ITEM
1. BUSINESS
General.
We
are a leukemia-focused biotechnology company that has been developing therapeutics to address the unmet need that exists for acute myeloid
leukemia, or AML, and other forms of leukemia and lymphoma. AML is generally a disease of older adults, with onset typically after the
age of 45 (average patient age approximately 68 years old). Our strategy is to develop small molecule drug candidates targeting two genes:
NPM1 and LSD1, which are considered to control major pathways underlying etiology of majority of AML sub-types.
RASP-201
is a novel, orally dosed, selective reversible inhibitor of lysine specific demethylase, or LSD1, a pathway that blocks differentiation
and confers a poor prognosis to AML. We expect RASP-201 to display a safer metabolic profile than competitor irreversible inhibitors
such as GSK2879552 (GlaxoSmithKline) and ORY-1001 (Oryzon/Roche). RASP-201 when dosed orally shows in vivo therapeutic utility
in murine (mouse) models of AML.
RASP-301 is
our innovative, first- in-class, oral, small molecule inhibitor that in preclinical studies has been shown to disrupt NPM1 oligomerization
(aggregation of individual subunits) and has the potential to treat refractory AML with reduced toxicity at low dose levels. RASP-301 exhibits
cytotoxic effects at nanomolar concentrations against AML cells in culture and was not cytotoxic to normal cells at the same
concentrations. In vivo usefulness of these compounds in AML murine models has been evaluated confirming the druggability of
the target and its potential to treat refractory AML.
Our
primary indication is AML which may be fatal within weeks to months, has a 5-year survival rate of only about 25% and very
poor prospects for long-term survival of patients. Treatment options for AML comprise a variety of chemotherapy regimens, biologic agents,
and stem cell transplantation. Current standard chemotherapy regimens cure only a minority of patients with AML. As a result, all patients
should be evaluated for entry into well-designed clinical trials. If a clinical trial is not available, the patient can be treated with
standard therapy. For consolidation chemotherapy or for the management of toxic effects of chemotherapy, readmission is required. Our
strategy is to target master regulators of cancer through deep knowledge of highly conserved pathways that are common to leukemia sub-types.
Employing a multi-pronged approach, our programs are focused on three druggable intervention points with a potential to
improve safety and efficacy of current AML mono and/or combination therapies.
Leukemia
Overview and Market Opportunity
Leukemia
is a cancer of the blood or bone marrow involving abnormal proliferation of white blood cells, called WBCs or leukocytes. Leukemia is
caused by a mutation of the DNA in bone marrow stem cells resulting in the abnormal multiplication of leukocytes. If untreated, surplus
leukocytes will overwhelm the bone marrow, enter the bloodstream and eventually invade other parts of the body, such as the lymph nodes,
spleen, liver, and central nervous system. In this way, the behavior of leukemia is different from that of other cancers, which usually
begin in major organs and ultimately spread to the bone marrow. Leukemia is an umbrella term covering a large group of blood cancers.
All
leukemia arises from mutations or damage to the DNA within the blood cells. These mutations may occur spontaneously or as a result of
exposure to radiation or carcinogenic substances. Ionizing radiation, as well as exposure to chemicals such as benzene, increases the
risk of AML, while agricultural chemicals have been linked to an increased incidence of chronic lymphocytic leukemia, or CLL. A weak
immune system, some virus forms such as human T-cell Leukemia virus I, or HTLV-1, genetic predisposition, cigarette smoking, and reactions
to some therapeutic drugs are also implicated in the etiology of leukemia.
Diagnosis, Treatment, and Management
The
first symptoms of leukemia are often vague and are correlated with other disorders. Common symptoms include fatigue and malaise, excessive
bruising, and abnormal bleeding due to low platelet count. Further symptoms can include weight loss, bone and joint pain, infection and
fever, and an enlarged spleen, lymph nodes and liver. After a blood test, several blood abnormalities such as anemia, or leucopenia may
be observed, and in most cases a bone marrow test is required to confirm the diagnosis.
The
preliminary diagnostic test for leukemia is a blood cell count, which is followed by immune-phenotyping to assess whether the abnormal
lymphocyte levels are caused by inflammation or cancer. The physician may also require additional confirmatory tests such as cytogenetic
analysis or bone marrow sampling.
The
specific variety and combination of anticancer drugs prescribed depends on the form and stage of the disease. For example, treatment
for AML, the most common form of leukemia, usually involves chemotherapy with cytotoxic cytarabine in conjunction with an anthracycline
such as daunorubicin or idarubicin. Because of the severity of the cytotoxic treatment, bone marrow transplants, or BMTs are sometimes
necessary. By transplanting healthy bone marrow into the body, BMTs help rebuild tissue damaged by the treatment. Interferon, or INF,
therapy, particularly with INF-alpha, is an alternative or additional treatment offered to almost all newly diagnosed patients in these
markets. However, it is very difficult to cure, even though early treatment indicates it will help people to live longer.
The
standard first-line treatment strategy for CLL for patients who might not be able to tolerate the side effects of strong chemotherapy
is to be treated with chlorambucil alone or with a monoclonal antibody like rituximab (Rituxan) or obinutuzumab (Gazyva). Other options
include ibrutinib (Imbruvica), rituximab alone, or a corticosteroid like prednisone.
Other
drugs or combinations of drugs may also be also used. If the only problem is an enlarged spleen or swollen lymph nodes in one region
of the body, localized treatment with low-dose radiation therapy may be used. Splenectomy (surgery to remove the spleen) is another option
if the enlarged spleen is causing symptoms.
In
addition, very high numbers of leukemia cells in the blood causes problems with normal circulation. This is called leukostasis. Leukapheresis
is also sometimes used before chemotherapy if there are very high numbers of leukemia cells (even when they aren’t causing problems)
to prevent tumor lysis syndrome.
Upon
the failure of first line therapy, the standard therapy is usually to administer many of the drugs and combinations listed above as potential
second-line treatments. For many people who have already had fludarabine, alemtuzumab seems to be helpful as second-line treatment, but
it carries an increased risk of infections. Other purine analog drugs, such as pentostatin or cladribine (2-CdA), may also be tried.
Newer drugs such as ofatumumab, ibrutinib, idelalisib (Zydelig), and venetoclax (Venclexta) may be other options. If these types of chemotherapy
fail, the next option is usually a bone marrow transplant. A stem cell transplant is a third treatment option depending on leukemia response.
Our
business strategy focuses on differentiated targeted therapies for genetic pathways which are known to be involved in etiologies of number
of leukemia and other cancers. Our clinical program is based around three druggable intervention points with potential to improve
safety and efficacy of current AML therapies, namely “stemness” (activation of stem cell-like growth patterns), cell signaling
(between nucleus and cytoplasm) and stress-induced apoptosis (programmed cell death). Our focus is to target two specific genetic
pathways NPM1 and LSD1, which are known to be associated with etiologies of a number of cancers, including AML (Figure 1).
Figure
1 Key Regulators for Developing Targeted AML Therapies
Roles
of NPM1 and LSD1 in Tumorigenesis
Leukemia
arises due to DNA damage or mutations. Chromosomal aberrations involving NPM1 and LSD1 have been found in patients with non-Hodgkin lymphoma,
acute promyelocytic leukemia, myelodysplastic syndrome, and AML. Thus, targeting NPM1 and LSD1 is an appropriate approach for treatment
of AML. In addition, combination of therapies targeting these two genes could also be effective in treatment of relapse AML.
The
NPM1 gene is up-regulated, mutated and chromosomally translocated in many tumor types. NPM1 is transferred from nucleolus to nucleoplasm
and cytoplasm by anticancer drugs. When expressed at high level, NPM1 could promote tumor growth by inactivation of tumor suppressor
p53/ARF pathway; when expressed at low level, NPM1 could suppress tumor growth by inhibition of centrosome duplication. NPM1 is haplo
insufficient in hemizygous mice that are vulnerable to tumor development. NPM1c+ (cytoplasm form) translocation into cytoplasm could
serve as an AML remission signal. NPM1 forms a pentamer that could serve as a potential anticancer target. Our technology (the process
of targeting the mutation of the NPM1 gene), is believed to inhibit the NPM1 gene, reducing levels of NPM1 and consequently reducing
a tumor cell’s ability to duplicate. High affinity, NPM1 binding molecules exhibiting cytotoxic activity on AML cells and safe
on normal cells have been identified.
The
histone H3K4/K9 demethylase LSD1 can regulate gene activation and repression in epigenetic regulation and is a key effector of the differentiation
block in MLL-rearranged leukemia. High LSD1 expression blocks differentiation and is associated with a poor prognosis in
AML. LSD1 can be targeted by tranylcypromine analogs or downregulated by RNA interference which induces differentiation of MLL-rearranged
leukemic cells. A number of different small molecular inhibitors of LSD1 have been in clinical evaluation. While this class of inhibitors
has shown clinical activity in AML patients, toxicities associated with irreversible inhibitors prohibited their further development.
Reversible inhibitors of LSD1 have shown good potential for further development.
Other
Leukemias
Differences
between the different leukemias are dependent on the types of cells involved. Myeloid leukemias originate in the bone marrow and involve
granulocytes, white and red blood cells. Lymphoid leukemias, including lymphomas, originate in the lymph nodes and lymphoid tissue but
involve immune cells including lymphocytes, T cells and B cells. MDS are group of bone marrow failure disorders that have various subtypes
with variable onsets, prognoses and risks of developing leukemia.
RASP-201
(LSD1)
LSD1
is an enzyme that demethylates (remove methyl groups) lysine side chain of histones. The levels of LSD1 are elevated (overexpressed)
in several human cancers as compared to healthy normal adults. In AML, elevated levels of LSD1 are observed in less differentiated blood
cells (immature cells). Inhibition of the enzyme activity was found to promote differentiation. Hence, inhibitors of LSD1 are promising
therapeutic candidates that can make drug-insensitive forms of AML, due to reduced levels of methylated histones, responsive to treatment
with all-trans-retinoic acid, or ATRA an agent that induces differentiation (maturation)and used to treat a subtype of AML called acute
promyelocytic leukemia, or APL.
Working
from this premise, we executed a research agreement with TES Pharma for screening of compounds and to conduct animal studies to identify
lead compounds with suitable druggability properties. TES Pharma has screened ~34000 compounds across 4 chemical series for their ability
to inhibit LSD1 in vitro. The hit rate was ~1%. The hits from this assay were expanded and IC50 (half maximal inhibitory concentration)
values were determined for 115 compounds. One chemical class namely, Thienopyrrole series was prioritized for further expansion and in
vitro characterization.
We
have filed patent applications covering this novel potent inhibitor class. The current lead compound DDP_43242 inhibitory effect
on the LSD1 in in-vitro assay and in-vivo efficacy in two AML animal models.
These
studies have facilitated the selection of DDP_43242 as the current lead compound. Additional absorption, distribution, metabolism and
excretion, or ADME, and selectivity characterization is underway for drug candidate selection for clinical trials. We anticipate filing
an investigation new drug application, or IND, in the near future. We believe that this breakthrough program may have significant benefits
across all forms of leukemia. We are focusing on reversible small molecular inhibitors of LSD1 because these compounds are expected to
exhibit less toxicity while retaining desirable efficacy.
RASP-301
(NPM1)
The
NPM1 gene provides instructions for making a protein called nucleophosmin (NPM) which is found in a small region inside the nucleus of
the cell called the nucleolus. Nucleophosmin shuttles back and forth between the nucleus and the fluid surrounding it (the cytoplasm).
Nucleophosmin helps to transport other proteins from ribosomes (sites of protein synthesis) through the membrane surrounding the nucleus.
The NPM-1 gene is mutated in approximately 35% of new cases of AML. However, mutations in the NPM1 gene, result in dislocation of NPM1
protein in the cytoplasm. NPM1 mutation may be an early event in development of leukemia. Given that NPM1 is thought to
have a tumor-suppressor function, alterations in its localization in the cell (from the nucleus to the cytoplasm) may be crucial for
the cell to change from normal to cancerous state. Our approach is to identify small molecule drugs that physically interfere with
the aggregation of NPM1 which is important for normal function. RASP-301 is our innovative, first- in-class, oral, small molecule, potent
inhibitor that disrupts NPM1-1 oligomerization (aggregation of individual subunits) and has the potential to treat refractory (resistant
to treatment) AML with reduced toxicity at low dose levels The current lead candidate, TES-2169, exhibits cytotoxic (toxic to cancer
cells) effects at nanomolar concentrations against AML cells in culture and was not cytotoxic to normal cells at the same concentrations.
In vivo usefulness of these compounds in AML murine (mouse) models has been evaluated confirming the druggability of the target and its
potential to treat refractory AML.
Strategy
Our
strategy is to target master regulators of cancer through deep knowledge of highly conserved pathways that are common to leukemia sub-types.
Employing a multi-pronged approach, our programs are focused on two druggable intervention points with a potential to improve safety
and efficacy of current AML mono and/or combination therapies. For the RASP-201 program, the lead reversible LSD-1 candidate has
been identified and manufacturing will be scaled for production of cGMP supplies for animal safety/toxicology studies, Phase 1, Phase
2 and Phase 3 clinical studies to support submission via the traditional 505(b)(1) regulatory pathway used for new chemical entities,
or NCEs. We expect to use a similar pathway for the RASP-301 program, following identification of the lead drug candidate.
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Complete
development of orally-available, small molecule, highly-selective, reversible inhibitor of LSD1 (RASP-201) and file IND in the
near future. Manufacture of the lead RASP -201 candidate will be scaled to supply animal safety/toxicology studies and Phase 1, 2 and 3 clinical
studies following the traditional 505(b)(1) pathway used for marketing approval of NCEs. |
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Selection
of a lead candidate for first in class NPM1 inhibitor (RASP-301). |
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Evaluate
strategic opportunities to accelerate development timelines and maximize the commercial potential of the drug candidates.
Such opportunities may include partnering to achieve business objectives and achieve maximum return on investment. |
Research
Agreement
On
December 17, 2013 TES Pharma S.R.L. (“TES”) and our predecessor, Arna Therapeutics Limited, entered into a research agreement
pursuant to which TES agreed to perform research related to the development of products and services associated with NPM1 and AML. The
initial term of the agreement was for two years and was extended by amendment on May 3, 2016 for an additional year. On September 8,
2016, the agreement was assigned to our subsidiary, Rasna Research, Inc. The agreement was further extended on March 24, 2017 until August
30, 2017. We are currently in discussions with TES Pharma S.R.L, profiling the next stage of research activity to be included in
a new research agreement.
Manufacturing
We
do not have any manufacturing facilities or personnel. We currently rely, and expect to continue to rely, on third parties for the manufacturing
of our product candidates for preclinical as well as for commercial manufacturing if our product candidates receive marketing approval.
Commercialization
We
plan to retain our worldwide commercialization rights for some of our key product candidates while for other product candidates we might
consider partnership opportunities to maximize returns.
While
we currently have no sales, marketing or commercial product distribution capabilities and have no experience as a company in commercializing
products, we intend to build our own commercialization organization and capabilities over time. When appropriate, we will decide whether
to build a specialty sales force to manage commercialization for these product candidates on our own or in combination with a larger
pharmaceutical partner, to maximize patient coverage in the United States and to support global expansion especially as our programs
have substantial opportunity for additional follow-up indications alone or in combinations.
As
product candidates advance through our pipeline, our commercial plans may change. Clinical data, the size of the development programs,
the size of the target market, the size of a commercial infrastructure and manufacturing needs may all influence our United States, European
Union and rest-of-world strategies
Government
Regulation
The
FDA and comparable regulatory authorities in state and local jurisdictions and in other countries impose substantial and burdensome requirements
upon companies involved in the clinical development, manufacture, marketing and distribution of drugs, such as those we are developing.
These agencies and other federal, state and local entities regulate, among other things, the research and development, testing, manufacture,
quality control, safety, effectiveness, labeling, storage, record keeping, approval, advertising and promotion, distribution, post-approval
monitoring and reporting, sampling and export and import of our product candidates.
U.S.
Government Regulation of Drug Products
In
the United States, the FDA regulates drugs under the Federal Food, Drug, and Cosmetic Act, or FDCA, and its implementing regulations.
The process of obtaining regulatory approvals and the subsequent compliance with applicable federal, state, local and foreign statutes
and regulations requires the expenditure of substantial time and financial resources. Failure to comply with the applicable U.S. requirements
at any time during the product development process, approval process or after approval, may subject an applicant to a variety of administrative
or judicial sanctions, such as the FDA’s refusal to approve pending NDAs, withdrawal of an approval, imposition of a clinical
hold, issuance of warning letters, product recalls, product seizures, total or partial suspension of production or distribution, injunctions,
fines, refusals of government contracts, restitution, disgorgement or civil or criminal penalties.
The
process required by the FDA before product candidates may be marketed in the United States generally involves the following:
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submission
to the FDA of an IND application which must become effective before human clinical trials may begin and must be updated annually; |
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completion
of extensive preclinical laboratory tests and preclinical animal studies, all performed in accordance with the FDA’s GLP regulations.
Preclinical testing generally includes evaluation of our products in the laboratory or in animals to characterize the product and
determine safety and efficacy; |
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approval
by an independent institutional review board, or IRB, at each clinical site before each trial may be initiated; |
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performance
of adequate and well-controlled human clinical trials in accordance with good clinical practice, or GCP, requirements to establish
the safety and efficacy of the product candidate for each proposed indication; |
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submission
to the FDA of a NDA after completion of all pivotal clinical trials; |
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a
determination by the FDA within 60 days of its receipt of an NDA to accept the filing for review; |
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satisfactory
completion of an FDA advisory committee review, if applicable; |
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satisfactory
completion of an FDA pre-approval inspection of the manufacturing facilities at which the active pharmaceutical ingredient, or API,
and finished drug product are produced and tested to assess compliance with cGMP regulations and to assure that the facilities, methods
and controls are adequate to preserve the drug’s identity, strength, quality and purity; |
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satisfactory
completion of FDA audits of clinical trial sites to assure compliance with GCPs and the integrity of the clinical data; |
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payment
of user fees and securing FDA approval of the NDA; and |
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compliance
with any post-approval requirements, including the potential requirement to implement a REMS and the potential requirement to
conduct post-approval studies. |
Preclinical
studies include laboratory evaluation of product chemistry, toxicity and formulation, as well as animal studies to assess potential safety
and efficacy. An IND is a request for authorization from the FDA to administer an investigational drug product to humans. The central
focus of an IND submission is on the general investigational plan and the protocol(s) for human studies. The IND also includes results
of preclinical studies or other human studies, as appropriate, as well as manufacturing information, analytical data and any available
clinical data or literature to support the use of the investigational new drug. An IND must become effective before human clinical trials
may begin. An IND will automatically become effective 30 days after receipt by the FDA, unless before that time the FDA raises concerns
or questions related to the proposed clinical trials. In such a case, the IND may be placed on clinical hold and the IND sponsor and
the FDA must resolve any outstanding concerns or questions before clinical trials can begin. Accordingly, submission of an IND may or
may not result in the FDA allowing clinical trials to commence. As a result, submission of an IND may not result in the FDA allowing
clinical trials to commence.
Clinical
trials involve the administration of the new investigational drug to human subjects under the supervision of qualified investigators
in accordance with GCPs, which include the requirement that all research subjects provide their informed consent for their participation
in any clinical trial. Clinical trials are conducted under protocols detailing, among other things, the objectives of the study, the
parameters to be used in monitoring safety, and the efficacy criteria to be evaluated. A protocol for each clinical trial and any subsequent
protocol amendments must be submitted to the FDA as part of the IND.
Additionally,
approval must also be obtained from each clinical trial site’s Institutional Review Board, or IRB, before the trials may be initiated,
and the IRB must monitor the study until completed. There are also requirements governing the reporting of ongoing clinical trials and
clinical trial results to public registries.
