Q4 2022 BioCardia Inc Earnings Call
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Speaker 2: I would now like to turn the call over to Miranda Pato of BioCardia Investor Relations. Please go ahead, Miranda.
Speaker 3: Good afternoon and thank you for participating in today's conference call. Joining me from BioCardio's leadership team are Peter Altman, PhD, President and Chief Executive Officer and David McClung, the company's Chief Financial Officer. During this call, management will be making forward-looking statements.
Speaker 3: including statements that address biocardial expectations for future performance and operational results, references to management's intentions, beliefs, projections, outlooks, analyses, and current expectations. Such factors include, among others, the inherent uncertainties associated with developing new products.
Speaker 3: technologies, and obtaining regulatory approvals. Forward-looking statements involve risks and other factors that may cause actual results to differ materially from those statements. For more information about these risks, please refer to the risk factors and cautionary statements described in Biocardia's report.
Speaker 3: on Form 10-K filed with the SEC this morning. The content of this call contains time-sensitive information that is accurate only as of today, March 29, 2023. Except as required by law, the complaint disclaims any obligation to publicly update or revise any information to reflect events or circumstances.
Speaker 3: that occur after this call. It is now my pleasure to turn the call over to Peter Altman, PhD, biocardialist president and CEO . Peter, please go ahead.
Speaker 4: Thank you, Miranda, and good afternoon to everyone on the call.
Speaker 4: We've had a great fiscal year in 2022.
Speaker 4: So before we get into the details, I always like to take a few moments and review what we are doing and why we are doing it.
Speaker 4: Biocardious efforts.
Speaker 4: are focused on advancing two cell therapy platforms to treat significant unmet cardiovascular and pulmonary diseases.
Speaker 4: Specifically, ischemic heart failure, chronic myocardial ischemia, and acute respiratory distress syndrome.
Speaker 4: All of our cell-based therapies involve local delivery of the therapeutic to the heart or lungs where we intend them to act locally.
Speaker 4: the heart. Our own proprietary helix minimally invasive delivery system is used to deliver the cells to target regions of damage.
Speaker 4: For the lungs, we intend to use intravenous delivery, which will result in the investigational cells being localized in the small blood vessels of the lungs.
Speaker 4: Local delivery of therapeutics to the target location where their action is desired maximizes their effective dosage within the tissues where delivered and minimizes potential negative effects remote from the target tissues.
Speaker 4: Heart failure is the first problem we are going after.
Speaker 4: Heart failure is an enormous unmet need that affects more than 26 million people worldwide. The latest blockbuster drugs and ischemic heart failure of reduced ejection fraction provide great benefits to patients but don't appear to have much of an impact on mortality.
Speaker 4: Patients in the published results of the pivotal trials for these new drugs have a cardiac mortality of roughly 7% and an all-cause mortality of 10% per year, regardless of whether they were treated or controlled patients.
Speaker 4: This data makes clear that heart failure is still a problem and great need of new therapeutic solutions.
Speaker 4: Our autologous mononuclear cell therapy platform, which we call Cardi-AMP cell therapy, is being advanced into cardiac clinical medications.
Speaker 4: In preclinical studies, cardiac mononuclear cell therapy has been shown to release proteins locally within the tissue to facilitate cardiac recovery after heart damage with improvements in heart perfusion and contractile function.
Speaker 4: All known previous clinical studies similar to the approach we are taking in our two lead cardi-amp cell therapy programs.
Speaker 4: have shown patient benefits on average.
Speaker 4: In some of these studies, including our own, the benefits have been remarkable.
Speaker 4: The FDA has supported this promise by granting breakthrough device designation to cardi-amp cell therapy in the indication of ischemic heart failure reduced ejection fraction.
Speaker 4: Advancing this and our other three therapeutic candidates is what we are all about.
Speaker 4: Our efforts to complete the Cardi-Amp Autologous Cell Therapy pivotal clinical trials for the indications of heart failure, or BCDA01, and chronic myocardial ischemia, or BCDA02, are furthest along clinically, with an estimated combined 1.6 million patients in the world.
