Technologies, Inc.
−Removed: (the “Company,” “we,” or “our”) develops noninvasive, early-stage diagnostics
−Removed: to detect and researches targeted therapies to detect and treat lung cancer and other diseases of the lung at the cellular level.
−Removed: Company also is conducting early-stage research focused on advancing therapeutic discoveries that could result in broad-spectrum cancer
−Removed: We develop proprietary noninvasive diagnostic tests and cancer therapeutics using technology that preferentially targets
−Removed: cancer cells and cell populations indicative of a diseased state.
−Removed: Company was formed as a Delaware corporation on March 26, 2014.
−Removed: On June 15, 2016, we formed OncoSelect ® Therapeutics,
−Removed: LLC, a Delaware limited liability company and wholly owned subsidiary of the Company.
−Removed: Research and optimization of our platform technologies
−Removed: are conducted in our laboratories at The University of Texas at San Antonio.
+Added: (the “Company,” “bioAffinity,” “we,” or “our”) develops noninvasive
+Added: diagnostics to detect early-stage lung cancer and other diseases of the lung.
+Added: We are advancing research into our therapeutic discoveries
+Added: which could result in broad-spectrum cancer treatments in the future.
+Added: We develop proprietary noninvasive diagnostic tests using flow
+Added: cytometry and automated analysis developed by artificial intelligence (“AI”).
+Added: Our diagnostic tests analyze cell populations,
+Added: including cancer and cancer-related cells, that are indicative of a specific diseased state.
+Added: were formed as a Delaware corporation on March 26, 2014.
+Added: On June 15, 2016, we formed OncoSelect ® Therapeutics, LLC (“OncoSelect ® ”) ,
+Added: a Delaware limited liability company and our wholly owned subsidiary which is a preclinical-stage biopharmaceutical discovery company
+Added: with a focus on therapeutics that deliver cytotoxic (cell-killing) effects on a broad selection of human cancers from diverse tissues
+Added: while having little or no effect on normal cells.
+Added: On August 14, 2023, we formed Precision Pathology Laboratory Services, LLC (“PPLS”),
+Added: a Texas limited liability company and our wholly owned subsidiary.
+Added: Research and optimization of our platform technologies for in vitro
+Added: diagnostics and technologies are conducted in laboratories at The University of Texas at San Antonio and PPLS in San Antonio, Texas.
first diagnostic test, CyPath ® Lung, addresses the need for noninvasive detection of early-stage lung cancer.
−Removed: is the leading cause of cancer-related deaths.
−Removed: Physicians are able to order CyPath ® Lung to assist in their assessment
−Removed: of patients who are at high risk for lung cancer.
−Removed: The CyPath ® Lung test enables physicians to more confidently distinguish
−Removed: between patients who will likely benefit from timely intervention and more invasive follow-up procedures from patients who are likely
−Removed: without lung disease and should continue annual screening.
−Removed: CyPath ® Lung has the potential to increase overall diagnostic
−Removed: accuracy of lung cancer, which could lead to increased survival, fewer unnecessary invasive procedures, reduced patient anxiety, and
−Removed: lower medical costs.
−Removed: our wholly owned subsidiary, OncoSelect ® Therapeutics, LLC, our research has led to discoveries and advancement of novel
−Removed: cancer therapeutics that specifically and selectively target cancer cells.
−Removed: We are focused on expanding our broad-spectrum platform technologies
−Removed: to continue developing tests that detect and therapies that target various types of cancer and potentially other diseases.
−Removed: regarding the general development of bioAffinity’s business can be found in the “Business” section of our final IPO
−Removed: prospectus filed with the SEC pursuant to Rule 424(b)(4) under the Securities Act of 1933, as amended (the “Securities Act”)
−Removed: on September 2, 2022 (the “Final Prospectus”) (see https://www.sec.gov/Archives/edgar/data/1712762/000149315222024949/form424b4.htm ).
+Added: is the leading cause of cancer-related deaths worldwide.
+Added: Physicians order CyPath ® Lung to assist in their assessment of
+Added: patients who are at high risk for lung cancer.
+Added: The CyPath ® Lung test enables physicians to more confidently identify patients
+Added: who will likely benefit from timely intervention and more invasive follow-up procedures and those who are likely without lung cancer
+Added: and should continue routine screening.
+Added: CyPath ® Lung has the potential to increase overall diagnostic accuracy of lung
+Added: cancer, which could lead to increased survival, fewer unnecessary invasive procedures, reduced patient anxiety, and lower medical costs.
+Added: Lung uses flow cytometry technology to detect and analyze cell populations in a person’s sputum, or phlegm, to find characteristics
+Added: indicative of lung cancer, including cancer and/or cancer-related cells that have shed from a lung tumor.
+Added: The flow cytometer is a well-established
+Added: instrument used in many commercial laboratories.
+Added: Flow cytometry collects data pertaining to properties of single cells labeled with antibodies
+Added: and dyes specific to cell types and characteristics.
+Added: Sputum is an excellent sample for analysis because it is in direct contact with
+Added: any malignancy in the lungs and can provide information about its area of field cancerization and the lung microenvironment.
+Added: Lung uses automated data analysis developed by AI that allows an entire sample of sputum averaging 16 million cells to be examined
+Added: in approximately 30 minutes, allowing for cost-effective, large-scale commercialization.
+Added: conducted a 150-patient test validation trial of people at high risk for lung cancer including patients with the disease (N=28) and those
+Added: who were cancer-free (N=122) that resulted in CyPath ® Lung’s overall 88% specificity, meaning the ability to correctly
+Added: identify a person without cancer, and 82% sensitivity, meaning the ability to correctly identify cancer in a person with the disease.
+Added: For the subset of patients in this trial who had lung nodules 20 millimeters (“mm”) or smaller, this trial resulted in 92%
+Added: sensitivity, 87% specificity, 99% negative predictive value, and 88% accuracy.
+Added: In this subset of 132 individuals with small nodules,
+Added: 119 patients were cancer-free and 13 had confirmed lung cancer.
+Added: The detection of small lung nodules in people who have early-stage cancer
+Added: can increase lung cancer survival.
+Added: OncoSelect ® , our research has led to discoveries of novel potential cancer therapeutics that specifically and selectively
+Added: target cancer cells that have been grown in petri dishes.
+Added: September 2023, through our wholly owned subsidiary PPLS, we acquired the assets of Village Oaks Pathology Services, P.A.,(“Village
+Added: Oaks”) a Texas professional association d/b/a Precision Pathology Services, including a clinical anatomic and clinical pathology
+Added: laboratory and related services business in San Antonio, Texas.
+Added: The laboratory is accredited by the College of American Pathologists
+Added: (“CAP”) and certified under the Clinical Laboratory Improvement Amendments of 1988 (“CLIA”).
+Added: Direct Offering
+Added: March 6, 2024, we raised $2.5 million in gross proceeds from the sale to four institutional investors of (1) 1,600,000 shares of our
+Added: common stock (the “Shares”), par value $0.007 per share (“Common Stock”) in a registered direct offering, and
+Added: (2) warrants to purchase an aggregate of 1,600,000 shares of Common Stock (the “Common Warrants”) with an exercise price
+Added: of $1.64 in a concurrent private placement.
+Added: See “Management’s Discussion and Analysis of Financial Condition and Results
+Added: of Operations” for a more detailed discussion of this transaction.
+Added: Code Specific to CyPath ® Lung for Proprietary Laboratory Analyses
+Added: November 30, 2023, we announced that the Centers for Medicare and Medicaid Services (“CMS”) had made a final determination
+Added: for payment for CyPath ® Lung, our noninvasive test for early-stage lung cancer, for the 2024 calendar year.
+Added: January 1, 2024, CyPath ® Lung is on CMS’ 2024 clinical laboratory fee schedule.
+Added: The CPT Proprietary Laboratory Analyses
+Added: (“PLA”) code assigned to CyPath ® Lung is 0406U with the descriptor “Oncology (lung), flow cytometry,
+Added: sputum, 5 markers (meso-tetra [4- carboxyphenyl] porphyrin [TCPP], CD206, CD66b, CD3, CD19), algorithm reported as likelihood of lung
+Added: Lung Branding
+Added: 2023, we developed a series of marketing tools based on branding for CyPath ® Lung that emphasize our test’s
+Added: ability to assist physicians with next steps in patient care.
+Added: In January 2024, we began using the new marketing materials with both physicians
+Added: and patients.
+Added: The branding concepts were developed by the marketing and advertising firms of Havas Health & You, Trinity Life Sciences,
+Added: and K2MD to build the CyPath ® Lung brand and position it for success in the cancer diagnostics sector.
+Added: Passes CAP Inspection
+Added: January 11, 2024, PPLS successfully passed its bi-annual CAP inspection necessary for continuing operations.
+Added: CAP accreditation ensures
+Added: that laboratories meet the highest standards of quality and patient care under the Clinical Laboratory Improvement Amendments (CLIA),
+Added: including personnel qualifications, equipment, facilities, safety protocols, and overall management and quality of testing.
+Added: Platt, Ph.D., Joins Board of Directors
+Added: December 2023, Jamie Platt, Ph.D., Managing Director and Chief Executive Officer of Pictor Limited, where she is leading a turnaround
+Added: by restructuring and accelerating product development, joined the bioAffinity Technologies Board of Directors.
+Added: Platt has more than
+Added: two decades of experience bringing novel diagnostic technologies to global markets.
+Added: She was instrumental in merger and acquisition exits
+Added: for two diagnostic companies with a combined value of approximately $1 billion.
+Added: She previously was Chief Operating Officer of Personal
+Added: Genome Diagnostics which was acquired by LabCorp for $575 million.
+Added: We believe Dr.
+Added: Platt’s scientific acumen, business leadership,
+Added: and board experience will contribute to the Company’s growth and successful commercialization of CyPath ® Lung.
+Added: Bansal, M.D., Joins Medical and Science Advisory Board
+Added: February 2024, Sandeep Bansal, M.D., Medical Director of Pennsylvania’s Lung Innovations Network, joined our Medical and Scientific
+Added: Advisory Board.
+Added: Bansal is Board certified in pulmonary disease, critical care medicine and interventional pulmonology and has also
+Added: served as principal investigator of multiple clinical research trials and peer reviewer for several medical journals.
+Added: Lung Innovations
+Added: Network, a patient-centered practice that offers comprehensive lung care to over 10,000 patients in central and western Pennsylvania,
+Added: incorporated CyPath ® Lung into its practice to aid in the detection of early-stage lung cancer in March 2024.
+Added: Bansal’s experience as both clinician and researcher is an important asset for bioAffinity Technologies.
+Added: of Department of Defense Research
+Added: the fourth quarter of 2023, we began selling CyPath ® Lung tests to the Department of Defense (DOD) to conduct an observational
+Added: study, “Detection of Abnormal Respiratory Cell Populations in Lung Cancer Screening Patients Using the CyPath ® Lung
+Added: Assay,” and for research and development on using bronchoalveolar lavage fluid as a biological sample to assess cardiopulmonary
+Added: function and exercise performance in military personnel post COVID-19 infection.
+Added: An additional research study was opened by Brooke Army
+Added: Medical Center in March 2023 to collect bronchoalveolar lavage samples to advance the research and development of a lung cancer test
+Added: to be used in conjunction with bronchoscopy to improve diagnostic accuracy with combined testing.
+Added: of Laboratory
+Added: September 18, 2023, PPLS consummated the acquisition of a clinical anatomic and clinical pathology laboratory and related services business
+Added: in San Antonio, Texas, pursuant to the terms of an Asset Purchase Agreement dated September 18, 2023, that we entered into with Village
+Added: Oaks Pathology Services, P.A., a Texas professional association d/b/a Precision Pathology Services, and Roby P.
+Added: PPLS is accredited
+Added: by the College of American Pathologists (“CAP”) and certified under the Clinical Laboratory Improvement Amendments of 1988
+Added: Founded in 2007 by Dr.
+Added: Joyce, the Medical Director and Laboratory Director of the clinical pathology laboratory
+Added: prior to and after the acquisition, has provided pathology services to physicians practicing in a variety of outpatient settings.
+Added: September 2021, Village Oaks, under the trade name Precision Pathology Services, has offered CyPath ® Lung for sale as
+Added: a laboratory developed test (“LDT”) for the detection of early-stage lung cancer.
+Added: In addition to CyPath ® Lung,
+Added: PPLS intends to continue to offer a range of laboratory services including respiratory testing for SARS-CoV-2 and influenza, anatomical
+Added: pathology, morphological stains, histological services, DNA extractions, STI testing, and women’s and men’s health testing.
+Added: to the terms of the Asset Purchase Agreement, PPLS acquired the laboratory assets, which included all of the assets owned by Village
+Added: Oaks other than medical assets, including the CLIA certification and CAP accreditation, which are assets Village Oaks used in connection
+Added: with its management and operation of a clinical pathology laboratory, now owned by PPLS, and related services business and assumed certain
+Added: liabilities and obligations.
+Added: Pursuant to the terms of the Asset Purchase Agreement, Village Oaks received $3,500,000 in consideration
+Added: for the assets to be purchased by PPLS, of which $1,000,000 was paid by the issuance of 564,972 shares of our restricted Common Stock
+Added: to a trust controlled by Dr.
+Added: Joyce which share number was determined by dividing $1,000,000 by $1.77, the average of the trading day
+Added: closing prices for the 30 days prior to September 15, 2023, rounded to the nearest whole share.
+Added: to the Asset Purchase Agreement, PPLS assumed all liabilities and obligations and obtained any and all rights, title and interest of
+Added: Village Oaks in and to (1) all leases for equipment and personal property related to the laboratory assets, pursuant to an Assumption
+Added: Agreement by and between Village Oaks and PPLS;
+Added: (2) certain other contracts related to the laboratory assets, including the license to
+Added: develop, manufacture, use, market, and sell CyPath ® Lung pursuant to the Assumption Agreement;
+Added: (3) all accounts payable
+Added: of Village Oaks as of September 18, 2023, that were incurred in the ordinary course of business consistent with past custom and practice;
+Added: and (4) the lease of the premises used in connection with operation of the CLIA-certified and CAP-accredited clinical pathology laboratory,
+Added: pursuant to an Assignment and Assumption of Lease by and between and PPLS.
+Added: connection with the Asset Purchase Agreement, PPLS entered into various other agreements, including a Management Services Agreement with
+Added: Village Oaks, a Succession Agreement with Village Oaks and Dr.
+Added: Joyce, and a Professional Services Agreement with Village Oaks pursuant
+Added: to which PPLS will provide comprehensive management and administrative services to Village Oaks in connection with the operation of its
+Added: professional cytopathology, histopathology, and clinical and anatomic pathology interpretation medical services practice.
+Added: PPLS will provide
+Added: space, equipment, administrative, management and clinical personnel, billing and collection, and related management services to Village
+Added: Oaks in exchange for a management fee of 70% of the net revenues received by Village Oaks from the provision of the medical services.