The
clinical investigation of a drug is generally divided into three phases. Although the phases are usually conducted sequentially, they
may overlap or be combined. The three phases of an investigation are as follows:
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Phase 1. Phase 1 includes
the initial introduction of an investigational new drug into humans. Phase 1 clinical trials are typically closely monitored
and may be conducted in patients with the target disease or condition or in healthy volunteers. These studies are designed to evaluate
the safety, dosage tolerance, metabolism and pharmacologic actions of the investigational drug in humans, the side effects
associated with increasing doses, and if possible, to gain early evidence on effectiveness. During Phase 1 clinical trials, sufficient information
about the investigational drug’s pharmacokinetics and pharmacological effects may be obtained to permit the design of well-controlled
and scientifically valid Phase 2 clinical trials. |
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Phase 2. Phase 2 includes
controlled clinical trials conducted to preliminarily or further evaluate the effectiveness of the investigational drug for a particular
indication(s) in patients with the disease or condition under study, to determine dosage tolerance and optimal dosage,
and to identify possible adverse side effects and safety risks associated with the drug. Phase 2 clinical trials are typically
well-controlled, closely monitored, and conducted in a limited patient population. |
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Phase 3. Phase
3 clinical trials are generally controlled clinical trials conducted in an expanded patient population generally at geographically
dispersed clinical trial sites. They are performed after preliminary evidence suggesting effectiveness of the drug has been obtained,
and are intended to further evaluate dosage, clinical effectiveness and safety, to establish the overall benefit-risk relationship
of the investigational drug product, and to provide an adequate basis for product approval. |
A
pivotal study is any clinical study, which adequately meets regulatory agency requirements for the evaluation of a drug candidate’s
efficacy and safety such that it can be used to justify the approval of the product. Generally, pivotal studies are Phase 3 studies but
may also be Phase 2 studies if the trial design provides a well-controlled and reliable assessment of clinical benefit, particularly
in situations where there is an unmet medical need.
Progress
reports detailing the results of the clinical trials must be submitted at least annually to the FDA and more frequently if serious adverse
events occur. Phase 1, Phase 2 and Phase 3 clinical trials may not be completed successfully within any specified period, or at all.
The FDA, the IRB, or the clinical trial sponsor may suspend or terminate a clinical trial at any time on various grounds, including a
finding that the research subjects are being exposed to an unacceptable health risk. Additionally, some clinical trials are overseen
by an independent group of qualified experts organized by the clinical trial sponsor, known as a data safety monitoring board or committee.
This group provides authorization for whether or not a trial may move forward at designated check points based on access to certain data
from the study. We may also suspend or terminate a clinical trial based on evolving business objectives and/or competitive climate.
Assuming
successful completion of all required testing in accordance with all applicable regulatory requirements, detailed investigational drug
product information is submitted to the FDA in the form of an NDA requesting approval to market the product for one or more indications.
The
application includes all relevant data available from pertinent preclinical and clinical trials, including negative or ambiguous results
as well as positive findings, together with detailed information relating to the product’s chemistry, manufacturing, controls and
proposed labeling, among other things. Data can come from company-sponsored clinical trials intended to test the safety and effectiveness
of a use of a product, or from a number of alternative sources, including studies initiated by investigators. To support marketing approval,
the data submitted must be sufficient in quality and quantity to establish the safety and effectiveness of the investigational drug product
to the satisfaction of the FDA.
In
most cases, the submission of an NDA is subject to a substantial application user fee. Under the Prescription Drug User Fee Act, or PDUFA,
guidelines that are currently in effect, the FDA has a goal of ten months from the date of “filing” of a standard NDA for
a new molecular entity to review and act on the submission. This review typically takes twelve months from the date the NDA is submitted
to FDA because the FDA has approximately two months to make a “filing” decision.
In
addition, under the Pediatric Research Equity Act of 2003, or PREA, as amended and reauthorized, certain NDAs or supplements to an NDA
must contain data that are adequate to assess the safety and effectiveness of the drug for the claimed indications in all relevant pediatric
subpopulations, and to support dosing and administration for each pediatric subpopulation for which the product is safe and effective.
The FDA may, on its own initiative or at the request of the applicant, grant deferrals for submission of some or all pediatric data until
after approval of the product for use in adults, or full or partial waivers from the pediatric data requirements.
The
FDA also may require submission of a risk evaluation and mitigation strategy, or REMS, plan to ensure that the benefits of the drug outweigh
its risks. The REMS plan could include medication guides, physician communication plans, assessment plans, and/or elements to assure
safe use, such as restricted distribution methods, patient registries, or other risk minimization tools.
The
FDA conducts a preliminary review of all NDAs within the first 60 days after submission, before accepting them for filing, to determine
whether they are sufficiently complete to permit substantive review. The FDA may request additional information rather than accept an
NDA for filing. In this event, the application must be resubmitted with the additional information. The resubmitted application is also
subject to review before the FDA accepts it for filing. Once the NDA submission has been accepted for filing, the FDA’s goal is
to review applications within ten months of submission or, if the application relates to an unmet medical need in a serious or life-threatening
indication, six months from submission. The review process is often significantly extended by FDA requests for additional information
or clarification. The FDA may refer the application to an advisory committee for review, evaluation and recommendation as to whether
the application should be approved. The FDA is not bound by the recommendation of an advisory committee but it typically follows such
recommendations.
The
FDA will not approve an application unless it determines that the manufacturing processes and facilities are in compliance with cGMP
requirements and adequate to assure consistent production of the product within required specifications. Additionally, before approving
an NDA, the FDA may inspect one or more clinical trial sites to assure compliance with GCP requirements. The FDA will not approve an
application unless it determines that the manufacturing processes and facilities are in compliance with cGMP requirements and adequate
to assure consistent production of the product within required specifications. Additionally, before approving an NDA, the FDA may inspect
one or more clinical trial sites to assure compliance with GCP requirements.
After
the FDA evaluates the NDA and conducts inspections of manufacturing facilities where the drug product and/or its active pharmaceutical
ingredient, or API, will be produced, it may issue an approval letter or a Complete Response Letter. An approval letter authorizes commercial
marketing of the drug with specific prescribing information for specific indications. A Complete Response Letter indicates that the review
cycle of the application is complete and the application is not ready for approval. A Complete Response Letter may require additional
clinical data and/or an additional pivotal Phase 3 clinical trial(s), and/or other significant, expensive and time-consuming requirements
related to clinical trials, preclinical studies or manufacturing. Even if such additional information is submitted, the FDA may ultimately
decide that the NDA does not satisfy the criteria for approval. The FDA could also approve the NDA with a Risk Evaluation and Mitigation
Strategies, or REMS, plan to mitigate risks, which could include medication guides, physician communication plans, or elements to assure
safe use, such as restricted distribution methods, patient registries and other risk minimization tools. The FDA also may condition approval
on, among other things, changes to proposed labeling, development of adequate controls and specifications, or a commitment to conduct
one or more post-market studies or clinical trials. Such post-market testing may include Phase 4 clinical trials and surveillance to
further assess and monitor the product’s safety and effectiveness after commercialization. Regulatory approval of oncology products
often requires that patients in clinical trials be followed for long periods to determine the overall survival benefit of the drug. The
FDA may prevent or limit further marketing of a product based on the results of post-marketing studies or surveillance programs. After
approval, some types of changes to the approved product, such as adding new indications, manufacturing changes, and additional labeling
claims, are subject to further testing requirements and FDA review and approval.
After
regulatory approval of a drug product is obtained, a company is required to comply with a number of post-approval requirements. As a
holder of an approved NDA, we would be required to report, among other things, certain adverse reactions and production problems to the
FDA, to provide updated safety and efficacy information, and to comply with requirements concerning advertising and promotional labeling
for any of our products. Also, quality control and manufacturing procedures must continue to conform to cGMP after approval to ensure
and preserve the long-term stability of the drug product. In addition, drug manufacturers and other entities involved in the manufacture
and distribution of approved drugs are required to register their establishments with the FDA and state agencies, and are subject to
periodic unannounced inspections by the FDA and these state agencies for compliance with cGMP requirements. In addition, changes to the
manufacturing process are strictly regulated, and, depending on the significance of the change, may require prior FDA approval before
being implemented. FDA regulations also require investigation and correction of any deviations from cGMP and impose reporting and documentation
requirements upon us and any third-party manufacturers that we may decide to use. Accordingly, manufacturers must continue to expend
time, money and effort in the area of production and quality control to maintain compliance with cGMP and other aspects of regulatory
compliance.
We
rely, and expect to continue to rely, on third parties for the production of clinical and commercial quantities of our product candidates.
Future FDA and state inspections may identify compliance issues at our facilities or at the facilities of our contract manufacturers
that may disrupt production or distribution, or require substantial resources to correct. In addition, discovery of previously unknown
problems with a product or the failure to comply with applicable requirements may result in, among other things,
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restrictions
on the marketing or manufacturing of the product, complete withdrawal of the product from the market or product recalls; |
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fines,
warning letters or holds on post-approval clinical trials; |
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refusal
of the FDA to approve pending NDAs or supplements to approved NDAs, or suspension or revocation of product approvals; |
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product
seizure or detention, or refusal to permit the import or export of products; or |
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injunctions
or the imposition of civil or criminal penalties. |
Newly
discovered or developed safety or effectiveness data may require changes to a product’s approved labeling, including the addition
of new warnings and contraindications, and also may require the implementation of other risk management measures. The FDA strictly regulates
marketing, labeling, advertising and promotion of products that are placed on the market. Drugs or devices may be promoted only for the
approved indications and in accordance with the provisions of the approved label. The FDA and other agencies actively enforce the laws
and regulations prohibiting the promotion of off-label uses, and a company that is found to have improperly promoted off-label uses may
be subject to significant liability. Also, from time to time, legislation is drafted, introduced and passed in Congress that could significantly
change the statutory provisions governing the approval, manufacturing and marketing of products regulated by the FDA. In addition, FDA
regulations and guidance are often revised or reinterpreted by the agency in ways that may significantly affect our business and our
products. It is impossible to predict whether legislative changes will be enacted, or FDA regulations, guidance or interpretations changed
or what the impact of such changes, if any, may be.
Marketing
Exclusivity
Market
exclusivity provisions under the FDCA also can delay the submission or the approval of certain applications. The FDCA provides a five-year
period of non-patent marketing exclusivity within the United States to the first applicant to obtain approval of an NDA for a new chemical
entity. A drug is a new chemical entity if the FDA has not previously approved any other new drug containing the same active moiety,
which is the molecule or ion responsible for the action of the drug substance. During the exclusivity period, the FDA may not accept
for review an abbreviated new drug application, or ANDA, or a 505(b)(2) NDA submitted by another company for another version of such
drug where the applicant does not own or have a legal right of reference to all the data required for approval. However, an application
may be submitted after four years if it contains a certification of patent invalidity or non-infringement. The FDCA also provides three
years of marketing exclusivity for an NDA, 505(b)(2) NDA or supplement to an approved NDA if new clinical investigations, other than
bioavailability studies, that were conducted or sponsored by the applicant are deemed by the FDA to be essential to the approval of the
application, for example, for new indications, dosages or strengths of an existing drug. This three-year exclusivity covers only the
conditions associated with the new clinical investigations and does not prohibit the FDA from approving ANDAs for drugs containing the
original active pharmaceutical ingredient. Five-year and three-year exclusivity will not delay the submission or approval of a full NDA;
however, an applicant submitting a full NDA would be required to conduct or obtain a right of reference to all of the preclinical studies
and adequate and well-controlled clinical trials necessary to demonstrate safety and effectiveness.
The
Hatch-Waxman Amendments: 505(b)(2) approval process
Section
505(b)(2) of the FDCA provides an alternate regulatory pathway to FDA approval for new or improved formulations or new uses of previously
approved drug products. Specifically, Section 505(b)(2) permits the filing of an NDA where at least some of the information required
for approval comes from studies not conducted by or for the applicant and for which the applicant has not obtained a right of reference.
The applicant may rely upon the FDA’s findings of safety and effectiveness for an approved product that acts as the Reference Listed
Drug, or RLD. If the 505(b)(2) applicant can establish that reliance on FDA’s previous findings of safety and effectiveness is
scientifically appropriate, it may eliminate the need to conduct certain preclinical or clinical studies of the new product. The FDA
may also require 505(b)(2) applicants to perform additional studies or measurements to support the change from the RLD. The FDA may then
approve the new product candidate for all or some of the labeled indications for which the referenced product has been approved, as well
as for any new indication sought by the Section 505(b)(2) applicant.
In
seeking approval for a drug through an NDA, including a 505(b)(2) NDA, applicants are required to list with the FDA certain patents whose
claims cover the applicant’s product. Upon approval of an NDA, each of the patents listed in the application for the drug is then
published in the Orange Book. Any applicant who files an ANDA seeking approval of a generic equivalent version of a drug listed in the
Orange Book or a 505(b)(2) NDA referencing a drug listed in the Orange Book must certify to the FDA that (1) no patent information on
the drug product that is the subject of the application has been submitted to the FDA; (2) such patent has expired; (3) the date on which
such patent expires; or (4) such patent is invalid or will not be infringed upon by the manufacture, use or sale of the drug product
for which the application is submitted. This last certification is known as a paragraph IV certification. A notice of the paragraph IV
certification must be provided to each owner of the patent that is the subject of the certification and to the holder of the approved
NDA to which the ANDA or 505(b)(2) application refers. The applicant may also elect to submit a ‘‘section viii’’
statement certifying that its proposed label does not contain (or carves out) any language regarding the patented method-of-use rather
than certify to a listed method-of-use patent. If the reference NDA holder and patent owners assert a patent challenge directed to one
of the Orange Book listed patents within 45 days of the receipt of the paragraph IV certification notice, the FDA is prohibited from
approving the application until the earlier of 30 months from the receipt of the paragraph IV certification expiration of the patent,
settlement of the lawsuit or a decision in the infringement case that is favorable to the applicant. The ANDA or 505(b)(2) application
also will not be approved until any applicable non-patent exclusivity listed in the Orange Book for the branded reference drug has expired.
Our
current and anticipated product candidates will be based on already approved active pharmaceutical ingredients, or APIs, rather than
new chemical entities, and a formulation that has been through Phase 1 studies. Accordingly, we expect to be able to rely on information
from previously conducted formulation studies involving our clinical development plans and our NDA submissions. For product candidates
that involve novel fixed-dose combinations of existing drugs or for studies of an existing product or product candidate in a new indication,
we believe we generally will be able to initiate Phase 2/3 studies without conducting any new non-clinical or Phase 1 studies, though
the FDA may not agree with our conclusions and may require us to conduct additional clinical or preclinical studies prior to initiating
Phase 3 or other pivotal clinical trials. In those instances where our product candidate is a pharmacokinetically enhanced version of
an approved API, we will need to conduct certain non-clinical and Phase 1 studies to confirm the pharmacokinetic profile of the product
candidate prior to conducting Phase 2/3 studies.
U.S.
Foreign Corrupt Practices Act
The
U.S. Foreign Corrupt Practices Act, to which we are subject, prohibits corporations and individuals from engaging in certain activities
to obtain or retain business or to influence a person working in an official capacity. It is illegal to pay, offer to pay or authorize
the payment of anything of value to any foreign government official, government staff member, political party or political candidate
to obtain or retain business or to otherwise influence a person working in an official capacity.
Federal
and State Fraud and Abuse Laws
Healthcare
providers, physicians and third-party payors play a primary role in the recommendation and prescription of drug and biologic product
candidates which obtain marketing approval. In addition to FDA restrictions on marketing of pharmaceutical products, pharmaceutical manufacturers
are exposed, directly, or indirectly, through customers, to broadly applicable fraud and abuse and other healthcare laws and regulations
that may affect the business or financial arrangements and relationships through which a pharmaceutical manufacturer can market, sell
and distribute drug and biologic products. These laws include, but are not limited to:
The
federal Anti-Kickback Statute which prohibits, any person or entity from, among other things, knowingly and willfully offering, paying,
soliciting, or receiving any remuneration, directly or indirectly, overtly or covertly, in cash or in-kind, to induce or reward either
the referring of an individual for, or the purchasing, leasing, ordering, or arranging for the purchase, lease, or order of any healthcare
item or service reimbursable, in whole or in part, under Medicare, Medicaid, or any other federally financed healthcare program. The
term “remuneration” has been broadly interpreted to include anything of value. This statute has been interpreted to apply
to arrangements between pharmaceutical manufacturers on one hand and prescribers, purchasers, and formulary managers on the other hand.
Although there are a number of statutory exemptions and regulatory safe harbors protecting certain common activities from prosecution,
the exemptions and safe harbors are drawn narrowly, and practices that involve remuneration intended to induce prescribing, purchases,
or recommendations may be subject to scrutiny if they do not qualify for an exemption or safe harbor.
The
federal false claims and civil monetary penalty laws, including the Federal False Claims Act, which imposes significant penalties and
can be enforced by private citizens through civil qui tam actions, prohibits any person or entity from, among other things, knowingly
presenting, or causing to be presented, a false, fictitious or fraudulent claim for payment to the federal government, or knowingly making,
using or causing to be made, a false statement or record material to a false or fraudulent claim to avoid, decrease or conceal an obligation
to pay money to the federal government. In addition, a claim including items or services resulting from a violation of the federal Anti-Kickback
Statute constitutes a false or fraudulent claim for purposes of the False Claims Act. As a result of a modification made by the Fraud
Enforcement and Recovery Act of 2009, a claim includes “any request or demand” for money or property presented to the U.S.
government. In addition, manufacturers can be held liable under the False Claims Act even when they do not submit claims directly to
government payors if they are deemed to “cause” the submission of false or fraudulent claims. Criminal prosecution is also
possible for making or presenting a false, fictitious or fraudulent claim to the federal government. Recently, several pharmaceutical
and other healthcare companies have been prosecuted under these laws for allegedly providing free product to customers with the expectation
that the customers would bill federal programs for the product. Other companies have been prosecuted for causing false claims to be submitted
because of the company’s marketing of the product for unapproved, and thus non-reimbursable, uses.
The
federal Health Insurance Portability and Accountability Act of 1996, or HIPAA, which, among other things, imposes criminal liability
for executing or attempting to execute a scheme to defraud any healthcare benefit program, including private third-party payors, knowingly
and willfully embezzling or stealing from a healthcare benefit program, willfully obstructing a criminal investigation of a healthcare
offense, and creates federal criminal laws that prohibit knowingly and willfully falsifying, concealing or covering up a material fact
or making any materially false, fictitious or fraudulent statements or representations, or making or using any false writing or document
knowing the same to contain any materially false, fictitious or fraudulent statement or entry in connection with the delivery of, or
payment for, benefits, items or services.
HIPAA,
as amended by the Health Information Technology and Clinical Health Act of 2009, or HITECH, and its implementing regulations, which impose
certain requirements relating to the privacy, security, transmission and breach reporting of individually identifiable health information
upon entities subject to the law, such as health plans, healthcare clearinghouses and healthcare providers and their respective business
associates that perform services for them that involve individually identifiable health information. HITECH also created new tiers of
civil monetary penalties, amended HIPAA to make civil and criminal penalties directly applicable to business associates, and gave state
attorneys general new authority to file civil actions for damages or injunctions in U.S. federal courts to enforce the federal HIPAA
laws and seek attorneys’ fees and costs associated with pursuing federal civil actions.
The
federal physician payment transparency requirements, sometimes referred to as the “Physician Payments Sunshine Act,” and
its implementing regulations, which require certain manufacturers of drugs, devices, biologics and medical supplies for which payment
is available under Medicare, Medicaid or the Children’s Health Insurance Program (with certain exceptions) to report annually to
the United States Department of Health and Human Services, or HHS, information related to payments or other transfers of value made to
physicians (defined to include doctors, dentists, optometrists, podiatrists and chiropractors) and teaching hospitals, as well as ownership
and investment interests held by physicians and their immediate family members.
State
and foreign law equivalents of each of the above federal laws, such as anti-kickback and false claims laws, that may impose similar or
more prohibitive restrictions, and may apply to items or services reimbursed by non-governmental third-party payors, including private
insurers.
State
and foreign laws that require pharmaceutical companies to implement compliance programs, comply with the pharmaceutical industry’s
voluntary compliance guidelines and the relevant compliance guidance promulgated by the federal government, or to track and report gifts,
compensation and other remuneration provided to physicians and other healthcare providers, and other federal, state and foreign laws
that govern the privacy and security of health information or personally identifiable information in certain circumstances, including
state health information privacy and data breach notification laws which govern the collection, use, disclosure, and protection of health-related
and other personal information, many of which differ from each other in significant ways and often are not pre-empted by HIPAA, thus
requiring additional compliance efforts.