Speaker 4: in a reachable US market. The Cardiac Cell Therapy Heart Failure Trial, or BCDA1, is a phase three, 260 patient, randomized controlled clinical study intended to provide the primary data to support safety and efficacy in pursuit of market clearance.
Speaker 4: Clinical investigators at 22 active partner sites across the United States and Canada have enrolled 119 patients today with 10 additional control patients having crossed over to receive therapy.
Speaker 4: We currently have eight active consents and 15 additional patients in the pre-consent queue.
Speaker 4: There is clearly increased momentum here, potentially driven by the clinical data.
Speaker 4: Data published to date has shown improved functional capacity and quality of life in treated patients.
Speaker 4: Earlier this month, clinical investigators presented blinded echocardiography data from the Yale University Core Laboratory from the open label rolling cohort of the Cardiomy Particular Trial at the annual meeting of the American College of Cardiology.
Speaker 4: Results presented showed a 35% improvement in left ventricular ejection fraction as compared to baseline with 100% survival and two year follow up.
Speaker 4: These are remarkable results in this population and the scientific poster presentation is available on our website if you are interested.
Speaker 4: The Independent Data Safety Monitoring Board completed both its fifth and sixth pre-specified data reviews in 2022, including a risk-benefit assessment with more than 100 patients past the primary clinical readout.
Speaker 4: Following the review, the Data Safety Monitoring Board indicated that it had no significant safety concerns and recommended that the study continue as designed.
Speaker 4: The Data Safety Monitoring Board also supported the company implementing an adaptive statistical analysis plan, which could enable an early readout for study treatment efficacy.
Speaker 4: Working with distinguished consultants, including former FDA leaders and a respected statistical consulting group, we have developed and submitted a supplement with a proposed adaptive statistical analysis plan to the FDA in February 2023.
Speaker 4: We have a meeting scheduled to discuss the FDA's comments on March 31, 2023, which is this Friday.
Speaker 4: The next pre-specified formal data safety monitoring board review is anticipated in the second quarter of 2023, and we believe it is likely we will be able to have the adaptive statistical analysis plan in place for the meeting.
Speaker 4: The specific details of any potential adaptive statistical analysis plan in combination with any modifications to the Data Safety Monitoring Board Charter will dictate what happens at the next subsequent Data Safety Monitoring Board reviews.
Speaker 4: as the Cardi-AMP cell therapy trial on heart failure.
Speaker 4: was over 90 percent power for success with a range of 86 to 126 patients.
Speaker 4: there is potential that the trial could meet its primary efficacy endpoint on the patients that have been enrolled to date.
Speaker 4: However, when the Data Safety Monitoring Board next meets, they may also recommend that the trial continue per plan, be stopped for safety, or be stopped for futility if the data does not support that achieving the primary one point is possible.
Speaker 4: Our second therapeutic program with the same autologous cell therapy for the treatment of chronic myocardial ischemia with refractory angina for BCO2.
Speaker 4: The CARDI-AMP Chronic Myocardoscimia Trial is a phase 3, multi-center, randomized, double-blinded, controlled study of up to 343 patients and up to 40 clinical sites.
Speaker 4: The Phase III PIVITAL trial is also designed to provide the primary support for the safety and efficacy of the Cardiac Cell Therapy System for this indication.
Speaker 4: It uses many of the same novel aspects of the Cardio Heart Failure trial and is expected to leverage our experience and investment in the heart failure trial.
Speaker 4: This program benefits from the 2022 Center for Medicaid and Medicare Services, or CMS, reimbursement for both treatment and control procedures at up to $20,000 for both trials.
Speaker 4: A significant number of patients to complete the open label rolling cohort have...
Speaker 4: Excuse me, a sufficient number of patients to complete the open label rolling cohort have already been consented.
Speaker 4: It is anticipated that this trial will report out the open label role in results in 2023.
Speaker 4: Trial design modifications to enhance enrollment efficacy and efficiency for the randomized cohort are being planned for submission to FDA.