+Added: Succession Agreement provides that Dr.
+Added: Joyce, as holder of 100% of the issued and outstanding stock of Village Oaks, and Village Oaks
+Added: are restricted from disposing of their equity interests in Village Oaks, subject to certain exceptions, without the prior written consent
+Added: of us and Village Oaks.
+Added: to a Professional Services Agreement, Village Oaks provides pathology interpretation services as requested on behalf of PPLS based on
+Added: the professional fees approved for the CPT code for the services provided under the Medicare Physician Fee Schedule in the locality where
+Added: the test is performed.
+Added: connection with the Asset Purchase Agreement, we entered into an Executive Employment Agreement with Dr.
+Added: Joyce for a term of three years,
+Added: pursuant to which he serves as the Medical Director and Laboratory Director of PPLS, at a base salary of $333,333 per year.
+Added: to the Joyce Employment Agreement, Dr.
+Added: Joyce was also appointed to serve on our Board of Directors.
First Diagnostic Test – CyPath ® Lung
−Removed: of the CyPath ® Lung Methodology
−Removed: cancer is the leading cause of cancer-related death worldwide, claiming nearly 1.8 million lives annually.
−Removed: 1 Individuals
−Removed: at high risk for lung cancer are recommended for annual screening by low-dose computed tomography (“LDCT”).
−Removed: Apart from LDCT,
−Removed: there is currently no reliable noninvasive method that can detect lung cancer at an early stage.
−Removed: Our first diagnostic test, CyPath ®
−Removed: Lung, is designed to be a cost-effective, 2 noninvasive, early-stage lung cancer diagnostic.
−Removed: Using CyPath ®
−Removed: Lung in conjunction with LDCT is predicted to improve the positive predictive value (the proportion of true positive results) by
−Removed: a factor of five.
−Removed: 2 Improving the positive predictive value of LDCT with the use of CyPath ® Lung can result
−Removed: in fewer patients unnecessarily subjected to invasive diagnostic procedures, earlier detection of lung cancer, and a reduction in healthcare
−Removed: The Cancer Atlas, Third Edition, American Cancer Society (ACS), World Health Organization (WHO) and The Union for International Cancer
−Removed: Control (UICC);
−Removed: https://canceratlas.cancer.org/the-burden/lung-cancer/.
−Removed: Analysis of the Potential Diagnostic, Patient and Economic Impact of CyPath® Lung When Used After
−Removed: LDCT Screening to Detect Lung Cancer, bioAffinity Technologies Internal Analysis, 2022;
−Removed: attached as Appendix I of the Company’s
−Removed: Final Prospectus filed with the SEC on September 2, 2022, pursuant to Rule 424(b)(4) under the Securities Act (see https://www.sec.gov/Archives/edgar/data/1712762/000149315222024949/form424b4.htm ).
+Added: cancer remains the most commonly diagnosed cancer and the leading cause of cancer-related deaths worldwide.
+Added: Globally, there were an estimated
+Added: 2.21 million lung cancer cases and 1.8 million lung cancer deaths in 2020, as reported by the World Health Organization in its 2020 Cancer
+Added: According to the American Lung Association (“ALA”), screening for individuals at high risk for lung cancer has
+Added: the potential to improve lung cancer survival rates by finding disease at an earlier stage when it is more likely to be curable.
+Added: published in the New England Journal of Medicine titled “Survival of patients with stage I lung cancer detected on CT screening”
+Added: dated October 26, 2006, reported that the survival rate of individuals with Stage I lung cancer who underwent surgical resection within
+Added: one month after diagnosis had a ten-year survival rate of 92%, as compared to the overall five-year survival rate in the U.S.
+Added: as reported by the ALA.
+Added: Unfortunately, most lung cancer is detected in late stages.
+Added: The results of a large national clinical trial that
+Added: was reported in the New England Journal of Medicine in an article dated August 4, 2011, titled “Reduced Lung-Cancer Mortality
+Added: with Low-Dose Computed Tomographic Screening” showed that screening for lung cancer using low-dose computed tomography (“LDCT”)
+Added: resulted in a reduction of the mortality rate by 20% as compared to screening by X-ray if LDCT screening is used by patients at high
+Added: risk for lung cancer on an annual basis.
+Added: Therefore, LDCT scans are recommended for screening of an estimated 14 million Americans who
+Added: are at high risk for lung cancer.
+Added: If half of these high-risk individuals were screened, more than 12,000 lung cancer deaths could be
+Added: prevented, according to the ALA.
+Added: However, the New England Journal of Medicine article also reported that LDCT was shown to have
+Added: a low positive predictive value of less than 4%.
+Added: This means that for every 100 people who receive a positive result from LDCT screening
+Added: and are suspected of having lung cancer, only four actually have the disease.
+Added: A reliable, noninvasive, and cost-effective diagnostic
+Added: test can increase diagnosis of early-stage lung cancer while lowering the number of unnecessary and invasive procedures for patients
+Added: with a false positive result from LDCT screening.
+Added: (A false positive test result indicates that the patient has lung cancer when he or
+Added: she does not have the disease.)
+Added: Lung is a test for early-stage lung cancer that is designed to meet the need for greater diagnostic certainty.
+Added: Based on our internal
+Added: analysis, its use in conjunction with LDCT is predicted to improve the positive predictive value (the probability that patients with
+Added: a positive LDCT scan truly have the disease) by a factor of five.
+Added: Our analysis concludes that improving the positive predictive value
+Added: of LDCT with the use of CyPath ® Lung has the potential to subject fewer patients to the stresses of misdiagnosis or unnecessary
+Added: diagnostic procedures, such as biopsies, while also reducing healthcare costs.
Lung uses flow cytometry technology to detect and analyze cell populations in a person’s sputum, or phlegm, to find characteristics
1 unchanged sentence
The flow cytometer is a well-established
−Removed: instrument used in many commercial laboratories that records properties of labeled and unlabeled single cells.
−Removed: Sputum is an excellent
−Removed: sample for analysis because it is in direct contact with any malignancy in the lungs and can thus provide a snapshot of the tumor itself,
−Removed: its microenvironment, and its area of field cancerization.
−Removed: While studies have shown that expert cytological analysis of sputum can detect
−Removed: cancerous and pre-malignant cells, 4 the process of looking at microscopy slides is an extremely laborious approach and demands
−Removed: years of expertise.
−Removed: CyPath ® Lung uses flow cytometry and automated data analysis developed by artificial intelligence
−Removed: (AI) that allows for an entire sample of sputum to be examined for cost-effective, large-scale screening or diagnosis.
−Removed: particular, CyPath ® Lung uses a synthetic porphyrin called meso-tetra (4-carboxyphenyl) porphine
−Removed: (“TCPP”), which is a naturally highly fluorescent porphyrin that has an unusually high affinity for cancer and
−Removed: cancer-associated cells.
−Removed: 5 The uptake and retention of TCPP in cancerous tissue and its fluorescent properties make TCPP
−Removed: an excellent bio-label for cancer.
−Removed: As used in CyPath ® Lung, the proportion of cells with high TCPP fluorescence
−Removed: intensity in a patient’s sputum sample is a significant predictor of lung cancer.
−Removed: bioAffinity holds multiple patents
−Removed: protecting its use of TCPP for the diagnosis, monitoring, and treatment of cancer.
−Removed: In addition, the Company has multiple domestic
−Removed: and foreign patent applications to protect the use of flow cytometry and its AI-developed automated analysis platform in the
−Removed: detection of lung cancer and other lung diseases using sputum as a sample.
−Removed: developed an algorithm using AI to distinguish samples from high-risk patients who had lung cancer from those who are cancer-free.
−Removed: Pathology Services (“Precision Pathology”) developed CyPath ® Lung for sale as a Laboratory Developed Test
−Removed: (an “LDT”) in accordance with the standards of the College of American Pathologists (“CAP”) and the regulations
−Removed: and guidance of the Clinical Laboratory Improvement Amendments of 1988 (“CLIA”) program, which is administered by the Centers
−Removed: for Medicare and Medicaid Services (“CMS”).
−Removed: In developing the test as an LDT, Precision Pathology developed and integrated
−Removed: software into the test protocol, which generated high-throughput and user-friendly, standardized analysis of flow cytometric sample data.
−Removed: Our test can analyze an average sputum sample containing about 20 million cells in less than 20 minutes.
−Removed: A physician’s report is
−Removed: generated within minutes after data acquisition.
−Removed: The test can be put into routine lab use without requiring expert evaluation of samples
−Removed: or being subject to operator bias.
−Removed: Our approach allows the entire sputum sample to be rapidly analyzed.
−Removed: The numerical analysis developed
−Removed: by AI captures complex interactions between lung cancer, the microenvironment, and areas of field cancerization that would be difficult
−Removed: if not impossible for individuals to predict or detect reliably by eye.
−Removed: For example, during test development, we discovered that viability
−Removed: staining density suggests a link with apoptosis, or cell death, that is linked to many cancers, including lung cancer.
−Removed: Our model also
−Removed: suggests that specific markers of immune cell populations may be informative as to the presence of cancer in the lung.
−Removed: These findings
−Removed: are the result of our AI approach to automated analysis.
−Removed: our knowledge, CyPath ® Lung is the first cancer diagnostic that combines automated flow cytometric analysis to predict
−Removed: the presence of lung cancer from sputum samples.
−Removed: Validation, Certification, and Classification of CyPath ® Lung
−Removed: 19-month test validation clinical trial of CyPath ® Lung 6 collected sputum noninvasively from people at high
−Removed: risk for lung cancer, including patients with the disease (N=28) and those cancer-free (N=122).
−Removed: Patients collected their sputum sample
−Removed: over three days at home before bringing their sample to the clinical collection site.
−Removed: Samples were shipped overnight to the laboratory
−Removed: for analysis.
−Removed: Study participants in the high-risk cohort had a CT to confirm they did not have lung cancer.
−Removed: Those in the cancer cohort
−Removed: had imaging and a biopsy that confirmed lung cancer.
−Removed: After providing a sputum sample, participants were released from the study after
−Removed: a physician either confirmed the individual was cancer-free by examination of CT imaging or confirmed the presence of lung cancer by
−Removed: Flow cytometry and patient data used in analysis to produce the results included (1) the proportion of cells with a high ratio
−Removed: of high TCPP fluorescence intensity over cell size;
−Removed: (2) the proportion of cells with an intermediate ratio of fluorescence intensity
−Removed: caused by the viability dye (FVS510) over cell size;
−Removed: (3) the proportion of cells that were CD206 negative but positive for one or more
−Removed: of the following markers:
−Removed: CD66b (granulocytes), CD3 (T cells), and CD19 (B cells);
−Removed: and (4) patient age.
−Removed: Neumann, et al., Premalignant and Malignant Cells in Sputum
−Removed: From Lung Cancer Patients, Cancer Cytopathology, Dec.
−Removed: 25, 2009, page 473-481.
−Removed: El-Far MA, Pimstone N.
−Removed: A comparative study of 28 porphyrins
−Removed: and their abilities to localize in mouse mammary carcinoma:
+Added: instrument used in many commercial laboratories.
+Added: Flow cytometry collects data pertaining to properties of single cells labeled with antibodies
+Added: and dyes specific to cell types and characteristics.
+Added: Sputum is an excellent sample for analysis because it is in direct contact with
+Added: any malignancy in the lungs and can provide information about its area of field cancerization and the lung microenvironment.
+Added: While studies
+Added: have shown that expert cytological analysis of sputum can detect cancerous and pre-malignant cells, the level of scrutiny required for
+Added: the analysis is not feasible in the laboratory routine, according to an October 22, 2009, article, “Premalignant and malignant
+Added: cells in sputum from lung cancer patients,” published in Cancer Cytopathology .
+Added: The process of looking at microscopy slides
+Added: is an extremely laborious approach and demands years of expertise.
+Added: CyPath ® Lung uses flow cytometry and automated data
+Added: analysis developed by AI that allows for an entire sample of sputum averaging 16 million cells to be examined in approximately 30 minutes,
+Added: allowing for cost-effective, large-scale commercialization.
+Added: particular, CyPath ® Lung uses a synthetic porphyrin called meso-tetra (4-carboxyphenyl) porphyrin (“TCPP”).
+Added: Porphyrins are biological pigments that, when exposed to ultraviolet light at certain wavelengths, can result in the cell fluorescing
+Added: a red or purplish color that can be detected under a microscope or by flow cytometry, according to an article titled “Laboratory
+Added: Diagnosis of Porphyria,” published in Diagnostics (Basel) on July 26, 2021.
+Added: Porphyrins can be man-made, like TCPP, or they
+Added: can be naturally occurring, like heme that is responsible for the red color in red blood cells.
+Added: Cancer cells are known to take up certain
+Added: porphyrins in higher amounts than non-cancer cells, and the high affinity for cancer cells displayed by TCPP makes it an excellent bio-label
+Added: for cancer, according to an article published in Progress in Clinical and Biological Research in 1984 titled “A comparative
+Added: study of 28 porphyrins and their abilities to localize in mammary mouse carcinoma:
uroporphyrin I superior to hematoporphyrin derivative.”
−Removed: Prog Clin Biol Res.
−Removed: 1984;170:661–672.
−Removed: Lemieux, et al., Detection of Early-Stage Lung Cancer
−Removed: in Sputum using Automated Flow Cytometry and Machine Learning.
−Removed: 2023;24(1):23.
−Removed: 10.1186/s12931-023-02327-3.
−Removed: than half of those in the cancer cohort had lung cancer in the earlier Stages I-II.
−Removed: The analysis, performed on an LSRII flow cytometer,
−Removed: resulted in 92% sensitivity and 87% specificity in the subgroup of these patients (N=132) who had no nodules or lung nodules smaller
−Removed: than 20 mm on their LDCT scan, while eight out of 10 (80%) of Stage I tumors were correctly identified.
−Removed: Sensitivity is the percentage
−Removed: of persons with the disease – in this case lung cancer – who are correctly identified by the test.
−Removed: Specificity is the percentage
−Removed: of persons without lung cancer who are correctly identified by the test.
−Removed: The cancer group included all lung cancer types, but mostly
−Removed: squamous cell carcinoma and adenocarcinoma lung cancer (in near equal numbers), showing that CyPath ® Lung detects all
−Removed: types of lung cancer.
−Removed: completion of the test validation trial, CyPath ® Lung was evaluated independently by Precision Pathology, which developed
−Removed: the test for sale as an LDT in accordance with CAP/CLIA standards.
−Removed: An LDT is a type of in vitro diagnostic (“IVD”)
−Removed: test that is developed, validated, and performed within a single laboratory.
−Removed: CyPath ® Lung has been validated and is being
−Removed: performed by Precision Pathology, a CAP-accredited, CLIA-certified clinical pathology laboratory in San Antonio, Texas, pursuant to a
−Removed: joint development agreement with the Company.