Because
of the breadth of these laws and the narrowness of the safe harbors, it is possible that some business activities can be subject to challenge
under one or more of such laws. The scope and enforcement of each of these laws is uncertain and subject to rapid change in the current
environment of healthcare reform, especially in light of the lack of applicable precedent and regulations. Federal and state enforcement
bodies have recently increased their scrutiny of interactions between healthcare companies and healthcare providers, which has led to
a number of investigations, prosecutions, convictions and settlements in the healthcare industry.
Ensuring
that business arrangements with third parties comply with applicable healthcare laws and regulations is costly and time consuming. If
business operations are found to be in violation of any of the laws described above or any other applicable governmental regulations
a pharmaceutical manufacturer may be subject to penalties, including civil, criminal and administrative penalties, damages, fines, disgorgement,
individual imprisonment, exclusion from governmental funded healthcare programs, such as Medicare and Medicaid, contractual damages,
reputational harm, diminished profits and future earnings, additional reporting obligations and oversight if subject to a corporate integrity
agreement or other agreement to resolve allegations of non-compliance with these laws, and curtailment or restructuring of operations,
any of which could adversely affect a pharmaceutical manufacturer’s ability to operate its business and the results of its operations.
Healthcare
Reform in the United States
In
the United States, there have been, and continue to be, a number of legislative and regulatory changes and proposed changes to the healthcare
system that could affect the future results of pharmaceutical manufactures’ operations. In particular, there have been and continue
to be a number of initiatives at the federal and state levels that seek to reduce healthcare costs. Most recently, the Patient Protection
and Affordable Care Act, or PPACA, was enacted in March 2010, which includes measures to significantly change the way healthcare is financed
by both governmental and private insurers. Among the provisions of the PPACA of greatest importance to the pharmaceutical and biotechnology
industry are the following:
|
● |
an
annual, nondeductible fee on any entity that manufactures or imports certain branded prescription drugs and biologic agents, apportioned
among these entities according to their market share in certain government healthcare programs; |
|
● |
implementation
of the federal physician payment transparency requirements, sometimes referred to as the “Physician Payments Sunshine Act”; |
|
● |
a
licensure framework for follow-on biologic products; |
|
● |
a
new Patient-Centered Outcomes Research Institute to oversee, identify priorities in, and conduct comparative clinical effectiveness
research, along with funding for such research; |
|
● |
establishment
of a Center for Medicare Innovation at the Centers for Medicare & Medicaid Services to test innovative payment and service delivery
models to lower Medicare and Medicaid spending, potentially including prescription drug spending; |
|
● |
an
increase in the statutory minimum rebates a manufacturer must pay under the Medicaid Drug Rebate Program, to 23.1% and 13% of the
average manufacturer price for most branded and generic drugs, respectively and capped the total rebate amount for innovator drugs
at 100% of the Average Manufacturer Price, or AMP; |
|
● |
a
new methodology by which rebates owed by manufacturers under the Medicaid Drug Rebate Program are calculated for certain drugs and
biologics, including our product candidates, that are inhaled, infused, instilled, implanted or injected; |
|
● |
extension
of manufacturers’ Medicaid rebate liability to covered drugs dispensed to individuals who are enrolled in Medicaid managed
care organizations; |
|
● |
expansion
of eligibility criteria for Medicaid programs by, among other things, allowing states to offer Medicaid coverage to additional individuals
and by adding new mandatory eligibility categories for individuals with income at or below 133% of the federal poverty level, thereby
potentially increasing manufacturers’ Medicaid rebate liability; |
|
● |
a
new Medicare Part D coverage gap discount program, in which manufacturers must agree to offer 50% point-of-sale discounts off negotiated
prices of applicable brand drugs to eligible beneficiaries during their coverage gap period, as a condition for the manufacturer’s
outpatient drugs to be covered under Medicare Part D; and |
|
● |
expansion
of the entities eligible for discounts under the Public Health program. |
Some of the provisions of the PPACA have yet to
be implemented, and there have been legal and political challenges to certain aspects of the PPACA. Since January 2017, former President
Trump has signed two executive orders and other directives designed to delay, circumvent, or loosen certain requirements mandated by the
PPACA. Concurrently, Congress has considered legislation that would repeal or repeal and replace all or part of the PPACA. While Congress
has not passed repeal legislation, the Tax Cuts and Jobs Act of 2017 includes a provision repealing, effective January 1, 2019, the tax-based
shared responsibility payment imposed by the PPACA on certain individuals who fail to maintain qualifying health coverage for all or part
of a year that is commonly referred to as the “individual mandate”. Congress may consider other legislation to repeal or replace
elements of the PPACA.
Many
of the details regarding the implementation of the PPACA are yet to be determined, and at this time, the full effect that the PPACA would
have on a pharmaceutical manufacturer remains unclear. In particular, there is uncertainty surrounding the applicability of the biosimilars
provisions under the PPACA. The FDA has issued several guidance documents, but no implementing regulations, on biosimilars. A number
of biosimilar applications have been approved over the past few years. The regulations that are ultimately promulgated and their implementation
are likely to have considerable impact on the way pharmaceutical manufacturers conduct their business and may require changes to current
strategies. A biosimilar is a biological product that is highly similar to an approved drug notwithstanding minor differences in clinically
inactive components, and for which there are no clinically meaningful differences between the biological product and the approved drug
in terms of the safety, purity, and potency of the product.
Individual
states have become increasingly aggressive in passing legislation and implementing regulations designed to control pharmaceutical and
biological product pricing, including price or patient reimbursement constraints, discounts, restrictions on certain product access,
and marketing cost disclosure and transparency measures, and to encourage importation from other countries and bulk purchasing. Legally
mandated price controls on payment amounts by third-party payors or other restrictions could harm a pharmaceutical manufacturer’s
business, results of operations, financial condition and prospects. In addition, regional healthcare authorities and individual hospitals
are increasingly using bidding procedures to determine what pharmaceutical products and which suppliers will be included in their prescription
drug and other healthcare programs. This could reduce ultimate demand for certain products or put pressure product pricing, which could
negatively affect a pharmaceutical manufacturer’s business, results of operations, financial condition and prospects.
In
addition, given recent federal and state government initiatives directed at lowering the total cost of healthcare, Congress and state
legislatures will likely continue to focus on healthcare reform, the cost of prescription drugs and biologics and the reform of the Medicare
and Medicaid programs. While no one cannot predict the full outcome of any such legislation, it may result in decreased reimbursement
for drugs and biologics, which may further exacerbate industry-wide pressure to reduce prescription drug prices. This could harm a pharmaceutical
manufacturer’s ability to generate revenue. Increases in importation or re-importation of pharmaceutical products from foreign
countries into the United States could put competitive pressure on a pharmaceutical manufacturer’s ability to profitably price
products, which, in turn, could adversely affect business, results of operations, financial condition and prospects. A pharmaceutical
manufacturer might elect not to seek approval for or market products in foreign jurisdictions in order to minimize the risk of re-importation,
which could also reduce the revenue generated from product sales. It is also possible that other legislative proposals having similar
effects will be adopted.
Furthermore,
regulatory authorities’ assessment of the data and results required to demonstrate safety and efficacy can change over time and
can be affected by many factors, such as the emergence of new information, including on other products, changing policies and agency
funding, staffing and leadership. No one can be sure whether future changes to the regulatory environment will be favorable or unfavorable
to business prospects. For example, average review times at the FDA for marketing approval applications can be affected by a variety
of factors, including budget and funding levels and statutory, regulatory and policy changes.
International
Regulations
In
addition to regulations in the United States, we are and will be subject to a variety of foreign regulations regarding development, approval,
commercial sales and distribution of our products. Whether or not we obtain FDA approval for a product, we must obtain the necessary
approvals by the comparable regulatory authorities of foreign countries before we can commence clinical trials or marketing of the product
in those countries. The approval process varies from country to country and can involve additional product testing and additional review
periods, and the time may be longer or shorter than that required to obtain FDA approval. The requirements governing, among other things,
the conduct of clinical trials, product licensing, pricing and reimbursement vary greatly from country to country. Regulatory approval
in one country does not ensure regulatory approval in another, but a failure or delay in obtaining regulatory approval in one country
may negatively impact the regulatory process in others. If we fail to comply with applicable foreign regulatory requirements, we may
be subject to fines, suspension or withdrawal of regulatory approvals, product recalls, seizure of products, operating restrictions and
criminal prosecution.
To
obtain regulatory approval of an investigational drug under European Union regulatory systems, we must submit a marketing authorization
application. The application used to file the NDA in the United States is similar to that required in Europe, with the exception of,
among other things, country-specific document requirements. For other countries outside of the European Union, such as countries in Eastern
Europe, Latin America or Asia, the requirements governing the conduct of clinical trials, product licensing, pricing and reimbursement
vary from country to country. In all cases, again, the clinical trials are conducted in accordance with GCP and the applicable regulatory
requirements and the ethical principles that have their origin in the Declaration of Helsinki.
If
we fail to comply with applicable foreign regulatory requirements, we may be subject to, among other things, fines, suspension or withdrawal
of regulatory approvals, product recalls, seizure of products, operating restrictions and criminal prosecution.
Centralized
Procedure
The
European Medicines Agency, or EMA, implemented the centralized procedure for the approval of human medicines to facilitate marketing
authorizations that are valid throughout the EU. This procedure results in a single marketing authorization issued by the European Commission
following a favorable opinion by the EMA that is valid across the European Union, as well as Iceland, Liechtenstein, and Norway. The
centralized procedure is compulsory for human medicines that are: derived from biotechnology processes, such as genetic engineering,
contain a new active substance indicated for the treatment of certain diseases, such as HIV/AIDS, cancer, diabetes, neurodegenerative
disorders or autoimmune diseases and other immune dysfunctions, and officially designated orphan medicines. For medicines that do not
fall within these categories, an applicant has the option of submitting an application for a centralized marketing authorization to the
EMA, as long as the medicine concerned is a significant therapeutic, scientific or technical innovation, or if its authorization would
be in the interest of public health.
There
are also two other possible routes to authorize medicinal products in several European Union countries, which are available for investigational
medicinal products that fall outside the scope of the centralized procedure: the decentralized procedure and the mutual recognition procedure.
Under the decentralized procedure, an applicant may apply for simultaneous authorization in more than one EU country for medicinal products
that have not yet been authorized in any EU country and that do not fall within the mandatory scope of the centralized procedure. Under
the mutual recognition procedure, a medicine is first authorized in one EU Member State, in accordance with the national procedures of
that country. Following a national authorization, the applicant may seek further marketing authorizations from other EU countries under
a procedure whereby the countries concerned agree to recognize the validity of the original, national marketing authorization.
In
the EU, medicinal products designated as orphan drug products benefit from financial incentives such as reductions in marketing authorization
application fees or fee waivers and 10 years of marketing exclusivity following medicinal product approval. For a medicinal product to
qualify as orphan drugs: (i) it must be intended for the treatment, prevention or diagnosis of a disease that is life-threatening or
chronically debilitating; (ii) the prevalence of the condition in the EU must not be more than five in 10,000 or it must be unlikely
that marketing of the medicine would generate sufficient returns to justify the investment needed for its development; and (iii) no satisfactory
method of diagnosis, prevention or treatment of the condition concerned can be authorized, or, if such a method exists, the medicine
must be of significant benefit to those affected by the condition.
Other
Regulations
We
are also subject to numerous federal, state and local laws relating to such matters as safe working conditions, manufacturing practices,
environmental protection, fire hazard control, and disposal of hazardous or potentially hazardous substances and biological materials.
We may incur significant costs to comply with such laws and regulations now or in the future.
Reimbursement
Obtaining
coverage and reimbursement approval for a product from a government or other third-party payor is a time-consuming and costly process
that can require the provision of supporting scientific, clinical and cost effectiveness data for the use of drug or biologic products
to the payor. There may be significant delays in obtaining such coverage and reimbursement for newly approved products, and coverage
may be more limited than the purposes for which the product is approved by the FDA or similar regulatory authorities outside of the United
States. Moreover, eligibility for coverage and reimbursement does not imply that a product will be paid for in all cases or at a rate
that covers operating costs, including research, development, intellectual property, manufacture, sale and distribution expenses. Reimbursement
rates may vary according to the use of the product and the clinical setting in which it is used, may be based on reimbursement levels
already set for lower cost products and may be incorporated into existing payments for other services. Net prices for products may be
reduced by mandatory discounts or rebates required by government healthcare programs or private payors and by any future relaxation of
laws that presently restrict imports of product from countries where they may be sold at lower prices than in the United States.
There
is significant uncertainty related to the insurance coverage and reimbursement of newly approved products. Third-party payors often rely
upon Medicare coverage policy and payment limitations in setting their own reimbursement policies, but also have their own methods and
approval process apart from Medicare coverage and reimbursement determinations. It is difficult to predict what third party payors will
decide with respect to coverage and reimbursement for new drug and biologic product candidates. An inability to promptly obtain coverage
and adequate reimbursement rates from both government-funded and private payors for any approved products could have a material adverse
effect on a pharmaceutical manufacturer’s operating results, ability to raise capital needed to commercialize products and overall
financial condition.
Reimbursement
may impact the demand for, and/or the price of, any product which obtains marketing approval. Even if coverage is obtained for a given
product by a third-party payor, the resulting reimbursement payment rates may not be adequate or may require co-payments that patients
find unacceptably high. Patients who are prescribed medications for the treatment of their conditions, and their prescribing physicians,
generally rely on third-party payors to reimburse all or part of the costs associated with those medications. Patients are unlikely to
use products unless coverage is provided and reimbursement is adequate to cover all or a significant portion of the cost of the products.
Therefore, coverage and adequate reimbursement is critical to new product acceptance. Coverage decisions may depend upon clinical and
economic standards that disfavor new drug products when more established or lower cost therapeutic alternatives are already available
or subsequently become available.
The
U.S. government, state legislatures and foreign governmental entities have shown significant interest in implementing cost containment
programs to limit the growth of government-paid healthcare costs, including price controls, restrictions on reimbursement and coverage
and requirements for substitution of generic products for branded prescription drugs. Adoption of government controls and measures, and
tightening of restrictive policies in jurisdictions with existing controls and measures, could exclude or limit our products from coverage
and limit payments for pharmaceuticals.
In
addition, it is expected that the increased emphasis on managed care and cost containment measures in the United States by third-party
payors and government authorities will continue and place further pressure on pharmaceutical pricing and coverage. Coverage policies
and third-party reimbursement rates may change at any time. Even if favorable coverage and reimbursement status is attained for one or
more drug products that gain regulatory approval, less favorable coverage policies and reimbursement rates may be implemented in the
future.
Intellectual
Property
Our
success depends, in part, on our ability to obtain, maintain, and enforce patents and other proprietary protections of our commercially
important technologies and product candidates, to operate without infringing the proprietary rights of others, and to maintain trade
secrets or other proprietary know-how, both in the United States and other countries. Our ability to stop third parties from making,
using, selling, offering to sell or importing our products will depend on the extent to which we have rights under valid and enforceable
patents or trade secrets that protect these activities. We seek to protect proprietary technology, inventions, and improvements that
are commercially important to our business by seeking, maintaining, and defending patent rights, whether developed internally or licensed
from third parties.
We
have two active patent families relating to our dactinomycin program. Currently, we have one granted US patent and ten pending patent
applications in these families in the US, Australia, Canada, Europe, and Japan.
We
also have an exclusive license to patents and patent applications across seven different patent families relating to our LSD1 program.
We currently have four granted patents and two pending application in the U.S. We also have granted patents and/or pending applications
in these families in Europe, Australia, Brazil, Canada, China, Eurasia, India, Israel, Japan, Mexico, and South Africa.
The
patent positions of biotechnology companies like ours are generally uncertain and involve complex legal, scientific and factual questions.
In addition, the coverage claimed in a patent application can be significantly reduced before the patent is issued. Consequently, we
do not know whether the product candidates we are developing will gain patent protection or, if patents are issued, whether they will
provide significant proprietary protection or will be challenged, circumvented, invalidated, or found to be unenforceable. Because patent
applications in the United States and certain other jurisdictions are maintained in secrecy for 18 months, and since publication of discoveries
in the scientific or patent literature often lags behind actual discoveries, we cannot be certain of the priority of inventions or filing
dates covered by pending patent applications. Moreover, we may have to participate in post-grant proceedings, interference proceedings,
or third-party ex parte or inter partes reexamination proceedings before the U.S. Patent and Trademark Office, or in opposition
proceedings in a foreign patent office, any of which could result in substantial cost to us, even if the eventual outcome is favorable
to us. There can be no assurance that the patents, if issued, would be held valid and enforceable by a court of competent jurisdiction.
An adverse outcome could subject us to significant liabilities to third parties, require disputed rights to be licensed from third parties
or require us to cease using specific compounds or technology. To the extent prudent, we intend to bring litigation against third parties
that we believe are infringing one or more of our patents or other intellectual property rights.
The
term of individual patents depends upon the legal term of the patents in the countries in which they are obtained. In most countries
in which we file, the patent term is 20 years from the earliest date of filing a non-provisional patent application. In the United States,
a patent term may be lengthened by patent term adjustment, which compensates a patentee for administrative delays by the U.S. Patent
and Trademark Office in granting a patent, or may be shortened if a patent is terminally disclaimed over another patent. Certain of our
patents currently benefit from patent term adjustment and some of our patents issuing in the future may benefit from patent term adjustment.
The
patent term of a patent that covers an FDA-approved product may also be eligible for patent term extension, which permits patent term
restoration as compensation for the patent term lost during the FDA regulatory review process. The Drug Price Competition and Patent
Term Restoration Act of 1984, or the Hatch-Waxman Act, permits a patent term extension of up to five years beyond the expiration of the
patent. The length of the patent term extension is related to the length of time the product is under regulatory review. Patent term
extension cannot extend the remaining term of a patent beyond a total of 14 years from the date of product approval and only one patent
applicable to an approved product may be extended. Similar provisions are available in Europe and other non-U.S. jurisdictions to extend
the term of a patent that covers an approved product. In the future, if and when our product candidates receive FDA approval, we expect
to apply for patent-term extensions on patents covering those products.
To
protect our rights to any of our issued patents and proprietary information, we may need to litigate against infringing third parties,
or avail ourselves of the courts or participate in hearings to determine the scope and validity of those patents or other proprietary
rights. These types of proceedings are often costly and could be very time-consuming to us, and there can be no assurance that the deciding
authorities will rule in our favor. An unfavorable decision could allow third parties to use our technology without being required to
pay us licensing fees or may compel us to license needed technologies to avoid infringing third-party patent and proprietary rights.
Such a decision could even result in the invalidation or a limitation in the scope of our patents or forfeiture of the rights associated
with our patents or pending patent applications.
We
intend to seek orphan drug status whenever it is available. If a product which has an orphan drug designation subsequently receives the
first regulatory approval for the indication for which it has such designation, the product is entitled to orphan exclusivity, meaning
that the applicable regulatory authority may not approve any other applications to market the same drug for the same indication, except
in certain very limited circumstances, for a period of seven years in the United States and 10 years in the European Union. Orphan drug
designation does not prevent competitors from developing or marketing different drugs for an indication.
We
also rely on trade secret protection for our confidential and proprietary information. No assurance can be given that others will not
independently develop substantially equivalent proprietary information and techniques or otherwise gain access to our trade secrets or
disclose such technology, or that we can meaningfully protect our trade secrets. However, we believe that the substantial costs and resources
required to develop technological innovations will help us to protect the competitive advantage of our products.
It
is our policy to require our employees, consultants, outside scientific collaborators, sponsored researchers and other advisors to execute
confidentiality agreements upon the commencement of employment or consulting or collaborative relationships with us. These agreements
provide that all confidential information developed or made known to the individual during the course of the individual’s relationship
with us is to be kept confidential and not disclosed to third parties except in specific circumstances. In the case of employees, the
agreements provide that all inventions conceived by the individual shall be and are our exclusive property. There can be no assurance,
however, that these agreements will provide meaningful protection or adequate remedies for our trade secrets in the event of unauthorized
use or disclosure of such information.
