Q3 2024 Capricor Therapeutics Inc Earnings Call

Speaker Change: Good afternoon ladies and gentlemen and welcome to the Capricor's 3rd Quarter 2024 Financial Results Incorporate Update Call.

At this time, all participant lines are in listen-only mode.

Speaker Change: Following the presentation, we will conduct a question and answer session.

Speaker Change: If at any time during this call you require immediate assistance, please press star zero for the operator. This call is being recorded on Wednesday, November 13, 2024. I would now like to turn the conference over to our host.

Speaker Change: Mr. E.J. Bergmann, Capricor's Chief Financial Officer for the Forward-Looking Statement. Please go ahead.

Thank you and good afternoon, everyone.

Speaker Change: Before we start, I would like to state that we will be making certain forward-looking statements during today's presentation. These statements may include statements regarding, among other things, the efficacy, safety, and intended utilization of our product candidates.

Speaker Change: Our future R&D plans, including our anticipated conduct and timing of pre-clinical and clinical studies, our enrollment of patients in our clinical studies, our plans to present to report additional data, our plans regarding regulatory filings, potential regulatory developments involving our product candidates.

Speaker Change: Revenue and Reimbursement Estimates, Projected Terms of Definitive Agreements, Manufacturing Capabilities, Potential Milestone Payments, our Financial Position and our Possible Uses of Existing Cash and Investment Resources.

Speaker Change: These forward-looking statements are based on current information, assumptions, and expectations that are subject to change, and involve a number of risks and uncertainties that may cause actual results to differ materially from those contained in the forward-looking statements.

Speaker Change: These and other risks are described in our periodic filings made with the SEC, including our quarterly and annual reports. Your caution not to place undue reliance on these forward-looking statements, and we disclaim any obligation to update such statements. With that, I'll turn the call over to Linda Marbn, CEO.

Linda Marbn: Thanks, AJ. Good afternoon, everyone, and thank you for joining today's third quarter conference call. I am extremely proud of the progress we have made in the last quarter.

Linda Marbn: As you know, we have been working to develop DERAMYCEL, formerly known as CAP-1002, for the treatment of DMD for the last 8 years.

Linda Marbn: We have shown in multiple clinical trials the salutary benefits of deromyocell in attenuating the consequences of the skeletal muscle myopathy and improving the cardiomyopathy associated with this devastating disease.

Linda Marbn: We have consistently presented the data as it has become available to the FDA and the data has shown clinically meaningful as well as statistically significant improvements.

Linda Marbn: Based on the strength of the data as well as the large unmet medical need of the cardiac implications, we have decided after conferring with the FDA to file a BLA for full approval for the cardiomyopathy associated with DMT.

Linda Marbn: To say that we are proud and excited about our progress here is an understatement.

Linda Marbn: For the new listeners and supporters of Capricor on this call, I will walk you through some of the developments that have brought us here today.

Linda Marbn: and outline the steps Capricor is taking as we position our organization to become a revenue-generating, commercial-stage company should we receive FDA approval, for which I am very optimistic.

Linda Marbn: Now first I'd like to provide a regulatory update. 2024 has been an extraordinary year for Capricor.

Linda Marbn: We have taken the opportunity to work in collaboration with the FDA to prepare for the potential approval and commercialization of daramiazole to treat the cardiomyopathy associated with DMT.

Linda Marbn: Our BLA will be based on existing cardiac data from our Phase II, HOPE II, and HOPE II open-label extension clinical studies, compared to patient-level natural history data from the DMD Cardiac Consortium.

led by Dr. Jonathan Soslow at Vanderbilt University.

Linda Marbn: I will now take a few minutes to explain how we've got to this point from a regulatory perspective.

Linda Marbn: As I have stated previously, we have been presenting clinical data as it becomes available to FDA.

and as part of our pre-BLA meeting in August.

Linda Marbn: when we show them the cardiac data from the HOPE-2 open-label extension study compared to the natural history data set.

Linda Marbn: It became clear that daramysel was slowing the trajectory of cardiac dysfunction in DMD measured by ejection fraction and measurements of end-systolic and end-diastolic index volumes.

Linda Marbn: FDA noted the strength of our data and also noted that there were no approved therapies for cardiomyopathy associated with DMG.