Speaker 4: As we have shared previously in July , we had our second consultation with Japan's pharmaceutical and medical device agency regarding registration of cardiac cell therapy for ischemic heart failure.
Speaker 4: After working with distinguished physician leaders, BioCard expects to complete its formal submission for Japanese approval in the second quarter of 2023.
Speaker 4: As I've mentioned in previous calls, Japanese researchers established the building blocks of this therapy many years ago.
Speaker 4: The therapeutic approach we are pursuing was first studied in the preclinical model by physician scientists in Yokohama.
Speaker 4: This early work was performed in parallel to another Japanese vascular biology scientist who identified important aspects of bone marrow derived mononuclear cells in tissue repair.
Speaker 4: Their early efforts underlie our Cardi-M cell therapy, and we hope to be able to provide this therapy to the many in Japan who could benefit from it.
Speaker 4: Now, I'd like to move to our two allogeneic cell therapy product candidates.
Speaker 4: based on our allogeneic neurokinin-1 receptor-positive mesenchymal stem cell platform. These are off-the-shelf cells from young healthy donors intended to be expanded to produce many doses for many patients.
Speaker 4: The neurokinin-1 receptor-positive mesenchymal stem cells are particularly interesting as neurokinin-1 is the primary receptor for substance P, an important neuropeptide mediator of inflammation which plays a central role in both heart failure and regenerative processes.
Speaker 4: following myocardial injury. I encourage listeners to Google substance P to understand why advancing the mesenchymal stem cells that bind to this neuropeptide is exciting.
Speaker 4: Our allogeneic mesenchymal stem cell program in ischemic etiology heart failure of reduced ejection fraction is designed, is designated as BCD03.
Speaker 4: This is a phase 1-2, multi-center, randomized, double-blinded, controlled study of up to 69 patients.
Speaker 4: designed to assess the safety and efficacy of this therapeutic candidate. The investigational new drug application was approved by the FDA in December 2022. The trial is designed for patients with New York Heart Association class 2 and 3 ischemic heart failure of reduced ejection fraction.
Speaker 4: whose own cell composition makes them ineligible for the company's phase 3 Cardi-Amp Heart Failure trial studying autologous cell therapy or BCD01.
Speaker 4: Clinical grade allogeneic cells for this program have been manufactured in our Sunnyvale facility and are ready for use.
Speaker 4: These cells will be delivered under the protocol with our proprietary minimally invasive biotherapeutic delivery system. We expect to begin enrolling patients in the second quarter of 2023. Our allogeneic mesenchymal stem cell program in patients recovering from acute respiratory distress syndrome secondary to COVID
Speaker 4: which we have designated BCO4, was approved by the FDA in April 2022 to treat patients.
Speaker 4: The trial is a phase one, multi-center, open-label study of up to nine patients. While the number of patients with COVID-induced ARDS has decreased, ARDS unrelated to COVID is still significantly impacting patients.
Speaker 4: The company intends to work with the FDA to modify the study eligibility criteria to include these patients. In this trial, increasing dosages of the cells will initially be evaluated, and then the optimal dose will be taken to phase 2 in a randomized study in adult patients recovering from ARDS.
Speaker 4: This therapy is intended to address the enormous unmet need to sustain local and systemic inflammation after a patient is taken off respiratory support, with the goals of accelerating recovery, enhancing survival, and reducing both relapse and rehospitalization. Local grade cells are also ready for use in this study.
Speaker 4: The ARGS trial is expected to commence following the initiation of BCD-A03, studying these allogeneic mesenchymal stem cells for heart failure reduced ejection practice.
Speaker 4: In summary, we are advancing four clinical stage therapeutic product candidates that address important unmet cardiac and pulmonary diseases based on our autologous and allogeneic cell therapy platforms.
Speaker 4: From these therapeutic development efforts, we now have four active business development initiatives.
Speaker 4: First is partnering our Cardiac Cell Therapy platform internationally. Second is licensing out our clinical stage Neurokinin 1 receptor-positive mesenchymal stem cell platform for other clinical indications which have shown promise with other mesenchymal stem cell preparations.