Competition
The
biotechnology and pharmaceutical industries are characterized by rapidly advancing technologies, intense competition and a strong emphasis
on proprietary products. While we believe that our technology, development experience and scientific knowledge provide us with competitive
advantages, we face potential competition from many different sources, including major pharmaceutical, specialty pharmaceutical and biotechnology
companies, academic institutions and governmental agencies and public and private research institutions. Any product candidates that
we successfully develop and commercialize will compete with existing therapies and new therapies that may become available in the future.
Several
types of existing treatments may be used for people with AML. The main treatments include chemotherapy, bone marrow transplants, stem
cell transplants and/or interferon therapy. In most cases AML can progress rapidly, so it is important to start treatment as soon as
possible after the diagnosis is made. In addition to currently marketed therapies, there are also a number of products in late stage
clinical development to treat AML. These products in development may provide efficacy, safety, convenience and other benefits that are
not provided by currently marketed therapies. As a result, they may provide significant competition for any of our product candidates
for which we obtain market approval.
There
are other companies and research institutions working to develop therapies that target AML. Many of our competitors may have significantly
greater financial resources and expertise in research and development, preclinical testing, conducting clinical trials, obtaining regulatory
approvals and marketing approved products than we do. Mergers and acquisitions in the pharmaceutical, biotechnology and diagnostic industries
may result in even more resources being concentrated among a smaller number of our competitors. These competitors also compete with us
in recruiting and retaining qualified scientific and management personnel and establishing clinical trial sites and patient registration
for clinical trials, as well as in acquiring technologies complementary to, or necessary for, our programs. Smaller or early stage companies
may also prove to be significant competitors, particularly through collaborative arrangements with large and established companies.
A
listing of approved products currently used for treatment of AML include the following: topoisomerase II inhibitors, e.g., Cerubidine®
(daunorubicin HCL, Bedford Labs), Novantrone® (mitoxantrone HCL, Pfizer) and Idamycin® (idarubicin HCl, Pfizer); alkylating agents,
e.g., Cytoxan® (cyclophosphamide, Baxter); DNA polymerase inhibitors, e.g,. Cytarabine® (cytarabine, Pfizer); DNA binding agents,
e.g., Doxil® (doxorubicin HCl liposome, Alza); purine analogs, e.g., Tabloid® (thioguanine, GlaxoSmithKline); mitotic spindle
inhibitors, e.g., Vincasar PFS® (vincristine sulfate, Teva); DNA fragmentation agents, e.g,. Trisenox® (arsenic trioxide, Cephalon);
FLT3 inhibitors, e.g., Rydapt® (midostaurin, Novartis); IDH2 inhibitors, e.g., IDHIFA® (enasidenib mesylate, Celgene).
A
listing of AML drugs in advanced clinical development by our competitors include the following: (irreversible) LSD-1 inhibitors, e.g.
ORY-1001 (Oryzon); FLT3 inhibitors, e.g., quizartinib (Daiichi Sankyo), crenolanib (Arog Pharma) and gilteritinib (Astellas); topoisomerase
inhibitors, e.g., Vosaroxin® (qinprezo, Sunesis Pharma), CPX-351 (vyxeos, Celator Pharma); DNA hypomethylating agents, e.g., guadecditabine
(ASTX Pharma); PLK1 inhibitors, e.g., volasertib (Boehringer Ingelheim); IDH2 inhibitors, e.g., enasidenib (Agios Pharma); IDH1 inhibitors,
e.g., ivosidenib (Agios Pharma); DOT1L ihibitors, e.g., pinometostat (Epizyme); BCL2 inhibitors, e.g., venetoclax (Roche); BET inhibitors,
e.g., OTX-015 (OncoEthix) and HDAC inhibitors, e.g., pracinostat (MEI Pharma).
A
large number of irreversible inhibitors of LSD1 have been developed by major pharmaceutical companies and research institutes. Among
them, ORY-1001 and GSK2879552, two TCP derivatives, developed by Oryzon Genomics and GSK, respectively, have been in Phase 1 clinical
trials for treatment of AML We have focused on development of reversible inhibitors instead of irreversible inhibitors with the expectation
of better therapeutic effect, safety profiles and lower toxicity compared to the irreversible inhibitors
The
key competitive factors affecting the success of all our targets, if approved, are likely to be their efficacy, safety, convenience,
price, the level of generic competition and the availability of reimbursement from government and other third-party payors.
Our
commercial opportunity could be reduced or eliminated if our competitors develop and commercialize products that are safer, more effective,
have fewer or less severe side effects, are more convenient or are less expensive than any products that we may develop. Our competitors
also may obtain FDA or other regulatory approval for their products more rapidly than we may obtain approval for ours, which could result
in our competitors establishing a strong market position before we are able to enter the market. In addition, our ability to compete
may be affected in many cases by insurers or other third-party payors seeking to encourage the use of generic products. There are many
generic products currently on the market for the indications that we are pursuing, and additional products are expected to become available
on a generic basis over the coming years. If our therapeutic product candidates are approved, we expect that they will be priced at a
significant premium over competitive generic products.
Shared
Services Agreement
On
January 1, 2017, Tiziana Life Sciences plc, a company incorporated in England and Wales (“Tiziana”), entered into a Shared
Services Agreement with us pursuant to which Tiziana agreed to provide certain services to us including various administrative, financial,
legal, tax, insurance, facility and information technology services. The term of the agreement is until April 1, 2018 and is renewed
automatically thereafter for successive three month terms with respect to any services still in effect unless either party elects not
to renew the agreement or any specific service by notice in writing to the other party no later than 45 days prior to the end of any
term. We may terminate any of the services provided under the agreement at any time upon 30 days prior written notice. Tiziana may terminate
any of the services provided under the agreement if we shall have failed to perform any of our material obligations under the agreement
and failed to cure any such failure within 30 days after receiving notice thereof.
Employees
As
of September 30, 2021, and September 30, 2020 we had no employees.
ITEM
1A. RISK FACTORS
Risks
Relating to Our Business
We
are a leukemia-focused biotechnology company with limited operations to date.
We
are a leukemia-focused biotechnology company with limited operations to date and no revenue. We have not yet commenced clinical trials,
have no product candidates ready for commercialization, have not generated any revenue from operations and expect to incur substantial
net losses for the foreseeable future to further develop and commercialize our product candidates. We are unable to predict the extent
of these future net losses, or when we may attain profitability, if at all. We may never be able to generate any revenues or royalties
from the sales of our therapeutics or become profitable even if we do generate revenues or royalties.
We
expect to continue to incur increasing net losses for the foreseeable future, and we may never achieve or maintain profitability.
Investment in biopharmaceutical product development
is highly speculative because it entails substantial upfront capital expenditures and significant risk that any potential product candidate
will fail to demonstrate adequate effect or an acceptable safety profile, gain regulatory approval and become commercially viable. We
have no products approved for commercial sale and have not generated any revenue from product sales to date, and we continue to incur
significant research and development and other expenses related to our ongoing operations. As a result, we are not profitable and have
incurred losses in each period since our inception. For the year ended September 30, 2021 and 2020, we reported a net loss of $785,082 and
$5,346,672, respectively. As of September 30, 2021, we had an accumulated deficit of $23,443,563.
To
become and remain profitable, we or our partners must succeed in developing our product candidates, obtaining regulatory approval for
them, and manufacturing, marketing and selling those products for which we or our partners may obtain regulatory approval. We or they
may not succeed in these activities, and we may never generate revenue from product sales that is significant enough to achieve profitability. Because
of the numerous risks and uncertainties associated with biopharmaceutical product development and commercialization, we are unable to
accurately predict the timing or amount of future expenses or when, or if, we will be able to achieve or maintain profitability. Currently,
we have no products approved for commercial sale, and to date we have not generated any product revenue. We have financed our operations
primarily through the sale of equity securities. The size of our future net losses will depend, in part, on the rate of growth or contraction
of our expenses and the level and rate of growth, if any, of our revenues. Our ability to achieve profitability is dependent on our ability,
alone or with others, to complete the development of our products successfully, obtain the required regulatory approvals, manufacture
and market our proposed products successfully or have such products manufactured and marketed by others, and gain market acceptance for
such products. There can be no assurance as to whether or when we will achieve profitability.
We
will require substantial additional funding which may not be available to us on acceptable terms, or at all. If we fail to raise the
necessary additional capital, we may be unable to complete the development and commercialization of our product candidates, or continue
our development programs.
We
expect to escalate moderately our spending to advance the pre-clinical and clinical development of our product candidates.
We
cannot be certain that additional funding will be available on acceptable terms, or at all. If we are unable to raise additional capital
in sufficient amounts or on terms acceptable to us we may have to significantly delay, scale back or discontinue the development or commercialization
of our product candidate. We may also seek collaborators for one or more of our current or future product candidates at an earlier stage
than otherwise would be desirable or on terms that are less favorable than might otherwise be available. Any of these events could significantly
harm our business, financial condition and prospects.
Our
future capital requirements will depend on many factors, including:
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● |
the
progress of the development of our product candidates; |
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● |
the
number of product candidates we pursue; |
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the
time and costs involved in obtaining regulatory approvals; |
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● |
the
costs involved in filing and prosecuting patent applications and enforcing or defending patent claims; |
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● |
our
plans to establish sales, marketing and/or manufacturing capabilities; |
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● |
the
effect of competing technological and market developments; |
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● |
the
terms and timing of any collaborative, licensing and other arrangements that we may establish; |
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general
market conditions for offerings from biopharmaceutical companies; |
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● |
our
ability to establish, enforce and maintain selected strategic alliances and activities required for product commercialization; and |
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● |
our
revenues, if any, from successful development and commercialization of our product candidates. |
In
order to carry out our business plan and implement our strategy, we anticipate that we will need to obtain additional financing from
time to time and may choose to raise additional funds through strategic collaborations, licensing arrangements, public or private equity
or debt financing, bank lines of credit, asset sales, government grants, or other arrangements. We cannot be sure that any additional
funding, if needed, will be available on terms favorable to us or at all. Furthermore, any additional equity or equity-related financing
may be dilutive to our stockholders, and debt or equity financing, if available, may subject us to restrictive covenants and significant
interest costs. If we obtain funding through a strategic collaboration or licensing arrangement, we may be required to relinquish our
rights to certain of our product candidate or marketing territories. Our inability to raise capital when needed would harm our business,
financial condition and results of operations, and could cause our stock price to decline or require that we wind down our operations
altogether.
Our
independent registered public accounting firm has expressed substantial doubt about our ability to continue as a going concern, which
may hinder our ability to obtain future financing.
Our
consolidated financial statements as of September 30, 2021 were prepared under the assumption that we will continue as a going concern
for the next twelve months. Due to our recurring losses from operations, we concluded that there is substantial doubt in our ability
to continue as a going concern within one year after the financial statements are issued without additional capital becoming available.
Our independent registered public accounting firm has issued an audit opinion that included an explanatory paragraph referring to our
projected future losses along with recurring losses from operations and expressing substantial doubt in our ability to continue as a
going concern without additional capital becoming available. Our ability to continue as a going concern is dependent upon our ability
to obtain additional equity or debt financing, attain further operating efficiencies, reduce expenditures, and, ultimately, to generate
revenue. The financial statements do not include any adjustments that might result from the outcome of this uncertainty.
If
we fail to select product candidates, fail to successfully complete clinical trials and commercialize product candidates or fail to obtain
regulatory approval, our business would be harmed and the value of our securities would decline.
We
must be evaluated in light of the uncertainties and complexities affecting a pre-commercial biopharmaceutical company. We have not completed
preclinical or clinical research and have not completed the development of our product candidates. Our failure to develop and commercialize
such product candidates successfully may cause us to cease operations. We are performing preclinical research on NPM1 and LSD1. This
research will require significant additional development efforts by us and significant additional development efforts by us and regulatory
approvals prior to commercialization. We cannot be certain that our efforts in this regard will lead to commercially viable therapeutics.
We do not know what the final cost to select and commercialize product candidates will be.
We
do not know whether any of our molecular targets under development ultimately will be selected as product candidates or whether our product
candidates will be shown to be effective. Moreover, governmental authorities may enact new legislation or regulations that could limit
or restrict our development efforts. We may receive unfavorable results from pre-clinical studies or clinical studies on the molecular
targets, which may cause us to abandon the product selection process and further development efforts.
Regulatory
agencies must approve our product candidates, if any, before they can be marketed or sold. The approval process is lengthy, requires
significant capital expenditures, and uncertain as to outcome. Our ability to obtain regulatory approval of any product candidate depends
on, among other things, completion of additional clinical trials, whether our clinical trials demonstrate statistically significant efficacy
with safety issues that do not potentially outweigh the therapeutic benefit of the product candidates, and whether the regulatory agencies
agree that the data from our future clinical trials are sufficient to support approval for any of our product candidates. The final results
of our current and future preclinical or clinical trials may not meet FDA or other regulatory agencies’ requirements to approve
a product candidate for marketing, and the regulatory agencies may otherwise determine that our manufacturing processes or facilities
are insufficient to support approval. We or our collaborators may need to conduct more preclinical or clinical trials than we currently
anticipate. Even if we do receive FDA or other regulatory agency approval, we or our collaborators may not be successful in commercializing
approved product candidates. If any of these events occur, our business could be materially harmed and the value of our securities would
decline.
All
of our current data for our lead product candidate are the result of Phase 2 clinical trials conducted by third parties and do not necessarily
provide sufficient evidence that our product candidates will be viable as potential pharmaceutical products.
To
date, long-term safety and efficacy have not yet been demonstrated in clinical trials for our product candidates. Favorable results in
early studies or trials may not be repeated in later studies or trials. Even if our clinical trials are initiated and completed as planned,
we cannot be certain that the results will support our product candidate claims. Success in preclinical testing and early clinical trials
does not ensure that later clinical trials will be successful. We cannot be sure that the results of later clinical trials would replicate
the results of prior clinical trials and preclinical testing, nor that they would satisfy the requirements of the FDA or other regulatory
agencies. Clinical trials may fail to demonstrate that our product candidate is safe for humans and effective for indicated uses. Preclinical
and clinical results are frequently susceptible to varying interpretations that may delay, limit or prevent regulatory approvals or commercialization.
Any delay in, or termination of, our clinical trials would delay our obtaining FDA or EMA approval for the affected product candidate
and, ultimately, our ability to commercialize that product candidate.
If
we cannot demonstrate an acceptable toxicity profile for our product candidates, if any, in non-clinical studies, we will not be able
to initiate or continue clinical trials or obtain approval for our product candidates.
To
move a product candidate into human clinical trials, we must first demonstrate an acceptable toxicity profile in preclinical testing.
Furthermore, to obtain approval, we must also demonstrate safety in various non-clinical tests. We may not have conducted or may not
conduct the types of non-clinical testing required by regulatory authorities, or future non-clinical tests may indicate that our product
candidates are not safe for use. Preclinical and non-clinical testing is expensive, time-consuming and has an uncertain outcome. In addition,
success in initial non-clinical testing does not ensure that later non-clinical testing will be successful. We may experience numerous
unforeseen events during the non-clinical testing process, which could delay or prevent our ability to develop or commercialize our product
candidates, including:
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our
preclinical and non-clinical testing may produce inconclusive or negative safety results, which may require us to conduct additional
non-clinical testing or to abandon product candidates; |
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|
our
product candidates may have unfavorable pharmacology or toxicity characteristics; |
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our
product candidates may cause undesirable side effects such as negative immune responses that lead to complications; |
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our
enrolled patients may have allergies that lead to complications after treatment; and |
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the
FDA or other regulatory authorities may determine that additional safety testing is required. |
Any
such events would increase our costs and could delay or prevent our ability to commercialize our product candidates, which could adversely
impact our business, financial condition and results of operations.
We,
or our collaborators, may face delays in completing our pre-clinical or clinical trials, and may not be able to complete them at all.
We
have not completed the pre-clinical and clinical trials necessary to support an application for approval to market of our product candidates,
if any. Our or our collaborators’ current and future clinical trials may be delayed, unsuccessful, or terminated as a result of
many factors, including:
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delays
in designing an appropriate clinical trial protocol and reaching agreement on trial design with investigators and regulatory authorities;
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governmental
or regulatory delays, failure to obtain regulatory approval or changes in regulatory requirements, policy or guidelines; |
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adding
new clinical trial sites |
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reaching
agreement on acceptable terms with prospective contract research organizations, or CROs, and clinical trial sites, the terms of which
can be subject to extensive negotiation and may vary significantly among different CROs and trial sites; |
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the
actual performance of CROs and clinical trial sites in ensuring the proper and timely conduct of our clinical trials; |
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adverse
effects experienced by subjects in clinical trials; |
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manufacturing
sufficient quantities of product candidates for use in clinical trials; and |
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delays
in achieving study endpoints and completing data analysis for a trial. |
In
addition to these factors, our trials may be delayed, unsuccessful or terminated because:
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regulators
or institutional review boards, or IRBs, may not authorize us to commence a clinical trial; |
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regulators
or IRBs may suspend or terminate clinical research for various reasons, including noncompliance with regulatory requirements or concerns
about patient safety; |
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we
may suspend or terminate our clinical trials if we believe that they expose the participating patients to unacceptable health risks;
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patients
may not complete clinical trials due to safety issues, side effects, such as injection site discomfort, a belief that they are receiving
placebo instead of our product candidates, or other reasons; |
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patients
with serious diseases included in our clinical trials may die or suffer other adverse medical events for reasons that may not be
related to our product candidates; |
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in
those trials where our product candidate is being tested in combination with one or more other therapies, deaths may occur that may
be attributable to the other therapies; |
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we
may have difficulty in maintaining contact with patients after treatment, preventing us from collecting the data required by our
study protocol; |
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product
candidates may demonstrate a lack of efficacy during clinical trials; |
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personnel
conducting clinical trials may fail to properly administer our product candidates; and |
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our
collaborators may decide not to pursue further clinical trials. |
We could encounter delays if our clinical trials are suspended or terminated by us, by IRBs of the institutions in which such
trials are being conducted, by the Data Safety Monitoring Boards for such trials or by the FDA or other regulatory authorities. Such
authorities may impose such a suspension or termination due to a number of factors, including potential for unacceptable safety risks
to patients, inspection of the clinical trial operation or trial site, changes in government regulations or administrative actions.
In
addition, we rely on academic institutions, physician practices and CROs to conduct, supervise or monitor some or all aspects of clinical
trials involving our product candidates. We have less control over the timing and other aspects of these clinical trials than if we conducted
the monitoring and supervision entirely on our own. Third parties may not perform their responsibilities for our clinical trials on our
anticipated schedule or consistent with a clinical trial protocol or applicable regulations. We also may rely on CROs to perform our
data management and analysis. They may not provide these services as required or in a timely or compliant manner, and we may be held
legally responsible for any or all of their performance failures or inadequacies.
Moreover,
our development costs will increase because we will be required to complete additional or larger clinical trials for our product candidates
prior to FDA or other regulatory approval. If we or our collaborators experience delays in the completion of, or termination of, any
clinical trial of our product candidates, the commercial prospects of our product candidates will be harmed, and our ability to generate
product revenues from any of these product candidates will be delayed or eliminated. In addition, any delays in completing our clinical
trials will increase our costs, slow down our product candidate development and approval process, and jeopardize our ability to commence
product sales and generate revenues. Any of these occurrences may harm our business, financial condition and prospects. In addition,
many of the factors that cause, or lead to, a delay in the commencement or completion of clinical trials may also lead to the denial
of regulatory approval of our product candidates.
We
have limited experience in the development of therapeutic product candidates and therefore may encounter difficulties developing our
product candidate or managing our operations in the future.
We
have limited experience in the discovery, development and manufacturing of therapeutic compounds. In order to successfully develop our
product candidate, we must continuously supplement our research, clinical development, regulatory, medicinal chemistry, and manufacturing
capabilities through the addition of key employees, consultants or third-party contractors to provide certain capabilities and skill
sets that we do not possess.