Linda Marbn: based on that meeting and subsequent meetings with FDA, we have decided to move forward to file for full approval.

Linda Marbn: The opportunity here is to focus initially on the cardiomyopathy as it addresses a major unmet medical need of those with DMD. It's supported by significant clinical data.

Linda Marbn: And most importantly, it is de-risked in that that data is already available.

Linda Marbn: No more clinical data is theoretically necessary and the label for the cardiomyopathy, which I will provide details on the projected economics of in a few minutes, is broad and ultimately will encompass a large proportion of those with DMD.

Linda Marbn: Now let me explain the next steps for HOPE 3, Cohort A, which was originally slated to be unblinded by year-end of 2024.

Linda Marbn: HOPE-3 was designed to show that daromyocel attenuates upper limb skeletal muscle disease progression and as you may recall the primary efficacy endpoint of HOPE-3 is the pull or performance of the upper limb 2.0

Linda Marbn: Therefore, the approval based on HOPE-3 will be to treat the skeletal muscle myopathy.

Linda Marbn: And while we are pleased thus far with the effect of daramycel on upper limb function, it is not as important for the first indication, which will now be cardiomyopathy, and which presents a greater initial market opportunity for daramycel.

Linda Marbn: Therefore, we have decided after conferring with FDA to combine cohorts A and B and use that data to serve as a post-approval supplement and add skeletal muscle myopathy to the label in the future.

Linda Marbn: Furthermore, Capricor may elect to use this data set to support marketing authorizations outside of the USA should that be necessary, which we will have more clarity on in 2025.

Linda Marbn: So let me summarize. We are filing for full approval for DMD cardiomyopathy with the substantially de-risked and previously analyzed data.

Linda Marbn: We expect to hear from FDA by the end of the first quarter of 2025 regarding the status of the application, and if the FDA review goes well, we anticipate a potential producer date set for the second half of 2025.

Linda Marbn: We will combine cohort A and B together, increasing the power of the trial and use that data when I'm blinded to add the treatment of skeletal muscle myopathy to the label.

Linda Marbn: It is a clear strategy which gives Capricor the opportunity to achieve potential approval for a first-in-class treatment for one of the most devastating consequences of DMDM.

Linda Marbn: I am pleased to report that the first module of the BLA was submitted and we are in track to fully submit our BLA package by year-end 2024.

Linda Marbn: I want to thank my team for their extraordinary efforts to this point and reiterate that we are focusing...

all of our efforts on this endeavor.

This includes preparations for CMC inspection.

Linda Marbn: pre-commercial activities and market access work with our distribution partner NS Pharma.

Linda Marbn: While we believe that an ADCOM may not be necessary, we are preparing internally for that eventuality.

Linda Marbn: Now I would like to spend the next few minutes highlighting the patient population we are targeting with this first label.

Linda Marbn: Cardiac disease is a standard feature of DMD and most individuals with DMD will eventually have cardiomyopathy.

Linda Marbn: For many, the insidious breakdown of cardiac muscle begins very young.

Linda Marbn: Some patients will have evidence of cardiac dysfunction before 10 years of age, most by age 16.

The pathogenesis is not like any standard cardiac disease process.

Linda Marbn: and it's taken nearly a decade of careful imaging and evaluation.

Linda Marbn: to understand why these patients have what appears to be normal cardiac function and then they fall off the cliff of reduced ejection fraction from which recovery is not likely.

Linda Marbn: Please keep in mind there are currently no approved therapies for GMD cardiomyopathy and the data suggests that standard cardiac medications do not have a significant impact on progression in most cases.

Linda Marbn: If approved, we are anticipating that approximately 50 to 60 percent of the overall DMT population in the United States, or around 8,000 people with DMT, would be eligible for treatment with daramiocell.

Linda Marbn: Because Garamayasal would be a first-in-class therapeutic for an aspect of DMD that has no approved medicines, our initial discussions of payers have been very positive.

Linda Marbn: We expect reimbursement would be consistent with other recently approved DMD therapies such as ExxonSkippers.

Linda Marbn: Our treatment is administered intravenously every three months and is designed to be used chronically to slow cardiac disease progression in those with GMD.

Linda Marbn: The opportunity for Garamayakal has great promise, both in terms of revenue generation and in treating one of the most devastating aspects of DMD, which is the heart disease.