−Removed: In third quarter 2022, Precision was inspected by CAP in accordance with CAP/CLIA regulatory standards and regulations
−Removed: resulting in continued accreditation for the laboratory and the CyPath ® Lung test as an LDT.
−Removed: part of CAP/CLIA certification, Precision Pathology evaluated the performance of CyPath ® Lung employing its own laboratory
−Removed: technicians and a different flow cytometer, the Navios EX.
−Removed: Results of Precision Pathology’s certification were comparable to those
−Removed: from the test validation trial and demonstrated that CyPath ® Lung remains robust to differences in sample handling, processing,
−Removed: and the type of flow cytometer.
−Removed: Technologies intends to voluntarily seek FDA clearance of the CyPath ® Lung as a Class II IVD medical device for the detection
−Removed: of lung cancer.
−Removed: The Company has designed its pivotal trial with guidance from its clinical research organization (“CRO”),
−Removed: Courante Oncology, and has prepared a pre-submission that will be submitted to the FDA for review and feedback.
−Removed: We anticipate a three-year
−Removed: diagnostic trial including an 18-month patient enrollment of approximately 1,800 patients, with participants followed for at least one
−Removed: year after enrollment to determine whether they have lung cancer.
−Removed: Similar to the test validation trial, the planned pivotal trial will
−Removed: analyze flow cytometry and patient data including (1) the proportion of cells with a high ratio of high TCPP fluorescence intensity over
−Removed: (2) the proportion of cells with an intermediate ratio of fluorescence intensity caused by the viability dye (FVS510) over
−Removed: (3) the proportion of cells that were CD206 negative but positive for one or more of the following markers:
−Removed: CD66b (granulocytes),
−Removed: CD3 (T cells), and CD19 (B cells);
−Removed: and (4) patient age.
−Removed: Patient enrollment is scheduled to begin in 2023 at up to 20 collection sites.
−Removed: Assuming the study is successful, we intend to submit a de novo classification request to the FDA within six months of study completion.
−Removed: Patient- and Physician-Friendly CyPath ® Lung Process
−Removed: Lung is designed to be noninvasive and patient friendly.
−Removed: The diagnostic process uses sputum that is obtained noninvasively in the privacy
−Removed: of a patient’s home.
−Removed: Physicians order the test for their patients after lung cancer screening reveals a lung nodule considered
−Removed: to be indeterminate because of the nodule size and lack of suspicious characteristics.
−Removed: Lung nodules are considered indeterminate if their
−Removed: size is between 6-20 mm in diameter.
−Removed: Lung nodules of that size are associated with a lung cancer risk as low as 0.5% and up to 16%.
−Removed: the CyPath ® Lung test, patients are given a small sample collection kit during an office visit with their physician.
−Removed: Figure 1 below.) From the privacy of the patient’s home, the patient collects a sample of his or her sputum over three days using
−Removed: a hand-held assist device that comes in the collection kit called an acapella ® Choice Blue made by Smiths Medical, which
−Removed: acts to break up mucus in the patient’s lung and facilitates the patient’s ability to cough up sputum from the lung into
−Removed: a collection cup that is also supplied with the kit.
−Removed: In addition to the kit’s step-by-step instructions, an instructional video
−Removed: and a live patient coach are available by calling 855-MYLUNGS to help patients with sample collection.
−Removed: With the patient’s permission,
−Removed: the patient coach will proactively call or text patients to offer assistance.
−Removed: After the three-day sample of sputum is collected in the
−Removed: collection cup, the patient puts the collection cup into the kit and uses a pre-addressed envelope provided in the kit to overnight the
−Removed: sample to the laboratory.
−Removed: Gierada et al;
−Removed: https://pubmed.ncbi.nlm.nih.gov/25326638/.
−Removed: the laboratory, the sputum is processed by technicians into a single-cell suspension and labeled with TCPP, which preferentially binds
−Removed: to cancer cells and/or cancer-related cells.
−Removed: Cells are also stained with fluorescently labeled antibodies that identify hematopoietic
−Removed: and epithelial cells within the sputum sample.
−Removed: A viability dye is used to eliminate dead cells.
−Removed: The sputum sample is analyzed using flow
−Removed: cytometry, which allows an average sputum sample containing about 20 million cells to be profiled in less than 20 minutes.
−Removed: technician skilled in general laboratory techniques can accomplish sample processing, labeling, and data collection.
+Added: As used in CyPath ® Lung, the proportion of cells with high TCPP fluorescence intensity in a patient’s sputum sample
+Added: is a significant predictor of lung cancer.
+Added: We hold multiple patents protecting our use of TCPP for the diagnosis, monitoring, and treatment
+Added: In addition, we have multiple domestic and foreign patent applications to protect the use of flow cytometry and our AI-developed
+Added: automated analysis platform in the detection of lung cancer and other lung diseases using sputum as a sample.
+Added: developed an algorithm as part of a test validation trial that used machine learning to distinguish samples from high-risk patients who
+Added: had lung cancer from those who are cancer-free.
+Added: Results of the trial were published January 21, 2023, in the peer-reviewed journal Respiratory
+Added: Village Oaks developed CyPath ® Lung for sale as an LDT in accordance with the standards of the CAP and the
+Added: regulations and guidance of the CLIA program, which is administered by CMS.
+Added: Lung can be put into routine lab use without requiring expert evaluation of samples or being subject to operator bias.
+Added: allows the entire sputum sample to be rapidly analyzed.
+Added: The numerical analysis developed with machine learning captures complex interactions
+Added: between lung cancer, the microenvironment, and areas of field cancerization that would be difficult if not impossible for individuals
+Added: to predict or detect reliably by eye.
+Added: For example, during test development, we discovered that viability staining density suggests a
+Added: link with apoptosis, or cell death, that is linked to many cancers, including lung cancer.
+Added: Our model also suggests that specific markers
+Added: of immune cell populations may be informative as to the presence of cancer in the lung.
+Added: These findings are the result of our machine
+Added: learning approach to automated analysis.
+Added: Lung uses sputum that is obtained noninvasively by patients in the privacy of their home.
+Added: Physicians most often order the test
+Added: for patients after CT imaging reveals one or more pulmonary nodules that are suspected to be lung cancer.
+Added: A patient collects his or her
+Added: sample using a hand-held, noninvasive assist device, ICU Medical’s Acapella ® Choice Blue, that acts to break up
+Added: mucus in the lungs and help a person cough up sputum from the lung into a collection cup.
+Added: The Acapella ® Choice Blue has
+Added: been 510(k) cleared by the FDA as a positive expiratory pressure device to help mobilize lung secretions in people with certain lung
+Added: sputum sample is shipped overnight by the patient to PPLS and processed into a single-cell suspension, then labeled with antibodies that
+Added: distinguish different cell types and the synthetic porphyrin TCPP that identifies cancer cells and/or cancer-associated cells.
+Added: can analyze an average sputum sample containing about 16 million cells in approximately 30 minutes using integrated software for high-throughput,
+Added: user-friendly standardized analysis of flow cytometric sample data.
+Added: A physician’s report is generated within minutes after data
+Added: The report stratifies the patient into one of two risk groups.
+Added: Those patients deemed “likely or very likely”
+Added: to have cancer may benefit from aggressive intervention.
+Added: Those “unlikely or very unlikely” to have a malignancy may continue
+Added: imaging surveillance.
+Added: The physician also receives a numerical score between 0.1 to 1.0, with 0.1-0.49 being a negative result and 0.5
+Added: to 1.0 considered positive for lung cancer.
+Added: The proprietary automated analysis software was developed and is wholly owned and patent
+Added: protected by bioAffinity Technologies.
receive test results within three days after the laboratory receives the patient’s sputum sample.
4 unchanged sentences
decision to monitor this patient by following a recommended LDCT screening routine.
−Removed: Patient- and Physician-Friendly CyPath ® Lung Process.
−Removed: Lung Research and Clinical Studies
−Removed: high affinity of TCPP for cancer and cancer-related cells and its fluorescent nature makes it an excellent bio-label for cancer.
−Removed: CyPath ® Lung technology is based on this concept and scientific work originating at Los Alamos National Laboratory in
−Removed: collaboration with St.
+Added: reported in an article titled “Detection of Early-Stage Lung Cancer in Sputum using Automated Flow Cytometry and Machine Learning,”
+Added: published in Respiratory Research on January 21, 2023, we conducted a 150-patient test validation trial of people at high risk
+Added: for lung cancer including patients with the disease (N=28) and those who were cancer-free (N=122) that resulted in CyPath ®
+Added: Lung’s overall 88% specificity, meaning the ability to correctly identify a person without cancer, and 82% sensitivity, meaning
+Added: the ability to correctly identify cancer in a person with the disease.
+Added: For the subset of patients in this trial who had lung nodules
+Added: 20 mm or smaller or no nodules at all, this trial resulted in 92% sensitivity, 87% specificity, 99% negative predictive value, and 88%
+Added: In this subset of 132 individuals with small nodules, 119 patients were cancer-free and 13 had confirmed lung cancer.
+Added: out of 10 (80%) of Stage I tumors were correctly identified.
+Added: Sensitivity is the percentage of persons with the disease – in this
+Added: case, lung cancer – who are correctly identified by the test.
+Added: Specificity is the percentage of persons without lung cancer who
+Added: are correctly identified by the test.
+Added: The cancer group included all lung cancer types, but mostly squamous cell carcinoma and adenocarcinoma
+Added: lung cancer (in near equal numbers), showing that CyPath ® Lung detects all types of lung cancer.
+Added: The detection of small
+Added: lung nodules in people who have early-stage cancer can increase lung cancer survival.
+Added: this 19-month test validation trial participants provided a sputum sample and were released from the study after a physician either confirmed
+Added: the individual was cancer-free by examination of CT imaging or confirmed the presence of lung cancer by biopsy.
+Added: Flow cytometry and patient
+Added: data used in the analysis produced results that included (1) the proportion of cells with a high ratio of high TCPP fluorescence intensity
+Added: over cell size;
+Added: (2) the proportion of cells with an intermediate ratio of fluorescence intensity caused by the viability dye (FVS510)
+Added: over cell size;
+Added: (3) the proportion of cells that were CD206 negative but positive for one or more of the following markers:
+Added: CD66b (granulocytes),
+Added: CD3 (T cells), and CD19 (B cells);
+Added: and (4) patient age.
+Added: CyPath ® Lung technology is based on scientific work originating at Los Alamos National Laboratory in collaboration with
Mary’s Hospital in Colorado.
−Removed: A blinded clinical trial 8 (Patriquin, et.
−Removed: al, 2015) of an earlier
−Removed: version of CyPath ® Lung used a microscope to directly identify cells labeled with TCPP in one-third or less of the sputum
−Removed: For each trial participant, researchers manually scanned 12 microscope slides labeled with TCPP for the presence of red fluorescing
−Removed: cells (“RFCs”) displaying a spectral signature that indicated uptake of TCPP in the cell.
−Removed: In addition to measuring the spectral
−Removed: signature, the fluorescent intensity and cell size of RFCs were measured.
−Removed: The test data, including fluorescent intensity over cell size,
−Removed: was analyzed.
−Removed: The Patriquin trial was conducted over 24 months and resulted in 81% test accuracy, 77.9% sensitivity, and 65.7% specificity
−Removed: in the ability to correctly differentiate between samples from lung cancer patients and those at high risk who were cancer-free.
−Removed: Patriquin trial required participants to provide a sputum sample and CT imaging of the lungs.
−Removed: Those in the cancer cohort underwent a
−Removed: biopsy to confirm lung cancer.
−Removed: High-risk patients displaying indeterminate nodules were followed for 18 months to confirm they were cancer-free.
−Removed: The Patriquin study concluded that optimizing the test to provide for analysis of the entire sputum sample would improve results.
−Removed: Patriquin, et.al., Early detection of lung cancer with Meso-Tetra (4-Carboxyphenyl) Porphyrin-Labeled Sputum, J Thorac Oncol.
−Removed: 2015;10(9):1311-1318.
−Removed: 10.1097/JTO.0000000000000627.
−Removed: Company continued development of its lung cancer diagnostic technology culminating in a flow cytometry-based CyPath ® Lung
−Removed: test incorporating automated AI analysis that evaluates the entire sputum sample.
−Removed: A blinded diagnostic trial of the advanced test 9
−Removed: (Lemieux, et al, 2023) resulted in 92% sensitivity and 87% specificity in the subgroup of these patients (N=132) who had no nodules
−Removed: or lung nodules smaller than 20 mm on their LDCT scan, while eight out of 10 (80%) of Stage I tumors were correctly identified.
−Removed: group included all lung cancer types, but mostly squamous cell carcinoma and adenocarcinoma lung cancer (in near equal numbers), showing
−Removed: that CyPath ® Lung detects all types of lung cancer.
−Removed: studies performed to date are summarized in the table below.
−Removed: Lung Studies and Clinical Trials
−Removed: localization and evaluation of cancer cell uptake of four different porphyrins
−Removed: porphyrin localizes more than other porphyrins in cancer cells;
−Removed: higher uptake of TCPP in cancer cells than in normal cells.
−Removed: was determined by visual assessment.
−Removed: Cell lines were used.
−Removed: Researchers did not report the length of time taken to conduct this study,
−Removed: nor any follow-up.
−Removed: study to diagnose lung cancer by labeling sputum with TCPP and identifying red fluorescing cells under a microscope
−Removed: of uranium miners (cancer N=8 / healthy N=4) that labeled sputum with TCPP resulted in 100% sensitivity and 100% specificity.
−Removed: Classification
−Removed: of cancer was made by subjective visual assessment of the presence and intensity of red fluorescing cells on slides.
−Removed: In this blinded
−Removed: study, one patient initially enrolled as a healthy subject was correctly diagnosed with cancer by the test.
−Removed: Length of study not reported.
−Removed: No patient follow-up was reported except for correct detection of cancer in patient initially enrolled as healthy.
−Removed: validation study with microscopy-based assay completed to optimize TCPP labeling of sputum containing cancer and cancer-related cells
−Removed: in lung cancer samples
−Removed: this research study lasting eight months, the florescence intensity of TCPP-labeled cells in sputum was measured by subjective visual
−Removed: assessment of microscope slides to distinguish samples from cancer and healthy cohorts.
−Removed: Researchers who were blinded to sample origin
−Removed: correctly identified samples from lung cancer patients (cancer N=15 / healthy N=12) resulting in 100% sensitivity and 100% specificity.
−Removed: Participants were not followed up after providing the sputum sample and CT scan or biopsy.
−Removed: Lemieux, et al.
−Removed: Detection of Early-Stage Lung Cancer in Sputum using Automated Flow Cytometry and Machine Learning.
−Removed: 2023;24(1):23.
−Removed: 10.1186/s12931-023-02327-3.