Furthermore,
we have adopted an operating model that largely relies on the outsourcing of a number of responsibilities and key activities to third-party
consultants, and contract research and manufacturing organizations in order to advance the development of our product candidates. Therefore,
our success depends in part on our ability to retain highly qualified key management, personnel, and directors to develop, implement
and execute our business strategy, operate the company and oversee the activities of our consultants and contractors, as well as academic
and corporate advisors or consultants to assist us in this regard. We are currently highly dependent upon the efforts of our management
team. In order to develop our product candidates, we need to retain or attract certain personnel, consultants or advisors with experience
in drug development activities that include a number of disciplines, including research and development, clinical trials, medical matters,
government regulation of pharmaceuticals, manufacturing, formulation and chemistry, business development, accounting, finance, regulatory
affairs, human resources and information systems..
Our success depends in part on our continued ability to attract, retain
and motivate highly qualified management, clinical and scientific personnel and on our ability to develop and maintain important relationships
with leading academic institutions, clinicians and scientists. The competition for qualified personnel in the biotechnology and pharmaceuticals
field is intense. We will need to hire additional personnel as we expand our clinical development and commercial activities. While we
have not had difficulties recruiting qualified individuals, to date, we may not be able to attract and retain quality personnel on acceptable
terms given the competition for such personnel among biotechnology, pharmaceutical and other companies. Although we have not experienced
material difficulties in retaining key personnel in the past, we may not be able to continue to do so in the future on acceptable terms,
if at all.
We
have limited capacity for recruiting and managing clinical trials, which could impair our timing to initiate or complete clinical trials
of our product candidates and materially harm our business.
We
have limited capacity to recruit and manage the clinical trials necessary to obtain FDA approval or approval by other regulatory authorities.
By contrast, larger pharmaceutical and bio-pharmaceutical companies often have substantial staff with extensive experience
in conducting clinical trials with multiple product candidates across multiple indications. In addition, they may have greater financial
resources to compete for the same clinical investigators and patients that we are attempting to recruit for our clinical trials. If potential
competitors are successful in completing drug development for their product candidates and obtain approval from the FDA, they could limit
the demand for our product candidates.
As
a result, we may be at a competitive disadvantage that could delay the initiation, recruitment, timing, completion of our clinical trials
and obtaining regulatory approvals, if at all, for our product candidate.
If
we encounter difficulties enrolling patients in our clinical trials, our clinical trials could be delayed or otherwise adversely affected.
Clinical
trials for our product candidates, if any, will require us to identify and enroll a large number of patients with the disease under investigation.
We may not be able to enroll a sufficient number of patients, or those with required or desired characteristics, in a timely manner.
Patient enrollment is affected by factors including:
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severity
of the disease under investigation; |
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design
of the trial protocol; |
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the
size and nature of the patient population; |
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eligibility
criteria for the study in question; |
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lack
of a sufficient number of patients who meet the enrollment criteria for our clinical trials; |
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delays
required to characterize the infection to allow us to select a product candidate, which may lead patients to seek to enroll in other
clinical trials or seek alternative treatments; |
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perceived
risks and benefits of the product candidate under study; |
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availability
of competing therapies and clinical trials; |
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efforts
to facilitate timely enrollment in clinical trials; |
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scheduling
conflicts with participating clinicians; |
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patient
referral practices of physicians; |
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the
ability to monitor patients adequately during and after treatment; and |
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proximity
and availability of clinical trial sites for prospective patients. |
If
we have difficulty enrolling a sufficient number or diversity of patients to conduct our clinical trials as planned, we may need to delay
or terminate ongoing or planned clinical trials, either of which would have an adverse effect on our business.
Results
of earlier studies and clinical trials may not be predictive of future trial results.
Clinical
testing is expensive and can take many years to complete, and its outcome is inherently uncertain. Failure can occur at any time during
the clinical trial process. The results of preclinical studies and early clinical trials of our product candidates, if any, may not be
predictive of the design or results of later-stage clinical trials. Any positive results generated to date do not ensure that later trials
will demonstrate similar results. While we have observed statistically significant improvements in the outcomes of some of our clinical
trials, many of the improvements we have seen have not reached statistical significance. Statistical significance is a statistical term
that means that an effect is unlikely to have occurred by chance. In order to be approved, product candidates must demonstrate that
their effect on patients’ diseases in the trial is statistically significant. Product candidates in later stages of clinical trials
may fail to show the desired safety and efficacy traits despite having progressed through preclinical studies and initial clinical trials.
Early clinical trials frequently enroll patient populations that are different from the patient populations in later trials, resulting
in different outcomes in later clinical trials from those in earlier stage clinical trials. In addition, adverse events may not occur
in early clinical trials and only emerge in larger, late-stage clinical trials or after commercialization. A number of companies in the
biopharmaceutical industry have suffered significant setbacks in advanced clinical trials due to lack of efficacy or adverse safety profiles,
notwithstanding promising results in earlier clinical trials. If later stage clinical trials do not demonstrate efficacy and safety of
our product candidates we will not be able to market them and our business will be materially harmed.
Regulatory
authorities may not approve our product candidates, if any, even if they meet safety and efficacy endpoints in clinical trials.
Under
certain circumstances, regulatory authorities may revise or retract previous guidance during the course of our clinical activities or
after the completion of our clinical trials. A regulatory authority may also disqualify a clinical trial in whole or in part from consideration
in support of approval of a potential product for commercial sale or otherwise deny approval of that product. Prior to regulatory approval,
a regulatory authority may elect to obtain advice from outside experts regarding scientific issues and/or marketing applications under
a regulatory authority review. In the United States, these outside experts are convened through the FDA’s Advisory Committee process,
which would report to the FDA and make recommendations that may differ from the views of the FDA. Should an Advisory Committee be convened,
it would be expected to lengthen the time for obtaining regulatory approval, if such approval is obtained at all.
The
FDA and foreign regulatory agencies may delay, limit or deny marketing approval for many reasons, including:
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a
product candidate may not be considered safe or effective; |
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|
our
manufacturing processes or facilities may not meet the applicable requirements; |
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|
changes
in the agencies’ approval policies or adoption of new regulations may require additional work on our part, for example, the
FDA may require us to change or expand the endpoints in our clinical trials; |
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|
different
divisions of the FDA are reviewing different product candidates and those divisions may have different requirements for approval;
and |
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|
changes
in regulatory law, FDA or foreign regulatory agency organization, or personnel may result in different requirements for approval
than anticipated. |
Our
product candidates may not be approved even if they achieve their endpoints in clinical trials. Regulatory agencies, including the FDA,
or their advisors may disagree with our trial design and our interpretations of data from preclinical studies and clinical trials. Regulatory
agencies also may approve a product candidate for fewer or more limited indications than requested or may grant approval subject to the
performance of post-marketing studies. In addition, regulatory agencies may not approve the labeling claims that are necessary or desirable
for the successful commercialization of our product candidates.
Any
delay in or failure to receive or maintain approval for any of our product candidates could prevent us from ever generating revenues
or achieving profitability.
We
may be required to suspend, repeat or terminate our clinical trials if they are not conducted in accordance with regulatory requirements,
the results are negative or inconclusive, or the trials are not well designed.
Clinical
trials must be conducted in accordance with FDA regulations governing clinical studies, or other applicable foreign government guidelines,
and are subject to oversight by the FDA, other foreign governmental agencies and IRBs at the medical institutions where the clinical
trials are conducted. In addition, clinical trials must be conducted with product candidates produced under current Good Manufacturing
Practices, or cGMP, and may require large numbers of test subjects. Clinical trials may be suspended by the FDA, other foreign governmental
agencies or us for various reasons, including:
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|
deficiencies
in the conduct of the clinical trials, including failure to conduct the clinical trial in accordance with regulatory requirements
or clinical protocols; |
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deficiencies
in the clinical trial operations or trial sites; |
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the
product candidate may have unforeseen adverse side effects; |
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the
time required to determine whether the product candidate is effective may be longer than expected; |
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deaths
or other adverse events arising during a clinical trial due to medical problems that may not be related to clinical trial treatments;
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the
product candidate may not appear to be more effective than current therapies; |
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the
quality or stability of the product candidate may fall below acceptable standards; and |
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insufficient
quantities of the product candidate might be available to complete the trials. |
In
addition, changes in regulatory requirements and guidance may occur and we may need to amend clinical trial protocols to reflect these
changes. Amendments may require us to resubmit our clinical trial protocols to IRBs for reexamination, which may impact the costs, timing
or successful completion of a clinical trial. Due to these and other factors, our product candidates could take longer to gain regulatory
approval than we expect or we may never gain approval for any product candidates, which could reduce or eliminate our revenue by delaying
or terminating the commercialization of our product candidates.
Any
product candidate for which we, or our collaborators, obtain marketing approval could be subject to restrictions or withdrawal from the
market, and we may be subject to penalties if we fail to comply with regulatory requirements or if we experience unanticipated problems
with our products, when and if any of them are approved.
Any
product candidate that we or our collaborators obtain marketing approval for, along with the manufacturing processes, post-approval clinical
data, labeling, advertising and promotional activities for such product, will be subject to continual requirements of the FDA and other
regulatory authorities. These requirements include submissions of safety and other post-marketing information, reports, registration
and listing requirements, cGMP requirements relating to quality control, quality assurance and corresponding maintenance of records and
documents, requirements regarding the distribution of samples to physicians and recordkeeping. Even if marketing approval of a product
candidate is granted, the approval may be subject to limitations on the indicated uses for which the product may be marketed or to conditions
of approval, or contain requirements for costly post-marketing testing and surveillance to monitor the safety or efficacy of the product.
The FDA closely regulates the post-approval marketing and promotion of drugs to ensure drugs are marketed only for the approved indications
and in accordance with the provisions of the approved labeling. The FDA imposes stringent restrictions on manufacturers’ communications
regarding off-label use. If we market our products outside of their approved indications, we will be subject to enforcement action for
off-label marketing.
In
addition, later discovery of previously unknown problems with these products, manufacturers or manufacturing processes, or failure to
comply with regulatory requirements, may yield various results, including:
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restrictions
on such products, manufacturers or manufacturing processes; |
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restrictions
on the labeling or marketing of a product; |
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restrictions
on product distribution or use; |
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requirements
to conduct post-marketing clinical trials; |
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warning
or untitled letters; |
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withdrawal
of the products from the market; |
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refusal
to approve pending applications or supplements to approved applications that we submit; |
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recall
of products, fines, restitution or disgorgement of profits or revenue; |
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suspension
or withdrawal of marketing approvals; |
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refusal
to permit the import or export of our products; |
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injunctions
or the imposition of civil or criminal penalties. |
The
FDA’s policies may change and additional government regulations may be enacted that could prevent, limit or delay regulatory approval
of our product candidates. If we, or our collaborators, are slow or unable to adapt to changes in existing requirements or the adoption
of new requirements or policies, or if we, or our collaborators, are not able to maintain regulatory compliance, any marketing approval
that was obtained could be lost, which would adversely affect our business, prospects and ability to achieve or sustain profitability.
If
we, or our collaborators, are unable to comply with foreign regulatory requirements or obtain foreign regulatory approvals, our ability
to develop foreign markets for our products could be impaired.
Sales
of our product candidates, if any, outside the United States will be subject to foreign regulatory requirements governing clinical trials,
marketing approval, manufacturing, product licensing, pricing and reimbursement. These regulatory requirements vary greatly from country
to country. As a result, the time required to obtain approvals outside the United States may differ from that required to obtain FDA
approval and we may not be able to obtain foreign regulatory approvals on a timely basis or at all. Approval by the FDA does not ensure
approval by regulatory authorities in other countries, and approval by one foreign regulatory authority does not ensure approval by regulatory
authorities in other countries or by the FDA and foreign regulatory authorities could require additional testing. Failure to comply with
these regulatory requirements or obtain required approvals could impair our ability to develop foreign markets for our products.
Competitive
products for treatment of AML may reduce or eliminate the commercial opportunity for our product candidates, if any.
The
clinical and commercial landscape for AML is rapidly changing. New data from commercial and clinical-stage products continue to emerge.
It is possible that these data may alter current standards of care, completely precluding us from further developing our product candidates,
if any, or getting them approved by regulatory agencies. Further, it is possible that we may initiate a clinical trial or trials for
these product candidates, only to find that data from competing products make it impossible for us to complete enrollment in these trials,
resulting in our inability to file for marketing approval with regulatory agencies. Even if these products are approved for marketing
in a particular indication or indications, they may have limited sales due to particularly intense competition in these markets.
We
will need to develop or acquire additional manufacturing and distribution capabilities in order to commercialize our product candidates,
if any, that obtain marketing approval, and we may encounter unexpected costs or difficulties in doing so.
If
we independently develop and commercialize one or more of our product candidates, if any, we will need to invest in acquiring or building
additional capabilities and effectively manage our operations and facilities to successfully pursue and complete future research, development
and commercialization efforts. We will require additional investment and validation process development in order to qualify our commercial-scale
manufacturing process to manufacture clinical trial materials and commercial material if any of our products are approved for marketing.
This investment and validation process development may be expensive and time-consuming. We will require additional personnel with experience
in commercial-scale manufacturing, managing of large-scale information technology systems and managing a large-scale distribution system.
We will need to add personnel and expand our capabilities, which may strain our existing managerial, operational, regulatory compliance,
financial and other resources. To do this effectively, we must:
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recruit,
hire, train, manage and motivate a growing employee base; |
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accurately
forecast demand for our products; |
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assemble
and manage the supply chain to ensure our ability to meet demand; and |
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expand
existing operational, manufacturing, financial and management information systems. |
We
may seek FDA approval for our production process and facilities simultaneously with seeking approval for sale of our product candidates.
Should we not complete the development of adequate capabilities, including manufacturing capacity, or fail to receive timely approval
of our manufacturing process and facilities, our ability to supply clinical trial materials for planned clinical trials or supply products
following regulatory approval for sale could be delayed, which would further delay our clinical trials or the period of time when we
would be able to generate revenues from the sale of such products, if we are even able to obtain approval or generate revenues at all.
Additionally,
we may decide to outsource some or all of our manufacturing activities to a third party commercial manufacturing organization, or CMO.
Under any agreement with a CMO, we would have less control over the timing and quality of manufacturing than if we were to perform such
manufacturing ourselves. A CMO would be manufacturing other pharmaceutical products in the same facilities as our product candidates,
increasing the risk of cross product contamination. Further, there is no guarantee that any CMO will continue ongoing operations, causing
potential delays in product supply, reduced revenues and other liabilities for us.
Any
such events would increase our costs and could delay or prevent our ability to commercialize our product candidates, which could adversely
impact our business, financial condition and results of operations.
Our
product candidates may cause undesirable side effects or have other properties that could delay or prevent their regulatory approval,
limit the commercial profile of an approved label, or result in significant negative consequences following marketing approval, if any.
Undesirable
side effects caused by our product candidates, if any, could cause us, our collaborators, or regulatory authorities to interrupt, delay
or halt clinical trials and could result in a more restrictive label or the delay or denial of regulatory approval by the FDA or other
comparable foreign regulatory authorities. As a result of any side effects, our clinical trials could be suspended or terminated and
the FDA or comparable foreign regulatory authorities could order us to cease further development, or deny approval, of our product candidates
for any or all targeted indications. The drug-related side effects could affect patient recruitment or the ability of enrolled patients
to complete the trial or result in potential product liability claims. Any of these occurrences may harm our business, financial condition
and prospects significantly.
Additionally
if one or more of our product candidates receives marketing approval, and we, our collaborators, or others later identify undesirable
side effects caused by such products, a number of potentially significant negative consequences could result, including:
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regulatory
authorities may withdraw approvals of such product; |
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regulatory
authorities may require additional warnings on the label; |
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we
may be required to create a medication guide outlining the risks of such side effects for distribution to patients; |
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we
may be sued and held liable for harm caused to patients; and |
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our
reputation may suffer. |
Any
of these events could prevent us from achieving or maintaining market acceptance of the particular product candidate, if approved, and
could significantly harm our business, results of operations and prospects.
If
we are unable to establish sales and marketing capabilities or enter into agreements with third parties to sell and market our product
candidates, we may not be successful in commercializing our product candidates if and when they are approved.
We
do not have a sales and marketing infrastructure or any experience in the sales, marketing or distribution of pharmaceutical products.
We may seek additional third-party collaborators for the commercialization of our other product candidates. In the future, we may choose
to build a focused sales and marketing infrastructure to market or co-promote some of our product candidates if and when they are approved,
which would be expensive and time-consuming. Alternatively, we may elect to outsource these functions to third parties. Either approach
carries significant risks. For example, recruiting and training a sales force is expensive and time-consuming and, if done improperly,
could delay a product launch and result in limited sales. If the commercial launch of a product candidate for which we recruit a sales
force and establish marketing capabilities is delayed or does not occur for any reason, we would have prematurely or unnecessarily incurred
these commercialization expenses. This may be costly, and our investment would be lost if we cannot retain or reposition our sales and
marketing personnel.
Factors
that may inhibit our efforts to commercialize our products on our own include:
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our
inability to recruit, manage and retain adequate numbers of effective sales and marketing personnel; |
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the
inability of marketing personnel to develop effective marketing materials; |
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the
inability of sales personnel to obtain access to or persuade adequate numbers of physicians to prescribe any future products; |
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the
lack of complementary products to be offered by sales personnel, which may put us at a competitive disadvantage relative to companies
with more extensive product lines; and |
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unforeseen
costs and expenses associated with creating an independent sales and marketing organization. |
The
availability and amount of reimbursement, if approved, for our product candidates, if any, and the manner in which government and private
payors may reimburse for any potential products, are uncertain.
In
both U.S. and foreign markets, sales of any products will depend in part on the availability of reimbursement from third-party payors
such as government health administration authorities, private health insurers and other organizations. The future magnitude of our revenues
and profitability may be affected by the continuing efforts of governmental and third-party payors to contain or reduce the costs of
health care. We cannot predict the effect that private sector or governmental health care reforms may have on our business, and there
can be no assurance that any such reforms will not have a material adverse effect on our business, financial condition and results of
operations.In addition, in both the United States and elsewhere, sales of prescription drugs are dependent in part on the availability
of reimbursement to the consumer from third-party payors, such as government and private insurance plans. The ability to obtain
reimbursement of our products from these parties is a critical factor in the commercial success for any of our products. Failure to obtain
appropriate reimbursement could result in reduced or no sales of our products.
Third-party
payors are increasingly challenging the price and cost-effectiveness of medical products and services. Significant uncertainty exists
as to the reimbursement status of newly-approved health care products. There can be no assurance that our products will be considered
cost-effective or that adequate third-party reimbursement will be available to enable us to maintain price levels sufficient to realize
an appropriate return on our investment in product development. Legislation and regulations affecting the pricing of pharmaceuticals
may change before any of our products are approved for marketing. Adoption of such legislation could further limit reimbursement for
medical products and services. We, or our collaborators, may elect not to market future products in certain markets.
We
may expend our limited resources to pursue a particular research program, product candidate or indication and fail to capitalize on product
candidates or indications that may be more profitable or for which there is a greater likelihood of success.
Because
we have limited financial and managerial resources, we focus on research programs and eventually product candidates for the indications
that we believe are the most scientifically and commercially promising. Our resource allocation decisions may cause us to fail to capitalize
on viable scientific or commercial products or profitable market opportunities. In addition, we may spend valuable time and managerial
and financial resources on research programs and product candidates for specific indications that ultimately do not yield any scientifically
or commercially viable products. If we do not accurately evaluate the scientific and commercial potential or target market for a particular
product candidate, we may relinquish valuable rights to that product candidate through collaboration, licensing or other royalty arrangements
in situations where it would have been more advantageous for us to retain sole rights to development and commercialization.
Failure
to attract and retain key personnel could impede our ability to develop our products and to obtain new collaborations or other sources
of funding.
