Item 2. Management’s Discussion and Analysis
ITEM
2: Management’s Discussion and Analysis of Financial Condition and Results of Operations
Special
Note Regarding Forward-Looking Statements
Certain
statements in this Report contain forward-looking statements within the meaning of Section 27A of the Securities Act and Section 21E
of the Exchange Act. All statements, other than statements of historical fact, included or incorporated herein regarding our
strategy, future operations, financial position, future revenues, projected costs, plans, prospects and objectives are
forward-looking statements. Words such as “expect,” “anticipate,” “intend,” “plan,”
“believe,” “seek,” “estimate,” “think,” “may,” “could,”
“will,” “would,” “should,” “continue,” “potential,”
“likely,” “opportunity” and similar expressions or variations of such words are intended to identify
forward-looking statements but are not the exclusive means of identifying forward-looking statements and their absence does not mean
that a statement is not forward-looking. Our forward-looking statements are not guarantees of performance, and actual results could
vary materially from those contained in or expressed by such statements due to risks and uncertainties. These statements are based
on our management’s current beliefs, expectations and assumptions about future events, conditions and results and on
information currently available to us. Discussions containing these forward-looking statements may be found, among other places,
below in this Item 2: “Management’s Discussion and Analysis of Financial Condition and Results of Operations” and
in Part II: Other information: Item 1A: “Risk Factors” of this report, and the following sections of our Annual Report
on Form 10-K for the year ended December 31, 2023: Part I; Item 1. “Business”, Part I; Item 1A. “Risk
Factors”, Part I; Item 3. “Legal Proceedings”, and Part I; Item 2. “Management’s Discussion and
Analysis of Financial Condition and Results of Operations” of this Report. Among other things, for those statements, we claim
the protection of safe harbor for forward-looking statements contained in the Private Securities Litigation Reform Act of 1995. Any
forward-looking statements set forth in this presentation speak only as of the date of this presentation. We do not undertake to
update any of these forward-looking statements to reflect events or circumstances that occur after the date hereof. We are in
various stages of seeking to determine whether Ampligen® will be effective in the treatment of multiple types of viral diseases,
cancers, and immune-deficiency disorders and the presentation sets forth our current and anticipated future activities. These
activities are subject to change for a number of reasons. Significant additional testing and trials will be required to determine
whether Ampligen® will be effective in the treatment of these conditions. Results obtained in animal models do
not necessarily predict results in humans. Human clinical trials will be necessary to prove whether or not Ampligen® will be
efficacious in humans. No assurance can be given as to whether current or planned clinical trials will be successful or yield
favorable data and the trials are subject to many factors including lack of regulatory approval(s), lack of study drug, or a change
in priorities at the institutions sponsoring other trials. Even if these clinical trials are initiated, we cannot assure that the
clinical studies will be successful or yield any useful data or require additional funding. Among the studies are clinical trials
that provide only preliminary data with a small number of subjects, and no assurance can be given that the findings in these studies
will prove true or that the study or studies will yield favorable results. Some of the world’s largest pharmaceutical
companies and medical institutions are working on a treatment for COVID-19. Even if Ampligen® proves effective in combating the
virus, no assurance can be given that our actions toward proving this will be given first priority or that another treatment that
eventually proves capable will not make our efforts ultimately unproductive, as multiple vaccines, and some treatments, are now
available and major pharma companies are working to develop their own disease treatments. Some of the world’s largest
pharmaceutical companies are also working on treatments and cures for different types of cancers. No assurance can be given that the
use of Ampligen with these proposed treatments and cures will prove effective. No assurance can be given that future studies will
not result in findings that are different from those reported in the studies referenced or incorporated by reference herein.
Operating in foreign countries carries with it a number of risks, including potential difficulties in enforcing intellectual
property rights. In addition, many countries, including Argentina, are still dealing with COVID-19 outbreaks and have made that
their primary focus. We believe that this may be delaying our commercialization of Ampligen® in Argentina until COVID-19 is more
under control. We cannot assure that our potential foreign operations will not be adversely affected by these risks. No assurance can be given that we will be able to raise additional equity or other financing pursuant to the ATM,
Atlas Equity Line or otherwise.
Our
filings are available at www.aimimmuno.com. The information found on our website is not incorporated by reference into this Report and
is included for reference purposes only.
We
operate in an evolving environment. New risk factors and uncertainties emerge from time to time, and it is not possible for our management
to predict all risk factors and uncertainties, nor are we able to assess the impact of all of these risk factors on our business or the
extent to which any risk factor, or combination of risk factors, may cause actual results to differ materially from those contained in
any forward-looking statements.
Given
these uncertainties, you are cautioned not to place undue reliance on such forward-looking statements. We disclaim any obligation to
update any such factors or to publicly announce the result of any revisions to any of the forward-looking statements contained herein
to reflect future events or developments.
24
Overview
General
AIM
ImmunoTech Inc. and its subsidiaries (collectively, “AIM”, “Company”, “we”, “us” or “our”)
are an immuno-pharma company headquartered in Ocala, Florida, focused on the research and development of therapeutics to treat multiple
types of cancers, viral diseases and immune-deficiency disorders. We have established a strong foundation of laboratory, pre-clinical
and clinical data with respect to the development of nucleic acids and natural interferon to enhance the natural antiviral defense system
of the human body, and to aid the development of therapeutic products for the treatment of certain cancers and chronic diseases.
Our
flagship products are Ampligen (rintatolimod) and Alferon N Injection (Interferon alfa). Ampligen is a double-stranded RNA (“dsRNA”)
molecule being developed for globally important cancers, viral diseases and disorders of the immune system. Ampligen has not been approved
by the FDA or marketed in the United States but is approved for commercial sale in the Argentine Republic for the treatment of severe
Chronic Fatigue Syndrome (“CFS”).
We
are currently proceeding primarily in four areas:
● Conducting
clinical trials to evaluate the efficacy and safety of Ampligen for the treatment of pancreatic
cancer.
● Evaluating
Ampligen across multiple cancers as a potential therapy that modifies the tumor microenvironment
with the goal of increasing anti-tumor responses to checkpoint inhibitors.
● Exploring
Ampligen’s antiviral activities and potential use as a prophylactic or treatment for
existing viruses, new viruses and mutated viruses thereof.
● Evaluating
Ampligen as a treatment for myalgic encephalomyelitis/chronic fatigue syndrome (“ME/CFS”)
and fatigue and/or the Post-COVID condition of fatigue.
We
are prioritizing activities in an order related to the stage of development, with those clinical activities such as pancreatic cancer,
ME/CFS and Post-COVID conditions having priority over antiviral experimentation. We intend that priority clinical work be conducted in
trials authorized by the Food and Drug Administration (“FDA”) or European Medicines Agency (“EMA”), which trials
support a potential future NDA. However, our antiviral experimentation is designed to accumulate additional preliminary data supporting
their hypothesis that Ampligen is a powerful, broad-spectrum prophylaxis and early-onset therapeutic that may confer enhanced immunity
and cross-protection. Accordingly, we will conduct antiviral programs in those venues most readily available and able to generate valid
proof-of-concept data, including foreign venues.
Please
see “Immuno-Oncology” below.
Immuno-Oncology .
We
are focused on pancreatic cancer because testing results, to date, primarily conducted in the Netherlands, have been very promising.
The Netherlands study generated statistically significant data indicating that Ampligen extended survival well beyond the Standard of
Care (“SOC”), when compared to well-matched historical controls. These data support the proposition that Ampligen, when administered
to either patients with locally advanced or metastatic pancreatic cancer after systemic chemotherapy showed a statistically significant
increase in survival rate. In October 2021, we and our Contract Research Organization, Amarex, submitted an Investigational New Drug
(“IND”) application to the FDA for a planned Phase 2 study of Ampligen as a therapy for locally advanced or metastatic late-stage
pancreatic cancer.
25
Because
of the differences in the scale of necessary trials, our initial primary focus when it comes to pancreatic cancer will be cases that
are locally advanced, rather than metastatic. The number of different approaches to treating metastatic pancreatic cancer — approaches
which would be determined by treating physicians — would require a much larger, far more expensive trial than a trial for
locally advanced pancreatic cancer. Therefore, we are focusing on patients who have completed FOLFIRINOX and have stable disease. In
August 2022, we received Institutional Review Board (“IRB”) approval of the trial protocol in locally advanced pancreatic
cancer and announced the trial’s commencement. The study is recruiting patients. Assuming this trial and subsequent planned
clinical trials confirm the existing data, our goal is to then submit an NDA for use of Ampligen in pancreatic cancer patients.
Ampligen
has also demonstrated in the clinic the potential for standalone efficacy in a number of other solid tumors. We have also seen success
in increasing survival rates and efficacy in the treatment of animal tumors when Ampligen is used in combination with checkpoint blockade
therapies. In fact, in March 2022 we announced interim data from an investigator-initiated, Phase 2, single-arm, efficacy/safety trial
to evaluate the effectiveness of combining intensive locoregional intraperitoneal (IP) chemoimmunotherapy of cisplatin with IP Ampligen
(TLR-3 agonist) and IV infusion of the checkpoint inhibitor pembrolizumab for patients with recurrent platinum-sensitive ovarian cancer.
We believe that data from the study, which is being conducted by the University of Pittsburgh Medical Center and funded by a Merck grant,
demonstrated that when combining three drugs – Ampligen and pembrolizumab, which are both immune therapies, with cisplatin, a chemotherapy
– evidence of increased biomarkers associated with T cell chemotaxis and cytolytic function has been seen. Importantly, increases
of these biomarkers in the tumor microenvironment have been correlated with favorable tumor responses. These successes in the field of
immuno-oncology have guided our efforts toward the potential use of Ampligen as a combinational therapy for the treatment of a variety
of solid tumor types. The first of our patent applications in this space was granted by the Netherlands on March 15, 2021.
Please
see “ Immuno-Oncology ” below.
Ampligen
as a Potential Antiviral
We
have a research and pre-clinical history that indicates broad-spectrum antiviral capability of Ampligen in animals. We hope to demonstrate
that it has the same effect in humans. To do this, among other things, we need a population infected with a virus. That is why we have
spent significant resources on COVID-19 (the disease caused by SARS-CoV-2) which is active and still infecting many subjects. While much
would need to be done to get Ampligen to market as a broad-spectrum antiviral, we believe that it is important to focus our efforts first
and foremost on thoroughly proving the concept, especially while there is still a large COVID-19-infected population. Previously, animal
studies were conducted that yielded positive results utilizing Ampligen to treat numerous viruses, such as Western Equine Encephalitis
Virus, Ebola, Vaccinia Virus (which is used in the manufacture of smallpox vaccine) and SARS-CoV-1. We have conducted experiments in
SARS-CoV-2 showing Ampligen has a powerful impact on viral replication. The prior studies of Ampligen in SARS-CoV-1 animal experimentation
may predict similar protective effects against SARS-CoV-2.
The
FDA has requested that we provide additional data to assist the agency in evaluating the potential risks and benefits of administering
Ampligen to asymptomatic and mild COVID-19 individuals. However, as discussed in more detail below, where the threat to the patient from
COVID-19 is high, the FDA has already authorized Ampligen in a clinical trial of patients with COVID-19 who have a pre-existing cancer, although this study is currently suspended.
We have also elected to explore studies (initially with healthy volunteers) outside the United States and have already conducted a study
in the Netherlands to determine the safety profile of the intranasal delivery of Ampligen.
In
this regard, CHDR, a foundation located in Leiden in the Netherlands, managed a Phase 1 randomized, double-blind study for us to evaluate
the safety, tolerability, and biological activity of repeated administration of Ampligen intranasally. A total of 40 healthy subjects
received either Ampligen or a placebo in the trial, with the Ampligen given at four escalating dosages across four cohorts, to a maximum
level of 1,250 micrograms. The study was completed, and the Final Safety Report reported no Serious or Severe Adverse Events at any dosage
level.
While
there are approved therapies for COVID-19, we believe that, if Ampligen has the broad-spectrum antiviral properties that we believe that
it has, it could be a very valuable tool in treating variants of existing viral diseases, including COVID-19, or novel ones that arise
in the future. Unlike most developing therapeutics which attack the virus, Ampligen works differently. We believe that it activates antiviral
immune system pathways that fight not just a particular virus or viral variant, but other similar viruses as well.
Please
see “ Ampligen as a Potential Antiviral ” below.
Ampligen
as a Treatment for Post-COVID Conditions
In
July 2023, we enrolled and dosed the first patient in our Phase 2 study evaluating Ampligen® as a potential therapeutic for people
with post-COVID conditions (“AMP-518”). We announced in August 2023 that the study had met the planned enrollment of 80 subjects
ages 18 to 60 years who have been randomized 1:1 to receive twice-weekly intravenous infusions of Ampligen or placebo for 12 weeks, with
a follow-up phase of two weeks. All patients have completed the study, with topline data reported in February 2024 and an analysis of
complete patient clinical data reported in January 2024.
26
Please see “Ampligen as a Treatment for Post-COVID Conditions” below.