Linda Marbn: If approved, we are anticipating entering the market with approximately 100 patients transferring from open-label extension groups to commercial products.

Linda Marbn: Based on market research and discussions with advocacy groups, we anticipate rapid adoption of DERAMIASOM.

Linda Marbn: We are actively focusing on scaling our manufacturing capacity as well as supporting NS Pharma and working with payers as we prepare for robust patient and physician demand.

Now let's turn to CMC or Chemistry, Manufacturing and Controls.

Linda Marbn: Based on those predictions of demand, front and center in our minds is preparing for commercial manufacturing in order to meet sales forecasts.

Linda Marbn: As you know, we manufacture DERAMYFL in-house at our GMP facility, and while we know that our current facility can meet initial demand, we are currently in late-stage planning for scaling up manufacturing.

Linda Marbn: We built a small commercial manufacturing plant in San Diego to mirror the clinical one in Los Angeles.

Linda Marbn: Non-clinical comparability between manufacturing at our San Diego and Los Angeles facilities was achieved, which agent future manufacturing expansion activities.

Linda Marbn: Our goal is to have another facility online within a year of launch to meet the demand we anticipate.

Linda Marbn: Seromycel is made from transplant qualified human hearts that cannot be used for transplant for technical reasons and which we source across the United States from a consortium of OPOs or organ procurement agencies in a carefully curated process.

Linda Marbn: From one heart, we are able to generate thousands of doses of diramisal.

Linda Marbn: While not necessary at this time, product development activities are underway to increase the yield further.

Linda Marbn: The product is manufactured on a modular basis with each individual clean room capable of Jeremiah cell production.

Linda Marbn: Our operations team at Capricor is experienced in building, staffing, and qualifying these clean rooms so we can continue to expand our manufacturing capabilities to meet demand.

Linda Marbn: The clinical shelf life of the frozen product is currently five years, so we are able to stockpile doses in order to meet increasing demand clinically and commercially.

Linda Marbn: Currently, as we reported last quarter, our San Diego manufacturing facility is fully operational and actively underweight generating doses.

Linda Marbn: In addition, we are also actively preparing for pre-licensing inspection, otherwise referred to as PLI, and anticipate that being a successful endeavor. Please stay tuned for more color on these important milestones as they become available.

Now turning to the corporate and commercial funds.

Linda Marbn: In October, we completed an oversubscribed public offering of common stock, raising approximately $86 million with participation from some of the top healthcare funds in the world.

Linda Marbn: We believe this institutional validation was fundamental to our story and a testament to the scientific development to this point. I am very appreciative of our new investors in this deal, as well as our legacy shareholders, who have positioned themselves as strong supporters of Capricor throughout our history.

Linda Marbn: Factoring in this raise and our Q3 cash balance, we have approximately $165 million in cash, which gives us a strong runway into 2027.

Linda Marbn: These funds will be used to expand our manufacturing capabilities, the plans for which are already underway for a new facility, and will also be used to enhance our management and commercial operations team to support a successful launch.

Linda Marbn: Nippon Shinyaku is fully engaged with Capricor as we prepare for a potential launch. Their team in the United States is comprised of 125 people, with market access, reimbursement, medical affairs, and advocacy programs actively preparing for the launch of Dare Myself.

We continue to work in close collaboration with them.

Linda Marbn: If this agreement is executed, it would be similar to the U.S. agreement.

Linda Marbn: Based on our current agreements with Nippon Shinyaku, if we enter into a definitive agreement for the European region on the anticipated terms, we would have the potential for milestone payments totaling $1.5 billion payable to Capricor.

Linda Marbn: In addition, in the U.S., we are entitled to between 30% to 50% of revenue share based on sales of the product, inclusive of cost of goods sold.

This capital will continue to fuel future product development.

Linda Marbn: strengthen our commercial organization, and enable us to build the organization into a world-class revenue-generating, cash-flow positive company with a commercial product on the market and a robust pipeline of expansion opportunities leveraging cell and exosome-based therapeutics.

Linda Marbn: In addition, and as we have been guiding, we are now actively exploring the opportunity to potentially expand into Becker Muscular Dystrophy with Deremyosel as the cardiac manifestations are very similar to that of DMD.