Because
of the specialized scientific nature of our business, our success is highly dependent upon our ability to attract and retain qualified
scientific and technical personnel, consultants and advisors. We will also need to recruit a considerable number of additional personnel
to achieve our operating goals and financial reporting obligations. To pursue our product development and marketing and sales plans,
we will need to hire additional qualified scientific personnel to perform research and development, as well as personnel with expertise
in clinical testing, government regulation, manufacturing, marketing and sales, which may strain our existing managerial, operational,
regulatory compliance, financial and other resources. We also rely on consultants and advisors to assist in formulating our research
and development strategy and adhering to complex regulatory requirements. We face competition for qualified individuals from numerous
pharmaceutical and biotechnology companies, universities and other research institutions. There can be no assurance that we will be able
to attract and retain such individuals on acceptable terms, if at all. The failure to attract and retain qualified personnel, consultants
and advisors could have a material adverse effect on our business, financial condition and results of operations.
The
ongoing COVID-19 pandemic may, directly or indirectly, adversely affect our business, results of operations and financial condition.
Our
business could be materially adversely affected, directly or indirectly, by the widespread outbreak of contagious disease, including
the ongoing COVID-19 pandemic, which has spread to many of the countries in which we, our suppliers and our collaboration partners do
business. National, state and local governments in affected regions have implemented and may continue to implement safety precautions,
including quarantines, border closures, increased border controls, travel restrictions, shelter in place orders and shutdowns, business
closures, cancellations of public gatherings and other measures. Organizations and individuals are taking additional steps to avoid or
reduce infection, including limiting travel and staying home from work. These measures are disrupting normal business operations both
in and outside of affected areas and have had significant negative impacts on businesses and financial markets worldwide.
We
continue to monitor our operations and applicable government recommendations, and we have made some modifications to our normal operations
because of the COVID-19 pandemic, including requiring most office-based support staff to work remotely. Notwithstanding these measures,
the COVID-19 pandemic could affect the health and availability of our support staff as well as those of the third parties we rely on
taking similar measures. We also recognize that the global economic climate may impact our ability to raise funds.
Risks
Relating to Our Industry
The
biopharmaceutical industry is subject to significant regulation and oversight in the United States, in addition to approval of products
for sale and marketing. We may be subject, directly or indirectly, to federal and state healthcare fraud and abuse laws, transparency,
health information privacy and security laws and other healthcare laws and regulations. If we are unable to comply, or have not fully
complied, with such laws, we could face substantial penalties.
Healthcare
providers, physicians and third-party payors will play a primary role in the recommendation and prescription of any future product candidates
we may develop and any product candidates for which we obtain marketing approval. In addition to FDA restrictions on marketing of biopharmaceutical
products, we are exposed, directly, or indirectly, through our customers, to broadly applicable fraud and abuse and other healthcare
laws and regulations that may affect the business or financial arrangements and relationships through which we would market, sell and
distribute our products. The laws that may affect our ability to operate include, but are not limited to:
The
federal Anti-Kickback Statute which prohibits any person or entity from, among other things, knowingly and willfully offering, paying,
soliciting or receiving any remuneration, directly or indirectly, overtly or covertly, in cash or in-kind, to induce or reward either
the referring of an individual for, or the purchasing, leasing, ordering or arranging for the purchase, lease or order of any health
care item or service reimbursable, in whole or in part, under Medicare, Medicaid or any other federally financed healthcare program.
The term “remuneration” has been broadly interpreted to include anything of value. This statute has been interpreted to apply
to arrangements between pharmaceutical manufacturers on one hand and prescribers, purchasers and formulary managers on the other hand.
Although there are many statutory exemptions and regulatory safe harbors protecting certain common activities from prosecution, the exemptions
and safe harbors are drawn narrowly, and practices that involve remuneration intended to induce prescribing, purchases or recommendations
may be subject to scrutiny if they do not qualify for an exemption or safe harbor. Our practices may not in all cases meet all of the
criteria for safe harbor protection from anti-kickback liability.
The
federal false claims and civil monetary penalty laws, including the Federal False Claims Act, which imposes significant penalties and
can be enforced by private citizens through civil qui tam actions, prohibits any person or entity from, among other things, knowingly
presenting, or causing to be presented, a false, fictitious or fraudulent claim for payment to the federal government, or knowingly making,
using or causing to be made, a false statement or record material to a false or fraudulent claim to avoid, decrease or conceal an obligation
to pay money to the federal government. In addition, a claim including items or services resulting from a violation of the federal Anti-Kickback
Statute constitutes a false or fraudulent claim for purposes of the False Claims Act. As a result of a modification made by the Fraud
Enforcement and Recovery Act of 2009, a claim includes “any request or demand” for money or property presented to the U.S.
government. Further, manufacturers can be held liable under the False Claims Act even when they do not submit claims directly to government
payors if they are deemed to “cause” the submission of false or fraudulent claims. Criminal prosecution is also possible
for making or presenting a false, fictitious or fraudulent claim to the federal government. Several pharmaceutical and other health care
companies have been prosecuted under these laws for allegedly providing free product to customers with the expectation that the customers
would bill federal programs for the product. Other companies have been prosecuted for causing false claims to be submitted because of
marketing of the product for unapproved, and thus non-reimbursable, uses.
The
federal Health Insurance Portability and Accountability Act of 1996, or HIPAA, which, among other things, imposes criminal liability
for executing or attempting to execute a scheme to defraud any healthcare benefit program, including private third-party payors, knowingly
and willfully embezzling or stealing from a healthcare benefit program, willfully obstructing a criminal investigation of a healthcare
offense, and creates federal criminal laws that prohibit knowingly and willfully falsifying, concealing or covering up a material fact
or making any materially false, fictitious or fraudulent statements or representations, or making or using any false writing or document
knowing the same to contain any materially false, fictitious or fraudulent statement or entry in connection with the delivery of, or
payment for, benefits, items or services.
HIPAA,
as amended by the Health Information Technology and Clinical Health Act of 2009, or HITECH, and its implementing regulations, which impose
certain requirements relating to the privacy, security, transmission and breach reporting of individually identifiable health information
upon entities subject to the law, such as health plans, healthcare clearinghouses and healthcare providers and their respective business
associates that perform services for them that involve individually identifiable health information. HITECH also created new tiers of
civil monetary penalties, amended HIPAA to make civil and criminal penalties directly applicable to business associates, and gave state
attorneys general new authority to file civil actions for damages or injunctions in U.S. federal courts to enforce the federal HIPAA
laws and seek attorneys’ fees and costs associated with pursuing federal civil actions.
The
federal physician payment transparency requirements, sometimes referred to as the “Physician Payments Sunshine Act,” and
its implementing regulations, which require certain manufacturers of drugs, devices, biologics and medical supplies for which payment
is available under Medicare, Medicaid or the Children’s Health Insurance Program (with certain exceptions) to report annually to
the United States Department of Health and Human Services, or HHS, information related to payments or other transfers of value made to
physicians (defined to include doctors, dentists, optometrists, podiatrists and chiropractors) and teaching hospitals, as well as ownership
and investment interests held by physicians and their immediate family members.
State
and foreign law equivalents of each of the above federal laws, such as anti-kickback and false claims laws, that may impose similar or
more prohibitive restrictions, and may apply to items or services reimbursed by non-governmental third-party payors, including private
insurers.
State
and foreign laws that require pharmaceutical companies to implement compliance programs, comply with the pharmaceutical industry’s
voluntary compliance guidelines and the relevant compliance guidance promulgated by the federal government, or to track and report gifts,
compensation and other remuneration provided to physicians and other healthcare providers, and other federal, state and foreign laws
that govern the privacy and security of health information or personally identifiable information in certain circumstances, including
state health information privacy and data breach notification laws which govern the collection, use, disclosure, and protection of health-related
and other personal information, many of which differ from each other in significant ways and often are not pre-empted by HIPAA, thus
requiring additional compliance efforts.
Because
of the breadth of these laws and the narrowness of the safe harbors, it is possible that some of our business activities could be subject
to challenge under one or more of these laws. The scope and enforcement of each of these laws is uncertain and subject to rapid change
in the current environment of healthcare reform, especially considering the lack of applicable precedent and regulations. Federal and
state enforcement bodies have recently increased their scrutiny of interactions between healthcare companies and healthcare providers,
which has led to several investigations, prosecutions, convictions and settlements in the healthcare industry.
Ensuring
that our business arrangements with third parties comply with applicable healthcare laws and regulations will likely be costly and time
consuming. If our operations are found to be in violation of any of the laws described above or any other governmental regulations that
apply to us, we may be subject to penalties, including civil, criminal and administrative penalties, damages, fines, disgorgement, individual
imprisonment, exclusion from governmental funded healthcare programs, such as Medicare and Medicaid, contractual damages, reputational
harm, diminished profits and future earnings, additional reporting obligations and oversight if we become subject to a corporate integrity
agreement or other agreement to resolve allegations of non-compliance with these laws, and the curtailment or restructuring of our operations,
any of which could adversely affect our ability to operate our business and our results of operations.
Health
care reform measures could adversely affect our business.
In
the United States and foreign jurisdictions, there have been, and continue to be, many legislative and regulatory changes and proposed
changes to the healthcare system that could affect our future results of operations. There have been and continue to be a number of initiatives
at the U.S. federal and state levels that seek to reduce healthcare costs. In 2010, the PPACA was enacted, which includes measures to
significantly change the way health care is financed by both governmental and private insurers. Among the provisions of the PPACA of
greatest importance to the pharmaceutical and biotechnology industry are the following:
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an
annual, nondeductible fee on any entity that manufactures or imports certain branded prescription drugs and biologic agents, apportioned
among these entities according to their market share in certain government healthcare programs; |
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implementation
of the federal physician payment transparency requirements, sometimes referred to as the “Physician Payments Sunshine Act”;
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a
licensure framework for follow-on biologic products; |
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a
new Patient-Centered Outcomes Research Institute to oversee, identify priorities in, and conduct comparative clinical effectiveness
research, along with funding for such research; |
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establishment
of a Center for Medicare Innovation at the Centers for Medicare & Medicaid Services to test innovative payment and service delivery
models to lower Medicare and Medicaid spending, potentially including prescription drug spending; |
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an
increase in the statutory minimum rebates a manufacturer must pay under the Medicaid Drug Rebate Program, to 23.1% and 13% of the
average manufacturer price for most branded and generic drugs, respectively and capped the total rebate amount for innovator drugs
at 100% of the Average Manufacturer Price, or AMP; |
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a
new methodology by which rebates owed by manufacturers under the Medicaid Drug Rebate Program are calculated for certain drugs and
biologics, including our product candidates, that are inhaled, infused, instilled, implanted or injected; |
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extension
of manufacturers’ Medicaid rebate liability to covered drugs dispensed to individuals who are enrolled in Medicaid managed
care organizations; |
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expansion
of eligibility criteria for Medicaid programs by, among other things, allowing states to offer Medicaid coverage to additional individuals
and by adding new mandatory eligibility categories for individuals with income at or below 133% of the federal poverty level, thereby
potentially increasing manufacturers’ Medicaid rebate liability; |
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a
new Medicare Part D coverage gap discount program, in which manufacturers must agree to offer 50% point-of-sale discounts off negotiated
prices of applicable brand drugs to eligible beneficiaries during their coverage gap period, as a condition for the manufacturer’s
outpatient drugs to be covered under Medicare Part D; and |
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expansion
of the entities eligible for discounts under the Public Health program. |
Some of the provisions of the PPACA have yet to
be implemented, and there have been legal and political challenges to certain aspects of the PPACA. Since January 2017, former President
Trump has signed two executive orders and other directives designed to delay, circumvent, or loosen certain requirements mandated by the
PPACA. Concurrently, Congress has considered legislation that would repeal or repeal and replace all or part of the PPACA. While Congress
has not passed repeal legislation, the Tax Cuts and Jobs Act of 2017 includes a provision repealing, effective January 1, 2019, the tax-based
shared responsibility payment imposed by the PPACA on certain individuals who fail to maintain qualifying health coverage for all or part
of a year that is commonly referred to as the “individual mandate”. Congress may consider other legislation to repeal or replace
elements of the PPACA.
Many
of the details regarding the implementation of the PPACA are yet to be determined, and at this time, the full effect that the PPACA would
have on our business remains unclear. There is uncertainty surrounding the applicability of the biosimilars provisions under the PPACA
to our product candidates. The FDA has issued several guidance documents, but no implementing regulations, on biosimilars. Many biosimilar
applications have been approved over the past few years. It is not certain that we will receive 12 years of biologics marketing exclusivity
for any of our products. The regulations that are ultimately promulgated and their implementation are likely to have considerable impact
on the way we conduct our business and may require us to change current strategies. A biosimilar is a biological product that is highly
similar to an approved drug notwithstanding minor differences in clinically inactive components, and for which there are no clinically
meaningful differences between the biological product and the approved drug in terms of the safety, purity, and potency of the product.
Individual
states have become increasingly aggressive in passing legislation and implementing regulations designed to control pharmaceutical and
biological product pricing, including price or patient reimbursement constraints, discounts, restrictions on certain product access,
and marketing cost disclosure and transparency measures, and to encourage importation from other countries and bulk purchasing. Legally
mandated price controls on payment amounts by third-party payors or other restrictions could harm our business, results of operations,
financial condition and prospects. In addition, regional healthcare authorities and individual hospitals are increasingly using bidding
procedures to determine what pharmaceutical products and which suppliers will be included in their prescription drug and other healthcare
programs. This could reduce ultimate demand for our products or put pressure on our product pricing, which could negatively affect our
business, results of operations, financial condition and prospects.
In
addition, given recent federal and state government initiatives directed at lowering the total cost of healthcare, Congress and state
legislatures will likely continue to focus on healthcare reform, the cost of prescription drugs and biologics and the reform of the Medicare
and Medicaid programs. While we cannot predict the full outcome of any such legislation, it may result in decreased reimbursement for
drugs and biologics, which may further exacerbate industry-wide pressure to reduce prescription drug prices. This could harm our ability
to generate revenues. Increases in importation or re-importation of pharmaceutical products from foreign countries into the United States
could put competitive pressure on our ability to profitably price our products, which, in turn, could adversely affect our business,
results of operations, financial condition and prospects. We might elect not to seek approval for or market our products in foreign jurisdictions
to minimize the risk of re-importation, which could also reduce the revenue we generate from our product sales. It is also possible that
other legislative proposals having similar effects will be adopted.
Furthermore,
regulatory authorities’ assessment of the data and results required to demonstrate safety and efficacy can change over time and
can be affected by many factors, such as the emergence of additional information, including on other products, changing policies and
agency funding, staffing and leadership. We cannot be sure whether future changes to the regulatory environment will be favorable or
unfavorable to our business prospects. For example, average review times at the FDA for marketing approval applications can be affected
by a variety of factors, including budget and funding levels and statutory, regulatory and policy changes.
We
are subject to U.S. and certain foreign export and import controls, sanctions, embargoes, anti-corruption laws, and anti-money laundering
laws and regulations. Compliance with these legal standards could impair our ability to compete in domestic and international markets.
We can face criminal liability and other serious consequences for violations, which can harm our business.
We
are subject to export control and import laws and regulations, including the U.S. Export Administration Regulations, U.S. Customs regulations,
various economic and trade sanctions regulations administered by the U.S. Treasury Department’s Office of Foreign Assets Controls,
the U.S. Foreign Corrupt Practices Act of 1977, as amended, or FCPA, the U.S. domestic bribery statute contained in 18 U.S.C. §
201, the U.S. Travel Act, the USA PATRIOT Act, and other state and national anti-bribery and anti-money laundering laws in the countries
in which we conduct activities. Anti-corruption laws are interpreted broadly and prohibit companies and their employees, agents, contractors,
and other collaborators from authorizing, promising, offering, or providing, directly or indirectly, improper payments or anything else
of value to recipients in the public or private sector. We may engage third parties for clinical trials outside of the United States,
to sell our products abroad once we enter a commercialization phase, and/or to obtain necessary permits, licenses, patent registrations,
and other regulatory approvals. We have direct or indirect interactions with officials and employees of government agencies or government-affiliated
hospitals, universities, and other organizations. We can be held liable for the corrupt or other illegal activities of our employees,
agents, contractors, and other collaborators, even if we do not explicitly authorize or have actual knowledge of such activities. Any
violations of the laws and regulations described above may result in substantial civil and criminal fines and penalties, imprisonment,
the loss of export or import privileges, debarment, tax reassessments, breach of contract and fraud litigation, reputational harm, and
other consequences.
An
NDA submitted under Section 505(b)(2) subjects us to the risk that we may be subject to a patent infringement lawsuit that would delay
or prevent the review or approval of our product candidate.
Section
505(b)(2) permits the submission of an NDA where at least some of the information required for approval comes from studies that were
not conducted by, or for, the applicant and on which the applicant has not obtained a right of reference. The 505(b)(2) application would
enable us to reference published literature and/or the FDA’s previous findings of safety and effectiveness for the branded reference
drug. For NDAs submitted under Section 505(b)(2) of the FDCA, the patent certification and related provisions of the Hatch-Waxman Act
apply. In accordance with the Hatch- Waxman Act, such NDAs may be required to include certifications, known as paragraph IV certifications,
that certify that any patents listed in the Patent and Exclusivity Information Addendum of the FDA’s publication, Approved Drug
Products with Therapeutic Equivalence Evaluations, commonly known as the Orange Book, with respect to any product referenced in the 505(b)(2)
application, are invalid, unenforceable or will not be infringed by the manufacture, use or sale of the product that is the subject of
the 505(b)(2) NDA.
Under
the Hatch-Waxman Act, the holder of patents that the 505(b)(2) application references may file a patent infringement lawsuit after receiving
notice of the paragraph IV certification. Filing of a patent infringement lawsuit against the filer of the 505(b)(2) applicant within
45 days of the patent owner’s receipt of notice triggers a one-time, automatic, 30-month stay of the FDA’s ability to approve
the 505(b)(2) NDA, unless patent litigation is resolved in the favor of the paragraph IV filer or the patent expires before that time.
Accordingly, we may invest a significant amount of time and expense in the development of one or more product candidates only to be subject
to significant delay and patent litigation before such product candidates may be commercialized, if at all. In addition, a 505(b)(2)
application will not be approved until any non-patent exclusivity, such as exclusivity for obtaining approval of a new chemical entity,
or NCE, listed in the Orange Book for the referenced product has expired. The FDA may also require us to perform one or more additional
clinical studies or measurements to support the change from the branded reference drug, which could be time consuming and could substantially
delay our achievement of regulatory approvals for such product candidates. The FDA may also reject our future 505(b)(2) submissions and
require us to file such submissions under Section 505(b)(1) of the FDCA, which would require us to provide extensive data to establish
safety and effectiveness of the drug for the proposed use and could cause delay and be considerably more expensive and time consuming.
These factors, among others, may limit our ability to successfully commercialize our product candidates.
We
may seek Fast Track designation for one or more of our product candidates, but we might not receive such designation, and even if we
do, such designation may not actually lead to a faster development or regulatory review or approval process.
If
a product is intended for the treatment of a serious condition and nonclinical or clinical data demonstrate the potential to address
unmet medical need for this condition, a product sponsor may apply for FDA Fast Track designation. If we seek Fast Track designation
for a product candidate, we may not receive it from the FDA. However, even if we receive Fast Track designation, Fast Track designation
does not ensure that we will receive marketing approval or that approval will be granted within any particular timeframe. We may not
experience a faster development or regulatory review or approval process with Fast Track designation compared to conventional FDA procedures.
In addition, the FDA may withdraw Fast Track designation if it believes that the designation is no longer supported by data from our
clinical development program. Fast Track designation alone does not guarantee qualification for the FDA’s priority review procedures.
If
the FDA does not conclude that our product candidates satisfy the requirements for the 505(b)(2) regulatory approval pathway, or if the
requirements for approval of any of our product candidates under Section 505(b)(2) are not as we expect, the approval pathway for our
product candidates will likely take significantly longer, cost significantly more and encounter significantly greater complications and
risks than anticipated, and in any case may not be successful.
