Suyash Prasad
Analyst · William Blair. Please proceed with your question.
Sure. Yes. Thanks for the question, Raju. I think, yes, it’s going to be interesting. I am looking forward to seeing the panel, actually in seeing how the discussion goes. The way the FDA have structured the panel looking at five specific areas. They look for integration and oncogenicity risks, toxicity, thrombotic microangiopathy tissues and the nonclinical front of toxicity especially related to DRG and then clinical finds on neurotoxicity that based on brain MRI findings. So, I think we are actually just looking forward to listening and learning. All those five areas that if they are talking about, we have given us some considerable thought to and have mitigated against them, both by looking at them, looking for some of these issues, specifically in our preclinical work. For example, we look at DRGs in all of our preclinical NHP studies now. And thus far, we haven’t seen any signs of DRG inflammation. And not just looking at things from the nonclinical perspective, but you also build in appropriate mitigations into the clinical trial design as well, i.e. we built in monitoring to local hepatotoxicity tissues. We have built in clinical monitoring to look at platelet counts, which gives a clue to early issues with thrombotic microangiopathy. We look at – we actually have – it’s been an interesting discussion with the regulators just in general about how to monitor for DRG inflammation over – in the clinical trial. And essentially, we come up with a good plan that the regulator has been very acceptable of, which is looking at reflex testing periodically at each visit. So specifically, the six reflexes in the body, ankle, knee, etcetera. And also nerve conduction studies at baseline and the three-month period to the first year thereafter. So, we have been giving this a lot of thought. I am not expecting to hear anything at this meeting that’s a big surprise to us. I am hoping to learn more that I am hoping to go into more detail around the mechanism of what’s happening. And I am also hoping that they take the safety issues that they are thinking about considering and they look at it from the context of the balance of risks and benefits in the patients because once again, for the patient communities that we are trying to serve, these are children who have demonstrating will offer the rapid progression towards that. And in that context, some minor safety issue should not be – should not preclude a charter being included in the clinical trial or being dosed.