Ampligen
as a treatment for ME/CFS and Post-COVID Conditions
We
have long been focused on seeking the FDA’s approval for the use of Ampligen to treat myalgic encephalomyelitis/chronic fatigue
syndrome (“ME/CFS”). In fact, in February 2013, we received a Complete Response letter (“CRL”) from the FDA for
our Ampligen NDA for ME/CFS, stating that we should conduct at least one additional clinical trial, complete various nonclinical studies
and perform a number of data analyses.
While
developing a comprehensive response to the FDA and a plan for a confirmatory trial for the FDA NDA, we proceeded independently in Argentina
and, in August 2016, we received approval of an NDA from ANMAT for commercial sale of Ampligen in the Argentine Republic for the treatment
of severe CFS. In September 2019, we received clearance from the FDA to ship Ampligen to Argentina for the commercial launch and subsequent
sales. On June 10, 2020, we received import clearance from ANMAT to import the first shipment of commercial grade vials of Ampligen into
Argentina. The next steps in the commercial launch of Ampligen include ANMAT conducting a final inspection of the product and release
tests before granting final approval to begin commercial sales. This testing and approval process is ongoing due to ANMAT’s internal
processes. Once final approval by ANMAT is obtained, GP Pharm will be responsible for distributing Ampligen in Argentina.
The
FDA authorized an open-label treatment protocol (“AMP-511”) allowing patient access to Ampligen for treatment in a study
under which severely debilitated CFS patients have the opportunity to be on Ampligen to treat this very serious and chronic
condition. The data collected from the AMP-511 protocol through a consortium group of clinical sites provide safety information
regarding the use of Ampligen in patients with CFS. The AMP-511 protocol is ongoing. In October 2020, we received IRB approval for
the expansion of the AMP-511 protocol to include patients previously diagnosed with SARS-CoV-2 following clearance of the virus, but
who still demonstrate chronic fatigue-like symptoms that we refer to as Post-COVID conditions. As of September 30, 2024, there were
7 patients enrolled in this open-label, expanded access treatment protocol (including two patients with Post-COVID Conditions). To
date, there have been eight such Post-COVID patients treated in the study. AIM previously reported positive preliminary results
based on data from the first four Post-COVID Condition patients enrolled in the study. The data show that, by week 12, compared to
baseline, there was what the investigators considered a clinically significant decrease in fatigue-related measures.
We
plan on a comprehensive follow through with the FDA regarding the use of Ampligen as a treatment for ME/CFS. We have learned a great
deal since the FDA’s CRL and plan to adjust our approach to concentrate on specific ME/CFS symptoms. Responses to the CRL and a
proposed confirmatory trial are being worked on now by our R&D team and consultants.
Please
see “ Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) ” below.
Atlas
Equity Line of Credit
On
March 28, 2024, we entered into a purchase agreement (the “Purchase Agreement”) and a registration rights agreement (the
“Registration Rights Agreement”) with Atlas Sciences, LLC, a Utah limited liability company (“Atlas”), pursuant
to which Atlas has committed to purchase up to $15 million of our common stock. No assurance can be given as to the actual amount that will be raised pursuant to the Purchase Agreement.
Under
the terms and subject to the conditions of the Purchase Agreement, we have the right, but not the obligation, to sell to Atlas, and Atlas
is obligated to purchase up to $15 million of our common stock (the “Commitment Amount”). Such sales by us, if any, will
be subject to certain limitations, and may occur from time to time, at our sole discretion, over the 24-month period commencing on the
date that a registration statement covering the resale of shares that have been and may be issued under the Purchase Agreement. We agreed
to file the registration statement with the SEC pursuant to the Registration Rights Agreement. Sales could not commence until the registration
statement was declared effective by the SEC and a final prospectus in connection therewith is filed and the other conditions set forth
in the Purchase Agreement are satisfied. The registration statement was declared effective and the final prospectus was filed on May
1, 2024.
Atlas
has no right to require us to sell any shares to Atlas, but Atlas is obligated to make purchases as we direct, subject to certain conditions.
There are no upper limits on the price per share that Atlas must pay for shares of common stock. Actual sales of shares to Atlas will
depend on a variety of factors to be determined by us from time to time, including, among others, market conditions, the trading price
of the common stock and determinations by us as to the appropriate sources of funding for us and our operations.
The
net proceeds under the Purchase Agreement will depend on the frequency and prices at which we sell shares to Atlas. We expect that any
proceeds received by us will be used for working capital and general corporate purposes.
27
We
cannot sell shares below the Minimum Price (as defined by the NYSE American) under the Purchase Agreement that would represent, in the
aggregate, more than 19.99% of the outstanding shares on the date that the Purchase Agreement was executed. Before we could do that,
we would need to obtain stockholder approval.
We
have agreed with Atlas that we will not enter into any “variable rate” transactions with any third party for a period
defined in the Purchase Agreement. Atlas has covenanted not to cause or engage in any manner whatsoever, any direct or indirect
short selling or hedging of our shares. Pursuant to the purchase agreement, our ATM with Maxim Group is not deemed to be a variable
rate transaction.
As
consideration for Atlas’s irrevocable commitment to purchase shares upon the terms of and subject to satisfaction of the conditions
set forth in the Purchase Agreement, upon execution of the Purchase Agreement, we agreed to pay Atlas an initial commitment fee in shares
equal to 1.0% of the Commitment Amount. The initial commitment fee was paid upon execution of the Purchase Agreement through the issuance
of 338,600 shares of common stock.
The
Purchase Agreement and the Registration Rights Agreement contain customary representations, warranties, conditions and indemnification
obligations of the parties. We have the right to terminate the Purchase Agreement at any time, at no cost or penalty.
During
any period where bankruptcy, insolvency, reorganization or liquidation proceedings or other proceedings, voluntary or involuntary, for
relief under any bankruptcy law or any law for the relief of debtors shall be instituted or anticipated by or against us or any of our
subsidiaries, and in the case of such a proceeding being involuntary or commenced against us, which is not dismissed within 60 days,
we may not initiate any purchase of shares by Atlas.
The
representations, warranties and covenants contained in such agreements were made only for purposes of such agreements and as of specific
dates, were solely for the benefit of the parties to such agreements and may be subject to limitations agreed upon by the contracting
parties. The foregoing descriptions of the Agreements are qualified in their entirety by reference to the full text of these Agreements
which were filed as exhibits 10.104 and 10.105 to our 2023 Annual Report on Form 10-K.
Securities
Purchase Agreement
On
May 31, 2024, we entered into a Securities Purchase Agreement (the “Purchase Agreement”) to complete an offering (the “Transactions”)
with a single accredited investor (the “Purchaser”), pursuant to which we issued to the Purchaser, (i) in a registered
direct offering, 5,640,958 shares of our common stock (the “Shares”), par value $0.001 per share (“Common Stock”)
and (ii) in a concurrent private placement, we issued to the Purchaser Class A common warrants to purchase an aggregate of up to
5,640,958 shares of its common stock (the “A Warrants”) at an exercise price of $0.363 per share and Class B common warrants
to purchase an aggregate of up to 5,640,958 shares of its common stock (the “B “Warrants” and, along with the A Warrants,
the “Common Warrants”) at an exercise price of $0.363 per share. The A Warrants and B Warrants will not be exercisable for
six months after the issuance date and will expire, respectively, 24 months and five years and six months after the issuance date. The
Common Warrants and the shares of common stock issuable upon the exercise of such warrants are offered pursuant to an exemption from
the registration requirements of the Securities Act provided in Section 4(a)(2) of the Securities Act and Rule 506(b) promulgated thereunder.
We
received aggregate gross proceeds from the Transactions of approximately $2,047,688, before deducting fees to the Placement Agent and
other estimated offering expenses payable by us. The Shares are being offered by us pursuant to a shelf registration statement on Form
S-3 (File No. 333-262280), which was declared effective on February 4, 2022 (as amended from time to time, the “Registration Statement”).
Pursuant
to the terms of the Purchase Agreement, subject to certain exceptions, we could not issue any equity securities for 60 days following the
issuance date, provided that we are able to utilize the at-the-market offering program with the Placement Agent after 30 days.
Additionally, we cannot enter into a variable rate transaction (other than the ATM program with the Placement Agent) for 120 days after
the issuance date. In addition, our executive officers and each of our directors have entered into lock-up agreements with us pursuant
to which each of them has agreed not to, for a period of 90 days from the closing of the Transactions, offer, sell, transfer or otherwise
dispose of our securities, subject to certain exceptions.
The
exercise price of the Common Warrants, and the number of Common Warrant Shares, are subject to adjustment in the event of any stock
dividend or split, reverse stock split, recapitalization, reorganization or similar transaction, as described in the Common
Warrants. If a Fundamental Transaction (as defined in the Common Warrants) occurs, then the successor entity will succeed to, and be
substituted for us, and may exercise every right and power that we may exercise and will assume all of its obligations under the
Common Warrants with the same effect as if such successor entity had been named in the warrant itself. Common Warrant Holders will
have additional rights defined in the Common Warrants. The Common Warrants are exercisable on a “cashless” basis only if
there is not a current registration statement permitting public resale. In this regard, the Company filed a registration statement
to register the resale of the Common Warrant Shares. That registration statement was
declared effective by the SEC on July 11, 2024. The Company has agreed to use commercially reasonable efforts to keep such
registration statement effective at all times until no Purchaser owns any Warrants or Warrant Shares issuable upon exercise
thereof.
28
Maxim
Group LLC acted as the placement agent (the “Placement Agent”) on a “commercially reasonable best efforts”
basis, in connection with the Transactions pursuant to the Placement Agency Agreement, dated May 31, 2024 (the “Placement
Agency Agreement”), by and between us and the Placement Agent. Pursuant to the Placement Agency Agreement, the Placement Agent was paid a cash fee of 8% of the aggregate gross proceeds paid to the Company for the securities sold in
the Transactions and reimbursement of certain out-of-pocket expenses.
On
September 30, 2024, the Company entered into a Securities Purchase Agreement to complete an offering with a single accredited investor.
For more information see Note 15: Subsequent Events.
OUR
PRODUCTS
Our
primary pharmaceutical product platform consists of Ampligen (rintatolimod), a first-in-class drug of large macromolecular double-stranded
(ds) RNA (ribonucleic acid) molecules, and our FDA-approved natural alpha-interferon product, Alferon N Injection.
Ampligen
is approved for sale in Argentina (to 2026) for severe CFS and is an experimental drug in the United States currently undergoing
clinical development for the treatment of certain cancers, ME/CFS and Post-COVID Conditions. Over its developmental history, Ampligen has received various
designations, including Orphan Drug Product Designation (FDA and EMA), Treatment protocol (e.g., “Expanded Access” or
“Compassionate” use authorization) with Cost Recovery Authorization (FDA) and “promising” clinical outcome
recognition based on the evaluation of certain summary clinical reports (“AHRQ” or Agency for Healthcare Research and
Quality). Based on the results of published, peer-reviewed pre-clinical studies and clinical trials, we believe that Ampligen may
have broad-spectrum antiviral and anti-cancer properties.
We
believe that nucleic acid compounds represent a potential new class of pharmaceutical products designed to act at the molecular level
for treatment of many human diseases. Ampligen represents the first drug in the class of large (macromolecular) dsRNA molecules to apply
for NDA review. There are two forms of nucleic acids: deoxyribonucleic acid (“DNA”) and ribonucleic acid (“RNA”).
DNA is a group of naturally occurring molecules found in chromosomes, the cell’s genetic machinery. RNA is a group of naturally
occurring informational molecules which orchestrate a cell’s behavior which, in turn, regulates the action of groups of cells,
including the cells which comprise the body’s immune system. RNA directs the production of proteins and regulates certain cell
activities including the activation of an otherwise dormant cellular defense against viruses and tumors. Our drug technology utilizes
specifically configured RNA and is a selective Toll-like Receptor 3 (“TLR3”) agonist that can be administered intravenously,
intranasally and intraperitoneally. Ampligen has been assigned the generic name rintatolimod by the United States Adopted Names Council
(“USANC”) and has the chemical designation poly(I):poly(C12U).
Expanded
Access Program/Early Access Programs/clinical trials of Ampligen that have been conducted or that are ongoing include studies of the
potential treatment of patients with pancreatic cancer, renal cell carcinoma, malignant melanoma, non-small cell lung cancer, ovarian
cancer, breast cancer, colorectal cancer, prostate cancer, ME/CFS, Hepatitis B, HIV, COVID-19 and Post-COVID conditions.