Linda Marbn: We continue to believe in dermiaceous cells potential to be a transformational treatment for DMD cardiomyopathy and beyond and our current plan is to make indication expansion an important goal for 2025.

Linda Marbn: I'd like to give you a little bit of an update on our exosomes program. While our primary focus has been on advancing duromycel, we remain committed to our Stealth-X exosome platform technology as part of our next generation drug delivery platform.

Linda Marbn: We have been planning to build a pipeline of exosome products which are engineered to enhance drug delivery and can be targeted. We are able to capitalize on our years of building cell-based products with the goal of bringing exosomes to the clinic.

Linda Marbn: Our program focuses on the use of our StealthX technology developed here at Capricorn, which will allow us to develop therapeutics and vaccines by harnessing exosomes as delivery vehicles.

Linda Marbn: The goal is not only to have efficacious products, but to create a delivery vehicle that can outperform a lipid nanoparticle and also be cost effective.

Linda Marbn: We have achieved this goal in preclinical studies and we can now focus on translating these fundamental properties into therapeutic opportunities.

Linda Marbn: We recently presented preclinical data showing that a PMO can be loaded into our Stealth-X platform and targeted using a TFR moiety on the surface for enhanced exon skipping.

Linda Marbn: We also have been able to show life-extending enzyme replacements in an ARG1 knockout mouse using nanogram doses of protein, suggesting successful uptake and utilization of the protein.

Linda Marbn: We are planning for an IND for a therapeutic exosome program based on some of this exciting data.

Please stay tuned for more updates on this front.

Linda Marbn: Regarding our Stealth-X vaccine, we are collaborating with the United States government's Project NextGen, which aims to test vaccine candidates for COVID-19 prevention and to prepare for future pandemics.

Currently, our Stealth-X vaccine candidate is in the manufacturing phase.

Linda Marbn: with plans to deliver to NIAID, which is the National Institutes of Allergy and Infectious Disease, in the first quarter of 2025.

Linda Marbn: The NIAID will then conduct and fully fund a Phase I clinical trial. We expect to have some preliminary data available in the second quarter of 2025, subject to NIAID's evaluation.

Linda Marbn: Further, if NIAID decides that our vaccine meets their criteria for safety and efficacy, they will consider further support for a Phase II study.

Linda Marbn: This presents a tremendous opportunity to generate proof-of-concept first in human safety and efficacy data And we see this collaboration as a chance to showcase the power of our exosome platform for the broader scientific and business development communities

Linda Marbn: To remind you, the Stealth-X vaccine platform will not only serve as a clinical proof-of-concept for the Stealth-X technology, but our vaccine is comprised of native proteins and not reliant

Linda Marbn: on mRNA which enables us to rapidly adapt the protein to a new pandemic or to changes in viral epitopes.

Linda Marbn: If successful, our vaccine would continue to combine the speed and adaptability of mRNA vaccines with the known greater efficacy of protein vaccines.

Linda Marbn: Further, our vaccine uses no adjuvants. Recently, there has been much ado about the potential toxicity of certain adjuvants in existing vaccines.

Speaker Change: In conclusion, this has been a transformational quarter for Capricor. We have made significant strides in our regulatory pathway, getting closer to potential approval of Daramifel.

Speaker Change: Patients and families are fully supportive of our efforts and see the lasting power of DARE MyCell in helping those with GMG to feel and function better.

Speaker Change: Our recent financing has secured our path forward to execute on our milestones for the foreseeable future.

Speaker Change: Over the next several months we will be presenting at various medical, scientific, and investor-related conferences including the Piper Sandler Global Healthcare Conference and the Oppenheimer Rare Disease Mover Day. Most importantly we are on track to complete the submission of our BLA later this year.

Speaker Change: Finally, I want to thank the patients, their families and our investors for their continued support. CapiCorps' goal is to continue to meet its milestones and deliverables as we have set forth, as we continue to focus our efforts on bringing DERA micelle towards potential commercialization and are investing judiciously across the organization to prepare for that endeavor.

Speaker Change: I will now turn the call over to A.J. Bergmann to run through our financials. A.J.?

A.J. Bergmann: and I'm going to be talking about the the the the the the the the the the the the the the

Thanks, Linda.