−Removed: Detection of Lung Cancer with Meso-Tetra (4-Carboxyphenyl) Porphyrin-Labeled Sputum 10
−Removed: 24-month clinical trial of 128 high-risk smokers and cancer patients used microscopy-based assay to identify TCPP-labeled cells in
−Removed: sputum (cancer N=26 / high risk N=102) that resulted in 81% accuracy, 77.9% sensitivity, 65.7% specificity.
−Removed: Slides were scanned.
−Removed: Fluorescent intensity and cell size of RFCs were objectively measured by software.
−Removed: High-risk participants who were cancer-free were
−Removed: followed for 18 months to confirm status.
−Removed: analysis by flow cytometry;
−Removed: an effective platform to analyze the lung environment.
−Removed: reporting on the CyPath ® Lung test’s quality controls included manual analysis of cell population data acquired
−Removed: by flow cytometry analysis of sputum.
−Removed: This research evaluated flow cytometry data from 164 participants’ sputum samples analyzed
−Removed: manually for differences in cell characteristics, cell population size, and cell fluorescence intensity.
−Removed: of Early-Stage Lung Cancer in Sputum using Automated Flow Cytometry and Machine Learning 12
−Removed: validation clinical trial using bioAffinity’s automated flow cytometry CyPath ® Lung test (cancer N=28 / high risk
−Removed: N=122) resulted in overall 82% sensitivity and 88% specificity for the test;
−Removed: CyPath ® Lung sensitivity is 92% and specificity
−Removed: is 87% for patients with lung nodules smaller than 20 mm.
−Removed: Porphyrin-modified
−Removed: beads for use as compensation controls in flow cytometry 13
−Removed: on the protocol for preparing porphyrin-labeled compensation beads invented by bioAffinity and used to optimize the results of CyPath ®
−Removed: Lung test to detect early-stage lung cancer.
+Added: In the Los Alamos research study, sputum samples from lung cancer patients were differentiated
+Added: from non-cancer samples with 100% accuracy.
+Added: This early research was conducted with sputum from 12 uranium miners.
+Added: Microscope slides of
+Added: sputum samples were labeled with the synthetic fluorescent porphyrin TCPP.
+Added: The Los Alamos research study of 12 uranium miners included
+Added: eight men with cancer and four healthy individuals.
+Added: Researchers were blinded to the sample origin and looked for the presence of highly
+Added: fluorescent cells indicating uptake of TCPP as an indicator of lung cancer.
+Added: The length of the study and specific follow-up was not reported,
+Added: but researchers did report that one patient entering the study as a healthy subject was correctly diagnosed with cancer by the test.
+Added: Later, a blinded clinical trial was conducted and results published September 2015 in an article titled “Early Detection of Lung
+Added: Cancer with Meso-Tetra (4-Carboxyphenyl) Porphyrin-Labeled Sputum” in the Journal of Thoracic Oncology .
+Added: This study reported
+Added: on an earlier version of CyPath ® Lung that used a fluorescent microscope to directly identify cells labeled with TCPP
+Added: in one-third or less of the sputum sample.
+Added: For each trial participant, researchers manually scanned 12 microscope slides labeled with
+Added: TCPP for the presence of red fluorescent cells (“RFCs”) displaying a spectral signature that indicated uptake of TCPP in
+Added: In addition to measuring the spectral signature, the fluorescent intensity and cell size of RFCs were measured.
+Added: The test data,
+Added: including fluorescent intensity over cell size, was analyzed.
+Added: The trial was conducted over 24 months and resulted in 81% test accuracy,
+Added: 77.9% sensitivity, and 65.7% specificity in the ability to correctly differentiate between samples from lung cancer patients and those
+Added: at high risk who were cancer-free.
+Added: The Patriquin trial required participants to provide a sputum sample and CT imaging of the lungs.
+Added: Those in the cancer cohort underwent a biopsy to confirm lung cancer.
+Added: High-risk patients displaying indeterminate nodules were followed
+Added: for 18 months to confirm they were cancer-free.
+Added: The Patriquin study concluded that optimizing the test to provide for analysis of the
+Added: entire sputum sample would improve results.
+Added: January 1, 2024, the Medicare reimbursement code 0406U specific for CyPath ® Lung became effective after multiple regulatory
+Added: decisions in 2023 leading to approval.
+Added: On June 6, 2023, the American Medical Association (“AMA”) approved a Current Procedural
+Added: Terminology (“CPT”) Proprietary Laboratory Analysis (“PLA”) code specifically for use with CyPath ®
+Added: Lung, which was publicly released on June 30, 2023.
+Added: The new CPT code became effective for use on October 1, 2023.
+Added: On November 30, 2023,
+Added: we announced CMS’ final determination for payment for CyPath ® Lung, and CyPath ® Lung is on CMS’
+Added: 2024 clinical laboratory fee schedule.
+Added: The CPT PLA code assigned to CyPath® Lung is 0406U with the descriptor “Oncology (lung),
+Added: flow cytometry, sputum, 5 markers (meso-tetra [4- carboxyphenyl] porphyrin [TCPP], CD206, CD66b, CD3, CD19), algorithm reported as likelihood
+Added: of lung cancer.”
+Added: have an agreement with GO2 Partners to produce patient collection kits and to provide warehousing and distribution services for sending
+Added: out the kits.
+Added: Laboratory reagents, supplies, and equipment are commercially available through multiple vendors.
+Added: Sample processing, labeling,
+Added: and data collection can be accomplished by a laboratory technician skilled in general laboratory techniques.
+Added: Data analysis leading to
+Added: a physician’s report is done by automated analysis software fully integrated into the test.
+Added: our knowledge, CyPath ® Lung is the first cancer diagnostic that combines flow cytometry and automated analysis to predict
+Added: the presence of lung cancer from sputum samples.
Cancer Diagnostics Market and CyPath ® Lung
global cancer diagnostic market is projected to grow from an estimated $102.24 billion in 2022 to $162.57 billion in 2030, with a compound
−Removed: annual growth rate (“CAGR”) of 6.8%.
−Removed: 14 The market worldwide for lung cancer diagnostic tests was estimated at
−Removed: $2.6 billion in 2022 and is projected to reach $4.7 billion by 2030, with a CAGR of 7.8% over 2022-2030.
−Removed: 15 bioAffinity Technologies
−Removed: has the potential to play a significant role in the cancer diagnostic market because our platform is noninvasive, easy to use, cost-effective,
−Removed: and has a potential to lead to better patient outcomes.
−Removed: (See Analysis of the Potential Diagnostic, Patient And Economic Impact of
−Removed: CyPath ® Lung When Used After LDCT Screening to Detect Lung Cancer, bioAffinity Technologies Internal Analysis with citations,
−Removed: attached as Appendix I of the Company’s Final Prospectus filed with the SEC on September 2, 2022, pursuant to Rule 424(b)(4)
−Removed: under the Securities Act) (see https://www.sec.gov/Archives/edgar/data/1712762/000149315222024949/form424b4.htm ).
−Removed: Patriquin, et al.
−Removed: Early Detection of Lung Cancer with Meso-Tetra (4-Carboxyphenyl) Porphyrin-Labeled Sputum.
−Removed: J Thorac Oncol.
−Removed: 2015;10(9):1311-1318.
−Removed: 10.1097/JTO.0000000000000627.
−Removed: Bederka, et al.
−Removed: Sputum analysis by flow cytometry;
−Removed: an effective platform to analyze the lung environment.
−Removed: PLoS One 2022;17(8).
−Removed: 10.1371/journal.pone.0272069.
−Removed: Lemieux, et al.
−Removed: Detection of Early-Stage Lung Cancer in Sputum using Automated Flow Cytometry and Machine Learning.
−Removed: 2023;24(1):23.
−Removed: 10.1186/s12931-023-02327-3.
−Removed: Bauta, et al., Porphyrin-modified beads for use as compensation controls in flow cytometry, Journal of Visualized Experiments (JoVE)
−Removed: 2023, CITATION
−Removed: Research and Markets.
−Removed: Cancer Diagnostics Market Size, Share & Trends Analysis Report by Product (Consumables, Instruments), by Technology,
−Removed: by Screening Type, by Application, by End-user, by Region, and Segment Forecasts, 2022-2030.
−Removed: ResearchAndMarkets.com.
−Removed: ReportLinker.
−Removed: Global Lung Cancer Diagnostics Industry.
−Removed: ReportLinker.com.
−Removed: Lung is currently utilized as a diagnostic tool for detecting early-stage lung cancer.
−Removed: bioAffinity is conducting research for the
−Removed: expansion of its flow cytometric platform technology to detect and monitor lung diseases, such as Chronic Obstructive Pulmonary Disease (COPD) and asthma, and other cancers.
−Removed: Company licensed CyPath ® Lung to Precision Pathology, which began marketing CyPath ® Lung in Texas as an
−Removed: LDT in accordance with CAP/CLIA regulations pursuant to the terms of the joint development agreement between the Company and Precision
−Removed: Limited funds were available to market CyPath ® Lung until the Company completed its IPO in September 2022.
−Removed: CyPath ® Lung is sold to physicians who order CyPath ® Lung for patients at high risk for lung cancer after
−Removed: an LDCT confirms the presence of lung nodule(s).
−Removed: a front-end diagnostic tool used in conjunction with LDCT, the Company’s lung cancer test will help determine whether more expensive,
−Removed: specialized, and/or invasive tests are warranted.
−Removed: CyPath ® Lung compares favorably to current standards of care for diagnosing
−Removed: lung cancer, including invasive biopsies, as seen in the table shown below.
+Added: annual growth rate (“CAGR”) of 6.1%, according to a market research report issued by Research and Markets in June
+Added: A January 2023 report, also by Research and Markets , stated that the market worldwide for lung cancer diagnostic tests was
+Added: estimated at $2.6 billion in 2022 and is projected to reach $4.7 billion by 2030, with a CAGR of 7.8% over 2022-2030.
+Added: We have the potential
+Added: to play a significant role in the cancer diagnostic market because our platform is noninvasive, cost-effective, and has the potential
+Added: to lead to better patient outcomes.
of CyPath ® Lung to Current Standards of Care
−Removed: Diagnostic Test or
+Added: of Early-Stage Lung Cancer in Sputum using Automated Flow Cytometry and Machine Learning,” published in Respiratory Research
+Added: on January 21, 2023
risk – nodules less than 20 mm
−Removed: Dose CT screening 17
−Removed: PET imaging 18
−Removed: Bronchoscopy 19
+Added: of Early-Stage Lung Cancer in Sputum using Automated Flow Cytometry and Machine Learning,” published in Respiratory Research
+Added: on January 21, 2023
+Added: of initial low dose computed tomographic screening for lung cancer,” published in the New England Journal of Medicine
+Added: on May 23, 2013
+Added: of FDG-PET to diagnose lung cancer in areas with infectious lung disease:
+Added: a meta-analysis,” published in JAMA in September
lung nodules – central lesions
−Removed: collapsed/bleeding lung infection
−Removed: Needle Biopsy 20
−Removed: collapsed/bleeding lung infection
+Added: collapsed/bleeding lung;
+Added: bronchial genomic classifier for the diagnostic evaluation of lung cancer,” published in the New England Journal of Medicine
+Added: on July 16, 2015
needle biopsy
−Removed: collapsed/bleeding lung infection
−Removed: Rebel, VI, et al.
−Removed: Automated Flow Cytometry Test Distinguishes
−Removed: Cancer from Non-Cancer in Sputum with High Sensitivity and Specificity, poster, 2020 World Conference on Lung Cancer.
−Removed: January 2021.
−Removed: National Lung Screening Trial Research Team, Church TR, Black
−Removed: WC, Aberle DR, Berg CD, Clingan KL, et al.
−Removed: Results of initial low dose computed tomographic screening for lung cancer.
−Removed: N Engl J Med.
−Removed: 2013;368(21):1980-1991.
−Removed: 10.1056/NEJMoa1209120.
−Removed: Deppen SA, et al.
−Removed: Accuracy of FDG-PET to diagnose lung cancer
−Removed: in areas with infectious lung disease:
−Removed: a meta-analysis, JAMA.
−Removed: 2014;312(12):1227-1336.
−Removed: 10.1001/jama.2014.11488.
−Removed: Silvestri GA, et al.
−Removed: A bronchial genomic classifier for the
−Removed: diagnostic evaluation of lung cancer.
−Removed: N Engl J Med.
−Removed: 2015;373:243-251.
−Removed: 10.1056/NEJMoa1504601
−Removed: Yao X, Gomes MM, Tsao MS, Allen CJ, Geddie W, Sekhon H.
+Added: collapsed/bleeding lung;
aspiration biopsy versus core-needle biopsy in diagnosing lung cancer:
−Removed: a systemic review.
−Removed: 2012;19(1):e16-e27.
−Removed: 10.3747/co.19.871.
−Removed: Zhang Y, Luo G, Etxeberria J, Hao Y.
−Removed: Global patterns and trends
−Removed: in lung cancer incidence:
−Removed: a population-based study.
−Removed: J Thorac Oncol.
−Removed: 2021;16:933–944.
−Removed: bioAffinity’s
+Added: a systemic review,” published in Current Oncology
+Added: in February 2012
+Added: needle biopsy 21
+Added: collapsed/bleeding lung;
+Added: patterns and trends in lung cancer incidence:
+Added: a population-based study,” published in the Journal of Thoracic Oncology
+Added: on February 16, 2021
business model is to immediately address the need for a quick-to-market, noninvasive, cost-effective lung cancer diagnostic that will
save lives and reduce medical costs.
−Removed: The Company is ready to capture a growing market.
−Removed: Preventive Services Task Force recommended
−Removed: doubling the number of Americans at high risk for lung cancer who are recommended for annual screening from 9 million to an estimated
−Removed: China has an estimated 300 million smokers.
−Removed: 46 The European Union is estimated to have 34 million people at high
−Removed: risk for lung cancer.
−Removed: Following its entry into the U.S.
−Removed: market, the Company expects to pursue CE marking of CyPath ® Lung
−Removed: for sale in the European Union and is pursuing collaboration with a strategic partner to develop the test for the China market.
−Removed: conducted market research with pulmonologists, oncologists, cardiothoracic surgeons, radiologists, and internists engaged in the diagnosis
−Removed: and treatment of lung cancer to help assess these stakeholders’ reactions to the new diagnostic, CyPath ® Lung.
−Removed: revealed a strong interest in CyPath ® Lung, driven by the high level of unmet clinical need for noninvasive diagnostics.
−Removed: A survey conducted with 240 pulmonologists and internists, the primary audience for the test, showed that 96% would use CyPath ®
−Removed: Lung if it were available today as an adjunct used for diagnosis after LDCT screening.
−Removed: Physicians see the value of a noninvasive
−Removed: diagnostic technology with the ability to confirm or rule out cancer and reduce the number of costly invasive procedures that result
−Removed: from LDCT’s low positive predictive rate.