We
have received approval of our NDA from ANMAT for the commercial sale of Ampligen in the Argentine Republic for the treatment of severe
CFS. The product will be marketed by GP Pharm, our commercial partner in Latin America. Shipment of the drug product to Argentina was
initiated in 2018 to complete the release testing by ANMAT needed for commercial distribution. In September 2019, we received clearance
from the FDA to ship Ampligen to Argentina for the commercial launch and subsequent sales. In June 2020, we received import clearance
from ANMAT to import the first shipment of commercial grade vials of Ampligen into Argentina. We are currently working with GP Pharm
on the commercial launch of Ampligen in Argentina. Commercialization in Argentina will require, among other things, GP Pharm to establish
disease awareness, medical education, creation of an appropriate reimbursement level, design of marketing strategies and completion of
manufacturing preparations for launch and ANMAT conducting a final inspection of the product and release tests before granting final
approval to begin commercial sales. AIM has supplied GP Pharm with the Ampligen required for testing and ANMAT release. This testing
and approval process is ongoing due to ANMAT’s internal processes. Once final approval by ANMAT is obtained, GP Pharm will begin
distributing Ampligen in Argentina. Argentina has experienced hyper-inflation and recently devalued its currency to the U.S. dollar by
50%. Contracts with GP Pharm are U.S. dollar contracts and the parties must evaluate the impact of the recent devaluation on its relationship.
29
The
FDA has authorized an open-label expanded access treatment protocol (AMP-511) allowing patient access to Ampligen in a study under which
severely debilitated CFS patients have the opportunity to be on Ampligen to treat this serious and chronic condition. The AMP-511 protocol
started in the 1990s and is ongoing. The data collected from the AMP-511 protocol through clinical sites provide safety information regarding
the use of Ampligen in patients with CFS. We are establishing an enlarged database of clinical safety information which we believe will
provide further documentation regarding the absence of autoimmune disease associated with Ampligen treatment. We believe that continued
efforts to understand existing data, and to advance the development of new data and information, will ultimately support our future filings
for Ampligen and/or the design of future clinical studies that the FDA requested in a CRL. The FDA approved an increased reimbursement
level from $200 to $345 per 200 mg vial of Ampligen, due to increased production costs; which was re-authorized in 2021, 2022, 2023 and
2024. At this time, we do not plan on passing this adjustment along to the patients in this program. In October 2020, we received IRB
approval for the expansion of the AMP-511 Expanded Access Program clinical trial for ME/CFS to include patients previously diagnosed
with SARS-CoV-2 following clearance of the virus, but who still demonstrate chronic fatigue-like symptoms that we refer to as Post-COVID
conditions. As of September 30, 2024, there were 7 patients enrolled in this open-label expanded access treatment protocol. In July 2022, AIM
reported positive preliminary results based on data from the first four Post-COVID Condition patients enrolled in the study. The data
show that, by week 12, compared to baseline, the investigators observed what they considered a clinically significant decrease in fatigue-related
measures. To date, there have been eight such Post-COVID patients treated in this study.
In
May 2016, we entered into a five-year agreement with myTomorrows, a Netherlands based company, for the commencement and management of
an Early Access Program (“EAP”) in Europe and Turkey related to ME/CFS. Pursuant to the agreement, as amended, myTomorrows
also is managing all Early Access Programs and Special Access Programs in Europe, Canada, and Turkey to treat pancreatic cancer and ME/CFS
patients. The agreement was automatically extended for a period of 12 months on May 20, 2021; has been automatically extended for 12
months on each subsequent May 20; and will continue to be automatically extended for periods of 12 months every May 20 until terminated
or the terms of the agreement are met.
In
June 2018, Ampligen was cited as outperforming two other TLR3 agonists — poly IC and natural double stranded RNA — in creating
an enhanced tumor microenvironment for checkpoint blockade therapy in the journal of Cancer Research . In a head-to-head study in explant
culture models, Ampligen activated the TLR3 pathway and promoted an accumulation of killer T cells but, unlike the other two TLR3 agonists,
it did so without causing regulatory T cell (Treg) attraction. These findings were considered important because they indicate that Ampligen
selectively reprograms the tumor microenvironment by inducing the beneficial aspects of tumor inflammation (attracting killer T cells),
without amplifying immune-suppressive elements such as regulatory T cells. The study was conducted at the University of Pittsburgh and
Roswell Park as a part of the NIH-funded P01 CA132714 and Ovarian Cancer Specialized Program of Research Excellence (“SPORE”).
In
2018, we completed production of two commercial-size batches of more than 16,000 vials of Ampligen, following its “Fill & Finish”
at Jubilant HollisterStier, the Contract Manufacturing Organization. These lots passed all required testing for regulatory release for
human use and are being used for multiple programs, including: the treatment of ME/CFS; the pancreatic cancer EAP in the Netherlands;
and will continue to be used for ongoing and future clinical studies in oncology. Lots of Ampligen were manufactured in December 2019,
January 2020 and December 2023. Additionally, in December 2020, we added Pharmaceutics International Inc. (“Pii”) as a “Fill
& Finish” provider to enhance our capacity to produce Ampligen. This addition amplifies our manufacturing capability by providing
redundancy and cost savings. The contracts augment our active and in-process fill and finish capacity.
Immuno-Oncology
The
potential of Ampligen as an immuno-oncology therapeutic has been a major focus of AIM since our current leadership took over in 2016.
We have been working with the University of Pittsburgh’s chemokine modulation research initiative, which includes the use of Ampligen
as a potential adjuvant to modify the tumor microenvironment (“TME”) with the goal of increasing anti-tumor responses to
check point inhibitors (“CPI”). As part of this collaboration, we have supplied Ampligen to the University. The study, under
the leadership of Robert P. Edwards, MD, chair of gynecologic services at Magee-Women’s Hospital of the University of Pittsburgh
School of Medicine, and Professor of Surgery Pawel Kalinski, M.D., Ph.D., at Roswell Park, Buffalo, N.Y., involved the chemokine modulatory
regimen developed by Dr. Kalinski’s group and successfully completed the Phase 1 dose escalation in patients with resectable colorectal
cancer.
30
Multiple
Ampligen clinical trials are underway or recently completed at major university cancer centers testing whether tumor microenvironments
can be reprogrammed to increase the effectiveness of cancer immunotherapy, including checkpoint inhibitors. The underway trials include:
● Pancreatic
Cancer Trial
○ The
Phase 2 AMP-270 clinical trial is a randomized, open-label, controlled, parallel-arm study
with the primary objective of comparing the efficacy of Ampligen versus a no treatment control
group following FOLFIRINOX for subjects with locally advanced pancreatic adenocarcinoma.
Secondary objectives include comparing safety and tolerability. AMP-270 is expected to enroll
approximately 90 subjects in up to 30 centers across the U.S. and Europe. In March 2022,
the FDA granted clearance to proceed with the study. In April 2022, we executed a work order
with Amarex to manage the clinical trial. In August 2022, we received IRB approval of the
trial protocol and so announced the trial’s commencement. The authorization to proceed
with the Phase 2 pancreatic cancer clinical trial has been received with potential sites
in the Netherlands at Erasmus MC, and also at major cancer research centers in the United
States such as The Buffett Cancer Center at the University of Nebraska Medical Center (UNMC).
A Type D meeting package seeking the FDA guidance on expansion of inclusion criteria and
treatment arms to be included was submitted to the FDA. In June 2024, a written response
to that meeting package was received from the FDA. The study protocol
was amended and resubmitted to the FDA in October 2024. The study is still recruiting patients under the current
protocol. ( https://clinicaltrials.gov/ct2/show/NCT05494697 ).
○ The
DURIPANC Study is a Phase 1b/2 clinical trial combining Ampligen with AstraZeneca’s
anti-PD-L1 immune checkpoint inhibitor Imfinzi® (durvalumab) for the treatment of late-stage
pancreatic cancer. The primary objective of the Phase 1b portion is to determine the safety
of combination therapy. Investigators at Erasmus Medical Center (“Erasmus MC”)
in the Netherlands had completed the safety evaluation of subjects enrolled in the first
dose level of the dose escalation design, finding the combination therapy to be generally
well-tolerated with no severe adverse events or dose-limiting toxicities. That first cohort
has now reached the pre-determined 6-month stability assessment timepoint and AIM is pleased
to announce that two of the three subjects remain stable. The subjects will continue to be
treated and receive formal assessment of progression every three months. The standard for
calculating median progression-free survival (“PFS”) requires that 50% or more
of the subjects have seen disease progression. Because 67% of the patients in the cohort
evaluated at 6 months have remained stable, AIM cannot yet report on PFS. Two of the three
subjects in the higher-dose second cohort of subjects also have stable disease, although
they have not yet reached the 6-month stability assessment timepoint. Investigators continue
to treat and monitor these subjects.
● Advanced
Recurrent Ovarian Cancer
○ Results
of the Phase 1 portion of a Phase 1/2 study of intraperitoneal chemo-immunotherapy in advanced
recurrent ovarian cancer were published in the American Association for Cancer Research publication,
Clinical Cancer Research (Clin Cancer Res January 19, 2022 DOI: 10.1158/1078-0432.CCR-21-3659).
The study results represent an important extension of prior studies using human tumor explants
that showed Ampligen’s potentially important role as a TLR3 agonist acting synergistically
with high-dose IFNα and celecoxib to selectively enhance Teff cell-attractants while
suppressing Treg-attractants in the tumor microenvironment with a concomitant increase in
the Teff/Treg ratio. The importance of boosting the Teff/Treg ratio in the tumor microenvironment
is that it is associated with the conversion of ‘cold’ tumors into ‘hot’
tumors, which have an increased sensitivity to chemo-immunotherapy and an improved chance
of showing tumor regression. The Phase 1 portion was designed to establish intraperitoneal
safety. The Phase 2 portion of the study is recruiting subjects. https://clinicaltrials.gov/ct2/show/NCT02432378
○ A
Phase 2 study of advanced recurrent ovarian cancer using cisplatin, pembrolizumab, plus Ampligen;
up to 45 patients to be enrolled; enrollment has commenced, and numerous patients have commenced
treatment. In April 2024, researchers released topline data that saw an Objective Response
Rate (“ORR”) of 45% in platinum-sensitive subjects with recurrent ovarian cancer.
ORR includes complete response (“CR”) and partial response (“PR”)
to treatment. There was a total Clinical Benefit Rate (“CBR”) of 55% when including
patients who experienced stable disease (“SD”). Researchers also reported a median
Progression-Free Survival (“PFS”) of 7.8 months. Based on these results and other
research suggesting a similar effect in other solid tumor types, AIM sees an Ampligen combination
therapy as having potential across multiple types of cancers. Additional clinical studies
are underway and planned in many of these types of tumors to further confirm these effects.”
https://clinicaltrials.gov/ct2/show/NCT03734692
In
March 2021, we were granted a patent by the Netherlands Patent Office with granted patent claims that include, but are not limited to,
the use of Ampligen as a combination cancer therapy with checkpoint blockade inhibitors (e.g. pembrolizumab, nivolumab). We believe that
the above positive data makes this patent have heightened potential. Similar patents are pending in other countries.
31
● Stage
4 Metastatic Triple Negative Breast Cancer - Phase 1 study of metastatic triple-negative
breast cancer using chemokine modulation therapy, including Ampligen and pembrolizumab. Eight
patients were enrolled and 6 patients were evaluable. https://www.clinicaltrials.gov/ct2/show/NCT03599453 .
The key findings announced first in April 2022, and later published in November 2023, included:
○ The
pre-determined primary endpoint of efficacy was met (increase in CD8 in TME).
○ Uniform
increase of immune markers upon treatment was observed: CD8 mRNA (6.1-fold; p-0.034), GZMB
mRNA (3.5-fold; p=0.058), ratios of CD8 /FOXP3 and GZMB/FOXP3 (5.7-fold; p=0.036, and 7.6-fold;
p=0.024 respectively), thus successfully meeting the pre-determined primary endpoint in the
study (increase in CD8 in TME).
○ In
addition, an increase in CTL attractants CXCL10 (2.6-fold; p=0.104) and CCL5 (3.3-fold; p=0.019)
was observed. In contrast, Treg marker FOXP3 or Treg attractants CCL22 or CXCL12 were not
enhanced.
○ Three
patients had stable disease lasting 2.4, 2.5 and 3.8 months, as of data cut off September
1, 2021.
○ An
additional patient (non-evaluable) had a partial response (breast tumor autoamputation) with
massive tumor necrosis in the post-CKM biopsy.
● Stage
4 Colorectal Cancer Metastatic to the Liver - Phase 2a study of Ampligen as a component
of chemokine modulatory regimen on colorectal cancer metastatic to liver; recruitment has
been completed; 19 patients were enrolled and 12 patients were evaluable for the primary
endpoint https://clinicaltrials.gov/ct2/show/NCT03403634 . The key findings announced
in April 2022 included:
○ The
study’s primary endpoint was met, evidenced by increased CD8a expression post-treatment
(p=0.046).
○ Saw
increase in the CD8a/CD4 (p=0.03), CD8a/FOXP3 (p<0.01) and GZMB/FOXP3 (p<0.01) ratios.
○ The
expression of CTL-attracting chemokines CCL5 (p=0.08), CXCL9 (p=0.05), and CXCL10 (p=0.06)
were increased, while expression of the Treg/MDSC attractant CXCL12 (p=0.07) was decreased
post-treatment.
○ Median
OS was 10.5 (90% CI 2.2-15.2) months, and the median PFS was 1.5 (90% CI 1.4, 1.8) months.