Speaker Change: This afternoon's press release provided a summary of our third quarter 2024 financials on a GAAP basis. You may also refer to our quarterly report on Form 10-Q, which we expect to become available shortly and will be accessible on the FCC website as well as the financial section of Capricor's website.

Speaker Change: Let me start with our cash position. As of September 30th, 2024, cash, cash equivalents and marketable securities totaled approximately $85 million.

Speaker Change: Turning to the financials, revenues for the third quarter of 2024 were approximately $2.3 million compared with approximately $6.2 million for the third quarter of 2023. The source of the revenue is the ratable recognition of the $40 million that we have received from our U.S. exclusive commercialization and distribution agreement with Nippon Shinyako.

Speaker Change: Moving now to our operating expenses for the third quarter of 2024, excluding stock-based compensation, our research and development expense was approximately $11 million, compared to approximately $9.5 million in Q3 2023.

Turning now to GNA, excluding stock-based compensation.

Speaker Change: with approximately $2.2 million in Q3 2024 and approximately $1.8 million in Q3 2023.

Speaker Change: Net loss for the third quarter of 2024 was approximately $12.6 million.

Speaker Change: compared to a net loss of approximately $6.4 million for the third quarter of 2023, and net loss for the nine months ended September 30, 2024 was approximately $33.4 million compared to a net loss of approximately $21.5 million for the nine months ended September 30, 2023.

I will now open up the line for questions.

Speaker Change: Thank you. Ladies and gentlemen, we will now begin the question-and-answer session. Should you have a question, please press star 5 with the 1 on your telephone keypad.

Speaker Change: You will hear a prompt that your hand has been raised. And should you wish to cancel your request, please press star followed by 2. If you are using a speakerphone, please lift the handset before pressing any keys. One moment please for your first question.

Speaker Change: Your first question comes from the line of Ted Tenthoff from Piper Sandler. Please go ahead. Great, thank you so much and really exciting to be on the call and congrats on all the progress.

Can you hear me okay?

Please stay on the line.

Your conference will resume momentarily. Thank you.

Thank you. Thank you. Thank you.

Thank you very much.

Hello, are you there?

Speaker Change: Hello, your speaker is now back to the conference. Your first question comes from the line is from Ted Tenthoff from Piper Sandler. Please go ahead.

Ted Tenthoff: Great, thank you very much and congrats on all the progress. So I wanted to get a sense, obviously you know there's a lot to do behind the scenes here with the filings and with the regulatory.

approval that you're seeking with the FDA.

Ted Tenthoff: What are you and Nippon Shinyaku doing to prepare this market and to get ready for launch?

Speaker Change: And I guess coupled in that question is, you mentioned some of the work that you're doing on the manufacturing front. How can you also sort of prepare to scale up to meet that potential commercial demand? Thanks.

Speaker Change: Hi Ted, always great to hear from you. So in terms of your first question which what's going on with Nippon Shinyaku. So one of the advantages of our deal with Nippon Shinyaku and SFARMA U.S. branch

Speaker Change: is that they are already on the market with Vilkepso, which is exactly penetrating into the same basic community, Duchenne muscular dystrophy. So they already have a sales team, a Medifare team, a market access team, a reimbursement team, that has already gone ahead and done this with Vilkepso. So it really is just a plug and play model.

and we have great opportunities ahead for launch.

In terms of your second question with manufacturing,

We've been preparing for this day for a long time.

Speaker Change: So, we started thinking about the commercialization of DERAMYCEL, you know, let's call it a decade ago when we entered into the clinic. And so, we knew what we had to do. The good thing is that we have done is we have kept manufacturing in-house all this time. So, it's a de-risk manufacturing procedure because nobody knows it better than we have. When we built the San Diego manufacturing facility, it's small, but it's commercial scale. So, we know exactly how to do it.

Speaker Change: since we designed and opened that facility. So that one is ready to go. We have high confidence that we should be able to pass inspection. And now, because we are anticipating great adoption of DeremiaCell by Duchenne patients.

Speaker Change: We're also planning and executing a build-out of a new manufacturing facility. But again, the nice part of this is that it's not like a gene therapy, where the manufacturing for scale-up is much more complicated, exponentially more difficult, trying to deal with empty capsids. This is a modular plug-and-play manufacturing paradigm, where we just add more clean rooms to the mix. So instead of two clean rooms, we have eight, or 10, or 20, or 100. And we have a great experience with this. So overall, I think we're in pretty good shape. We're working on getting ready for market.