+Added: Preventive Services Task Force recommended new guidelines for screening in March 2021,
+Added: nearly doubling the number of Americans at high risk for lung cancer who are recommended for annual screening to 14 million people, according
+Added: In November 2023, the American Cancer Society updated its guidelines for lung cancer screening to include all former smokers
+Added: over the age of 50 regardless of when they quit, increasing the number of American adults eligible for screening to 19 million.
+Added: has an estimated 300 million smokers, according to the World Health Organization.
+Added: In Europe, it is estimated that there is one new case
+Added: of lung cancer diagnosed every minute, with incidence rates for males the highest in Eastern European countries and a five-year survival
+Added: rate of only 13%, as reported by a May 2021 article, “Lung cancer screening in Europe:
+Added: where are we in 2021?” published in
+Added: Translational Lung Cancer Research.
+Added: We expect to pursue CE marking of CyPath ® Lung for sale in the European Union.
+Added: conducted market research in the U.S.
+Added: with pulmonologists, oncologists, cardiothoracic surgeons, radiologists, and internists engaged
+Added: in the diagnosis and treatment of lung cancer to help assess their reactions to our diagnostic tool.
+Added: Research revealed a strong interest
+Added: in CyPath ® Lung, driven by the high level of unmet clinical need for noninvasive diagnostics.
+Added: A survey conducted with
+Added: 240 pulmonologists and internists, the primary audience for the test, showed that 96% would use CyPath ® Lung if it were
+Added: available today as an adjunct used for diagnosis after LDCT screening.
+Added: Physicians responded favorably to a noninvasive diagnostic technology
+Added: that gives them more confidence in their decision to proceed with more aggressive follow-up procedures if the test comes back positive.
+Added: If test results are negative, physicians can rule out lung cancer, thus reducing the number of costly invasive procedures that result
+Added: from the LDCT false-positive rate.
Lung Business Development Plan
−Removed: believe in the viability of the Company’s Business Plan based on the circumstances surrounding our business that are known to us
−Removed: as of the date of this report.
−Removed: However, the timing, strategies, and stages of our Business Plan may evolve in light of new circumstances
−Removed: that cannot be predicted with certainty at this time.
−Removed: Our Business Plan envisions four phases of expanding market entry into the U.S.,
−Removed: the EU, and worldwide that are timed to maximize Company resources and minimize market risk.
−Removed: Phase 1 of our Business Plan begins with
−Removed: a controlled market launch of the Company’s LDT CyPath ® Lung in Texas followed by expansion into the Southwest market
−Removed: Limited marketing was undertaken prior to the IPO that provided funds necessary to begin our controlled market launch.
−Removed: 2023, the Company announced that the marketing and advertising firms of Havas Health & You and Trinity Life Sciences had been engaged
−Removed: to build the CyPath ® Lung brand and position it for success in the cancer diagnostics sector.
−Removed: Havas Health & You,
−Removed: the world’s largest global health network, is creating the branding and broader marketing strategy to align with the need for a
−Removed: patient-friendly diagnostic that gives physicians another tool to assess the potential or presence of lung cancer in their high-risk
−Removed: Trinity Life Sciences is providing advisory services, insights, and analytics to bioAffinity Technologies’ marketing
−Removed: strategy for CyPath ® Lung.
−Removed: The Company expects to begin a staged nationwide expansion of sales and marketing following
−Removed: the successful completion of its controlled launch in 2023.
−Removed: Phase 2 of our Business Plan anticipates entering the EU market with CyPath ®
−Removed: Lung as a CE-marked IVD test with sales in the Netherlands, followed by a staged EU expansion.
−Removed: Phase 3 of our Business Plan focuses
−Removed: on the marketing of an FDA-cleared CyPath ® Lung test, beginning with a pivotal clinical trial in the U.S.
−Removed: Phase 4 of our
−Removed: Business Plan accelerates the market presence of CyPath ® Lung in countries in Asia, Eastern Europe, and Australia after
−Removed: obtaining FDA marketing authorization in 2026.
−Removed: each phase of commercialization, bioAffinity Technologies will develop messaging and marketing programs, including key convention attendance,
−Removed: digital marketing, social media presence, and advertising, to create an “inbound” lead generation mechanism that delivers
−Removed: our message to our target audience.
−Removed: In addition, bioAffinity will collaborate with key opinion leaders (“KOLs”) to expand
−Removed: our third-party reference and speaking pool of experts.
−Removed: The Company will provide support and collateral materials, including posters,
−Removed: presentations, videos, and peer-reviewed papers, to our KOLs who will present data and their experience with CyPath ® Lung
−Removed: at key meetings.
−Removed: This content can be shared across platforms, including websites and sales tools, and will be used as references to support
−Removed: our product claims as well as sales and marketing efforts to physicians, reference laboratories, and patients.
−Removed: We will also work with
−Removed: lung cancer advocacy groups throughout all phases to support the message that routine screening can diagnose cancer at an early stage
−Removed: and save lives.
+Added: believe in the viability of our business plan based on the circumstances surrounding our business that are known to us as of the date
+Added: of this Annual Report.
+Added: However, the timing, strategies, and stages of our business plan may evolve in light of new circumstances that
+Added: cannot be predicted with certainty at this time.
+Added: Our business plan envisions four phases of expanding market entry into the U.S., the
+Added: EU, and worldwide that are timed to maximize our resources and minimize market risk.
+Added: Phase 1 of our business plan has already begun with
+Added: a limited market launch of our LDT CyPath ® Lung in Texas.
+Added: This limited test market launch is designed to evaluate our
+Added: marketing program and help us ensure each step in the care pathway – from the initial order by physicians to sputum collection
+Added: and processing, to generating and delivering the patient report – is efficient and effective.
+Added: This limited test market approach
+Added: allows us to refine future positioning and develop strategic insight for our CyPath ® Lung test before expanding to a larger
+Added: believe that our strategy related to a limited market launch is proving successful.
+Added: On March 5, 2024, we reported accelerating growth
+Added: of 375% in CyPath ® Lung tests ordered and processed over from December 1, 2023, through February 29, 2024, as compared
+Added: to the prior three-month period.
+Added: We attribute the growth in sales to three 2023 initiatives that came to fruition early in 2024:
+Added: CMS’ inclusion of reimbursement for CyPath ® Lung on its 2024 clinical laboratory fee schedule;
+Added: (2) the hiring of
+Added: our new National Director of Sales, Dallas Coleman, who is experienced and well respected in the pulmonary field;
+Added: and (3) marketing materials
+Added: for the newly branded CyPath ® Lung that emphasize our test’s ability to assist physicians with next steps in patient
+Added: next step in our marketing plan is expansion into the Southwest market area in 2024 followed by a staged nationwide expansion of sales
+Added: and marketing beginning later in 2024.
+Added: In addition to introducing pulmonologists, family practitioners, and other providers to CyPath ®
+Added: Lung, we are selling CyPath ® Lung tests to the Department of Defense, which represents a significant potential market
+Added: for CyPath ® Lung.
+Added: Phase 2 of our business plan anticipates entering the EU market with CyPath ® Lung as
+Added: a CE-marked IVD test with sales in the Netherlands, followed by a staged EU expansion.
+Added: Phase 3 of our business plan focuses on the marketing
+Added: of an FDA-cleared CyPath ® Lung test, beginning with a pivotal clinical trial in the U.S.
+Added: Toward that end, we intend to
+Added: voluntarily seek FDA clearance of the CyPath ® Lung as a Class II IVD medical device for the detection of lung cancer.
+Added: We have designed our pivotal trial with guidance from our Clinical Research Organization (“CRO”), Courante Oncology, and
+Added: we are preparing a pre-submission that will be submitted to the FDA for review and feedback.
+Added: We anticipate a three-year diagnostic trial
+Added: including an 18-month patient enrollment of approximately 1,800 patients.
+Added: Similar to the test validation trial, the planned pivotal trial
+Added: will analyze flow cytometry and patient data including (1) the proportion of cells with a high ratio of high TCPP fluorescence intensity
+Added: over cell size;
+Added: (2) the proportion of cells with an intermediate ratio of fluorescence intensity caused by the viability dye (FVS510)
+Added: over cell size;
+Added: (3) the proportion of cells that were CD206 negative but positive for one or more of the following markers:
+Added: CD66b (granulocytes),
+Added: CD3 (T cells), and CD19 (B cells);
+Added: and (4) patient age.
+Added: Patient enrollment is scheduled to begin in 2024 at up to 20 collection sites.
+Added: Assuming the study is successful, we intend to submit a de novo classification request to the FDA within six months of study completion.
+Added: Phase 4 of our business plan accelerates the market presence of CyPath ® Lung in countries in Asia, Eastern Europe, and
+Added: Australia after obtaining FDA marketing authorization.
+Added: each phase of commercialization, we plan to develop messaging and marketing programs, including key convention attendance, digital marketing,
+Added: social media presence, and advertising, to create an “inbound” lead generation mechanism that delivers our message to our
+Added: target audience.
+Added: In addition, we plan to collaborate with key opinion leaders (“KOLs”) to expand our pool of third-party
+Added: experts and speakers.
+Added: We will provide support and collateral materials, including posters, presentations, videos, and peer-reviewed papers,
+Added: to our KOLs who will present data and their experience with CyPath ® Lung at key meetings.
+Added: This content can be shared across
+Added: platforms, including websites and sales tools, and will be used as references to support our product claims as well as sales and marketing
+Added: efforts to physicians, reference laboratories, and patients.
+Added: We will also work with lung cancer advocacy groups throughout all phases
+Added: to support the message that routine screening can save lives by diagnosing cancer at an early stage.
Competition for CyPath ® Lung
−Removed: 2022, we evaluated 67 companies advancing tests for the early detection of lung cancer that provided at least a scientific foundation
−Removed: for their tests.
−Removed: These competitors are investigating lung cancer screening and diagnostic methods that use various types of collected
−Removed: samples (blood, breath, nasal epithelial cells, saliva, sputum, and urine) or imaging systems.
−Removed: Of those 67 companies, we found that only
−Removed: 11 had conducted clinical studies in a manner and with results that could lead to further analysis.
−Removed: The majority of these 11 tests are
−Removed: in research and development, with only four tests on the market and one available to a limited number of medical centers.
−Removed: Although CyPath ®
−Removed: Lung was never tested directly against any of these five tests, comparison of the published performance numbers suggests CyPath ®
−Removed: Lung might outperform them all.
−Removed: (See Summary of Comparative Performance Analysis of Tests on the Market, bioAffinity Technologies
−Removed: Internal Analysis, 2022 ;
−Removed: attached as Appendix II of the Company’s Final Prospectus (see https://www.sec.gov/Archives/edgar/data/1712762/000149315222024949/form424b4.htm )).
−Removed: the 67 companies we evaluated, we found only seven tests, including CyPath ® Lung, that represent a balanced test for early
−Removed: lung cancer detection and that have advanced to the point that there is sufficient data for evaluation.
−Removed: Of our six competitors with well-balanced
−Removed: tests (two sell the same test;
−Removed: one in the U.S.
−Removed: and one in China), four companies (20/20 GeneSystems 48,49 ;
−Removed: Savicell 51 ;
−Removed: Visongate 52 ) conducted their studies on a population that does not match the high-risk population for
−Removed: which the test is intended.
−Removed: Their clinical data, therefore, is suspect as it applies to the population of patients who actually will
−Removed: use the test.
−Removed: The two remaining balanced tests are not on the market.
+Added: Lung has not been tested directly against its competitors’ products, but a comparison of the published performance numbers
+Added: suggests CyPath ® Lung is among the highest performing tests on the market.
+Added: Furthermore, CyPath ® Lung is
+Added: noninvasive – not even requiring a needle stick – and cost effective, and processing and analysis procedures are easy to
+Added: data and the results of clinical trials allow us to group lung cancer diagnostic tests into three categories:
+Added: (1) balanced tests;( 2)
+Added: rule-out tests, and (3) rule-in tests.
+Added: Balanced tests aim at excluding patients without cancer from unnecessary follow-up diagnostic
+Added: procedures and detecting patients with early-stage cancer who can proceed to more aggressive procedures to confirm diagnosis.
+Added: tests aim to exclude patients without cancer from unnecessary follow-up procedures with high accuracy (if the test provides a “negative”
+Added: result), but among the remainder of patients who do not receive an unambiguous negative result, there is still uncertainty about who
+Added: has cancer and who does not.
+Added: Cancer patients for whom time is of the essence are included in this group of patients still in uncertainty.
+Added: The patient can lose precious time with a rule-out test.
+Added: Rule-in tests aim to identify patients with cancer but in doing so may identify
+Added: many people without cancer as positive.
+Added: Therefore, rule-in tests have a low positive predictive value.
+Added: believe that balanced tests, like CyPath ® Lung, can be the most cost effective.
+Added: Those that perform well are most useful
+Added: to a physician and his or her patient because they provide the most information, allowing a quicker decision on what follow-up path to
+Added: whether to move forward with more aggressive follow-up procedures (i.e., in the case of CyPath ® Lung, if the test
+Added: reveals a “likely” or “highly likely” cancer result) or to follow a more conservative approach (i.e., when the
+Added: CyPath ® Lung test reveals an “unlikely” or “very unlikely” cancer result).
+Added: completed a competitive analysis in 2022 of 67 companies that published research sufficient to provide a scientific basis for evaluation.
+Added: We found only seven tests, including CyPath ® Lung, that represent a balanced test for early lung cancer detection and
+Added: have advanced to the point that there is sufficient data for evaluation.
+Added: One test is sold by two companies:
+Added: one from the U.S.
+Added: In the U.S., the test is called Lung LB (sold by LungLife AI) and is now on the market.
+Added: LungLB is a FISH-based test that
+Added: requires a significant amount of experience to conduct.
+Added: Four companies, each selling unique tests for early lung cancer detection, conducted
+Added: their studies on a population that does not match the high-risk population for which the test is intended.
+Added: Their clinical data, therefore,
+Added: is not necessarily representative of the results that would be achieved in the population of patients who actually will use the test.
+Added: The remaining balanced test, ProLung, is from IONIQ Sciences.
+Added: The test requires an expensive machine to measure transcutaneous bioconductance.
+Added: The test is not on the market at this time.
+Added: First Look was recently launched to assist in determining whether a person should be screened by LDCT.
+Added: While CyPath Lung ®
+Added: is positioned to help diagnose lung nodules in patients who have already undergone screening by LDCT, First Look is intended to be used
+Added: prior to LDCT.
+Added: As such, this test may increase lung cancer screening uptake and potentially increase the need for CyPath Lung ® .
+Added: found two rule-out tests on the market.
+Added: Both REVEAL, offered by MagArray, and Nodify-XL2, offered by Biodesix, are rule-out tests, meaning
+Added: the tests aim to exclude patients without cancer.
+Added: The REVEAL test is a blood test intended for patients with indeterminant nodules.