○ No
tumor responses were seen. The treatment was well tolerated. Of all enrolled patients (N=19),
adverse events were noted in 74% of patients, with the most common being fatigue (58%). Grade
3 or higher adverse events were rare (5%).
● Early-Stage
Prostate Cancer - Phase 2 study investigating the effectiveness and safety of aspirin
and Ampligen with or without interferon-alpha 2b (Intron A) compared to no drug treatments
in a randomized three-arm study of patients with prostate cancer before undergoing radical
prostatectomy. Patient enrollment has been initiated in this study designed for up to 45
patients. The study is temporarily suspended due to the Merck discontinuation of Intron-A
production. Roswell Park has had a Type-C meeting with the FDA and is currently performing
the necessary experiments to replace Intron-A with a generic alpha-interferon. We expect
this trial to resume in the near future. https://clinicaltrials.gov/ct2/show/NCT03899987
● Early-Stage
Triple Negative Breast Cancer - The objective of this Phase 1 study is to evaluate the
safety and tolerability of a combination of Ampligen, celecoxib with or without Intron A,
when given along with chemotherapy in patients with early-stage triple negative breast cancer.
The now completed (as of September 2022) topline results from the study confirm the positive
findings that were previously presented at the 2022 Society for Immunotherapy of Cancer
(SITC) 37th Annual Meeting in a poster presentation titled Safety and efficacy of
de-escalated neoadjuvant chemoimmunotherapy of triple negative breast cancer (TNBC) using
chemokine-modulating regimen (rintatolimod, IFN-α2b, celecoxib) . The primary endpoint
of the study was safety and tolerability. The results demonstrated that treatment was well-tolerated
with mostly grade 1 or 2 treatment-related adverse events (TRAEs) without dose-limiting toxicities
(DLTs) or delayed or immune-related toxicities. DLT was defined as grade 3 or higher toxicities
within the first 3 weeks. Secondary endpoints included pCR rate where 5/9 (56%) of patients
attained pCR and 1 more patient attained ypTmic. Tumor and blood biomarkers were also analyzed
in exploratory studies. https://clinicaltrials.gov/ct2/show/NCT04081389
● Refractory
Melanoma — Roswell Park Comprehensive Cancer Center (“Roswell Park”),
in a clinical trial fully funded by the National Cancer Institute (NCI), has commenced patient
enrollment in its Phase 2 study in subjects with primary PD-1/PD-L1 resistant melanoma. The
Phase 2 study will evaluate type-1 polarized dendritic cell (αDC1) vaccine in combination
with tumor-selective chemokine modulation (“CKM”) comprised of Interferon alpha
2b, Ampligen (rintatolimod) and Celecoxib. Up to 24 patients are to be enrolled. The study
was temporarily suspended due to the Merck discontinuation of Intron-A production but has
since resumed recruitment (See: https://www.clinicaltrials.gov/show/NCT04093323 ).
32
● Metastatic
or Unresectable Triple Negative Breast Cancer – This phase 1/2a trial tests the
safety, side effects, and best dose of chemokine modulation therapy (CKM) (rintatolimod,
celecoxib, and interferon alpha 2b) in combination with pembrolizumab for the treatment of
patients with triple negative breast cancer that has spread from where it first started (primary
site) to other places in the body (metastatic) or that cannot be removed by surgery (unresectable).
The study is recruiting subjects.
https://clinicaltrials.gov/study/NCT05756166
Additional
Progress and Analysis Related to Pancreatic Cancer
In
January 2017, the EAP established under our agreement with myTomorrows to enable access of Ampligen to ME/CFS patients was extended to
pancreatic cancer patients beginning in the Netherlands. myTomorrows is our exclusive service provider in Europe and Turkey and will
manage all EAP activities relating to the pancreatic cancer extension of the program. In February 2018, the agreement with myTomorrows
was extended to cover Canada to treat pancreatic cancer patients, pending government approval. There have been no physician requests
to date that would cause the program to move forward with the approval process.
A
total of 42 pancreatic cancer patients initially received treatment with Ampligen immuno-oncology therapy under the EAP program at Erasmus
MC in the Netherlands; that initial program has since continued to expand and proceed with additional patients to be treated with Ampligen
supervised by Prof. C.H.J. van Eijck, MD. In March 2024, the team at Erasmus MC published a thorough data analysis in an article titled
“ Rintatolimod in Advanced Pancreatic Cancer enhances Anti-Tumor Immunity through Dendritic Cell-Mediated T Cell Responses ”
in the journal Clinical Cancer Research . The positive clinical findings relate to changes in the tumor microenvironment after
Ampligen use. We are working with our Contract Research Organization, Amarex Clinical Research LLC, to seek FDA “fast-track.”
We have applied for fast-track status; have received denials to date; and are currently working through the FDA process to provide all
the materials and information required to achieve fast-track status.
A
manuscript titled “ Rintatolimod in Advanced Pancreatic Cancer enhances Anti-Tumor Immunity through Dendritic Cell-Mediated
T Cell Responses ,” was published in the print version of the journal Clinical Cancer Research in August 2024. Researchers
at the Erasmus University Medical Center (“Erasmus MC”) found that Ampligen treatment in pancreatic cancer patients enhances
peripheral immune activity at the transcriptomic and proteomic levels, particularly involving type 1 conventional dendritic cells (cDC1s)
and T cells. Post-Ampligen, the increased peripheral abundance of BTLA+XCR1+ cDC1s and CD4+SELL+ T cells correlated with improved clinical
outcomes. Patients with stable disease exhibited pronounced overexpression of genes related to DC and T cell activation. Notably, the
expression of immune checkpoints PD-L1 and PD-L2 decreased post-Ampligen across all patients.
Additionally:
● In
December 2020, the FDA granted Ampligen Orphan Drug Designation status for the treatment
of pancreatic cancer. The Orphan Drug Designation program provides orphan status to drugs
and biologics which are defined as those intended for the treatment, prevention or diagnosis
of a rare disease or condition, which is one that affects less than 200,000 persons in the
United States or meets cost recovery provisions of the act. The status helps incentivize
the treatment of therapies to treat unmet medical needs by providing a company with seven
years of exclusivity rights once a drug reaches market.
● In
February 2021, our subsidiary, NV Hemispherx Biopharma Europe, received formal notification
from the European Commission (“EC”) granting Orphan Medicinal Product Designation
for Ampligen as a treatment for pancreatic cancer. Orphan products, once commercially approved
in the European Union (“EU”), receive benefits including up to ten years of protection
from market competition from similar medicines with similar active component and indication
for use that are not shown to be clinically superior.
In
June 2021, Ampligen was featured in a publication containing state-of-the-art methodologies in the peer-reviewed medical journal Cancers
as a potential treatment option for cancer patients who are infected with SARS-CoV-2. The study’s authors stated that Ampligen
has the potential to reduce the severity of the deadly respiratory disease COVID-19. According to laboratory data presented in the publication,
“Rintatolimod [Ampligen] activated the innate and the adaptive immune systems by activating a cascade of actions in human pancreatic
cancer cells”, including:
● Stimulation
of interferon regulatory factors and activation of the interferon signaling pathway,
33
● Production
of immunomodulatory activity and
● Induction
of the expression of MHC class I and II histocompatibility
The
full journal article is titled: “ Rintatolimod Induces Antiviral Activities in Human Pancreatic Cancer Cells: Opening for an
Anti-COVID-19 Opportunity in Cancer Patients? ” Cancers is a peer-reviewed, open access journal of oncology published
semimonthly online by MDPI. The study’s authors include Prof. C.H.J. van Eijck, MD, PhD, the lead investigator at Erasmus Medical
Center in the Netherlands.
In
October 2021, we and Amarex submitted an IND application with the FDA for a planned Phase 2 study of Ampligen as a therapy for locally
advanced or metastatic late-stage pancreatic cancer. In December 2021, the FDA responded with a Clinical Hold on the proposed study.
We submitted our response to the FDA in February 2022. In March 2022, we received notification from the FDA that the Clinical Hold was
released and cleared, meaning that we are now able to proceed with the study specifically to treat locally advanced pancreatic cancer
patients. In August 2022, we received IRB approval of the trial protocol and so announced the trial’s commencement.
A Type D meeting package seeking
the FDA guidance on expansion of inclusion criteria and treatment arms to be included was submitted to the FDA. In June 2024, a written
response to that meeting package was received from the FDA. The study protocol was amended and resubmitted to the FDA in October 2024.
The study is still recruiting patients under the current protocol.
Positive
data was published in March 2022 in a manuscript titled, “Rintatolimod (Ampligen®) enhances numbers of peripheral B cells
and is associated with longer survival in patients with locally advanced and metastasized pancreatic cancer pre-treated with FOLFIRINOX:
a single-center named patient program ,” in Cancers Special Issue: Combination and Innovative Therapies for Pancreatic Cancer .
In the single-center, named-patient program, patients with locally advanced pancreatic cancer (LAPC) or metastatic disease were treated
with Ampligen for 6 weeks, at 2 doses per week with 400 mg per infusion. The study found that Ampligen improved the median survival of
these patients. The study’s primary endpoints were the Systemic Immune-Inflammation Index (SIII), the Neutrophils to Lymphocyte
Ratio (NLR), and absolute counts of 18 different populations of circulating immune cells as measured by flow cytometry. Secondary endpoints
were progression-free survival (PFS) and overall survival (OS). The median overall survival in the Ampligen group was 19 months, compared
to a historical control group and subgroup (7.5 and 12.5, respectively) that did not receive Ampligen.
Also
in March 2022, we announced that study data evaluating the direct effects of Ampligen on human pancreatic ductal adenocarcinoma (PDAC)
cells was accepted for presentation at the 15th Annual International Hepato-Pancreato-Biliary Association World Congress in New York,
NY. For the study, three PDAC cell lines (CFPAC-1, MIAPaCa-2, and PANC-1) were treated with various concentrations of Ampligen and their
corresponding vehicle control. The proliferation and migration effects were examined using in-vitro assays and the molecular effect was
examined by targeted gene expression profiling. Additionally human PDAC samples were used to validate the expression of toll-like receptor
3 (TLR3) by immunohistochemistry. Results from the study demonstrated Ampligen decreased the proliferation and migration ability of CFPAC-1
cells. In addition, it decreased the proliferation of MIAPaCa-2 cells and the migration of PANC-1 cells. However, it did not have a dual
effect in MIAPaCa-2 and PANC-1 cells. Interestingly, TLR3 was highly expressed in CFPAC-1 cells, low expressed in MIAPaCa-2 and not expressed
in PANC-1. Gene expression analysis revealed the upregulation of interferon-related genes, chemokines, interleukins and cell cycle regulatory
genes. The heterogeneity of TLR3 expression was confirmed in human PDAC samples. Based on these results, treating pancreatic cancer with
Ampligen may have a direct anti-tumor effect in pancreatic cancer cells expressing TLR-3.
Ampligen
as a Potential Antiviral
Following
the SARS-CoV-1 outbreak in 2002-03, Ampligen exhibited excellent antiviral properties and protective survival effect in NIH-contracted
studies of SARS-CoV-1-infected mice, which is very similar to SARS-CoV-2, the novel virus that causes COVID-19.
● The
Barnard 2006 study ( https://journals.sagepub.com/doi/abs/10.1177/095632020601700505 )
found that Ampligen reduced virus lung levels to below detectable limits.
● The
Day 2009 study ( https://www.sciencedirect.com/science/article/pii/S0042682209005832 )
found that, instead of 100% mortality, there was 100% protective survival using Ampligen.
We
compared key transcription regulatory sequences of SARS-CoV-1 to SARS-CoV-2 and found significant similarities, suggesting highly probable
extension of the antiviral effects of Ampligen in the earlier NIH-contracted SARS experiments to COVID-19. The SARS-CoV-2 virus –
which causes COVID-19 – shares important genomic and pathogenic similarities with SARS-CoV-1 (hence its name). Since Ampligen has
shown antiviral activity against more distantly related coronaviruses, there was a reasonable probability that the antiviral effects
of Ampligen against SARS-CoV-1 will likely extend to SARS-CoV-2, and as discussed below, recently, Ampligen has demonstrated ex vivo
antiviral activity against SARS-CoV-2. We believe that this creates a compelling case for clinical trials to evaluate Ampligen as a potential
tool in the fight against COVID-19.
34
Since
the late 2019 outbreak of SARS-CoV-2, we have been actively engaged in determining whether Ampligen could be an effective treatment for
this virus or could be part of a vaccine. We believe that Ampligen has the potential to be both an early-onset treatment for and prophylaxis
against SARS-CoV-2. We believe that prior studies of Ampligen in SARS-CoV-1 animal experimentation may predict similar protective effects
against the new virus.
In
February 2020, we filed three provisional patent applications related to Ampligen in our efforts toward joining the global health community
in the fight against the deadly coronavirus (See: https://aimimmuno.com/press-release/aim-immunotech-files-provisional-patent-application-for-the-use-of-ampligenr-as-a-potential-therapy-for-covid-19-induced-chronic-fatigue/).