Speaker Change: Yep, awesome. Really exciting time. Thanks so much for taking my question.

Thanks, Ted. Talk soon.

Speaker Change: Thank you. And your next question comes from the line of Lillian Gershel from Primary. Please go ahead.

Hey, great to see all the progress and

Speaker Change: A few questions from us, just teeing off from Ted's question about expanding manufacturing, just wanted to drill in a bit further, particularly given the potential European option for commercialization, you could have many more patients, you could serve a fairer miocel. So as we think about your capabilities for serving the market,

Speaker Change: with your current manufacturing versus what you might be able to do as you build out. How should we think about that as it runs along in parallel to what could be Japan as well as European approvals in the not-too-distant future?

Right

Speaker Change: Yeah, so again, this has all been in the planning for a while. The facilities that we are building and manufacturing in, in San Diego, will be capable of serving the European community as well as the Japanese community. We have paradigms in place for shipping already set up and are working with European authorities as we speak in order to get ready for penetration into the European market.

Speaker Change: same thing with Japan. So all of this was factored into our thinking regarding manufacturing scaling up and as part of the planning for the expansion of DERMA IFL into global markets.

Speaker Change: Great. And once you have the cardiomyopathy label in hand and they're pursuing a label expansion

Speaker Change: with skeletal muscle improvement in the upper limb. I'm just wondering, since these children who were affected by DMD ...

Linda Marbn: tend to get cardiomyopathy, you know, by the age of 10 or not that much beyond. And you, Linda, had expected that 50 to 60 percent may be addressable by the product.

Speaker Change: What would be the incremental gain, I guess, to, you know, commercial size that you would get from having an expanded label? Or is that somewhat academic since presumably the cardiomyopathy label would be sort of the large factor?

Speaker Change: Yeah, Leland, great, great to hear from you, and that's a really important question, and I'd like to address

Speaker Change: on several levels. One, 100% of the people with DMD get cardiomyopathy. It is not related to the progression of the skeletal muscle myopathy, so you find sometimes little kids, very young, sometimes seven years of age, with pretty significant heart disease with preserved skeletal muscle function. And conversely, you'll sometimes find older guys with pretty attenuated skeletal muscle function with good preservation of cardiac function. And this has been observed sort of throughout the time of evaluation of cardiac function and Duchenne muscular dystrophy. So we think the TAM for the cardiomyopathy will be our broadest possible label. It's really the reason that we're so excited about this opportunity, in addition to the fact that it's essentially de-risked with all...

Naughton Saint Jacques

skeletal muscle myop... I'm in other district...

Speaker Change: that muscular dystrophy such as Becker muscular dystrophy or myoclonic dystrophy

Speaker Change: and other ones that have cardiomyopathy as a feature. To go to your other question regarding the increase in market size with the skeletal muscle label.

Speaker Change: It is possible, theoretically and perhaps practically, that somebody would need DERMA-ISL to attenuate skeletal muscle dysfunction if they have relatively preserved cardiac function. As I said, there are those outliers, and so we would then scoop those in under the expanded label. But in reality, the cardiomyopathy label is quite broad, and we're quite happy with it as our potential first indication.

Speaker Change: Great and then lastly just a quick one off your second half 25 guidance for the approval that captures what could be a priority review or a standard review but presumably given your RMAT designation, do you generally expect to have priority review? Did you request it? Did you need to request it or as you submit the BLS?

Speaker Change: Yeah, it's part of the RMAT, so it comes with the RMAT designation, so we are expecting a priority review and are building our timelines around it. We don't see that that's going to be an issue.

Great, thanks so much for taking my question.

Thank you Leland, good talking to you.

Speaker Change: Thank you once again. Should you have a question, that is star and 1. Your next question is from Kristen Kluska from Cantor Fitzgerald. Please go ahead.

Speaker Change: Hello team, this is Rick Miller on for Kristen. Thanks for taking our questions. Maybe just first, thinking about the world muscle data you presented, what constitutes a clinically meaningful benefit on cardiac function like left ventricular ejection fraction, specifically in the more severe patients with a baseline LVF, LVEF, excuse me, under 45% and how does this relate to what you saw in this subset in that data set?