Speaker 4: Third is licensing our catheter-based biotherapeutic delivery system for cell, gene, and protein therapy candidates to the heart, such as in the Blue Rock relationship we began last year.
Speaker 4: And fourth is monetizing our Avance transeptal introducer sheet product.
Speaker 4: Our steerable sheath assets were initially developed to help navigate our biotherapeutic delivery systems.
Speaker 4: and we use these products in every cardiac cell therapy procedure today.
Speaker 4: There have been recent acquisitions of established product offerings similar to our Avance product offering for between $70 million to $1.5 billion.
Speaker 4: Our Avant is our first FDA-approved offering for this transeptal indication and incorporates patented technology that may provide compelling benefits.
Speaker 4: Next week, we expect to announce the issuance of two additional new patents related to these steerable sheath assets.
Speaker 4: We are also looking forward to announcing an additional patent issuance related to our neurokinin-1 receptor-positive mesenchymal stem cells that has been allowed.
Speaker 4: and a patent that we expect soon to be allowed related to our Helix Biotherapeutic Delivery Platform.
Speaker 4: I will now pass the call to David McClung, our CFO , who will review our 2022 financial results.
Speaker 5: David? Thanks, Peter, and good afternoon, everyone. Today I'll review our financial results for the year ended December 31, 2022.
Speaker 5: Revenues for the fiscal year 2022 increased to $1.4 million from $1.0 million in fiscal year 2021, primarily due to the increased revenue from new and existing collaborative partners, including the Blue Rock relationship Peter just mentioned. Our revenues today contribute to reducing our burn rate and...
Speaker 5: down approximately 300,000 year over year, 13.3 million in 2022 compared to 13.6 million in 2021.
Speaker 5: R&D expenses increased modestly to $8.8 million in 2022 compared to $8.6 million in 2021, primarily due to increased expenses in support of the Cardiac Cell Therapy Heart Failure trial.
Speaker 5: particularly as our clinical sites continue to emerge from the effects of the pandemic. Selling general and administrative expenses decreased to $4.4 million in 2022 versus $5.1 million in 2021, even as we established and licensed our new cell therapy and device manufacturing facility.
Speaker 5: The decrease was primarily due to reduced professional service fees and lower stock compensation expense.
Speaker 5: Our net loss in 2022 was $11.9 million compared to a net loss of $12.6 million in 2021.
Speaker 5: And cash use and operations totaled $10.6 million in 2022, comparable to the $10.6 million in 2021.
Speaker 5: Now, Cardia ended the year with cash and cash equivalents totaling $7.4 million, which provides runaways in the third quarter without additional capital or funding from business development activities.
Speaker 5: This concludes management's remarks and we're happy to take questions. At this time, we will open the call to questions.
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Speaker 2: One moment please for the first question.
Speaker 2: And our first question comes from Joe with HC Wainwright. Please go ahead.masterclass.com
Speaker 5: Hey guys, good afternoon. Thanks for taking the question. I have three questions, one of which hopefully will be based on getting some, I believe, important perspective. So maybe I'll start with that one. So Peter, when we look at the blinded echo data for the roll in at ACC.
Speaker 6: you know, 35% overall improvement in LVEF. Maybe can you give the perspective of how that would compare, you know, to the inclusion criteria of the patient population and how that would relate to their natural history.
Speaker 4: Joe, great question. That is something that always makes it difficult.
Compare one trial to another, but in our population as we look at the data sets, we're looking at New York Heart Association class 2 and 3, ischemic, etiology, heart failure with reduced ejection fraction patients. Ejection fraction is also 20 to 40% of these patients. So this lines up well with...
what has been done in some of the other larger trials, where as the data I shared, mortality of
cardiac mortality of 7 to 8% and all-cause mortality of 10% per year in these patients. Now there are things that we're doing that could actually wind up excluding patients who are sicker. So for example the patients we're treating have to be eligible for cardiac catheterization and that could considerably
tilt us towards a healthier population. In addition, our cell population analysis.
selects patients who have really compelling potential for the autologous therapy. And there is potential that having superior autologous or patients' own cells could have an impact on their long-term prognosis.
but it's 100% survival in a patient population that we should have seen a 10% mortality per year. And at the same time, we're seeing improvements in a patient population group that typically deteriorates. So we recognize it's a small data set, but it's completely in line with what we saw in phase one and in phase two.
were patients approved across many metrics. And so the question that you pose is, how does this compare to a true placebo-controlled population or a controlled population? And that's what we're going to find out in this trial.