Our three provisional patent applications include: 1) Ampligen as a therapy for the coronavirus; 2) Ampligen as part of a proposed intranasal
universal coronavirus vaccine that combines Ampligen with inactivated coronavirus, conveying immunity and cross-protection and; 3) a
high-volume manufacturing process for Ampligen. Under the Patent Cooperation Treaty of 1970, which provides international protections
for patents, these three provisional patent applications were converted into two international patent applications based on the date
of their filings.
In
August 2020, we contracted Amarex to act as our Clinical Research Organization and provide regulatory support with regard to a possible
clinical trial testing Ampligen’s potential as a COVID-19 prophylaxis via intranasal delivery.
Beginning
in April 2020, we entered into confidentiality and non-disclosure agreements with numerous companies for the potential outsourcing of
the production of polymer, enzyme, placebo as well as Ampligen.
In
May 2020, the FDA authorized an IND for Roswell Park to conduct a Phase 1/2a study of a regimen of Ampligen and interferon alpha in cancer
patients with COVID-19 infections. This clinical trial, sponsored by Roswell Park in collaboration with us, will test the safety of this
combination regimen in patients with cancer and COVID-19, and the extent to which this therapy will promote clearance of the SARS-CoV-2
virus from the upper airway. Several subjects have been treated. It is planned that the phase 1/2a study will enroll up to 44 patients
in two stages. Phase 1 will see 12-24 patients receiving both Ampligen and interferon alpha-2b at escalating doses. Once that initial
phase is complete, further study participants will be randomized to two arms: one receiving the two-drug combination and a control group
who will not receive Ampligen or interferon alpha but will receive best available care. We are a financial sponsor of the study and will
provide Ampligen at no charge for this study. In November 2020, the first patient in the study had been enrolled and treated. This study
was amended to add 20 patients, with 10 randomized to receive a single dose of Ampligen and 10 patients to receive current best therapies.
(See clinicaltrials.gov/NCT04379518 ). Due to a shortage of qualifying subjects with COVID-19 and cancer as a result of the positive
impact of vaccinations and treatments for COVID-19, Roswell is seeking approval to expand the qualifying subject criteria to include
other diseases lethal to immuno-compromised cancer patients, such as influenza. Accordingly, the study is temporarily suspended while
seeking said approvals.
We
also entered into a specialized services agreement with Utah State University and have supplied Ampligen to support the University’s
Institute for Viral Research in its research into SARS-CoV-2. The Utah State results show that Ampligen was able to decrease SARS-CoV-2
infectious viral yields by 90% at clinically achievable intranasal Ampligen dosage levels.
In
October 2020, we received IRB approval for the expansion of the AMP-511 Expanded Access Program clinical trial for ME/CFS to include
patients previously diagnosed with SARS-CoV-2, but who still demonstrate chronic fatigue-like symptoms. Patients in the trial are treated
with our flagship pipeline drug Ampligen. In January 2021, we commenced with the treatment of the first previously diagnosed COVID-19
patient with long-COVID symptoms (i.e., Long Hauler) also known as Post-COVID Conditions in the AMP-511 study. Enrollment of post-COVID
patients continues in the study.
In
January 2021, we entered into a Sponsor Agreement with CHDR to manage a Phase 1 randomized, double-blind study to evaluate the safety
and activity of repeated intranasal administration of Ampligen. AIM funded and sponsored the study. This study was designed to assess
the safety, tolerability and biological activity of repeated administration of Ampligen intranasally. A total of 40 healthy subjects
received either Ampligen or a placebo in the trial, with the Ampligen given at four escalating dosages across four cohorts, to a maximum
level of 1,250 micrograms. The study was completed, and the Final Safety Report reported no Serious or Severe Adverse Events at any dosage
level. We believe that the trial is a critical step in our ongoing efforts to develop Ampligen as a potential prophylaxis or treatment
for COVID-19 and other respiratory viral diseases. Amarex provided us with monitoring support during the trial.
Additionally,
we filed two COVID-19-related provisional patent applications in the third quarter of 2021. In August, we filed an application for Ampligen
as both an intranasal and an intravenous therapy for what we describe as Post-COVID conditions. The people suffering from Post-COVID
conditions, including some young adults, can be afflicted with severe difficulties in concentrating; serious memory problems; and the
inability to live an active lifestyle, to work and even to perform everyday tasks. Early data has demonstrated that patients with symptoms
of Post-COVID conditions being treated with Ampligen in the ongoing AMP-511 Expanded Access Program have reported improvements in fatigue
symptoms. Similarly, in ME/CFS, data supports the claim that Ampligen improves fatigue symptoms. Then in September 2022, we filed a patent
application for Ampligen as a potential early-onset intranasal therapy designed to enhance and expand infection-induced immunity, epitope
spreading, cross-reactivity and cross-protection in patients exposed to a wide range of RNA respiratory viruses, such as influenza, Rhinoviruses
and SARS-CoV-2.
35
In
addition to securing these two provisional patent applications, we also moved forward with proposed studies in these areas and with Pre-Investigational
New Drug Applications in September 2021. One pre-IND was for a Phase 2, two-arm, randomized, double-blind, placebo-controlled, multicenter
study to evaluate the efficacy and safety of Ampligen in patients experiencing Post-COVID conditions (originally referred to as Post-COVID
Cognitive Dysfunction (PCCD) and has been revised to Post-COVID conditions).
Ampligen
as a Treatment for Post-COVID Conditions
In
July 2023, we enrolled and dosed the first patient in our Phase 2 study evaluating Ampligen® as a potential therapeutic for people
with post-COVID conditions (“AMP-518”). We announced in August 2023 that the study had met the planned enrollment of 80 subjects
ages 18 to 60 years who have been randomized 1:1 to receive twice-weekly intravenous infusions of Ampligen or placebo for 12 weeks, with
a follow-up phase of two weeks. All patients have completed the study and topline data was reported in February 2024.
In
September 2024, we announced that an analysis of the complete clinical patient data from the AMP-518 clinical trial supported our belief
in Ampligen as a potential therapeutic for people with the moderate-to-severe Post-COVID condition of fatigue, and that this would be
the likely subject population for AIM’s planned follow-up clinical trial. Study subjects with Long COVID were, on average, able
to walk farther in a Six-Minute Walk Test (“6MWT”) when compared to subjects who received a placebo. The 6MWT measured the
distance a subject was able to walk in six minutes as a baseline and then again at 13 weeks. A clear signal of significant potential
(p <0.02, two-tailed T-test) was observed in Ampligen-treated subjects with a baseline 6MWT less than 205 meters, who saw a mean improvement
of 139 meters, compared to a mean improvement of 91 meters in the corresponding part of the group who received the placebo. AIM therefore
believes that any future trial design should focus on Ampligen’s therapeutic potential for subjects whose Long COVID-related fatigue
can be categorized as moderate or worse.
Myalgic
Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)
Myalgic
Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), also known as Chronic Fatigue Immune Dysfunction Syndrome (“CFIDS”)
and Chronic Fatigue Syndrome (CFS), is a serious and debilitating chronic illness and a major public health problem. ME/CFS is recognized
by both the government and private sector as a significant unmet medical need, including the U.S. National Institutes of Health (“NIH”),
FDA and the CDC.
Many
severe ME/CFS patients become completely disabled or totally bedridden and are afflicted with severe pain and mental confusion even at
rest. ME/CFS is characterized by incapacitating fatigue with profound exhaustion and extremely poor stamina, sleep difficulties and problems
with concentration and short-term memory. It is also accompanied by flu-like symptoms, pain in the joints and muscles, tender lymph nodes,
sore throat and new headaches. A distinctive characteristic of the illness is a worsening of symptoms following physical or mental exertion,
which do not subside with rest.
The
high number of younger people being hospitalized for COVID-19 suggests considerable numbers of people in the prime of their lives may
have a COVID-induced ME/CFS-like illness in their future. According to a 2016 journal article, the estimated annual cost of lost productivity
related to ME/CFS was $9-37 billion in the United States, and for direct medical costs it was $9-14 billion.
In
June of 2020, we filed a provisional patent application for, among other discoveries, the use of Ampligen as a potential early-onset
therapy for the treatment of COVID-19-induced chronic fatigue.
Many
survivors of the first SARS-CoV-1 epidemic in 2003 continued to report chronic fatigue, difficulty sleeping and shortness of breath months
after recovering from the acute illness. “After one year, 17% of patients had not returned to work and 9% more had not returned
to their pre-SARS work levels,” according to Simmaron Research. Now there is increasing evidence that patients with COVID-19 can
develop a similar, ME/CFS-like illness. These patients are commonly referred to as “Long Haulers.”
In
October 2020, we received IRB approval for the expansion of the AMP-511 Expanded Access Program clinical trial for ME/CFS to include
patients previously diagnosed with SARS-CoV-2 following clearance of the virus, but who still demonstrate chronic fatigue-like symptoms.
For more information on our AMP-511 Expanded Access Program, please see “ OUR PRODUCTS: Ampligen ” above.
36
In
November 2020, we announced the publication of statistically significant data detailing how Ampligen could have a considerable positive
impact on people living with ME/CFS when administered in the early stages of the disease. The data were published in PLOS ONE ,
a peer-reviewed open access scientific journal published by the Public Library of Science. AIM researchers found that the TLR3 agonist
Ampligen substantially improved physical performance in a subset of ME/CFS patients.
As
noted above in Overview; General; Ampligen as a treatment for ME/CFS , we have long been focused on seeking the FDA’s approval
for the use of Ampligen to treat ME/CFS. In fact, in February 2013, we received a CRL from the FDA for our Ampligen NDA for ME/CFS, stating
that we should conduct at least one additional clinical trial, complete various nonclinical studies and perform a number of data analyses.
While
developing a comprehensive response to the FDA and a plan for a confirmatory trial for the FDA NDA, we proceeded independently in Argentina
and, in August 2016, we received approval of an NDA from ANMAT for commercial sale of Ampligen in the Argentine Republic for the treatment
of severe CFS. In September 2019, we received clearance from the FDA to ship Ampligen to Argentina for the commercial launch and subsequent
sales. On June 10, 2020, we received import clearance from ANMAT to import the first shipment of commercial grade vials of Ampligen into
Argentina. The next steps in the commercial launch of Ampligen include ANMAT conducting a final inspection of the product and release
tests before granting final approval to begin commercial sales. This testing and approval process is currently delayed due to ANMAT’s
internal processes. Once final approval by ANMAT is obtained, GP Pharm will begin distributing Ampligen in Argentina.
We
plan on a comprehensive follow through with the FDA regarding the use of Ampligen as a treatment for ME/CFS. We have learned a great
deal since the FDA’s CRL and plan to adjust our approach to concentrate on specific ME/CFS symptoms. Responses to the CRL and a
proposed confirmatory trial are being worked on now by our R&D team and consultants.
Other
Diseases
In
Europe, the EMA has approved the Orphan Medicinal Products Designation for Ampligen as a potential treatment of Ebola virus disease and
for Alferon N Injection as a potential treatment of MERS.
We
concluded our series of collaborations designed to determine the potential effectiveness of Ampligen and Alferon N Injection as potential
preventive and/or therapeutic treatments for Ebola-related disorders. Although we believe that the threat of both MERS and Ebola globally
may reemerge in the future, it appears that the spread of these disorders has diminished.
In
April 2021, we entered into an MTA with the University of Cagliari Dipartimento di Scienze della Vita e dell’Ambiente (“UNICA”),
an educational institution, under the laws of Italy, located in Monserrato (Cagliari), Italy. The MTA relates to the research and development
of the effects of Ampligen and its ability to induce interferon production in several cell lines, and also on the ability of the Ebola
virus protein VP35 to bind to viral dsRNA and impede interferon’s upregulation and activity, and on Ampligen’s ability to
reverse VP35 inhibition of interferon production in biological systems. The data analysis was published in the peer-reviewed journal
Antiviral Research , in a manuscript titled “Ebola virus disease: In vivo protection provided by the PAMP restricted TLR3
agonist rintatolimod and its mechanism of action.” We believe that the analysis supports a dual mechanism of action when Ampligen
is used as a prophylactic therapy against Ebola Virus Disease.
In
May 2021, we filed a U.S. Provisional Patent Application for Ampligen as a potential therapeutic to possibly slow, halt, or reverse the
progression of Alzheimer’s disease.
In
November 2022, we received notice that the FDA had granted Orphan Drug Designation to Ampligen for the treatment of Ebola virus disease.
In
October 2024, we were granted U.S. patent No. 12,102,649, covering both compositions and methods comprising Ampligen in the treatment
of endometriosis, a painful chronic condition in which tissue similar to the lining of the uterus grows outside the uterus, causing severe
pelvic pain and making it difficult or impossible to become pregnant. The patented method involves the administration of a therapeutically
effective amount of a pharmaceutical composition containing our proprietary double-stranded RNA products. The versatile administration
options offer flexibility for patient-specific needs and care. The patent also covers treatments targeting recurrent endometriosis and
includes options for co-administration with interferons, including well-known types such as alpha and beta interferons.