Speaker Change: Yeah, really, really good and important question again. So thanks Rick for asking it. So we saw improvement in all of the patients in the HOPE 2 open label extension treated with DERAMYCEL. What we found is that those that had more attenuated cardiac function below 45% the the improvement was

West

Speaker Change: was less than those that had above 45%. The theory and rationale for that is that there is more scar, more damaged tissue in the later stage patients with reduced ejection fraction below 45. So there's less cardiac muscle to preserve and to recruit in order to sustain cardiac function. But all patients showed a benefit. So while we think that greater than 45% is extremely important in terms of marketing, because we wanna get in these kids young, let's get it into them and let's keep their cardiac function high because unequivocally we saw benefits in those patients that were above 45%. So the takeaway from the World Muscle Society data is very clear, which is let's get their micelle started early.

Speaker Change: and Young and let's preserve that cardiac muscle and cardiac function while they have it.

Speaker Change: Thanks, and maybe just a follow-up from that, you know, from a patient journey perspective, can you kind of help us to better understand how these patients are monitored for cardiac decline? Do they undergo cardiac MRI often, and what age are physicians starting to think about seriously monitoring cardiac function in DMD patients, and is this something that you think the field could do better if there is an approved therapy?

Speaker Change: Yeah, so actually that's very true. So I'm going to start at the end of your question because it's so important. The cardiologists that we're working with, and we have the benefit of working with the real leaders in the space, and we have for for a while and have been part of sort of the

Speaker Change: the development of the ethos around developing a treatment for the cardiomyopathy because we are currently farthest ahead in developing a therapeutic for the cardiomyopathy associated with Duchenne.

Speaker Change: So, yes, the answer to your last question is, yes, we think that the approval of DERAMYCEL will actually accelerate measurements and aggressive treatment of the cardiac...

Speaker Change: a disease associated with Duchenne. To that end we plan not only on marketing to cardiologists who may or may not be involved in early stage of care but to the pediatric neurologist, the rehab med docs, even some of the pediatricians so that they are aware of the signs and symptoms of cardiac dysfunction. Now what we know is that many of these kids have silent cardiac disease until they're pretty old so let's go back to the beginning of your question which is how is it going to be monitored and determined? What is the patient's journey?

Speaker Change: Most kids get an MRI before the age of 10, a cardiac MRI, to evaluate cardiac function and structure.

Speaker Change: and what we're doing is we're sort of beginning to build the idea that it can be.

Speaker Change: start of the start of deromyocele would be based on either Aggregation of cardiac scar you've got some scar in your heart And if you ask the cardiologist how much scar is enough to start treatment They say any so any cardiac scar in the heart would trigger treatment with deromyocele on a quarterly basis for life or And so could be both cardiac dysfunction so that ejection fractions that start to drop below 55%

Speaker Change: those kids are, you know, starting to show evidence that there's, you know, something not quite right in the heart. Remember, these kids are not typically as active as a typical kid, so a drop in injection fraction signals cardiac dysfunction. And so, either or both, the measurement of scar, the measurement of cardiac dysfunction, which could be by MRI or echo, would be a trigger to start dermatophyllin on that patient journey.

Speaker Change: How, you know, physicians go about prescribing it will be up to us and NS Pharma to educate them to be aware that this exists. It's a...

Speaker Change: treatment that not only has been shown to be effective, but there are literally no side effects, can be given four times a year for life, and can be used in conjunction with any and all cardiac medication, steroids, and any of the therapies for skeletal muscle myopathy. So it's a win-win for everybody to get a patient started on Daramysel.

That's great color. Thank you for sharing. Thanks Rick.

Thank you. And your next question

Speaker Change: several geographies that you have in the outliers, China, South America, rest of the world, Eastern Europe, Australia. So what happens is that if some patients from these regions would like to have a drug, so would you sell it directly or you would sell it through your partners?

Speaker Change: Currently, Nippon Shinyaku has rights to sell, market, and distribute in Europe, the United States, and Japan. All other areas of the world are still owned by Capricor, and so our current plan would be to market directly.

Speaker Change: Okay, and another question I have is about potential label opportunities for DERMA ISO.