+Added: their 97-patient clinical validation trial, only patients with an intermediate risk of cancer, based either on a physician’s judgement
+Added: or a clinical model, took part.
+Added: This requirement led to 30% of high -risk patients being excluded at the onset of their analysis.
+Added: addition, the positive predictive value of the REVEAL test was 13.5% as compared to CyPath ® Lung’s positive predictive
+Added: value of 43.2%.
+Added: Importantly, no patients were excluded from the CyPath ® Lung test.
+Added: The tests had negative predictive values
+Added: of 98% and 97.8%, respectively.
+Added: The second rule-out test, Nodify-XL2, is used only by people with a pre-test probability of cancer less
+Added: As with the REVEAL test, a large number of patients were excluded from analysis.
+Added: In the case of Nodify-XL2, about 55% of patients
+Added: with lung nodules that physicians considered indeterminate, namely lung nodules sized between 8-30 mm, were excluded from the study.
+Added: In addition, Nodify XL-2 reported an AUC of 0.62 (unacceptable) and 0.76 (acceptable) for their two clinical trials, as compared to CyPath ®
+Added: Lung with an AUC of 0.89 and 0.90 in two independent study groups (excellent).
+Added: the Percepta nasal swab test offered by Veracyte is not widely available and is seeking a reimbursement code.
+Added: The test classifies patients
+Added: in low- and high-risk categories, or for those whose results are unclear, an intermediate category.
+Added: Test performance is different in
+Added: each risk category.
+Added: In a recently published paper of the test validation trial, the sensitivity and specificity for low-risk classification
+Added: was 97% and 40%, respectively, with those at low risk having an 8% calculated risk of having a malignancy.
+Added: The sensitivity and specificity
+Added: for the high-risk classification was 57% and 92%, respectively, and those patients who were put into the high-risk category had a 90%
+Added: risk of a malignancy.
+Added: One of the limitations of this study is that the participants in the validation trial had a cancer prevalence of
+Added: 54% as compared to the overall high-risk population that has an estimated lung cancer prevalence of 1.1%, according to the National Lung
+Added: Cancer Screening Trial.
+Added: Therefore, we believe the nasal swab test’s performance may suffer when the classifier is tested on more
+Added: realistic cohorts with a cancer prevalence lower than 10%.
+Added: Although it is a patient-friendly test, a major limitation of the test is
+Added: that nearly half of all patients who took part in the validation trial could not be classified as either low- or high-risk;
+Added: they are considered “intermediate risk” with a 50:50 chance of having cancer.
+Added: Thus, in nearly half of the patients who received
+Added: the Percepta nasal swab test, the results would not help advance the diagnostic process.
+Added: In fact, for those patients in this indeterminate
+Added: category who do have cancer, valuable time in diagnosis may be lost.
believe there are many reasons why CyPath ® Lung is a superior test when compared to its competitors.
3 unchanged sentences
sputum contains immune cell populations in reaction to the presence of a tumor.
−Removed: Second, bioAffinity’s proprietary technology is
−Removed: straightforward.
−Removed: bioAffinity’s CyPath ® Lung platform technology is not a molecular test and does not collect genetic
−Removed: material that requires immediate processing.
−Removed: CyPath ® Lung uses well-established flow cytometry techniques to investigate
−Removed: cells contained in the sputum for characteristics that indicate whether cancer is present.
−Removed: Sample processing is straightforward, and
−Removed: laboratory technicians can be easily trained.
+Added: Second, our proprietary technology is straightforward.
+Added: Our CyPath ® Lung platform technology is not a molecular test and does not collect genetic material that requires immediate
+Added: CyPath ® Lung uses well-established flow cytometry techniques to investigate cells contained in the sputum
+Added: for characteristics that indicate the likelihood of lung cancer.
+Added: Sample processing is straightforward, and laboratory technicians can
+Added: be easily trained.
Reagents used by the test are widely available.
−Removed: Data acquisition and analysis is fully
−Removed: automated, allowing for efficient test results.
−Removed: Third, CyPath ® Lung has shown high specificity and sensitivity that is
−Removed: similar to far more invasive and more expensive procedures currently used to detect lung cancer.
−Removed: Fourth, CyPath ® Lung
−Removed: is cost effective.
−Removed: Existing CPT cost codes that have a reimbursable track record have been identified for use with CyPath.
−Removed: as important as any of our test’s benefits, CyPath ® Lung is patient friendly, providing at-home sample collection
−Removed: that is noninvasive and offers particular benefit during a public healthcare crisis like the coronavirus pandemic.
−Removed: a discussion of our competitors and competitive analysis, please see the “Business – The Competition for CyPath ®
−Removed: Lung” section of our Final Prospectus (see https://www.sec.gov/Archives/edgar/data/1712762/000149315222024949/form424b4.htm ).
−Removed: Research and Development
−Removed: The Company is continuing its
−Removed: research and development activities pertaining to diagnostics that include multiple studies we believe will support FDA final approval
−Removed: of CyPath ® Lung, which we will seek after the pivotal trial is complete.
−Removed: Our scientists also have begun preliminary studies
−Removed: toward the development of CyPath ® Lung for detection of Chronic Obstructive Pulmonary Disease (COPD) and the assay’s
−Removed: use with bronchoalveolar lavage fluid (BAL).
−Removed: With regard to therapeutic research, the Company continues its experiments focused on establishing
−Removed: proof-of-concept for our discovery that the silencing or knockdown of two genes that each encode a cell surface receptor results in cancer
−Removed: death without much harm to healthy cells with the intent of advancing toward animal studies.
+Added: Data acquisition and analysis is fully automated, allowing for non-biased,
+Added: efficient test results.
+Added: Third, CyPath ® Lung has shown high specificity and sensitivity that is similar to far more invasive
+Added: and more expensive procedures currently used to detect lung cancer.
+Added: Fourth, CyPath ® Lung is cost effective, with a Medicare
+Added: reimbursement code billable to both government and private insurance carriers.
+Added: Fifth and as important as any of our test’s benefits,
+Added: CyPath ® Lung is patient friendly, providing at-home sample collection that is noninvasive and offers particular benefit
+Added: during a public healthcare crisis like the coronavirus pandemic.
+Added: and Development Activities
+Added: are continuing our research and development activities pertaining to diagnostics that include multiple studies we believe will support
+Added: FDA final approval of CyPath ® Lung, which we will seek after completing the pivotal trial.
+Added: With support from the DOD,
+Added: we are also conducting research advancing the development of CyPath ® Lung for detection of COPD and a test for use with
+Added: bronchoalveolar lavage fluid (BAL) as a companion test to bronchoscopy.
+Added: With regard to therapeutic research, we continue our experiments
+Added: focused on establishing proof-of-concept for our discovery that the silencing or knockdown of two genes that each encode a cell surface
+Added: receptor result in cancer death without perceived harm to healthy cells.
+Added: Diagnostic Applications for the CyPath ® Platform
+Added: expect to expand our platform technology to detect and monitor other lung diseases.
+Added: Our research is conducted, in part, in collaboration
+Added: with Brooke Army Medical Center in San Antonio, Texas, and partially funded by the DOD.
+Added: Obstructive Pulmonary Disease and Other Diseases of the Lung.
+Added: respiratory diagnostics market was valued at $5.6 billion in 2023 and is expected to reach $8.2 billion by 2029, according to a market
+Added: research study published by Research and Markets in November 2023.
+Added: The World Health Organization reports that COPD is the third
+Added: leading cause of death in the world, causing nearly 3.23 million deaths in 2019.
+Added: The disease is characterized as an abnormal inflammatory
+Added: response and airflow obstruction that cannot be fully reversed.
+Added: Early detection allows for the use of therapies when the disease is less
+Added: severe, which slows the progression of the disease.
+Added: We plan to build on our expertise in using sputum as a sample for flow cytometric
+Added: analysis to develop a test to detect COPD at an early stage and monitor for signs of impending exacerbations before clinical signs occur.
+Added: CyPath ® Lung’s flow cytometry platform provides for identification of cell populations and other parameters of disease
+Added: Our test illuminates the microenvironment of the lung.
+Added: We believe that our flow cytometric test can be designed to identify
+Added: other lung diseases, such as COPD and asthma, using antibodies that characterize cell populations in sputum specific to the disease.
+Added: Bronchoscopies.
+Added: market research firm Markets and Markets reports that the bronchoscopy market is primarily driven by an increasing prevalence of various
+Added: respiratory diseases such as COPD and lung cancer.
+Added: Improving reimbursement code policies, growing hospital investment in bronchoscopy
+Added: facilities, and technological advancements are factors driving growth of a market that was estimated at $2.5 billion in 2022 and expected
+Added: to reach an estimated $3.7 billion in 2027.
+Added: Despite advancements in bronchoscopy technologies, there remains a significant need for companion
+Added: tests that can increase diagnostic performance.
+Added: Bronchoscopy is considered minimally invasive but carries a risk of collapsed or bleeding
+Added: lung and risk of infection.
+Added: The sensitivity of bronchoscopy is 88% and specificity of 47%, according to the article “A bronchial
+Added: genomic classifier for the diagnostic evaluation of lung cancer” published in the New England Journal of Medicine on July
+Added: In collaboration with Brooke Army Medical Center, the CyPath ® process is being developed as a companion to bronchoscopy
+Added: in which samples are collected as part of the bronchoscopy process and processed using flow cytometry and automated analysis developed
+Added: Therapeutics Research
+Added: Therapeutics, LLC, a Delaware limited liability company and our wholly owned subsidiary, is a preclinical-stage biopharmaceutical
+Added: discovery company with a focus on therapeutics that deliver cytotoxic (cell-killing) effects on a broad selection of human cancers from
+Added: diverse tissues while having little or no effect on normal cells.
+Added: many of our industry competitors, OncoSelect ® does not pursue therapies that depend on specific mutations, biomarkers,
+Added: or other genetic or epigenetic abnormalities for their effect.
+Added: We pursue research based on our own scientific discoveries demonstrating
+Added: that inhibition of the expression of two specific cell membrane proteins results in the selective killing of various cancer cell types
+Added: grown in the laboratory with little or no effect on normal (non-cancerous) cells.
+Added: We have established several specific areas of therapeutic
+Added: research that offer the possibility of broad applications in cancer treatment.
+Added: OncoSelect ® will use a licensing business
+Added: model for selective chemotherapeutic compounds to be developed by the Company.
+Added: therapeutic platforms originated from our research on how TCPP, the synthetic porphyrin used in CyPath ® Lung, enters cancer
+Added: We conducted research to better understand the mechanism of TCPP’s selective uptake in cancer cells.
+Added: Our research identified
+Added: receptors, cell-membrane proteins which capture small molecules outside of the cell and bring them inside the cell, that are associated
+Added: Experiments that we conducted confirmed that at least two of these receptors, CD320 and LRP2, contributed to TCPP uptake by
+Added: cancer cells.
+Added: When these receptors were individually “knocked down” in cancer cells and therefore could not be made by the
+Added: cell, TCPP uptake was significantly decreased.
+Added: Knock-down of CD320 and LRP2 receptors was achieved by introducing siRNA molecules into
+Added: the cells that cause the destruction of CD320 and LRP2 gene products.
+Added: These gene products were the messenger (m)RNAs that are the precursors
+Added: of the receptor protein.
+Added: An siRNA is a small, chemically synthesized piece of RNA that specifically binds to mRNA, prohibiting the further
+Added: production of the corresponding proteins.
+Added: Thus, the reduction of CD320 or LRP2 mRNAs reduced the CD320 or LRP2 protein, respectively,
+Added: and resulted in decreased TCPP uptake in a variety of cancer cells, with a larger decrease observed when CD320 was knocked down.
+Added: We subsequently
+Added: discovered that the simultaneous knockdown of these two cell-surface receptors, CD320 and LRP2, was deadly to cancer cells or inhibited
+Added: their growth significantly but left normal cells virtually unharmed.
+Added: can be easily synthesized and are easily introduced into cells growing in a petri dish by a process called transfection.
+Added: been broadly adopted by academic and industrial researchers for the fundamental study of the function of genes and their proteins.
+Added: designed siRNAs to effectively eliminate CD320 and LRP2 protein production to study their role in TCPP uptake into the cell.
+Added: CD320 and LRP2 siRNAs, we achieved a reduction of CD320 and LRP2 protein levels of up to 90%.
+Added: Simultaneous siRNA knock-down of CD320
+Added: and LRP2 in normal cells, including skin fibroblasts and breast epithelial cells, did not affect cell growth.
+Added: However, knock-down of
+Added: CD320 and LRP2 in cancer cell lines derived from diverse tissues (lung, breast, prostate, brain, and skin cancers) inhibited cell growth
+Added: or killed the cells, in some cases up to 80%.
+Added: Interestingly, in some cell lines, when either CD320 or LRP2 were silenced individually,
+Added: a concurrent increase in protein expression of the other receptor was observed, suggesting that CD320 and LRP2 compensate for each other’s
+Added: hence, silencing both receptors is required for optimal cell killing.
+Added: These discoveries can lead to novel and very promising
+Added: therapeutic approaches for diverse cancers that do not appear to be dependent on any aberrant genetic or epigenetic profiles.
+Added: were incorporated in the State of Delaware on March 26, 2014.
+Added: Our principal executive office is located at 22211 West Interstate 10,
+Added: Suite 1206, San Antonio, Texas 78257, and our telephone number at that address is (210) 698-5334.
+Added: Our website address is https://www.bioaffinitytech.com/.
+Added: Information contained on or that can be accessed through our website is not incorporated by reference into this Annual Report.
+Added: should not consider any such information to be part of this Annual Report.
Property Portfolio
−Removed: of March 31, 2023, the Company and its subsidiary OncoSelect have a patent estate that includes 14 issued U.S.
+Added: strive to protect the proprietary technologies that we believe are important to our business, including pursuing and maintaining patent
+Added: protection intended to cover our commercialized diagnostic test, pipeline product candidates and their use, as well as other inventions
+Added: that are important to our business.
+Added: In addition to patent protection, we also protect valuable company assets with copyright, trademark,
+Added: trade secret, and know-how through confidentiality agreements, invention assignment agreements, and a trade secret program to protect
+Added: aspects of our business that are not amenable to, or that we do not consider appropriate for, patent protection.
+Added: The confidentiality
+Added: agreements are designed to protect our proprietary information, and the invention assignment agreements are designed to gain company
+Added: control and ownership of technologies that are developed for us by our employees, consultants, or other third parties.
+Added: We seek to preserve
+Added: the integrity and confidentiality of our data and trade secrets by maintaining physical security of our premises, physical and electronic
+Added: security of our information technology systems, and non-disclosure agreements with those that produce or receive company confidential
+Added: While we have confidence in our agreements and security measures, either may be breached, and we may not have adequate remedies.
+Added: In addition, our trade secrets may otherwise become known or independently discovered by competitors.