Alferon
N Injection®
Alferon
N Injection is the registered trademark for our injectable formulation of natural alpha interferon. Alferon N Injection is the only natural-source,
multi-species alpha interferon currently approved for sale in the United States and Argentina for the intralesional (within lesions)
treatment of refractory (resistant to other treatment) or recurring external genital warts in patients 18 years of age or older. Alferon
N Injection is also approved in Argentina for the treatment of refractory patients that failed or were intolerant to treatment with recombinant
interferons. Argentina has experienced hyper-inflation and recently devalued its currency to the U.S. dollar by 50%. Contracts with GP
Pharm are U.S. dollar contracts and the parties must evaluate the impact of the recent devaluation on its relationship. Certain types
of human papilloma viruses (“HPV”) cause genital warts, a sexually transmitted disease (“STD”). According to
the CDC, HPV is the most common sexually transmitted infection, with approximately 79 million Americans — most in their late teens
and early 20s — infected with HPV. In fact, the CDC states that “HPV is so common that nearly all sexually active men and
women get the virus at some point in their lives.” Although they do not usually result in death, genital warts commonly recur,
causing significant morbidity and entail substantial health care costs.
37
Interferons
are a group of proteins produced and secreted by cells to combat diseases. Researchers have identified four major classes of human interferon:
alpha, beta, gamma and omega. Alferon N Injection contains a multi-species form of alpha interferon. The worldwide market for injectable
alpha interferon-based products has experienced rapid growth and various alpha interferon injectable products are approved for many major
medical uses worldwide. Alpha interferons are manufactured commercially in three ways: by genetic engineering, by cell culture, and from
human white blood cells. All three of these types of alpha interferon are or were approved for commercial sale in the United States.
Our natural alpha interferon is produced from human white blood cells. The potential advantages of natural alpha interferon over recombinant
(i.e., synthetic) interferon produced and marketed by other pharmaceutical firms may be based upon their respective molecular compositions.
Natural alpha interferon is composed of a family of proteins containing many molecular species of interferon. In contrast, commercial
recombinant alpha interferon products each contain only a single species. Researchers have reported that the various species of interferons
may have differing antiviral activity depending upon the type of virus. Natural alpha interferon presents a broad complement of species,
which we believe may account for its higher activity in laboratory studies. Natural alpha interferon is also glycosylated (i.e., partially
covered with sugar molecules). Such glycosylation is not present on the currently U.S.-marketed recombinant alpha interferons. We believe
that the absence of glycosylation may be in part responsible for the production of interferon-neutralizing antibodies seen in patients
treated with recombinant alpha interferon. Although cell culture-derived interferon is also composed of multiple glycosylated alpha interferon
species, the types and relative quantity of these species are different from our natural alpha interferon.
Alferon
N Injection [Interferon alfa-n3 (human leukocyte derived)] is a highly purified, natural-source, glycosylated, multi-species alpha interferon
product. There are essentially no neutralizing antibodies observed against Alferon N Injection to date and the product has a relatively
low side-effect profile. The recombinant DNA derived alpha interferon formulations have been reported to have decreased effectiveness
after one year of treatment, probably due to neutralizing antibody formation (See “Manufacturing” and “Marketing/Distribution”
sections below for more details on the manufacture and marketing/distribution of Alferon N Injection). The production of new Alferon
N Injection Active Pharmaceutical Ingredient, or API, is currently on hold. We do not know when, if ever, our products will be generally
available for commercial sale for any indication. Additionally, on May 9, 2023, we were granted a U.S. Patent for a method for preventing
or reducing antigenic drift or viral reassortment in a host animal comprising determining if a host animal has been exposed to or infected
by an avian influenza virus and administering to the exposed host animal alpha-interferon.
MANUFACTURING
ANMAT
in Argentina approved Ampligen for commercial distribution for the treatment of CFS in 2016. Shipment of the drug product to Argentina
was initiated in 2018 to complete the release testing by ANMAT needed for commercial distribution. In September 2019, we received clearance
from the FDA to ship Ampligen to Argentina for the commercial launch and subsequent sales. In June 2020, we received import clearance
from ANMAT to import the first shipment of commercial grade vials of Ampligen into Argentina. We are currently working with GP Pharm
on the commercial launch of Ampligen in Argentina (See “Our Products; Ampligen” above).
Following
our approval in Argentina, in 2017 we engaged Jubilant HollisterStier (“Jubilant”) to be our authorized CMO for
Ampligen. Two lots of Ampligen consisting of more than 16,000 units were manufactured and released in 2018; these lots have been
designated for human use in the United States in the cost recovery CFS program and for expanded oncology clinical trials. The
production of additional polymer (Ampligen intermediates) took place in 2019 at our New Brunswick facility. Additionally, Jubilant
manufactured three more lots of Ampligen in December 2019, January 2020 and December 2023. In addition, we have supplied GP Pharm
with the Ampligen required for testing and ANMAT release. Once final approval by ANMAT is obtained, we anticipate that GP Pharm will
begin distributing Ampligen in Argentina.
In
December 2020, we added Pii as a “Fill & Finish” provider to enhance our capacity to produce Ampligen. This addition
amplifies our manufacturing capability by providing redundancy and cost savings. The contracts augment our existing fill and finish capacity.
We are prepared to initiate the production of additional Ampligen when and if needed.
In
June 2022 we entered into a lease agreement with the New Jersey Economic Development Authority for a 5,210 square-foot, state-of-the-art
R&D facility at the New Jersey Bioscience Center (NJBC), primarily consisting of two separate laboratory suites. The lease commenced
on July 1, 2022, and runs through August 31, 2027, but can be extended for an additional five-year period. The facility is AIM’s
operations, research and development center.
38
Our
business plan calls for the utilization of one or more CMOs to produce Ampligen API. While we believe we have sufficient Ampligen API
to meet our current needs, we are also continually exploring new efficiencies so as to maximize our ability to fulfill future obligations.
In this regard, on December 5, 2022, we entered into a Master Service Agreement and a Quality Agreement with Sterling Pharma Solutions
(“Sterling”) for the manufacture of our Poly I and Poly C12U polynucleotides and transfer of associated test methods at Sterling’s
Dudley, UK location to produce the polymer precursors to manufacture the drug Ampligen. We are utilizing Sterling’s expertise to
refine our approach to polymer production. In March 2023, we submitted a purchase order for a total of $1,432,257 to manufacture additional
lots of Ampligen at Jubilant. An additional lot was manufactured by Jubilant in December 2023.
Our
second product, Alferon N Injection, is approved by the FDA for commercial sales in the United States for the treatment of genital warts.
It is also approved by ANMAT in Argentina for commercial sales for the treatment of genital warts and in patients who are refractory
to treatment with recombinant interferons. Commercial sales of Alferon N Injection in the United States will not resume until new batches
of commercial filled and finished product are produced and released by the FDA. We will need the FDA’s approval to release commercial
product once we have identified our new manufacturing approach and submitted satisfactory stability and quality release data. Currently,
we are not manufacturing Alferon N Injection and there is no definitive timetable to resume production.
LICENSING/COLLABORATIONS/JOINT
VENTURES
To
enable potential availability of Ampligen to patients on a worldwide basis, we have embarked on a strategy to license the product and/or
to collaborate and/or create a joint venture with companies that have the demonstrated capabilities and commitment to successfully gain
approval and commercialize Ampligen in their respective global territories of the world. Ideal partners would have the following characteristics:
well-established global and regional experience and coverage; robust commercial infrastructure; a strong track record of successful development
and registration of in-licensed products; and a therapeutic area fit (e.g., ME/CFS, immuno-oncology).
MARKETING/DISTRIBUTION
In
May 2016, we entered into a five-year, exclusive Renewed Sales, Marketing, Distribution and Supply Agreement (the
“Agreement”) with GP Pharm. Under this Agreement, GP Pharm was responsible for gaining regulatory approval in Argentina
for Ampligen to treat severe CFS in Argentina and for commercializing Ampligen for this indication in Argentina. We granted GP Pharm
the right to expand rights to sell this experimental therapeutic into other Latin America countries based upon GP Pharm achieving
certain performance milestones. We also granted GP Pharm an option to market Alferon N Injection in Argentina and other Latin
America countries (See “Our Products; Ampligen” above). The GP Pharm contract was extended in May 2021 with an end date
of May 24, 2024. While we are in discussions with GP Pharm to extend the agreement, we are also open to the possibility of looking for a new partner. In August 2021, ANMAT
granted a five-year extension to a previous approval to sell and distribute Ampligen to treat severe CFS in Argentina. This extends
the approval until 2026.
In
May 2016, we entered into a five-year agreement (the “Impatients Agreement”) with Impatients, N.V. (“myTomorrows”),
a Netherlands-based company, for the commencement and management of an EAP in Europe and Turkey (the “Territory”) related
to ME/CFS. Pursuant to the agreement, myTomorrows, as our exclusive service provider and distributor in the Territory, is performing
EAP activities. These activities will be directed to (a) the education of physicians and patients regarding the possibility of early
access to innovative medical treatments not yet the subject of a Marketing Authorization (regulatory approval) through named-patient
use, compassionate use, expanded access and hospital exemption, (b) patient and physician outreach related to a patient-physician platform,
(c) the securing of Early Access Approvals (exemptions and/or waivers required by regulatory authorities for medical treatments prior
to Marketing Authorization) for the use of such treatments, (d) the distribution and sale of such treatments pursuant to such Early Access
Approvals, (e) pharmacovigilance (drug safety) activities and/or (f) the collection of data such as patient-reported outcomes, doctor-reported
experiences and registry data. We are supporting these efforts and supplying Ampligen to myTomorrows at a predetermined transfer price.
In the event that we receive Marketing Authorization in any country in the Territory, we will pay myTomorrows a royalty on products sold.
Pursuant to the Impatients Agreement, the royalty would be a percentage of Net Sales (as defined in the Impatients Agreement) of Ampligen
sold in the Territory where Marketing Authorization was obtained. The formula to determine the percentage of Net Sales will be based
on the number of patients that are entered into the EAP. We believe that disclosure of the exact maximum royalty rate and royalty termination
date could cause competitive harm. However, to assist the public in gauging these terms, the actual maximum royalty rate is somewhere
between 2% and 10% and the royalty termination date is somewhere between five and fifteen years from the First Commercial Sale of a product
within a specific country. The parties established a Joint Steering Committee comprised of representatives of both parties to oversee
the EAP. No assurance can be given that activities under the EAP will result in Marketing Authorization or the sale of substantial amounts
of Ampligen in the Territory. The agreement was automatically extended for a period of 12 months on May 20, 2021; has been automatically
extended for 12 months on each subsequent May 20; and will continue to be automatically extended for periods of 12 months every May 20
until terminated or the terms of the agreement are met.
39
In
January 2017, ANMAT granted a five-year extension to a previous approval to sell and distribute Alferon N Injection (under the brand
name “Naturaferon”) in Argentina. This extended the approval until 2022. A request to extend the approval beyond 2022 has
been filed and is still under review. In February 2013, we received ANMAT approval for the treatment of refractory patients that failed
or were intolerant to treatment with recombinant interferon, with Naturaferon in Argentina.
In
January 2017, the EAP through our agreement with myTomorrows designed to enable access of Ampligen to ME/CFS patients was extended to
pancreatic cancer patients beginning in the Netherlands. myTomorrows is our exclusive service provider in the Territory and will manage
all EAP activities relating to the pancreatic cancer extension of the program.
In
August 2017, we extended our agreement with Asembia LLC, formerly Armada Healthcare, LLC, to undertake the marketing, education and sales
of Alferon N Injection throughout the United States. This agreement has expired. We were in discussions with Asembia about the possibility
of continuing the relationship, while also exploring the possibility of working with other, similar companies. However, we still do not
foresee an immediate need for this service and continue to push this search further out in our expected timeline.
In
February 2018, we signed an amendment to the EAP with myTomorrows. This amendment extended the Territory to cover Canada to treat pancreatic
cancer patients, pending government approval. In March 2018, we signed an amendment to the EAP with myTomorrows, pursuant to which myTomorrows
will be our exclusive service provider for special access activities in Canada for the supply of Ampligen for the treatment of ME/CFS.
In
December 2020, we entered into a signed Letter of Agreement with myTomorrows for the delivery of Ampligen for the treatment of up to
16 pancreatic cancer patients. In November 2021, we entered into a signed Letter of Agreement with myTomorrows for the delivery of Ampligen
for the treatment of up to an additional 5 pancreatic cancer patients. In March 2022, we entered into a signed Letter of Agreement with
myTomorrows for the delivery of Ampligen for the treatment of up to an additional 10 pancreatic cancer patients. In November 2022, we
entered into a signed Letter of Agreement with myTomorrows for the delivery of Ampligen for the treatment of up to an additional 10 pancreatic
cancer patients.
401(k)
Plan
We
have a defined contribution plan, entitled the AIM ImmunoTech Employees 401(k) Plan and Trust Agreement (the “401(k) Plan”).