We
intend to seek FDA approval through the 505(b)(2) regulatory pathway for certain of our product candidates. The Hatch-Waxman Act, added
Section 505(b)(2) to the FDCA. Section 505(b)(2) permits the filing of an NDA where at least some of the information required for approval
comes from studies that were not conducted by or for the applicant. If the FDA does not allow us to pursue the 505(b)(2) regulatory pathway
for our product candidates as anticipated, we may need to conduct additional clinical trials, provide additional data and information
and meet additional standards for regulatory approval. If this were to occur, the time and financial resources required to obtain FDA
approval for our product candidates would likely substantially increase. Moreover, the inability to pursue the 505(b)(2) regulatory pathway
could result in new competitive products reaching the market faster than our product candidates, which could materially adversely impact
our competitive position and prospects. Even if we are allowed to pursue the 505(b)(2) regulatory pathway for a product candidate, we
cannot assure you that we will receive the requisite or timely approvals for commercialization of such product candidate. In addition,
we expect that our competitors will file citizens’ petitions with the FDA in an attempt to persuade the FDA that our product candidates,
or the clinical studies that support their approval, contain deficiencies. Such actions by our competitors could delay or even prevent
the FDA from approving any NDA that we submit under Section 505(b)(2).
We
expect to rely heavily on orphan drug status to commercialize some of our product candidates, if approved, but we might not receive such
designation and any orphan drug designations we receive may not confer marketing exclusivity or other expected commercial benefits.
We
expect to rely heavily on orphan drug exclusivity for our product candidates. Designation of orphan drug status is within the discretion
of the FDA and the FDA may determine that we do not meet the criteria for orphan drug status. In the United States, orphan drug designation
entitles a party to financial incentives such as opportunities for grant funding towards clinical trial costs, tax advantages and user-fee
waivers. In addition, if a product that has orphan drug designation subsequently receives the first FDA approval for the disease for
which it has such designation, the product is entitled to orphan drug exclusivity. Orphan drug exclusivity in the United States provides
that the FDA may not approve any other applications, including a full NDA, to market the same drug for the same indication for seven
years, except in limited circumstances the applicable exclusivity period is ten years in Europe. The European exclusivity period can
be reduced to six years if a drug no longer meets the criteria for orphan drug designation or if the drug is sufficiently profitable
so that market exclusivity is no longer justified. Even if we, or any future collaborators, obtain orphan drug designation for a product
candidate, we, or they, may not be able to obtain or maintain orphan drug exclusivity for that product candidate. We may not be the first
to obtain marketing approval of any product candidate for which we have obtained orphan drug designation for the orphan-designated indication
due to the uncertainties associated with developing pharmaceutical products, and it is possible that another company also holding orphan
drug designation for the same product candidate will receive marketing approval for the same indication before we do. If that were to
happen, our applications for that indication may not be approved until the competing company’s period of exclusivity expires. In
addition, exclusive marketing rights in the United States may be limited if we seek approval for an indication broader than the orphan-designated
indication or may be lost if the FDA later determines that the request for designation was materially defective or if we are unable to
assure sufficient quantities of the product to meet the needs of patients with the rare disease or condition. Further, even if we, or
any future collaborators, obtain orphan drug exclusivity for a product, that exclusivity may not effectively protect the product from
competition because different drugs with different active moieties may be approved for the same condition. Even after an orphan drug
is approved, the FDA can subsequently approve the same drug with the same active moiety for the same condition if the FDA concludes that
the later drug is clinically superior in that it is shown to be safer, more effective or makes a major contribution to patient care or
the manufacturer of the product with orphan exclusivity is unable to maintain sufficient product quantity. Orphan drug designation neither
shortens the development time or regulatory review time of a drug nor gives the drug any advantage in the regulatory review or approval
process, nor does it prevent competitors from obtaining approval of the same product candidate as ours for indications other than those
in which we have been granted orphan drug designation.
We
may seek a breakthrough therapy designation for one or more of our other product candidates, we might not receive such designation, and
even if we do, such designation may not lead to a faster development or regulatory review or approval process.
We
may seek a breakthrough therapy designation for one or more of our other product candidates. A breakthrough therapy is defined as a drug
that is intended, alone or in combination with one or more other drugs, to treat a serious condition, and preliminary clinical evidence
indicates that the drug may demonstrate substantial improvement over existing therapies on one or more clinically significant endpoints,
such as substantial treatment effects observed early in clinical development. For drugs and biologics that have been designated as breakthrough
therapies, interaction and communication between the FDA and the sponsor of the trial can help to identify the most efficient path for
clinical development while minimizing the number of patients placed in ineffective control regimens. Drugs designated as breakthrough
therapies by the FDA may also be eligible for priority review if supported by clinical data at the time the NDA is submitted to the FDA.
Designation as a breakthrough therapy is within the discretion of the FDA. Accordingly, even if we believe that one of our product candidates
meets the criteria for designation as a breakthrough therapy, the FDA may disagree and instead determine not to make such designation.
Even if we receive breakthrough therapy designation, the receipt of such designation for a product candidate may not result in a faster
development or regulatory review or approval process compared to drugs considered for approval under conventional FDA procedures and
does not assure ultimate approval by the FDA. In addition, even if one or more of our product candidates qualify as breakthrough therapies,
the FDA may later decide that the product candidates no longer meet the conditions for qualification or decide that the time period for
FDA review or approval will not be shortened.
We
may seek priority review designation for one or more of our other product candidates, but we might not receive such designation, and
even if we do, such designation may not lead to a faster development or regulatory review or approval process.
If
the FDA determines that a product candidate offers a treatment for a serious condition and, if approved, the product would provide a
significant improvement in safety or effectiveness, the FDA may designate the product candidate for priority review. A priority review
designation means that the goal for the FDA to review an application is six months, rather than the standard review period of ten months.
We may request priority review for our product candidates. The FDA has broad discretion with respect to whether or not to grant priority
review status to a product candidate, so even if we believe a particular product candidate is eligible for such designation or status,
the FDA may decide not to grant it. Moreover, a priority review designation does not necessarily mean a faster development or regulatory
review or approval process or necessarily confer any advantage with respect to approval compared to conventional FDA procedures. Receiving
priority review from the FDA does not guarantee approval within the six-month review cycle or at all.
Risks
Related to Third Parties
We
may rely on third parties to conduct our non-clinical studies and our clinical studies. If these third parties do not perform as contractually
required or expected, we may not be able to select product candidates or obtain market acceptance for our product candidates, if any,
or we may be delayed in doing so.
We
often rely on third parties, such as CROs, medical institutions, academic institutions, clinical investigators and contract laboratories,
to conduct our clinical studies. We are responsible for confirming that our clinical studies are conducted in accordance with applicable
regulations and in accordance with its general investigational plan and protocol. Our reliance on third parties does not relieve us of
these responsibilities. If the third parties conducting our clinical studies do not perform their contractual duties or obligations,
do not meet expected deadlines, fail to comply with Good clinical practice (GCP), do not adhere to our clinical study protocols
or otherwise fail to generate reliable clinical data, we may need to enter into new arrangements with alternative third parties and our
clinical study may be more costly than expected or budgeted, extended, delayed or terminated or may need to be repeated, and we may not
be able to obtain regulatory approval for or commercialize the target molecules or product candidates, if any, tested in such studies.
We
may explore strategic collaborations that may never materialize or may fail.
We
may, in the future, periodically explore a variety of possible strategic collaborations including international distributors and partners,
in an effort to gain access to new product candidates or resources. At the current time, we cannot predict what form such a strategic
collaboration might take. We are likely to face significant competition in seeking appropriate strategic collaborators, and these strategic
collaborations can be complicated and time-consuming to negotiate and document. We may not be able to negotiate strategic collaborations
on acceptable terms, or at all. We are unable to predict when, if ever, we will enter into any additional strategic collaborations because
of the numerous risks and uncertainties associated with establishing strategic collaborations.
Risks
Related to Our Intellectual Property
If
we are unable to protect our proprietary rights or to defend against infringement claims, we may not be able to compete effectively or
operate profitably.
Our
success will depend, in part, on our ability to obtain patents, operate without infringing the proprietary rights of others and maintain
trade secrets, both in the United States and other countries. Patent matters in the biotechnology and pharmaceutical industries can be
highly uncertain and involve complex legal and factual questions. Accordingly, the validity, breadth and enforceability of our patents
and the existence of potentially blocking patent rights of others cannot be predicted, either in the United States or in other countries.
There
can be no assurance that we will discover or develop patentable products or processes or that patents will issue from any of the currently
pending patent applications or that claims granted on issued patents will be sufficient to protect our technology or adequately cover
the actual products we may actually sell. Potential competitors or other researchers in the field may have filed patent applications,
been issued patents, published articles or otherwise created prior art that could restrict or block our efforts to obtain additional
patents. There also can be no assurance that our issued patents or pending patent applications, if issued, will not be challenged, invalidated,
rendered unenforceable or circumvented or that the rights granted hereunder will provide us with proprietary protection or competitive
advantages. Our patent rights also depend on our compliance with technology and patent licenses upon which our patent rights are based
and upon the validity of assignments of patent rights from consultants and other inventors that were, or are, not employed by us.
In
addition, competitors may manufacture and sell our potential products in those foreign countries where we have not filed for patent protection
or where patent protection may be unavailable, not obtainable or ultimately not enforceable. In addition, even where patent protection
is obtained, third-party competitors may challenge our patent claims in the various patent offices, for example via opposition in the
European Patent Office or reexamination or interference proceedings in the United States Patent and Trademark Office, or USPTO. The ability
of such competitors to sell such products in the United States or in foreign countries where we have obtained patents is usually governed
by the patent laws of the countries in which the product is sold.
We
will incur significant ongoing expenses in maintaining our patent portfolio. Should we lack the funds to maintain our patent portfolio
or to enforce our rights against infringers, we could be adversely impacted. Even if claims of infringement are without merit, any such
action could divert the time and attention of management and impair our ability to access additional capital and/or cost us significant
funds to defend.
Intellectual
property rights do not necessarily address all potential threats to our competitive advantage.
The
degree of future protection afforded by our intellectual property rights is uncertain because intellectual property rights have limitations,
and may not adequately protect our business, or permit us to maintain our competitive advantage. The following examples are illustrative:
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Others
may be able to make compounds that are similar to our product candidates but that are not covered by the claims of the patents that
we own or have exclusively licensed. |
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We
or our licensors or strategic collaborators might not have been the first to make the inventions covered by the issued patent or
pending patent application that we own or have exclusively licensed. |
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We
or our licensors or strategic collaborators might not have been the first to file patent applications covering certain of our inventions.
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Others
may independently develop similar or alternative technologies or duplicate any of our technologies without infringing our intellectual
property rights. |
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It
is possible that our pending patent applications will not lead to issued patents. |
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Issued
patents that we own or have exclusively licensed may not provide us with any competitive advantages, or may be held invalid or unenforceable,
as a result of legal challenges by our competitors. |
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Our
competitors might conduct research and development activities in countries where we do not have patent rights and then use the information
learned from such activities to develop competitive products for sale in our major commercial markets. |
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We
may not develop additional proprietary technologies that are patentable. |
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The
patents of others may have an adverse effect on our business. |
Should
any of these events occur, they could significantly harm our business, results of operations and prospects.
Patent
reform legislation could increase the uncertainties and costs surrounding the prosecution of our patent applications and the enforcement
or defense of our issued patents.
On
September 16, 2011, the Leahy-Smith America Invents Act, or the Leahy-Smith Act, was signed into law. The Leahy-Smith Act includes a
number of significant changes to U.S. patent law. These include provisions that affect the way patent applications will be prosecuted
and may also affect patent litigation. The USPTO is currently developing regulations and procedures to govern administration of the Leahy-Smith
Act, and many of the substantive changes to patent law associated with the Leahy-Smith Act will not become effective until one year or
18 months after its enactment. Accordingly, it is not clear what, if any, impact the Leahy-Smith Act will have on the operation of our
business, our current and pending patent portfolio and future intellectual property strategy. However, the Leahy-Smith Act and its implementation
could increase the uncertainties and costs surrounding the prosecution of our patent applications and the enforcement or defense of our
issued patents, all of which could have a material adverse effect on our business and financial condition.
We
may be subject to litigation with respect to the ownership and use of intellectual property that will be costly to defend or pursue and
uncertain in its outcome.
Our
success also will depend, in part, on our refraining from infringing patents or otherwise violating intellectual property owned or controlled
by others. Pharmaceutical companies, biotechnology companies, universities, research institutions and others may have filed patent applications
or have received, or may obtain, issued patents in the United States or elsewhere relating to aspects of our technology. It is uncertain
whether the issuance of any third-party patents will require us to alter our products or processes, obtain licenses, or cease certain
activities. Some third-party applications or patents may conflict with our issued patents or pending applications. Any such conflict
could result in a significant reduction of the scope or value of our issued or licensed patents.
In
addition, if patents issued to other companies contain blocking, dominating or conflicting claims and such claims are ultimately determined
to be valid, we may be required to obtain licenses to these patents or to develop or obtain alternative non-infringing technology and
cease practicing those activities, including potentially manufacturing or selling any products deemed to infringe those patents. If any
licenses are required, there can be no assurance that we will be able to obtain any such licenses on commercially favorable terms, if
at all, and if these licenses are not obtained, we might be prevented from pursuing the development and commercialization of certain
of our potential products. Our failure to obtain a license to any technology that we may require to commercialize our products on favorable
terms may have a material adverse impact on our business, financial condition and results of operations.
Litigation,
which could result in substantial costs to us (even if determined in our favor), may also be necessary to enforce any patents issued
or licensed to us or to determine the scope and validity of the proprietary rights of others. The FDA has only recently published draft
guidance documents for implementation of the Biologics Price Competition and Innovation Act (BPCIA) under the PPACA, related to the development
of follow-on biologics (biosimilars), and detailed guidance for patent litigation procedures under this act has not yet been provided.
If another company files for approval to market a competing follow-on biologic, and/or if such approval is given to such a company, we
may be required to promptly initiate patent litigation to prevent the marketing of such biosimilar version of our product prior to the
normal expiration of the patent. There can be no assurance that our issued or licensed patents would be held valid by a court of competent
jurisdiction or that any follow-on biologic would be found to infringe our patents.
In
addition, if our competitors file or have filed patent applications in the United States that claim technology also claimed by us, we
may have to participate in interference proceedings to determine priority of invention. These proceedings, if initiated by the USPTO,
could result in substantial costs to us, even if the eventual outcome is favorable to us. Such proceedings can be lengthy, are costly
to defend and involve complex questions of law and fact, the outcomes of which are difficult to predict. Moreover, we may have to participate
in post-grant proceedings or third-party ex parte or inter partes reexamination proceedings under the USPTO. An adverse outcome with
respect to a third-party claim or in an interference proceeding could subject us to significant liabilities, require us to license disputed
rights from third parties, or require us to cease using such technology, any of which could have a material adverse effect on our business,
financial condition and results of operations.
The
patent protection and patent prosecution for some of our target molecules and product candidates, if any, is dependent or may be dependent
in the future on third parties.
While
we normally seek and gain the right to fully prosecute the patents relating to our target molecules and product candidates, if any, there
may be times when platform technology patents or product-specific patents that relate to the target molecules or product candidates are
controlled by our licensors. In addition, our licensors and/or licensees may have back-up rights to prosecute patent applications in
the event that we do not do so or choose not to do so, and our licensees may have the right to assume patent prosecution rights after
certain milestones are reached. If any of our licensing collaborators fails to appropriately prosecute and maintain patent protection
for patents covering any of our product candidates, our ability to develop and commercialize those product candidates may be adversely
affected and we may not be able to prevent competitors from making, using and selling competing products.
We
have licensed, or will license, from third parties certain technology necessary to develop and commercialize its therapeutics. If these
licenses terminate, or if these third parties do not comply with the terms of the license, or if the underlying licensed patents are
found to be invalid, our business could be negatively impacted.
We
have licensed, or will license, from third parties, technology necessary to research, develop and commercialize our product candidiates.
In return for the use of their technology, we have paid or agreed, or will agree, to pay the licensor certain fees. We may need to license
additional technology to in the future. If these licenses terminate, if the licensors fail to abide by the terms of the license or fail
to prevent infringement by third parties, if the licensed patents or other rights are found to be invalid or if we are unable to enter
into necessary licenses on acceptable terms, our business could be negatively impacted.
We
may become involved in lawsuits to protect or enforce our patents or other intellectual property, which could be expensive, time consuming
and unsuccessful.
Competitors
may infringe our patents, trademarks, copyrights or other intellectual property. To counter infringement or unauthorized use, we may
be required to file infringement claims, which can be expensive and time consuming and divert the time and attention of our management
and scientific personnel. Any claims we assert against perceived infringers could provoke these parties to assert counterclaims against
us alleging that we infringe their patents, in addition to counterclaims asserting that our patents are invalid or unenforceable, or
both. In any patent infringement proceeding, there is a risk that a court will decide that a patent of ours is invalid or unenforceable,
in whole or in part, and that we do not have the right to stop the other party from using the invention at issue. There is also a risk
that, even if the validity of such patents is upheld, the court will construe the patent’s claims narrowly or decide that we do
not have the right to stop the other party from using the invention at issue on the grounds that our patent claims do not cover the invention.
An adverse outcome in a litigation or proceeding involving our patents could limit our ability to assert our patents against those parties
or other competitors, and may curtail or preclude our ability to exclude third parties from making and selling similar or competitive
products. Any of these occurrences could adversely affect our competitive business position, business prospects and financial condition.
Similarly, if we assert trademark infringement claims, a court may determine that the marks we have asserted are invalid or unenforceable,
or that the party against whom we have asserted trademark infringement has superior rights to the marks in question. In this case, we
could ultimately be forced to cease use of such trademarks.
Even
if we establish infringement, the court may decide not to grant an injunction against further infringing activity and instead award only
monetary damages, which may or may not be an adequate remedy. Furthermore, because of the substantial amount of discovery required in
connection with intellectual property litigation, there is a risk that some of our confidential information could be compromised by disclosure
during litigation. There could also be public announcements of the results of hearings, motions or other interim proceedings or developments.
If securities analysts or investors perceive these results to be negative, it could have a material adverse effect on the price of shares
of our common stock. Moreover, there can be no assurance that we will have sufficient financial or other resources to file and pursue
such infringement claims, which typically last for years before they are concluded. Even if we ultimately prevail in such claims, the
monetary cost of such litigation and the diversion of the attention of our management and scientific personnel could outweigh any benefit
we receive as a result of the proceedings.
We
may rely on trade secret and proprietary know-how which can be difficult to trace and enforce and, if we are unable to protect the confidentiality
of our trade secrets, our business and competitive position would be harmed.
We
also rely on trade secrets to protect technology, especially where patent protection is not believed to be appropriate or obtainable
or where patents have not issued. For example, our manufacturing process involves many trade secret steps, processes, and conditions.
Trade secrets and know-how can be difficult to protect. We attempt to protect our proprietary technology and processes, in part, with
confidentiality agreements and assignment of invention agreements with our employees and confidentiality agreements with our consultants
and certain contractors. Despite these efforts, any of these parties may breach the agreements and disclose our proprietary information,
including our trade secrets, and we may not be able to obtain adequate remedies for such breaches. Any disclosure, either intentional
or unintentional, by our employees, the employees of third parties with whom we share our facilities or third party consultants and vendors
that we engage to perform research, clinical studies or manufacturing activities, or misappropriation by third parties (such as through
a cybersecurity breach) of our trade secrets or proprietary information could enable competitors to duplicate or surpass our technological
achievements, thus eroding our competitive position in our market.
Enforcing
a claim that a party illegally disclosed or misappropriated a trade secret is difficult, expensive and time-consuming, and the outcome
is unpredictable. In addition, some courts inside and outside the United States are less willing or unwilling to protect trade secrets.
If any of our trade secrets were to be lawfully obtained or independently developed by a competitor or other third party, we would have
no right to prevent them from using that technology or information to compete with us. If any of our trade secrets were to be disclosed
to or independently developed by a competitor or other third party, our competitive position would be harmed.
There
can be no assurance that these agreements are valid and enforceable, will not be breached, that we would have adequate remedies for any
breach, or that our trade secrets will not otherwise become known or be independently discovered by competitors. We may fail in certain
circumstances to obtain the necessary confidentiality agreements or assignment of invention agreements, or their scope or term may not
be sufficiently broad to protect our interests or transfer adequate rights to us.