+Added: commercial success depends in part upon our ability to obtain and maintain patent and other proprietary protection for commercially important
+Added: technologies, inventions, and trade secrets related to our business, defend and enforce our intellectual property rights, particularly
+Added: our patent rights, preserve the confidentiality of our trade secrets, and operate without infringing valid and enforceable intellectual
+Added: property rights of others.
+Added: patent positions for biotechnology companies like us are generally uncertain and can involve complex legal, scientific, and factual issues.
+Added: In addition, the coverage claimed in a patent application can be significantly reduced before a patent is issued, and its scope can be
+Added: reinterpreted and even challenged after issuance.
+Added: As a result, we cannot guarantee that any of our product candidates will be protectable
+Added: or remain protected by enforceable patents.
+Added: We cannot predict whether the patent applications we are currently pursuing will issue as
+Added: patents in any particular jurisdiction or whether the claims of any issued patents will provide sufficient proprietary protection from
+Added: Any patents that we hold may be challenged, circumvented, or invalidated by third parties.
+Added: of April 1, 2024, we and our OncoSelect ® subsidiary have a patent estate that includes 16 issued U.S.
and foreign counterpart
patents including two U.S.
−Removed: patents and twelve foreign counterpart patents in Australia, Canada, China, France, Germany, Hong Kong, Italy,
−Removed: Mexico, Spain, Sweden, and the United Kingdom.
−Removed: patent and nine counterpart foreign patents directed at diagnostic applications
−Removed: expire in 2030.
−Removed: Therapeutic patents registered in Australia, China Mexico and the U.S.
−Removed: expire in 2037.
−Removed: regard to our diagnostic test CyPath ® Lung and other diagnostic candidates, we have one issued U.S.
−Removed: patent and nine foreign
−Removed: counterpart patents in Canada, China, France, Germany, Hong Kong, Italy, Spain, Sweden, and the United Kingdom.
−Removed: With regard to our diagnostic
−Removed: patent applications, one family is directed at diagnosing lung health using flow cytometry, and the other family is directed at proprietary
−Removed: compensation beads used to calibrate the flow cytometry instrument and used in CyPath ® Lung data acquisition.
−Removed: applications directed at diagnosing lung health include one pending U.S.
−Removed: non-provisional patent application and eight foreign counterpart
−Removed: patent applications in Australia, Canada, China, European Patent Office, Hong Kong, Japan, Mexico, and Singapore filed in 2019, one Patent
−Removed: Cooperation Treaty (PCT) International Application directed to the composition of compensation beads and one PCT International Application
−Removed: directed to diagnosing lung health using flow cytometry were filed in 2022.
+Added: patents and 14 foreign counterpart patents in Australia, Canada, China, France, Germany, Hong Kong, India,
+Added: Italy, Mexico, Spain, Sweden, and the United Kingdom.
+Added: We and OncoSelect ® own all patents and trademarks in our intellectual
+Added: property portfolio.
+Added: patent and nine counterpart foreign patents directed at diagnostic applications expire in 2030.
+Added: patent and five counterpart foreign patents directed at therapeutic applications expire in 2037.
+Added: regard to our diagnostic patent portfolio, we have one issued U.S.
+Added: patent and nine foreign counterpart patents in Canada, China, France,
+Added: Germany, Hong Kong, Italy, Spain, Sweden, and the United Kingdom.
+Added: With regard to our diagnostic patent applications, there are two families
+Added: of which one is directed at diagnosing lung health using flow cytometry and the other is directed at proprietary compensation beads used
+Added: in analysis by flow cytometry.
+Added: The diagnostic family of pending patent applications is directed at diagnosing lung health and includes
+Added: one pending non-provisional U.S.
+Added: patent application and eight foreign counterpart patent applications in Australia, Canada, China, European
+Added: Patent Office, Japan, Hong Kong, Mexico, and Singapore filed in 2019, one International Patent Application filed in 2022 and one International
+Added: Patent Application filed in 2023.
+Added: Also, a patent application directed at the composition of compensation beads was filed as an International
+Added: Patent application in 2022.
regard to our therapeutic product candidates, we have one issued U.S.
−Removed: patent, two pending U.S.
−Removed: patent applications, three issued foreign
−Removed: patents, ten foreign applications pending in Canada, China, European Patent Office, Hong Kong, India, and Japan and one pending PCT International
−Removed: Application,.
−Removed: The therapeutic intellectual property is made up of four families directed at our therapeutic product candidates, including
−Removed: two families directed at siRNA product candidates, one family directed at soluble CD320 used in the treatment of cancer, and one family
−Removed: directed at porphyrin conjugates for treating cancer.
−Removed: a discussion of the extensive government regulation that the Company and our IVD medical device, CyPath ® Lung, are subject
−Removed: to, please see the “Business – Government Regulation” section of our Final Prospectus (see https://www.sec.gov/Archives/edgar/data/1712762/000149315222024949/form424b4.htm ).
−Removed: Company places significant emphasis on the recruitment, development, and retention of its employees who include award-winning scientists
−Removed: dedicated to advancing scientific discovery from bench to bedside.
−Removed: Of the Company’s 14 employees, all of whom are employed full-time
−Removed: by the Company, one holds an MD and seven hold PhDs in biology or medicinal chemistry.
−Removed: Approximately nine employees are engaged in research
−Removed: and development and approximately five in sales or general administration.
−Removed: Executive Vice President and Chief Medical and Science Officer, Vivienne Rebel, holds an MD and PhD.
−Removed: Business development is led by our
−Removed: Vice President of Operations, Xavier Reveles, who has 25 years of experience as a clinical geneticist skilled in the creation and management
+Added: patent, five issued foreign patents in Australia, China, Hong Kong,
+Added: India and Mexico, two pending U.S.
+Added: applications, and 10 foreign applications pending in Canada, China, European Patent Office, Hong Kong,
+Added: India, and Japan and one pending International Patent Application filed in 2022.
+Added: The therapeutic intellectual property is made up of
+Added: two families, including one family directed at our siRNA product candidates for the treatment of cancer, and another family directed
+Added: at our porphyrin conjugates for treating cancer.
+Added: One therapeutic patent application has been granted in China that expires in 2037.
+Added: term of individual patents depends upon the legal term of the patents in the countries in which they are obtained.
+Added: In most countries
+Added: in which we file, the patent term is 20 years from the earliest date of filing a non-provisional patent application.
+Added: In the U.S., the
+Added: term of a patent covering an FDA-approved drug may be eligible for a patent term extension under the Hatch-Waxman Act as compensation
+Added: for the loss of patent term during the FDA regulatory review process.
+Added: The period of extension may be up to five years beyond the expiration
+Added: of the patent, but cannot extend the remaining term of a patent beyond a total of 14 years from the date of product approval.
+Added: patent among those eligible for an extension may be extended, and a given patent may only be extended once.
+Added: Similar provisions are available
+Added: in Europe and in certain other jurisdictions to extend the term of a patent that covers an approved drug.
+Added: It is possible that issued
+Added: patents covering each of our therapeutic product candidates may be entitled to patent term extensions.
+Added: If our product candidates
+Added: receive FDA approval, we intend to apply for patent term extensions, if available, to extend the term of patents that cover the approved
+Added: product candidates.
+Added: We also intend to seek patent term extensions in any jurisdictions where they are available;
+Added: however, there is no
+Added: guarantee that the applicable authorities, including the FDA, will agree with our assessment of whether such extensions should be granted,
+Added: and, if granted, the length of such extensions.
+Added: addition to patent protection, we also rely on know-how and trade secret protection for our proprietary information that is not amenable
+Added: to, or that we do not consider appropriate for, patent protection, to develop and maintain our proprietary position.
+Added: However, trade secrets
+Added: can be difficult to protect.
+Added: Although we take steps to protect our proprietary information, including restricting access to our premises
+Added: and our confidential information, as well as entering into agreements with our employees, consultants, advisors, and potential collaborators,
+Added: third parties may independently develop the same or similar proprietary information or may otherwise gain access to our proprietary information.
+Added: As a result, we may be unable to meaningfully protect our know-how, trade secrets, and other proprietary information.
+Added: addition, we plan to rely on regulatory protection based on orphan drug exclusivities, data exclusivities, and market exclusivities.
+Added: Products (including Medical Devices and Tests)
+Added: the U.S., medical devices, including IVDs are subject to extensive regulation by the FDA, under the federal Food, Drug and Cosmetic
+Added: Act (“FDCA”) and its implementing regulations, and certain other federal and state statutes and regulations.
+Added: and regulations govern, among other things, the design, manufacture, storage, recordkeeping, approval, labeling, promotion,
+Added: post-approval monitoring and reporting, distribution, and import and export of medical devices, including IVDs.
+Added: IVDs are a category
+Added: of medical device that can be purchased by clinical laboratories and used to perform laboratory testing.
+Added: IVDs include reagents and
+Added: instruments used to detect the presence of certain chemicals or other biomarkers in human specimens for the purpose of diagnosis or
+Added: detection of diseases or conditions.
+Added: IVDs can also be used to perform predictive, prognostic, and screening testing.
+Added: medical devices, IVDs may require premarket review and clearance, authorization, or approval by the FDA.
+Added: Failure to comply with
+Added: applicable requirements may subject a device and/or its manufacturer to a variety of administrative and judicial sanctions, such as
+Added: FDA refusal to approve pending premarket approval (“PMA”) applications, issuance of warning letters or untitled letters,
+Added: mandatory product recalls, import detentions, civil monetary penalties, and/or judicial sanctions, such as product seizures,
+Added: injunctions, and criminal prosecution.
+Added: Developed Tests
+Added: Lung has entered the U.S.
+Added: market as an LDT.
+Added: The FDA considers LDTs to be tests that are developed, validated, and performed within
+Added: a single laboratory.
+Added: While CMS oversees clinical laboratory operations through the CLIA program, the FDA has the authority to regulate
+Added: LDTs as IVDs under the FDCA but has generally exercised enforcement discretion with regard to LDTs.
+Added: This means that even though the FDA
+Added: believes it can impose IVD regulatory requirements on LDTs, such as requirements to obtain premarket approval, authorization, or clearance,
+Added: it has generally chosen not to enforce those requirements except in cases it deemed appropriate to address significant public health
+Added: September 2023, the FDA announced a proposed rule to ensure the safety and effectiveness of LDTs by amending regulations to explicitly
+Added: say that IVDs offered as LDTs fall under the FDCA and phase out its general enforcement discretion approach for most LDTs.
+Added: policy makes it clear that the FDA intends to provide greater oversight of LDTs.
+Added: The FDA plans to finalize its ruling in April 2024 and
+Added: initiate a phased implementation process in which it will require laboratories to register their LDTs and begin the premarket review
+Added: process over the next four years.
+Added: 2021, two bills were reintroduced in the U.S.
+Added: the Verifying Accurate, Leading-edge IVCT Development Act of 2020 (the “VALID
+Added: Act”), which would have expressly granted the FDA authority to regulate LDTs under a risk-based framework;
+Added: and the Verified Innovative
+Added: Testing in American Laboratories Act of 2020 (the “VITAL Act”), which would have assigned LDTs to regulation solely under
+Added: CLIA and would have directed CMS to update its CLIA regulations.
+Added: Neither of these bills were enacted.
+Added: The VALID Act was reintroduced
+Added: in March 2023.
+Added: The likelihood that Congress will pass the VALID Act, VITAL Act, or similar legislation, and the extent to which such
+Added: legislation may affect the FDA’s plans to regulate LDTs as medical devices is difficult to predict.
+Added: Laboratory Improvement Amendments of 1988
+Added: laboratories testing specimens collected in the U.S.
+Added: for the purpose of disease diagnosis or health assessment are subject to CLIA, unless
+Added: CLIA establishes quality standards for all clinical laboratory testing to ensure the accuracy, reliability, and timeliness of
+Added: patient test results regardless of where the test was performed.
+Added: In particular, these regulations mandate that clinical laboratories
+Added: must be certified by the federal government or an accreditation organization with deemed status from the federal government, or must
+Added: be located in a state that has been granted exemption from CLIA requirements because the state has laws in effect that provide for requirements
+Added: equal to or more stringent than CLIA requirements.
+Added: CLIA also requires that laboratories meet quality assurance, quality control and personnel
+Added: standards, perform proficiency testing, and undergo inspections.
+Added: The CLIA standards applicable to clinical laboratories are based on
+Added: the complexity of the testing performed by the laboratory, which ranges from “waived” to “moderate complexity”
+Added: to “high complexity.” In the case of tests performed using IVDs, test complexity categorization of the IVD is performed by
+Added: is a member-based physician organization comprising approximately 18,000 board-certified pathologists.
+Added: CAP’s Laboratory Accreditation
+Added: Program has been granted deeming authority from the federal government, meaning that CAP accreditation can be used to qualify for CLIA
+Added: certification and to satisfy CLIA inspection requirements.
+Added: FDCA classifies medical devices into one of three categories based on the risks associated with the device and the level of control necessary
+Added: to provide reasonable assurance of safety and effectiveness.
+Added: Class I devices are low risk and are subject only to general regulatory
+Added: Class II devices are moderate risk.
+Added: They are subject to general controls and may also be subject to special controls.
+Added: III devices are generally the highest risk devices.
+Added: They are required to obtain premarket approval and comply with postmarket conditions
+Added: of approval in addition to general regulatory controls.
+Added: establishments that design and/or manufacture devices are required to register their establishments with the FDA.
+Added: They also must provide
+Added: the FDA with a list of the devices that they design and/or manufacture at their facilities.
+Added: FDA enforces its requirements by market surveillance and periodic inspections, both announced and unannounced, to review records, equipment,
+Added: facilities, laboratories, and processes to confirm regulatory compliance.
+Added: These inspections may include the manufacturing facilities
+Added: of subcontractors.
+Added: Following an inspection, the FDA may issue a report, known as a Form 483 notice of observations, listing instances
+Added: where the manufacturer has failed to comply with applicable regulations and/or procedures.
+Added: The FDA may also issue a public warning letter.
+Added: If the manufacturer does not adequately respond to a Form 483 or warning letter, the FDA may take enforcement action against the manufacturer
+Added: or impose other sanctions or consequences, which may include:
+Added: and desist orders;
+Added: or consent decrees;
+Added: monetary penalties;
+Added: detention, or seizure of products;
+Added: restrictions, partial or total shutdown of production facilities;
+Added: of or delay in granting requests for 510(k) clearance, de novo classification, or premarket approval of new products or modified
+Added: 510(k) clearances, de novo classifications, or premarket approvals that are already granted;
+Added: to grant export approval or export certificates for devices;
+Added: Authorization and Notification
+Added: most Class I and some Class II devices may be marketed without prior FDA authorization, many Class II and most Class III medical devices
+Added: can be legally sold within the U.S.