Our full-time employees are eligible to participate in the 401(k) Plan following 61 days of employment. Subject to certain limitations
imposed by federal tax laws, participants are eligible to contribute up to 15% of their salary (including bonuses and/or commissions)
per annum. Participants’ contributions to the 401(k) Plan may be matched by us at a rate determined annually by the Board of Directors.
Each
participant immediately vests in his or her deferred salary contributions as well as our safe harbor contributions. A 6% safe harbor
matching contribution by us was reinstated effective January 1, 2021. For the nine months ending September 30, 2024 we made approximately
$134,200 in contributions, and for the year ending December 31, 2023 approximately $162,000 in contributions were made.
New
Accounting Pronouncements
See
“ Note 10: Recent Accounting Pronouncements”.
Critical
Accounting Policies and Use of Estimates
There
have been no material changes in our critical accounting policies and estimates from those disclosed in Part II; Item 7: “Management’s
Discussion and Analysis of Financial Condition and Results of Operations; Critical Accounting Policies” contained in our Annual
Report on Form 10-K for the year ended December 31, 2023 except for the policies regarding “Distinguishing Liabilities from Equity”
and “Derivative Instruments”.
Distinguishing
Liabilities from Equity
The
Company has adopted the guidance of ASC 480 in evaluating how it classifies and measures in its statement of financial position certain
financial instruments with characteristics of both liabilities and equity. Under this guidance the Company evaluates free-standing financial
instruments to determine whether the instruments are classified as liabilities or equity. The evaluation includes determining whether
the instruments are mandatorily redeemable, whether redemption includes a transfer of assets, and whether the redemption feature is conditional.
40
Derivative
Instruments
The
Company evaluates its financial instruments to determine if such instruments are derivatives or contain features that qualify as embedded
derivatives requiring bifurcation in accordance with ASC Topic 815, Derivatives and Hedging. Derivative instruments are measured at fair
value at issuance and at each reporting date in accordance with ASC 820 with changes in fair value recognized in the period of change
in the consolidated statements of operations and comprehensive loss.
RESULTS
OF OPERATIONS
Three
months ended September 30, 2024 versus three months ended September 30, 2023
Net
Loss
Our
net loss was approximately $3,700,000 and $7,816,000 for the three months ended September 30, 2024, and 2023, respectively, representing
a decrease in loss of approximately $4,116,000 or 53%. This decrease in loss was primarily due to the following:
● a
decrease in research and development expenses of $1,297,000,
● a
decrease in general and administrative expenses of $2,360,000,
● a
decrease in production costs of $22,000,
● an
increase in gain on investments of $583,000,
● an
increase in interest and other income of $424,000; offset by
● a
decrease in gain from sale of Income tax operating of $318,000, and an
● increase
in interest expense of $202,000.
Net
loss per share was $ (0.06) and $(0.16) for the three months ended September 30, 2024, and 2023, respectively. The weighted average number
of shares of our common stock outstanding as of September 30, 2024, was 57,677,016 as compared to 48,635,165 as of September 30, 2023.
Revenues
Revenues
from our Ampligen® Cost Recovery Program were $35,000 and $46,000 for the three months ended September 30, 2024, and 2023, respectively,
representing a decrease of $11,000 which is primarily related to the fluctuation of patient participation.
For
the three months ended September 30, 2024 and 2023, we had no Alferon N Injection® Finished Good product to commercially sell and
all revenue was generated from the EAP and our FDA approved open-label treatment protocol, (“AMP 511”), that allows patient
access to Ampligen® for treatment in an open-label safety study.
Interest
and Other Income
Interest
and other income for the three months ended September 30, 2024, and 2023 was approximately $718,000 and $294,000, respectively,
reflecting an increase of approximately $424,000. The increase was primarily due to an amendment in September 2024 to an original
agreement that was executed by us and Amarex clarifying and changing the nature of a remaining execution fee of $725,437. The
amendment allowed that the remainder would not be exclusive to the original agreement, that the nature of the payment changed from
an execution fee to a fully refundable deposit, and that it could be applied to any invoice upon mutual agreement of the parties,
removed the threshold contingencies, and if such invoices were not sufficient to exhaust the balance, that the refund would be
refunded in cash. Therefore, the nature of the payment changed to deposit status and outstanding invoices were applied against the
deposit resulting in an overall increase in other income of $657,300 for the three months ended September 30, 2024. The increase in
other income was offset by decreased interest income for the three months ended September 30, 2024 of approximately $233,000 interest income was $61,000 and $294,000, for the three months ended September 30, 2024 and 2023, respectively.
Gain
(loss) on Investments, net
Gain
(loss) on investments for the three months ended September 30, 2024, and 2023 was approximately $273,000 and ($310,000), respectively,
reflecting an increase in gain on investments of approximately $583,000. The increase in gain was due to the change in the fair value
of equity investments.
Production
Costs
Production
costs were approximately $8,000 and $30,000, respectively, for the three months ended September 30, 2024, and 2023, representing a decrease
of $22,000 in production costs. This decrease was due to an increase in production costs for the three months ended 2023 due to production
starting in that quarter.
41
Gain
(loss) from sale of income tax operating loss
The
quarterly income tax benefit for the three months ended September 30, 2024, was $0 compared to a gain of $318,000 for the three months
ended September 30, 2023. This was due to the lifetime limit of $20,000,000 for the sale of the New Jersey NOL being reached and therefore
no tax provision was calculated in 2024.
Research
and Development Costs
Overall
Research and Development (“R&D”) costs for the three months ended September 30, 2024, were approximately $1,437,000,
as compared to $2,734,000 for the same period a year ago, reflecting a decrease of approximately $1,297,000. The primary reason for the
decrease in R&D costs was a decrease in clinical expenses of $1,384,000 as well as a decrease in outside contractors of $20,000 offset
by an increase in patent and trademark expenses of approximately $44,000, salaries of $18,000, rent expense of $16,000, computer &
information services expense of $16,000 as well as consultant fees of $13,000.
General
and Administrative Expenses
General
and Administrative (“G&A”) expenses for the three months ended September 30, 2024, and 2023, were approximately $3,079,000
and $5,439,000, respectively, reflecting a decrease of approximately $2,360,000. The decrease in G&A expenses for the three months
ended September 30, 2024 was due primarily to approximate decreases of professional fees of $2,395,000, public relation expenses of $138,000,
insurance expense of $55,000, rent expense of $33,000, office expenses of $30,000, salaries of $27,000 offset by increases of stock compensation
of $280,000, and license and taxes of $44,000.
Interest
Expenses
Interest
expenses for the three months ended September 30, 2024 was approximately $202,000 and there was no interest expense for the three months
ended September 30, 2023. The increase in interest expense for the three months ended September 30, 2024 was due to the interest expense
incurred related to the Note Purchase Agreement entered into on February 16, 2024 with Streeterville.
Nine
months ended September 30, 2024 versus nine months ended September 30, 2023
Net
Loss
Our
net loss was approximately $11,353,000 and $16,386,000 for the nine months ended September 30, 2024, and 2023, respectively, representing
a decrease in loss of approximately $5,033,000 or 31%. This decrease in loss was primarily due to the following:
● a
decrease in research and development expenses of $3,206,000,
● a
decrease in general and administrative expenses of $795,000,
● a
decrease in production costs of $6,000,
● an
increase in gain on investments of $297,000,
● an
increase in interest and other income of $2,568,000; offset by
● a
decrease in gain from sale of Income tax operating of $900,000,
● an
increase in warrant valuation of $458,000, and an
● increase
in interest expense of $453,000.
Net
loss per share was $ (0.21) and $(0.34) for the nine months ended September 30, 2024, and 2023, respectively. The weighted average number
of shares of our common stock outstanding as of September 30, 2024, was 53,351,467 as compared to 48,483,802 as of September 30, 2023.
Revenues
Revenues
from our Ampligen® Cost Recovery Program were $125,000 and $137,000 for the nine months ended September 30, 2024, and 2023, respectively,
representing a decrease of $12,000 which is primarily related to the fluctuation of patient participation.
For the nine months ended September
30, 2024 and 2023, we had no Alferon N Injection® Finished Good product to commercially sell and all revenue was generated from the
EAP and our FDA approved open-label treatment protocol, (“AMP 511”), that allows patient access to Ampligen® for treatment
in an open-label safety study.
42
Interest
and Other Income
Interest
and other income for the nine months ended September 30, 2024, and 2023 was approximately $3,379,000 and $811,000, respectively, reflecting
an increase of approximately $2,568,000. The increase was primarily due to a recovery of $2,500,000 from the primary level of the Director and Officer (D&O)
insurance proceeds during the nine months ended September 30, 2024 related to legal costs recovered related to shareholder
litigation matters in addition to an amendment in September 2024 to an original agreement that was executed by us and Amarex clarifying
and changing the nature of a remaining execution fee of $725,437. The amendment allowed that the remainder would not be exclusive to
the original agreement, that the nature of the payment changed from an execution fee to a fully refundable deposit, and that it could
be applied to any invoice upon mutual agreement of the parties, removed the threshold contingencies, and if such invoices were not sufficient
to exhaust the balance, that the refund would be refunded in cash. Therefore, the nature of the payment changed to deposit status and
outstanding invoices were applied against the deposit. These changes resulted in an approximate overall increase in interest and other
income of $3,379,000 for the nine months ended September 30, 2024. During the nine months ended September 30, 2023, interest earnings
were $811,000.
Gain
(loss) on Investments, net
Gain
(loss) on investments for the nine months ended September 30, 2024, and 2023 was approximately $96,000 and ($201,000), respectively,
reflecting an increase in the gain on investments of approximately $297,000. The increase in gain was due to the change in the fair value
of equity investments.
Production
Costs
Production
costs were approximately $24,000 and $30,000, respectively, for the nine months ended September 30, 2024, and 2023, representing a decrease
of $6,000 in production costs.
Gain
(loss) from sale of income tax operating loss
The
quarterly income tax benefit for the nine months ended September 30, 2024, was $0 compared to a gain of $900,000 for the nine months
ended September 30, 2023. This was due to the lifetime limit of $20,000,000 for the sale of the New Jersey NOL being reached and therefore
no tax provision was calculated in 2024.
Research
and Development Costs
Overall
Research and Development (“R&D”) costs for the nine months ended September 30, 2024, were approximately $4,533,000, as
compared to $7,739,000 for September 30, 2023, reflecting a decrease of approximately $3,206,000. The primary reason for the
decrease in R&D costs were approximate decreases in outside contractors of $1,770,000, clinical expenses of $1,738,000, computer
and IT services of $111,000 offset by an increase in salaries of $270,000, patent and trademark expenses of $34,000, rent expense of
$30,000, consulting fees of $27,000, manufacturing expenses of $24,000, insurance of $18,000 and maintenance expense of $17,000.
General
and Administrative Expenses
General
and Administrative (“G&A”) expenses for the nine months ended September 30, 2024, and 2023, were approximately $9,485,000
and $10,280,000, respectively, reflecting a decrease of approximately $795,000. The decrease in G&A expenses for the nine months
ended September 30, 2024 was due primarily to approximate decreases in legal professional fees of approximately $968,000, insurance
expense of $208,000, public relations fees of $141,000, travel expenses of $58,000, interest expense of $23,000, rent expense of $19,000
offset by an increase in investment banker fees of $314,000 and stock compensation of $308,000.
Interest
Expenses
Interest
expenses for the nine months ended September 30, 2024 was approximately $453,000 and there was no interest expense for the nine months
ended September 30, 2023. The increase in interest expense for the nine months ended September 30, 2024 was due to the interest expense
incurred related to the Note Purchase Agreement entered into on February 16, 2024 with Streeterville.
43
Liquidity
and Capital Resources
Cash
used in operating activities for the nine months ended September 30, 2024, was approximately $10,933,000 compared to approximately $11,509,000
for the same period in 2023, a decrease of $576,000. The primary reasons for this decrease were a decrease in net loss during the nine
months of $5,033,000 as well as a decrease in gain from sale of income tax operating losses of $900,000, an increase in equity-based
compensation of $308,000 and an increase in loss on issuance of warrants of $458,000. This is partially offset by an increase in cash
utilized for accounts payable of $2,590,000, an increase in accrued expenses of $1,714,000, prepaid expenses of $255,000 as well as a
decrease in funds received from the 2023 sale of New Jersey net operating loss and received in 2024 of $495,000.
Cash
provided by investing activities for the nine months ended September 30, 2024, was approximately $1,002,000 compared to cash used in
investing activities for the nine months ended September 30, 2023, of approximately $618,000, representing a change of $1,620,000. The
primary reason for the change was the cash provided by the net purchase and sale of marketable securities activity of $1,439,000 compared
to cash used in the net purchase and sale of marketable securities of $231,000 for the same period in 2023, the loss on sale of property
and equipment of $0 in the current period in 2024, compared with $10,000 in the same period in 2023 as well as the net purchase and abandonment
of patents in the current period in 2024 of $417,000 compared with the net purchase and abandonment of patents in the same period in
2023 of $377,000.