Great, no, that's helpful, thank you. And then I guess, especially when you talk about cost management right now, expense management.
and you have multiple ongoing studies and what have you, I wanna focus on manufacturing with regard to your ability to serve your larger studies right now and your additional initiatives versus do you have any immediate term or nearer term needs with regard to manufacturing capacity?
So, right now, I actually think that our current manufacturing capabilities will be fine for all four clinical trials, for both the autologous BCA1 and BCA2 and the allogeneic BCD-A03 and BCD-A04. We have almost endeavored to have Season Explorer in thePrint And RaptureW Ou
taken, made the decision to own it and control it. So in our new facility that David mentioned, we are certified here for drug manufacturing as well as medical device manufacturing for those, for the delivery of those drugs with our delivery systems.
So our partnering with others could result in greater need. But most of the folks we're partnering with are not as far as advanced as we are in the clinic. So they're aspiring to do a 10-patient trial while we're working towards that.
343 patient trial in BCDO2. So I also note that as BCDO2 enrollment accelerates, we can handle the manufacturing here in our facility. We're currently only running one shift in both of our capabilities and we have rooms for example on the cell manufacturing.
we can add incubators, we can do things to expand our capabilities.
Got it. No, very helpful. And then my last question. With regard to the O1 study and heart failure, obviously right now, based on your comments and what we've obviously been discussing for a while, a lot of moving parts. So you know, a lot depends on what's coming up from your upcoming discussions with the FDA. So I guess I'd ask right now what we could.
analysis plan ahead of any changes from an adaptive design.
Yeah, definitely. It's a great question and that's one of the great challenges of these adaptive statistical analysis plans. I think the alpha spend is going to be very low and for folks that don't have a PhD on the call like Joe does, the alpha spend is what level of the p-value are you going to lose.
in order to have statistical significance. So right now, as we're regulated as a device system for this autologous therapy, we're expecting to only have to achieve a p-value of less than 0.05 in one large, well-performed study.
Again, the agency will look at the totality of data. We won't know what the alpha spend is until we get the adaptive statistical analysis plan reviewed and blessed by the agency. As I've shared, that is imminent.
We have a call scheduled with the agency for this Friday. But as I'm sure you can appreciate, Joe and others, it's typically a back and forth. We want to minimize the amount of alpha that we do spend, the amount of our, you know, power that we're going to lose. And so I'd much rather
be facing a p-value of 0.05 than one of 0.001 because we spent all the alpha. But I think they were going to wind up in a good place. There's a lot of experienced folks that we're working with on the design of this adaptive statistical analysis plan. We brought in some pretty high profile.
regulatory consultants to help, you know, the agency to appreciate this. I also note that in this trial, you know, we now have breakthrough designation for this LEAD program and breakthrough designation can enable us to collect additional safety data.
on the other side of presenting results that meet the primary end point in the trial. And I think that's the key thing for, when you're going after an approval, and this is why we brought in some very experienced folks, you wanna make sure, our job here is not to get a success in the trial.
Our job here is to get cardiac cell therapy approved and available for patients. And so we want to be very thoughtful in this process on maximizing our probability of technical success, but also near-term promotion success.
Thanks a lot for the color. No, great questions, John . Really appreciate them. Our next question will come from Tamar Raja with Roth Capital. Please go ahead. Thanks for taking my questions. Again, with regard to the left ventricular ejection fraction. Thank you.
Do you know what was the range at baseline and also the range at the one year and two year time point?