If
our trade secrets or other intellectual property become known to our competitors, it could result in a material adverse effect on our
business, financial condition and results of operations. To the extent that we or our consultants or research collaborators use intellectual
property owned by others in work for us, disputes may also arise as to the rights to related or resulting know-how and inventions.
We
may not be able to protect our intellectual property rights throughout the world.
Patents
are of national or regional effect, and filing, prosecuting and defending patents on all of our product candidates throughout the world
would be prohibitively expensive. As such, we may not be able to prevent third parties from practicing our inventions in all countries
outside the United States, or from selling or importing products made using our inventions in and into the United States or other jurisdictions.
Further, the legal systems of certain countries, particularly certain developing countries, do not favor the enforcement of patents and
other intellectual property protection, particularly those relating to pharmaceuticals or biologics, which could make it difficult for
us to stop the infringement of our patents or marketing of competing products in violation of our proprietary rights generally. In addition,
certain developing countries, including China and India, have compulsory licensing laws under which a patent owner may be compelled to
grant licenses to third parties. In those countries, we and our licensors may have limited remedies if patents are infringed or if we
or our licensors are compelled to grant a license to a third party, which could materially diminish the value of those patents. This
could limit our potential revenue opportunities. Accordingly, our efforts to enforce our intellectual property rights around the world
may be inadequate to obtain a significant commercial advantage from the intellectual property that we develop or license.
Patent
terms may be inadequate to protect our competitive position on our product candidates for an adequate amount of time.
Patent
rights are of limited duration. Given the amount of time required for the development, testing and regulatory review of new product candidates,
patents protecting such candidates might expire before or shortly after such product candidates are commercialized. Even if patents covering
our product candidates are obtained, once the patent life has expired for a product, we may be open to competition from biosimilar or
generic products. A patent term extension based on regulatory delay may be available in the United States. However, only a single patent
can be extended for each marketing approval, and any patent can be extended only once, for a single product. Moreover, the scope of protection
during the period of the patent term extension does not extend to the full scope of the claim, but instead only to the scope of the product
as approved. Laws governing analogous patent term extensions in foreign jurisdictions vary widely, as do laws governing the ability to
obtain multiple patents from a single patent family. Additionally, we may not receive an extension if we fail to apply within applicable
deadlines, fail to apply prior to expiration of relevant patents or otherwise fail to satisfy applicable requirements. If we are unable
to obtain patent term extension or restoration, or the term of any such extension is less than we request, the period during which we
will have the right to exclusively market our product will be shortened and our competitors may obtain approval of competing products
following our patent expiration, and our revenue could be reduced, possibly materially.
We
may be subject to claims by third parties asserting that our employees or we have misappropriated their intellectual property or claiming
ownership of what we regard as our own intellectual property.
Some
of our employees and our licensors’ employees, including our senior management, were previously employed at universities or at
other biotechnology or pharmaceutical companies, including our competitors or potential competitors. Some of these employees may have
executed proprietary rights, non-disclosure and non-competition agreements, or similar agreements, in connection with such previous employment.
Although we try to ensure that our employees do not use the proprietary information or know-how of others in their work for us, we may
be subject to claims that we or these employees have used or disclosed intellectual property, including trade secrets or other proprietary
information, of any such third party. Litigation may be necessary to defend against such claims. If we fail in defending any such claims,
in addition to paying monetary damages, we may lose valuable intellectual property rights or personnel or sustain damages. Such intellectual
property rights could be awarded to a third party, and we could be required to obtain a license from such third party to commercialize
our technology or products. Such a license may not be available on commercially reasonable terms or at all. Even if we are successful
in defending against such claims, litigation could result in substantial costs and be a distraction to management.
In
addition, while we typically require our employees, consultants and contractors who may be involved in the development of intellectual
property to execute agreements assigning such intellectual property to us, we may be unsuccessful in executing such an agreement with
each party who in fact develops intellectual property that we regard as our own, which may result in claims by or against us related
to the ownership of such intellectual property. If we fail in prosecuting or defending any such claims, in addition to paying monetary
damages, we may lose valuable intellectual property rights. Even if we are successful in prosecuting or defending against such claims,
litigation could result in substantial costs and be a distraction to our senior management and scientific personnel.
Obtaining
and maintaining our patent protection depends on compliance with various procedural, document submissions, fee payment and other requirements
imposed by governmental patent agencies, and our patent protection could be reduced or eliminated for non-compliance with these requirements.
Periodic
maintenance fees on any issued patent are due to be paid to the USPTO and foreign patent agencies in several stages over the lifetime
of the patent. The USPTO and various foreign governmental patent agencies require compliance with a number of procedural, documentary,
fee payment and other similar provisions during the patent application process. While an inadvertent lapse can in many cases be cured
by payment of a late fee or by other means in accordance with the applicable rules, there are situations in which noncompliance can result
in abandonment or lapse of the patent or patent application, resulting in partial or complete loss of patent rights in the relevant jurisdiction.
Non-compliance events that could result in abandonment or lapse of a patent or patent application include, but are not limited to, failure
to respond to official actions within prescribed time limits, non-payment of fees and failure to properly legalize and submit formal
documents. If we fail to maintain the patents and patent applications covering our product candidates, our competitive position would
be adversely affected.
Risks
Relating to Litigation
We
are exposed to potential product liability or similar claims, and insurance against these claims may not be available to us at a reasonable
rate in the future.
Our
business exposes us to potential liability risks that are inherent in the testing, manufacturing and marketing of human therapeutic products.
Clinical trials involve the testing of product candidates on human subjects or volunteers under a research plan, and carry a risk of
liability for personal injury or death to patients due to unforeseen adverse side effects, improper administration of the product candidate,
or other factors. Many of these patients are already seriously ill and are therefore particularly vulnerable to further illness or death.
We
currently do not carry clinical trial liability insurance but we will need to once we begin clinical trials. There can be no assurance
that we will be able to obtain such insurance or that the amount of such insurance will be adequate to cover claims. We could be materially
and adversely affected if we were required to pay damages or incur defense costs in connection with a claim outside the scope of indemnity
or insurance coverage, if the indemnity is not performed or enforced in accordance with its terms, or if our liability exceeds the amount
of applicable insurance. In addition, there can be no assurance that insurance will continue to be available on terms acceptable to us,
if at all, or that if obtained, the insurance coverage will be sufficient to cover any potential claims or liabilities. Similar risks
would exist upon the commercialization or marketing of any products by us or our collaborators.
Regardless
of their merit or eventual outcome, product liability claims may result in:
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decreased
demand for our product; |
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injury
to our reputation and significant negative media attention; |
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withdrawal
of clinical trial volunteers; |
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costs
of litigation; |
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distraction
of management; and |
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substantial
monetary awards to plaintiffs. |
Should
any of these events occur, it could have a material adverse effect on our business and financial condition.
Information technology
security breaches and other disruptions could compromise our information and expose us to legal responsibility which would cause our business
and reputation to suffer.
We are increasingly dependent
on information technology systems and infrastructure, much of which is outsourced to third parties including on “cloud” based
platforms. We collect, store, and use sensitive or confidential data, including intellectual property, our proprietary business information
and that of our suppliers, and business partners. The secure maintenance of this information is critical to our operations and business
strategy. We are subject to laws and regulations in the United States and abroad, such as the Health Insurance Portability and Accountability
Act of 1996 and European Union regulations related to data privacy, which require us to protect the privacy and security of certain types
of information. Our information technology and infrastructure may be vulnerable to attacks by hackers, breached due to employee error,
malfeasance, or other disruptions, or subject to system failures. Because the techniques used to obtain unauthorized access, disable,
or degrade service, or sabotage systems change frequently and may be difficult to detect for long periods of time, we may be unable to
anticipate these techniques or implement adequate preventive measures. Any breaches or failures could compromise sensitive and confidential
information stored on our networks or those of third parties and expose such information to public disclosure, loss, or theft. Any actual
or alleged unauthorized access, disclosure or other loss of information could result in legal claims or proceedings, liability under laws
that protect the privacy of personal information, disruption of our operations, and damage to our reputation, any of which could adversely
affect our business, financial condition, or results of operations. Costs we may incur as a result of any of the foregoing, could adversely
affect our business, financial condition, or results of operations. Given the increasing use of conferencing technologies to conduct business
virtually in light of the COVID-19 pandemic, these cybersecurity risks are becoming more prevalent.
Risks
Relating to Our Stock
Our
common stock is deemed a “penny stock,” which would make it more difficult for our investors to sell their shares.
Our
common stock is subject to the “penny stock” rules adopted under Section 15(g) of the Exchange Act. The penny stock rules
generally apply to companies whose common stock is not listed on the NASDAQ Stock Market or other national securities exchange and trades
at less than $4.00 per share, other than companies that have had average revenue of at least $6,000,000 for the last three years or that
have tangible net worth of at least $5,000,000 ($2,000,000 if the company has been operating for three or more years). These rules require,
among other things, that brokers who trade penny stock to persons other than “established customers” complete certain documentation,
make suitability inquiries of investors and provide investors with certain information concerning trading in the security, including
a risk disclosure document and quote information under certain circumstances. Many brokers have decided not to trade penny stocks because
of the requirements of the penny stock rules and, as a result, the number of broker-dealers willing to act as market makers in such securities
is limited. If we remain subject to the penny stock rules for any significant period, it could have an adverse effect on the market,
if any, for our securities. If our securities are subject to the penny stock rules, investors will find it more difficult to dispose
of our securities.
We
have not paid cash dividends in the past and do not expect to pay dividends in the future. Any return on investment may be limited to
the value of our common stock.
We
have never paid cash dividends on our common stock and do not anticipate doing so in the foreseeable future. The payment of dividends
on our common stock will depend on earnings, financial condition and other business and economic factors affecting us at such time as
our board of directors may consider relevant. If we do not pay dividends, our common stock may be less valuable because a return on your
investment will only occur if our stock price appreciates.
The
price of our common stock may fluctuate substantially.
You
should consider an investment in our common stock to be risky, and you should invest in our common stock only if you can withstand a
significant loss and wide fluctuations in the market value of your investment. Some factors that may cause the market price of our common
stock to fluctuate, in addition to the other risks mentioned in this “Risk Factors” section and elsewhere in this prospectus,
are:
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sale
of our common stock by our stockholders, executives, and directors; |
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volatility
and limitations in trading volumes of our shares of common stock; |
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our
ability to obtain financings to conduct and complete research and development activities including, but not limited to, our human
clinical trials, and other business activities; |
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our
announcements or our competitors’ announcements regarding new products or services, enhancements, significant contracts, acquisitions
or strategic investments; |
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failures
to meet external expectations or management guidance; |
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changes
in our capital structure or dividend policy; |
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announcements
and events surrounding financing efforts, including debt and equity securities; |
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our
inability to enter into new markets or develop new products; |
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announcements
of acquisitions, partnerships, collaborations, joint ventures, new products, capital commitments, or other events by us or our competitors;
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changes
in general economic, political and market conditions in any of the regions in which we conduct our business; |
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changes
in industry conditions or perceptions; |
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changes
in valuations of similar companies or groups of companies; |
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analyst
research reports, recommendation and changes in recommendations, price targets, and withdrawals of coverage; |
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departures
and additions of key personnel; |
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disputes
and litigations related to contractual obligations; |
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changes
in applicable laws, rules, regulations, or accounting practices and other dynamics; or |
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other
events or factors, many of which may be out of our control. |
In
addition, if the market for stocks in our industry or industries related to our industry, or the stock market in general, experiences
a loss of investor confidence, the trading price of our common stock could decline for reasons unrelated to our business, financial condition
and results of operations. If any of the foregoing occurs, it could cause our stock price to fall and may expose us to lawsuits that,
even if unsuccessful, could be costly to defend and a distraction to management.
Our
ability to use our net operating loss carry-forwards and certain other tax attributes is limited by Sections 382 and 383 of the Internal
Revenue Code.
Net
operating loss carryforwards allow companies to use past year net operating losses to offset against future years’ profits, if
any, to reduce future tax liabilities. Sections 382 and 383 of the Internal Revenue Code of 1986 limit a corporation’s ability
to utilize its net operating loss carryforwards and certain other tax attributes (including research credits) to offset any future taxable
income or tax if the corporation experiences a cumulative ownership change of more than 50% over any rolling three-year period. State
net operating loss carryforwards (and certain other tax attributes) may be similarly limited. An ownership change can therefore result
in significantly greater tax liabilities than a corporation would incur in the absence of such a change and any increased liabilities
could adversely affect the corporation’s business, results of operations, financial condition and cash flow.
Even
if another ownership change has not occurred and does not occur as a result of this offering, additional ownership changes may occur
in the future as a result of additional equity offerings or events over which we will have little or no control, including purchases
and sales of our equity by our five percent security holders, the emergence of new five percent security holders, redemptions of our
securities or certain changes in the ownership of any of our five percent security holders.
Our
principal stockholders and management own a significant percentage of our stock and will be able to exercise significant influence over
matters subject to stockholder approval.
As
of September 30, 2021, our executive officers, directors and principal security holders, together with their respective affiliates, owned
approximately 51.1% of our outstanding securities. Accordingly, this group of security holders will be able to exert a significant degree
of influence over our management and affairs and over matters requiring security holder approval, including the election of our Board
of Directors, future issuances of our securities, declaration of dividends and approval of other significant corporate transactions.
This concentration of ownership could have the effect of delaying or preventing a change-of-control of our company or otherwise discouraging
a potential acquirer from attempting to obtain control of us, which in turn could have a material and adverse effect on the fair market
value of our securities. In addition, this significant concentration of share ownership may adversely affect the trading price for our
common stock if investors perceive disadvantages in owning stock in a company with such concentrated ownership.
U.S.
federal income tax reform could adversely affect us.
On December 22, 2017, former President Trump signed
into law the “Tax Cuts and Jobs Act” (TCJA) that significantly reforms the Internal Revenue Code of 1986, as amended. The
TCJA, among other things, includes changes to U.S. federal tax rates, imposes significant additional limitations on the deductibility
of interest, allows for the expensing of capital expenditures, and puts into effect the migration from a “worldwide” system
of taxation to a territorial system. The tax reform did not have a material impact to our projection of minimal cash taxes or to our net
operating losses. Our net deferred tax assets and liabilities are revalued at the newly enacted U.S. corporate rate, and the impact has
been recognized in our tax expense in the year of enactment. Further, any eligibility we may have or may someday have for tax credits
associated with the qualified clinical testing expenses arising out of the development of orphan drugs was reduced to 25% as a result
of the TCJA; thus, our net taxable income is affected. We continue to examine the impact this tax reform legislation may have on our business.
The impact of this tax reform on holders of our common stock is uncertain and could be adverse. This prospectus does not discuss any such
tax legislation or the way it might affect purchasers of our common stock. We urge our stockholders, including purchasers of common stock
in this offering, to consult with their legal and tax advisors with respect to such legislation and the potential tax consequences of
investing in our common stock.
In preparing our consolidated financial
statements, our management determined that our disclosure controls and procedures and internal controls were ineffective as of September
30, 2021 and if they continue to be ineffective could continue to result in material misstatements in our financial statements.
Our management is responsible for establishing
and maintaining adequate internal control over our financial reporting, as defined in Rule 13a-15(f) under the Securities Exchange
Act of 1934, as amended, or the Exchange Act. As of September 30, 2021, our management has determined that our disclosure controls and
procedures and internal controls were ineffective due to weaknesses in our financial closing process, inadequate
segregation of duties over authorization, review and recording of transactions, lack of accounting resources, as well as the financial
reporting of such transactions.
We
intend to implement remedial measures designed to address the ineffectiveness of our disclosure controls and procedures and internal
controls. If these remedial measures are insufficient to address the ineffectiveness of our disclosure controls and procedures and internal
controls, or if material weaknesses or significant deficiencies in our internal control are discovered or occur in the future and the
ineffectiveness of our disclosure controls and procedures and internal controls continues, we may fail to meet our future reporting obligations
on a timely basis, our consolidated financial statements may contain material misstatements, we could be required to restate our prior
period financial results, our operating results may be harmed, we may be subject to class action litigation, and our common stock could
be delisted. Any failure to address the ineffectiveness of our disclosure controls and procedures could also adversely affect the results
of the periodic management evaluations regarding the effectiveness of our internal control over financial reporting and our disclosure
controls and procedures that are required to be included in our annual report on Form 10-K. Internal control deficiencies and ineffective
disclosure controls and procedures could also cause investors to lose confidence in our reported financial information. We can give no
assurance that the measures we plan to take in the future will remediate the ineffectiveness of our disclosure controls and procedures
or that any material weaknesses or restatements of financial results will not arise in the future due to a failure to implement and maintain
adequate internal control over financial reporting or adequate disclosure controls and procedures or circumvention of these controls.
In addition, even if we are successful in strengthening our controls and procedures, in the future those controls, and procedures may
not be adequate to prevent or identify irregularities or errors or to facilitate the fair presentation of our consolidated financial
statements.
Future
sales and issuances of our common stock or rights to purchase common stock pursuant to our equity incentive plan could result in additional
dilution of the percentage ownership of our stockholders and could cause our share price to fall.
We
expect that significant additional capital will be needed in the future to continue our planned operations, including expanding research
and development, funding clinical trials, purchasing of capital equipment, hiring new personnel, commercializing our products, and continuing
activities as an operating public company. To the extent we raise additional capital by issuing equity securities, our stockholders may
experience substantial dilution. We may sell common stock, convertible securities or other equity securities in one or more transactions
at prices and in a manner, we determine from time to time. If we sell common stock, convertible securities or other equity securities
in more than one transaction, investors may be materially diluted by subsequent sales. Such sales may also result in material dilution
to our existing stockholders, and new investors could gain rights superior to our existing stockholders.
We
may be at risk of securities class action litigation.
We
may be at risk of securities class action litigation. This risk is especially relevant for us due to our dependence on positive clinical
trial outcomes and regulatory approvals of each of our product candidates. In the past, biotechnology and pharmaceutical companies have
experienced significant stock price volatility, particularly when associated with binary events such as clinical trials and product approvals.
If we face such litigation, it could result in substantial costs and a diversion of management’s attention and resources, which
could harm our business and results in a decline in the market price of our common stock.
Our
articles of incorporation and bylaws and Nevada law may have anti-takeover effects that could discourage, delay or prevent a change in
control, which may cause our stock price to decline.
Our
amended and restated articles of incorporation, our amended and restated bylaws and Nevada law could make it more difficult for a third
party to acquire us, even if closing such a transaction would be beneficial to our stockholders. Although we currently do not have shares
of preferred stock outstanding, our board of directors could authorize the issuance of a series of preferred stock that would grant holders
preferred rights to our assets upon liquidation, special voting rights, the right to receive dividends before dividends would be declared
to common stockholders, and the right to the redemption of such shares, possibly together with a premium, prior to the redemption of
the common stock. To the extent that we do issue preferred stock, the rights of holders of common stock could be impaired thereby, including
without limitation, with respect to liquidation.
Provisions
of our bylaws may also prevent or frustrate attempts by our stockholders to replace or remove our management. In particular, our bylaws,
among other things:
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provide
the board of directors with the ability to alter the bylaws without stockholder approval; and |
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provide
that vacancies on the board of directors may be filled by a majority of directors in office, although less than a quorum. |
Reports
published by securities or industry analysts, including projections in those reports that exceed our actual results, could adversely
affect our common stock price and trading volume.
Securities
research analysts, including those affiliated with our underwriters from this offering, establish and publish their own periodic projections
for our business. These projections may vary widely from one another and may not accurately predict the results we actually achieve.
Our stock price may decline if our actual results do not match securities research analysts’ projections. Similarly, if one or
more of the analysts who writes reports on us downgrades our stock or publishes inaccurate or unfavorable research about our business
or if one or more of these analysts ceases coverage of our company or fails to publish reports on us regularly, our stock price or trading
volume could decline. While we expect securities research analyst coverage to continue going forward, if no securities or industry analysts
begin to cover us, the trading price for our stock and the trading volume could be adversely affected.