Cash
provided by financing activities for the nine months ended September 30, 2024, was approximately $5,407,000 compared to approximately
$338,000 for the same period in 2023, representing an increase of $5,069,000. The primary reason for this increase was the receipt of
$2,367,000 in net proceeds from the notes payable, net of issuance cost, an increase in the sale of shares in the current period in 2024
of $860,000 compared to $338,000 in the same period in 2023 as well as an increase in warrant valuation of $2,047,000 in the current
period in 2024.
Our principal source of
liquidity is our cash and cash equivalents, marketable securities, and proceeds from financing activities to provide the necessary
funding to meet our obligations as they become due. As noted above, as of September 30, 2024, we had approximately $7,202,000 in
cash, cash equivalents and marketable securities, inclusive of approximately $6,287,000 in marketable securities, representing a
decrease of approximately $5,868,000 from December 31, 2023. In addition, we have suffered losses from operations and net cash used
on operating activities for the three-month period ended September 30, 2024, and have a working capital deficit. These
conditions raise substantial doubt regarding our ability to continue as a going concern for a period of at least one year from the
date of issuance of these unaudited condensed consolidated financial statements. See Note 1 to our Unaudited Condensed Consolidated Financial Statements.
The accompanying condensed consolidated financial statements have been prepared assuming that we will continue as
a going concern. On September 30, 2024, our current liabilities exceeded our current assets by $2,530,000 which raised doubt our ability to continue as a going concern. Additionally, at September 30, 2024, our stockholders’ equity was
below the minimum requirements for continued listing on the NYSE American.
Management
evaluated the conditions, and their significance of those conditions related to our ability to meet our obligations and determined
that the primary cause of the working capital deficit was related to an accounts payable balance of $6,300,000. This balance
includes $4,900,000 of legal fees related to litigation. We are currently negotiating with the law firm to reduce prior billings.
These negotiations are ongoing and could, if resolved favorably to us, partially alleviate the working capital deficit. Further we are continuing to negotiate the recovery of an additional $2.5
million from our secondary director and officer coverage. There is no
assurance as to the timing or outcome of our efforts. If we are unable to implement sufficient mitigation efforts, we may be
forced to limit our business activities or be unable to continue as a going concern, which would have a material adverse effect on our
results of operations and financial condition.
On September 6, 2024, an amendment to an agreement dated April 7, 2022, was executed by us and Amarex clarifying
and changing the nature of the remaining execution fee of $725,437. The amendment allowed that the remainder would not be exclusive to
the agreement dated on April 7, 2022, that the nature of the payment changed from an execution fee to a fully refundable deposit, and
that it could be applied to any invoice upon mutual agreement of the parties, removed the threshold contingencies, and if such invoices
were not sufficient to exhaust the balance, that the refund would be refunded in cash. Due to the changes brought about by the amendment,
the nature of the payment changed to deposit status. At September 30, 2024, we had an outstanding deposit of $653,000 which may be used
to offset future clinical research expenditures. This deposit is listed as a non-current asset on the balance sheet but could provide
working capital if the timing of expenditures are realized within the next 15 months.
Additionally, we received $2.5 million of insurance recoveries under the first layer of our director and officer
insurance policy during the quarter ended June 30, 2024. We believe, but cannot assure, that an additional $2.5 million will be recovered under the second
layer of our director and officer insurance policy, however, the insurer has initially denied our claim for the additional $2.5 million.
We continue to pursue the collection of $2.5 million. If received, these proceeds would alleviate the negative working capital. There
is no assurance as to the timing or outcome of our efforts.
As
a research and development company, we are conducting research necessary to bring our product, Ampligen, to market. As such, we primarily
rely on financing activities to provide the necessary funding to meet our obligations as they become due. AIM has a long and demonstrated
history of success in these efforts, however, there is no assurance that we will be successful in attaining the necessary funding in
the future.
We
currently have two capital mechanisms in place:
On
April 19, 2023, we entered an ATM offering. The agreement expires on April 19, 2025.
In
February 2024, we entered into an agreement with Atlas Sciences, LLC. Under the terms of the Agreement Atlas may purchase up to
$15.0 million of our common stock puts at 95% of the then share market value at our sole discretion with no restrictions on our use
of the proceeds. Limitations of the agreement include volume based on average daily trading volume limited to 4.99% of total shares
outstanding for each put. There is no assurance as to the amount of funds that will be realized pursuant to the agreement.
No assurance can be given as to the amount of funding that will be received
from either of these capital mechanisms.
In
addition to providing working capital, if fully realized, we believe that the capital mechanisms could possibly provide the equity
necessary to correct the deficiency as required by the NYSE American.
We
are committed to a focused business plan oriented toward finding senior co-development partners with the capital and expertise needed
to commercialize the many potential therapeutic aspects of our experimental drugs and our FDA approved drug Alferon N Injection.
The
development of our products requires the commitment of substantial resources to conduct the time-consuming research, preclinical development,
and clinical trials that are necessary to bring pharmaceutical products to market. We believe, based on our current financial condition,
that we have adequate funds to meet our anticipated operational cash needs and fund current clinical trials over approximately the next
fifteen months. At present we do not generate any material revenues from operations, and we do not anticipate doing so in the near future.
We may need to obtain additional funding in the future for new studies and/or if current studies do not yield positive results, require
unanticipated changes and/or additional studies. In this regard, in February 2022, the SEC declared our S-3 shelf Registration Statement
effective which will allow us to raise additional capital in the future. On April 19, 2023, we entered into an Equity Distribution Agreement
(the “EDA”), with Maxim Group LLC (“Maxim”), pursuant to which we may sell from time to time, shares of our common
stock having an aggregate offering price of up to $8.5 million through Maxim, as agent. Sales under the EDA were registered under the
S-3 Shelf Registration Statement. Under the terms of the Distribution Agreement, Maxim is entitled to a transaction fee at a fixed rate
of 3.0% of the gross sales price of Shares sold under the EDA. For the nine months ended September 30, 2024, we sold 1,305,653 shares
under the EDA for total gross proceeds of approximately $630,204, which includes a 3.0% fee to Maxim of $18,906. During the year ended
December 31, 2023, we sold 598,114 shares under the EDA for total gross proceeds of approximately $344,000, which includes a 3.0% fee
to Maxim of $10,326. We hope to raise additional funds through the EDA. No assurance can be given as to the amount of any additional sales pursuant
to the EDA.
44
In
addition, we raised $2,500,000 in net proceeds from the sale of an unsecured Note and entered into an equity line of credit to raise
up to 15,000,000 (see Overview; The Atlas Equity Line of Credit above). Under the terms of the Atlas Equity Line of Credit, we,
at our sole discretion, shall have the right to issue Put shares to the Investor at 95% of the Market Price of the shares on the day
of trade. Sales under the agreement are limited to a daily maximum of the lessor of: $500,000, the Median Daily Trading volume, and a
beneficial ownership limitation of 4.99% and a maximum of 19.99% of the outstanding shares at the time of the agreement. In April 2024,
we filed a registration statement with the SEC on Form S-1 registering a total of 9,975,000 shares for resale pursuant to the Atlas Agreements,
consisting of 9,636,400 shares that can be sold by us to Atlas and 338,600 shares that were issued to Atlas as Commitment Shares. The
registration statement was declared effective and the final prospectus was filed on May 1, 2024. As of September 30, 2024, a total of
759,685 shares have been issued pursuant to this agreement for a total of approximately $128,000. No assurance can be given as to the amount of funds that will be raised pursuant to the Atlas Equity Line of Credit.
Securities
Purchase Agreement
On
May 31, 2024, we entered into a Securities Purchase Agreement (the “Purchase Agreement”) to complete an offering (the
“Transactions”) with a single accredited investor (the “Purchaser”), pursuant to which we issued to the
Purchaser, (i) in a registered direct offering, 5,640,958 shares of our common stock (the “Shares”), par value $0.001
per share (“Common Stock”) and (ii) in a concurrent private placement, we issued to the Purchaser Class A common
warrants to purchase an aggregate of up to 5,640,958 shares of its common stock (the “A Warrants”) at an exercise price
of $0.363 per share and Class B common warrants to purchase an aggregate of up to 5,640,958 shares of our common stock (the “B
“Warrants” and, along with the A Warrants, the “Common Warrants”) at an exercise price of $0.363 per share.
The A Warrants and B Warrants are not exercisable for six months after the issuance date and will expire, respectively, 24
months and five years and six months after the issuance date. The Common Warrants and the shares of common stock issuable upon the
exercise of such warrants are offered pursuant to an exemption from the registration requirements of the Securities Act provided in
Section 4(a)(2) of the Securities Act and Rule 506(b) promulgated thereunder.
We
received aggregate gross proceeds from the Transactions of approximately $2,047,688, before deducting fees to the Placement Agent and
other estimated offering expenses payable by us. The Shares are being offered by us pursuant to a shelf registration statement on Form
S-3 (File No. 333-262280), which was declared effective on February 4, 2022 (as amended from time to time, the “Registration Statement”).
Pursuant
to the terms of the Purchase Agreement, subject to certain exceptions, we could not issue any equity securities for 60 days
following the issuance date, provided that we were able to utilize our at-the-market offering program with the Placement Agent after
30 days. Additionally, we could not enter into a variable rate transaction (other than the ATM program with the Placement Agent) for
120 days after the issuance date. In addition, our executive officers and each of our directors have entered into lock-up agreements
with us pursuant to which each of them has agreed not to, for a period of 90 days from the closing of the Transactions, offer, sell,
transfer or otherwise dispose of our securities, subject to certain exceptions.
The
exercise price of the Common Warrants, and the number of Common Warrant Shares, are subject to adjustment in the event of any stock
dividend or split, reverse stock split, recapitalization, reorganization or similar transaction, as described in the Common
Warrants. If a Fundamental Transaction (as defined in the Common Warrants) occurs, then the successor entity will succeed to, and be
substituted for us, and may exercise every right and power that we may exercise and will assume all of its obligations under the
Common Warrants with the same effect as if such successor entity had been named in the warrant itself. Common Warrant Holders will
have additional rights defined in the Common Warrants. The Common Warrants will be exercisable on a “cashless” basis
only if there is not a current registration statement permitting public resale. In this regard, the Company filed a registration
statement to register the resale of the Common Warrant Shares. That registration statement was
declared effective by the SEC on July 11, 2024. The Company has agreed to use commercially reasonable efforts to cause such
registration statement to become effective within 181 days following the issuance date and to keep such registration statement
effective at all times until no Purchaser owns any Warrants or Warrant Shares issuable upon exercise thereof.
Maxim
Group LLC acted as the placement agent (the “Placement Agent”) on a “commercially reasonable best efforts” basis,
in connection with the Transactions pursuant to the Placement Agency Agreement, dated May 31, 2024 (the “Placement Agency Agreement”),
by and between us and the Placement Agent. Pursuant to the Placement Agency Agreement, the Placement Agent received a cash
fee of 8% of the aggregate gross proceeds paid to the Company for the securities sold in the Transactions and reimbursement of certain
out-of-pocket expenses.
45
No
assurance can be given as to the amount of funds that could be raised or the potential dilution to current stockholders. If we are unable
to commercialize and sell Ampligen and/or recommence material sales of Alferon N Injection, our operations, financial position and liquidity
may be adversely impacted, and additional financing may be required. There can be no assurances that, if needed, we will be able to raise
adequate funds from the EDA or otherwise, or enter into licensing, partnering or other arrangements to advance our business goals. We
may seek to access the public equity market whenever conditions are favorable, even if we do not have an immediate need for additional
capital at that time. We are unable to estimate the amount, timing or nature of future sales of outstanding common stock or instruments
convertible into or exercisable for our common stock. Any additional funding may result in significant dilution and could involve the
issuance of securities with rights, which are senior to those of existing stockholders. See Part I, Item 1A - “Risk Factors; We
may require additional financing which may not be available ” in our Annual Report on Form 10-K for the year ended December
31, 2023.
On
September 30, 2024, the Company entered into a Securities Purchase Agreement to complete an offering with a single accredited investor.
For more information see Note 15: Subsequent Events.
NYSE
American Continued Listing Requirements
To
maintain our listing on the NYSE American (the “NYSE American”), among other things, we are required to maintain Stockholders
Equity of $6,000,000 or we may receive a warning or a delisting notice. In either event, we would be provided a period in which to
submit a plan to meet listing standards. Taking into account funds received after September 30, 2024, our
Stockholders’ Equity is $4,291,888.
If
the common stock ultimately were to be delisted for any reason, it could negatively impact us by (i) reducing the liquidity and market
price of our common stock; (ii) reducing the number of investors willing to hold or acquire the common stock, which could negatively
impact our ability to raise equity financing; (iii) limiting our ability to use a registration statement to offer and sell freely tradable
securities, thereby preventing us from accessing the public capital markets; and (iv) impairing our ability to provide equity incentives
to our employees.
ITEM
3: Quantitative and Qualitative Disclosures About Market Risk
We
are a smaller reporting company as defined by Rule 12b-2 of the Exchange Act and are not required to provide the information required
under this item.
Text extracted from the filing as submitted to EDGAR. Formatting, tables and exhibits are simplified for reading; the original document is authoritative for anything you rely on.