So, actually, I think all of the data is presented in the poster that's available on our website, Kumar. And I appreciate the question. I think the inclusion criteria is that the patient is 20 to 40 percent. In addition, the follow-up is the 35 percent would be on top of that. So in my mind, I'm estimating it's—
range of like you know 25% to 45% that is seen with other treatments for heart failure I guess.
So, I think in general, so the one therapy in heart failure that can really enhance your heart function is, you know, biventricular pacing in some patients with a left bundle branch block.
But in truth, most of the heart failure therapies where you still have the native heart, and I'm excluding left ventricular assist devices and heart transplantation, but most of the therapies don't significantly improve LV ejection fraction. Typically these patients...
are slowly deteriorating. And so most other therapies in this space, in running a comparison, they're comparing it against a control group that doesn't have that therapy, and they're showing that they're better than that control group. Here in this rolling cohort, we show that the patients are actually better themselves than they were two years ago.
That's not been done. Heart ield. Now, this is a very small data. I don't want to overinterpret it, but it's worth looking at and it was a blind data set. I know that the mail echo correlab was blinded as to the time of these patients being treated and these are the results that they won' know.
Okay. And with regard to the statistical analysis plan, you mentioned that it would require about 86 to 126 patients. And in that context, you also have eight patients under active consent and 15 under pre-consent. And then you have the
So with regard to the timing of the next DSMB, what would be the number of patients that would be analyzed? So I don't have the exact answer there, Kumar, but that's a great question. So here's the way I would suggest that folks think about it. So let me do the finalomonitor
Again, this is, you know, to have a heart failure trial end this early would be very exciting, but at the same time, it's a success if the DSMB, with the number of patients we have and all the additional follow-up data, say keep on going. That's a success. Yes, there's a brass ring if they stop the trial, a recommended stop early for efficacy.
At our last DSMB review, we said that they have already looked at 100 patients past the primary endpoint.
And so, in light of the fact, and I also had a shareholder letter that we released at the end of December , which we plotted more color, one of the interesting things is the larger trial design was meant to address issues associated with patients lost to follow-up or greater variability in measures in the trial.
because of it being many more centers doing the measurements in different, you know, slightly different approaches, even though they're all trying to do it in a very controlled fashion. And what we saw in that data was that, you know, not only did we have a large number, you know, greater than 100.
aggregate patients past the primary endpoint and saw many of the endpoints improving and actually clinically meaningful levels. But there weren't patients lost to follow-up. And there was actually arguably a reduced variation in some of the baseline measures than we would have expected.
So there's some interesting things here. And I don't want to oversell this. I mean, this is, you know, reading two leaves to a degree. But the implementation of the adaptive statistical analysis plan, you know, will right-size the trial. And if we are already there, we will then pivot to...
completing the trial and going after approval and commercial. And if we're not, we will be continuing the trial. The enrollment is, looks like it's ticking up nicely, but you know, it's not done till it's done. And I guess the last thing I'd share, as you think about this,
adaptive statistical analysis plan. You know, we've gotten all of the data clean going into it. So even if we don't have the trial, we will not have the data clean.
halted early for efficacy, this next ESMB review is going to be done on very, very clean data. This is even more meaningful on its own.
That's very helpful. Thanks so much. I appreciate you being on the call. Thank you. Again, if you have a question, you may press star then 1 to join the queue.
Our next question will come from James Malloy with Alliance Global Partners. Please go ahead. Good morning, everyone.
Hey guys, thanks for taking my questions. I know I talked you through it a little bit, but can you sort of game out with your expectations for Friday's call or is that something you wouldn't want to do in advance of the call in more detail? And then on 02, you said you get the ten patients consented for the roll-in. Ok, excellent.