Speaker Change: So, would you expect any limitations in terms of using it after gene therapies or exon skippers on the label, or you would think that the FDA will give you a sort of open label and leave it to physicians how they're going to use it?

Speaker Change: Our current conversations with FDA have encompassed some of those questions and the current guidance that we have is that the use of DERAMYFL would be independent of any of the other therapeutics available, you know, gene therapies or exon skippers. We have had people in our clinical trials that have gotten exon skippers. We have people in our clinical trials that have received gene therapy and so our current guidance is that we would use it in an open fashion available to anybody with DMG cardiomyopathy.

Speaker Change: Would you would you expect outcomes based on your conversations and based on what what you've seen with prior Duchenne drugs, would you expect the Advisory Committee meeting?

Speaker Change: You know, I can't, there are no tea leaves to read, but I can tell you that our relationship with FDA has been extremely collaborative. They seem favorable to receiving the data. I'm sure they'll evaluate the data with all of the seriousness with which we provide it. It's a strong data package using natural history data of, you know, age and function masked patients. We have strong open label extension data.

Speaker Change: think we'll need an adcom, but we are preparing for an adcom, should we need one, and we will be ready should that become an eventuality.

Speaker Change: Got it, very helpful. Another question I have is about HOPE-3 readout potential in the future.

Speaker Change: So, just a sort of commercial question, do you think ...

Speaker Change: They hope through a readout a potential label change will add actual dollars.

Speaker Change: to their myosin sales, given that, as you said, there's 100% of DMD patients have cardiomyopathy, so everyone will be eligible. So do you think the readout would actually add dollar sales to potential future sales of their myosin?

Well, I guess the

Speaker Change: is any patient that we can treat would add dollars, right?

Speaker Change: benefit because of the skeletal muscle myopathy and may have missed the cardiac opportunity that patient would roll in and bring in dollars or you know in any any other way that we can expand the opportunity expand the label it's beneficial for any therapeutics so yes I do think it would be beneficial on some level but I also think that the opportunity to be the first in class only treatment approved for the cardiomyopathy and in situations where a hundred percent of the the kids get it and it you know it's life life attenuating gives great opportunity not only for an expanded TAM but also to really encourage payers to cover cover the expense of that so it's not another skeletal muscle therapeutic it's

Speaker Change: It's really the only thing to be able to treat the cardiac disease.

Speaker Change: Yeah, thank you. Very helpful. And the last one for me...

Speaker Change: So can we discuss your development plans for 2025? I know you are.

Speaker Change: You'll sell your PRV, it's almost $150 million. Then you have a milestone payment from Nippon. So basically...

Speaker Change: This does actually give you an opportunity to develop something on your own, and I think we've discussed in the past that you may have a trial in Becker Muscle Dystrophies. Could we talk a little bit about this, about potential trial design? How would you start? Would you design it as HOPE-2?

etc. if you could elaborate a little bit on this.

Speaker Change: Yeah, so you know one of our goals has been to begin to discuss Becker with the agency. Our KOLs, especially our cardiology KOLs, tell us that Becker cardiomyopathy is completely indistinguishable from Duchenne cardiomyopathy. So if you hand them an MRI, they can't tell if it's a Becker patient or a Duchenne patient. And furthermore, the Becker cardiomyopathy starts very young. These guys live longer and have better skeletal muscle function, so dealing with their cardiac disease is very important for them as well. We don't want their, you know, life to be attenuated or shortened in any way based on the cardiac disease. In terms of trial design...

Speaker Change: I can't answer that question yet. We are now working with the key opinion leaders, working with the agency, working with our own regulatory team in order to design the trial that is necessary to get this across the line. We anticipate it could be a very small clinical trial that would just add a little bit to the to the database of knowledge, but I don't have clarity and probably won't until after the first quarter.

Speaker Change: Okay, thank you. Thanks so much for taking questions and congrats with the progress.

Thanks.

Speaker Change: Thank you. There are no further questions at this time. I will now turn the call back to Capri Core Management for any closing remarks.

Speaker Change: I just would like to say thank you very much for joining today's call. We look forward to updating all of you on our progress as we continue through 2024. Have a nice evening and stay safe out there. Thank you.

Speaker Change: Thank you, and that concludes our conference for today. Thank you all for participating. You may now disconnect.