB1 agonist at 10 nanomolar, representing potential physiological conditions where both drugs showed similar potency. However, when challenged with an elevated concentration at 2,000 nanomolars, mimicking a pathological state such as obesity in which endocannabinoids become upregulated, Nimacimab potency remained remarkably stable while Monlunabant's activity was significantly compromised. This differentiated mechanism has significant clinical implications. In obesity where endocannabinoids can be greatly upregulated, small molecule CB1 inhibitors such as Monlunabant may face increasing competition to bind to the receptor. This circumstance may potentially require higher doses of the small molecule inhibitor, which will increase brain exposure and the potential for neuropsychiatric risks. Conversely, Nimacimab's allosteric binding avoids this competition, maintaining relatively similar potency regardless of endocannabinoid concentration. These data suggest that Nimacimab may offer the widest possible therapeutic window among CB1 inhibitors, potentially delivering significant metabolic benefits without having to navigate around the hurdle of neuropsychiatric side effects associated with achieving an appropriate peripheral exposure. We look forward to continuing our preclinical research efforts focused on further characterizing Nimacimab's differentiated and clinically relevant mechanism of action and having more data to share over the next month. Now I will turn the call over to our Chief Financial Officer, Kaitlyn Arsenault.