What's the next steps on that, and are we still anticipating the first 100 in the O2 trial potentially in 2025? So, James, thank you for being on the call, and great questions. We're all walking around here wondering what we're going to be doing on Friday's call as well. I want to give a lot of clarity on the design that we have.
we have before us. I will provide a little bit more color. So we are expecting today written comments from the agency and those comments have not yet come to us. We have a whole series of meetings and a whole series of high-profile folks to review those comments.
and to prepare for the conversation with the agency, as well as you might expect calls scheduled for after the call to digest what the feedback was and to address any outstanding issues here. Implementing an adaptive statistical analysis plan has no safety ramifications. It's really a trial design issue.
And we fully expect that the agency will say that, you know, that they're not comfortable with a smaller trial for approval. They'd like to see a certain level of data with respect to patient safety. But, you know, that's one of the reasons why we have
the folks coming into the conversation with us. And it's also a nice feature, just remind us that we have this breakthrough designation that lets us collect additional safety data after the completion of the trial. So that's sort of the color on it right now. We have been spending an enormous amount of time on it, and I could probably recite.
verbatim all of the details in the adaptive statistical analysis plan on the call. But as things may change, I think it's best to let us get it dialed in and implement it, and we'll share more likely on the other side. I do expect that we will have it in place.
in Q2 for the next DSMB, and the scheduling of that DSMB may be very much dated on getting this in place. And if we don't get it in place, we'll still have a DSMB meeting, I expect, in Q2. But my expectation is we will get it in place.
as regards to your second question on the status with BCDA 02 for the patients with chronic myocardial ischemia. So our expectation is the rolling cohort is up to ten patients and based on the experience we've had so far...
The logistics of the therapy, there's really no issues. It's very much what we have been doing in the Cardi-Amp Heart Failure trial. There are some things with respect to patient inclusion exclusion. And for folks on the call, this is a therapy that was initially advanced by Baxter Healthcare. One day.
initiated a phase three renew trial with a different cell therapy and different delivery approach, but it was an intramyocardial CD34 approach for chronic myoproluskemia. And much of their data was excellent, but they stopped the trial for business reasons after they enrolled 100 patients.
The answer is we kind of know why now. And so we are working through some of the issues in the trial design that we borrowed some of the significant elements from their effort because it was so successful.
but we are also in terms of efficacy for the patients, which is the goal, but we are we are looking at potentially modifying elements of the trial to make this go much smoother downstream and help the enrollment go much faster.
Also, as we're pushing all these elements on the CAR-D-AMP heart failure trial, the third program, the neurokinin-1 receptor-positive mesenchymal stem cells that we're advancing, those we think are actually going to enhance enrollment in the LEAD program as well.
And so a lot of these things dovetail nicely together. Patients who are excluded from Cardiamp because they are ejection fractions too high can qualify for the chronic myocardial ischemia trial. Patients who have a chronic myocardial ischemia trial,
poor bone marrow for therapy based on the data, they can qualify for the allogeneic culture expanded mesenchymal stem cell trial. So we're trying to do this in a way that really meets all of the patient's needs and and it gives us really three shots on goal.
Thank you for that answer. That dovetails nicely. You guys got to second quarter 23 for getting the 03 trial kicking off and then 04 you're saying is behind 03. Any guidance on how far behind?
At this point in time, I want to be humbler. The cell manufacturing last year, the long-term lot release testing, it wasn't the actual manufacturing, but it was some of the data sets that we need after we've manufactured the cells that delayed the timeline. We decided to prioritize the cardiac.
because we have those patients already. So as you might expect,
being 100 plus odd patients.
downstream in BCL1 that with a cell population analysis that roughly excludes 30% of the patients that would be we have 30 plus patients that would like cell therapy for their ischemic heart failure and can't have it and have already presented at the centers so we have patients that we could potentially bring them to that trial immediately.
And so that's something that we're going to be starting with. And we think that enhances the LEAD program as well. Great. Thank you for taking the questions. I appreciate it, James. You have a great day. Thank you.
And this concludes our question and answer session. I would now like to turn the call back over to Dr. Peter Altman for any closing remarks.
Thank you. I want to thank all of you for participating on today's call and for your interest in biocardia.
We look forward to sharing our continued progress.
Thanks. Thanks.
Stay healthy, be kind, and have a wonderful day. The conference is now concluded.