+Added: only if the FDA has:
+Added: (1) approved a PMA application prior to marketing, generally applicable to most
+Added: Class III devices;
+Added: (2) cleared the device in response to a premarket notification (a “510(k) submission”), generally applicable
+Added: to some Class I and most II devices;
+Added: or (3) authorized the device to be marketed through the de novo classification process, generally
+Added: applicable for novel low- or moderate-risk devices.
+Added: PMA applications, 510(k) premarket notifications, and de novo requests require
+Added: payment of user fees.
+Added: Premarket Notification
+Added: marketing in the U.S.
+Added: for most Class II and a limited number of Class I devices typically follows the 510(k) premarket notification pathway.
+Added: To obtain 510(k) clearance, a manufacturer must submit a premarket notification demonstrating that the proposed device is substantially
+Added: equivalent to a legally marketed device, referred to as the “predicate device.” A predicate device may be a previously 510(k)
+Added: cleared device or a Class III device that was in commercial distribution before May 28, 1976, for which the FDA has not yet called for
+Added: PMA applications, or a product previously placed in Class II or Class I through the de novo classification process.
+Added: The manufacturer
+Added: must show that the proposed device has the same intended use as the predicate device, and that it either has the same technological characteristics,
+Added: or has different technological characteristics but is shown to be equally safe and effective and does not raise different questions of
+Added: safety and effectiveness as compared to the predicate device.
+Added: FDA has a user fee goal to apply no more than 90 calendar review days to 510(k) submissions.
+Added: During the process, the FDA may issue an
+Added: Additional Information request, which stops the clock.
+Added: The applicant has 180 days to respond, although during the COVID-19 Public Health
+Added: Emergency, the FDA has permitted companies an additional 180 days in which to respond.
+Added: Therefore, the total review time absent the Public
+Added: Health Emergency could be up to 270 days, and in practice may be longer.
+Added: a device receives 510(k) clearance, any modification that could significantly affect its safety or effectiveness, or that would constitute
+Added: a major change in its intended use, requires a new 510(k) clearance or could require a PMA approval or de novo classification.
+Added: The FDA requires each manufacturer to make this determination in the first instance, but the FDA can review any such decision.
+Added: FDA disagrees with a manufacturer’s decision not to seek a new 510(k) clearance for the modified device, the agency may retroactively
+Added: require the manufacturer to seek 510(k) clearance, de novo classification, or PMA approval.
+Added: The FDA also can require the manufacturer
+Added: to cease marketing and/or recall the modified device until 510(k) clearance or PMA approval is obtained.
+Added: Novo Classification
+Added: of a new type that the FDA has not previously classified based on risk are automatically classified into Class III regardless of the
+Added: level of risk they pose.
+Added: To avoid requiring PMA review of novel low- to moderate-risk devices classified in Class III by operation of
+Added: law, Congress enacted a provision that allows the FDA to reclassify a novel low- to moderate-risk device into Class I or II in the absence
+Added: of a predicate device that would support 510(k) clearance.
+Added: The FDA evaluates the safety and effectiveness of devices submitted for review
+Added: under this de novo pathway and devices determined to be Class II can serve as predicate devices for future 510(k) applicants.
+Added: The de novo pathway can require clinical data.
+Added: FDA has a user fee goal to review a de novo request in 150 calendar review days.
+Added: During the process, the FDA may issue an Additional
+Added: Information request, which stops the clock.
+Added: The applicant has 180 days to respond.
+Added: Therefore, the total review time could be as long
+Added: as 330 days and in practice may be longer.
+Added: During the COVID-19 public health emergency, applicants were given an additional 180 days
+Added: in which to respond.
+Added: Class III product generally must follow the PMA approval pathway.
+Added: The PMA must be supported by sufficient valid scientific evidence,
+Added: including clinical study data, to assure that the device is safe and effective for its intended use(s).
+Added: After completion of clinical
+Added: testing, a PMA including the results of all non-clinical, clinical, and other testing and information relating to the product’s
+Added: marketing history, design, labeling, manufacture, and controls, is prepared and submitted to the FDA.
+Added: PMA approval process is generally more expensive, rigorous, lengthy, and uncertain than the 510(k) premarket notification process and
+Added: de novo classification process and requires proof of the safety and effectiveness of the device to the FDA’s satisfaction.
+Added: As part of the PMA review, the FDA will typically inspect the manufacturer’s facilities for compliance with Quality System Regulation
+Added: (“QSR”) requirements, which impose elaborate testing, control, documentation, and other quality assurance procedures.
+Added: FDA has a user fee goal to review a PMA in 180 calendar review days if the submission does not require advisory committee input, or 320
+Added: review days if the submission does require advisory committee input.
+Added: During the process, the FDA may issue a major deficiency letter,
+Added: which stops the review clock.
+Added: The applicant has up to 180 days to respond.
+Added: Therefore, the total review time could be up to 360 days,
+Added: if the submission does not require advisory committee input, or 500 days if the submission does require advisory committee input, and
+Added: in practice may be longer.
+Added: The COVID-19 pandemic significantly increased the FDA’s workload because of the need to review emergency
+Added: use authorization requests for IVDs and other regulated products, which delayed review timelines for some non-COVID-19 products.
+Added: the FDA’s evaluation of the PMA application is favorable, the FDA will issue a PMA for the approved indications, which can be more
+Added: limited than those originally sought by the manufacturer.
+Added: The PMA can include post-approval conditions that the FDA believes necessary
+Added: to ensure the safety and effectiveness of the device including, among other things, restrictions on labeling, promotion, sale, and distribution
+Added: or a requirement for postmarket surveillance or completion of postmarket studies.
+Added: Failure to comply with the conditions of approval can
+Added: result in material adverse enforcement action, including the loss or withdrawal of the approval and/or placement of restrictions on the
+Added: sale of the device until the conditions are satisfied.
+Added: after approval of a PMA, a new PMA or PMA supplement may be required in the event of a modification to the device, its labeling, or its
+Added: manufacturing process.
+Added: Supplements to a PMA may require the submission of the same type of information required for an original PMA,
+Added: except that the supplement is generally limited to that information needed to support the proposed change from the product covered by
+Added: the original PMA.
+Added: at least one clinical trial is required to support a PMA application.
+Added: Clinical studies also may be required for de novo classification
+Added: or a 510(k) premarket notification.
+Added: Clinical trials may also be conducted or continued to satisfy post-approval requirements for devices
+Added: For significant risk investigational device studies, the FDA regulations require that human clinical investigations conducted
+Added: be subject to an approved investigational device exemption (“IDE”).
+Added: An IDE application is considered approved
+Added: 30 days after it has been received by the FDA, unless the FDA otherwise informs the sponsor prior to that time that the IDE is approved,
+Added: approved with conditions, or disapproved.
+Added: A nonsignificant risk investigational device study does not require FDA approval of an IDE.
+Added: Some types of device studies, including many IVD studies, are exempt from IDE requirements altogether.
+Added: trials must be conducted in accordance with good clinical practice (“GCP”) requirements contained in federal regulations
+Added: and in international guidelines.
+Added: Clinical trials, for both significant and nonsignificant risk devices, as well as exempt studies, must
+Added: be approved by an institutional review board (“IRB”), an appropriately constituted group that has been formally designated
+Added: to review and monitor biomedical research involving human subjects and which has the authority to approve, require modifications in,
+Added: or disapprove research to protect the rights, safety, and welfare of the human research subject.
+Added: FDA may order the temporary or permanent discontinuation of a clinical trial at any time or impose other sanctions, if it believes that
+Added: the clinical trial either is not being conducted in accordance with FDA requirements or presents an unacceptable risk to the clinical
+Added: trial patients.
+Added: An IRB may also require the clinical trial it has approved to be halted, either temporarily or permanently, for failure
+Added: to comply with the IRB’s requirements or may impose other conditions or sanctions.
+Added: the QSR does not fully apply to investigational devices, the requirement for controls on design and development does apply.
+Added: also must manufacture the investigational device in conformity with the quality controls described in the IDE application and any conditions
+Added: of IDE approval that the FDA may impose with respect to manufacturing.
+Added: a device is placed on the market, numerous general regulatory controls apply.
+Added: These include the QSR, labeling regulations, medical device
+Added: reporting regulations (which require that manufacturers report to the FDA if their device may have caused or contributed to a death or
+Added: serious injury or malfunctioned in a way that would likely cause or contribute to a death or serious injury if it were to recur), and
+Added: reports of corrections and removals regulations (which require manufacturers to report recalls or removals and field corrections to the
+Added: FDA if initiated to reduce a risk to health posed by the device or to remedy a violation of the FDCA).
+Added: Failure to properly identify reportable
+Added: events or to file timely reports, as well as failure to address each of the observations to the FDA’s satisfaction, can subject
+Added: a manufacturer to warning letters, recalls, or other sanctions and penalties.
+Added: marketing, and promotional activities for devices are also subject to FDA oversight and must comply with the statutory standards of the
+Added: FDCA and the FDA’s implementing regulations.
+Added: Manufacturers
+Added: of medical devices are permitted to promote products solely for the uses and indications set forth in the approved or cleared product
+Added: A number of enforcement actions have been taken against manufacturers that promote products for “off-label” uses
+Added: (i.e., uses that are not described in the approved or cleared labeling).
+Added: of the FDCA relating to inappropriate promotion of medical devices may also lead to investigations alleging violations of federal and
+Added: state healthcare fraud and abuse and other laws, as well as state consumer protection laws.
+Added: a PMA or Class II 510(k) or de novo device, the FDA also may require postmarketing testing, surveillance, or other measures to
+Added: monitor the effects of an approved or cleared product.
+Added: The FDA may place conditions on a PMA-approved device that could restrict the
+Added: distribution or use of the product.
+Added: In addition, quality control, manufacture, packaging, and labeling procedures must continue to conform
+Added: to the QSR after approval and clearance, and manufacturers are subject to periodic inspections by the FDA.
+Added: Accordingly, manufacturers
+Added: must continue to expend time, money, and effort in the areas of production and quality control to maintain compliance with the QSR and
+Added: other applicable regulatory requirements.
+Added: The FDA may withdraw product approvals or recommend or require product recalls if a company
+Added: fails to comply with regulatory requirements.
+Added: Approval Process
+Added: the U.S., therapeutic products are subject to extensive regulation by the FDA.
+Added: The FDCA and other federal and state statutes and regulations,
+Added: govern, among other things, the research, development, testing, manufacture, storage, recordkeeping, approval, labeling, promotion and
+Added: marketing, distribution, post-approval monitoring and reporting, sampling, and import and export of pharmaceutical products.
+Added: to comply with applicable U.S.
+Added: requirements may subject a company to a variety of administrative or judicial sanctions, such as clinical
+Added: hold, FDA refusal to approve pending new drug applications (“NDAs”), warning or untitled letters, product recalls, product
+Added: seizures, total or partial suspension of production or distribution, injunctions, fines, civil penalties, and criminal prosecution.
+Added: for a new therapeutic product in the U.S.
+Added: typically involves preclinical laboratory and animal tests, the submission to the FDA of an
+Added: investigational new drug application (“IND”), which must become effective before clinical testing may commence, and adequate
+Added: and well-controlled clinical trials to establish the safety and effectiveness of the drug for each indication for which FDA approval
+Added: Satisfaction of FDA premarket approval requirements typically takes many years, and the actual time required may vary substantially
+Added: based upon the type, complexity, and novelty of the product or disease.
+Added: tests include laboratory evaluation of product chemistry, formulation, and toxicity, as well as animal trials to assess the characteristics
+Added: and potential safety and efficacy of the product.
+Added: The conduct of the preclinical tests must comply with federal regulations and requirements,
+Added: including Good Laboratory Practices.
+Added: The results of preclinical testing are submitted to the FDA as part of an IND along with other information,
+Added: including information about product chemistry, manufacturing and controls, a general investigational plan, and a proposed clinical trial
+Added: Long-term preclinical tests, such as tests of reproductive toxicity and carcinogenicity in animals, may continue after the
+Added: IND is submitted.
+Added: A 30-day waiting period after the submission of each IND is required prior to the commencement of clinical testing
+Added: If the FDA has neither commented on nor questioned the IND within this 30-day period, the clinical trial proposed in the IND
+Added: If the IND is placed on clinical hold, the sponsor must resolve any issues to the satisfaction of the FDA before the clinical
+Added: hold is lifted and the clinical trial may proceed.
+Added: trials involve the administration of the investigational drug to healthy volunteers or patients under the supervision of a qualified
+Added: investigator.
+Added: Clinical trials must be conducted (1) in compliance with federal regulations;
+Added: (2) in compliance with GCP requirements;
+Added: and (3) under protocols detailing the objectives of the trial, the parameters to be used in monitoring safety, and the effectiveness
+Added: criteria to be evaluated.
+Added: Each protocol involving testing on U.S.
+Added: patients and subsequent protocol amendments must be submitted to the
+Added: FDA as part of the IND.
+Added: FDA may order the temporary or permanent discontinuation of a clinical trial at any time or impose other sanctions if it believes that
+Added: the clinical trial either is not being conducted in accordance with FDA regulations or presents an unacceptable risk to the clinical
+Added: trial patients.
+Added: Imposition of a clinical hold may be full or partial.
+Added: The study protocol and informed consent information for patients
+Added: in clinical trials must also be submitted to an IRB for approval.
+Added: The IRB will also monitor the clinical trial until completed.
+Added: may also require the clinical trial at the site to be halted, either temporarily or permanently, for failure to comply with the IRB’s
+Added: requirements or may impose other conditions.
+Added: Additionally, some clinical trials are overseen by an independent group of qualified experts
+Added: organized by the clinical trial sponsor, known as a data safety monitoring board or committee.
+Added: This group provides authorization for
+Added: whether a trial may move forward at designated checkpoints based on access to certain data from the trial.
+Added: trials to support NDAs for marketing authorization are typically conducted in three sequential phases, which may overlap or be combined.
+Added: In Phase 1, the initial introduction of the drug into patients, the product is tested to assess safety, dosage tolerance, metabolism,
+Added: pharmacokinetics, pharmacological actions, side effects associated with drug exposure, and to obtain early evidence of a treatment effect
+Added: Phase 2 usually involves trials in a limited patient population to determine the effectiveness of the drug for a particular
+Added: indication, determine optimal dose and regimen, and to identify common adverse effects and safety risks.
+Added: If a compound demonstrates evidence
+Added: of effectiveness and an acceptable safety profile in Phase 2 evaluations, Phase 3 trials are undertaken to obtain additional information
+Added: about clinical effects and confirm efficacy and safety in a larger number of patients, typically at geographically dispersed clinical
+Added: trial sites, to permit the FDA to evaluate the overall benefit-risk relationship of the drug and to provide adequate information for
+Added: the labeling of the product.
+Added: In most cases, the FDA requires two adequate and well-controlled Phase 3 clinical trials to demonstrate
+Added: the safety and efficacy of the drug.
+Added: In rare instances, a single Phase 3 trial may be sufficient when either (1) the trial is a large,
+Added: multicenter trial demonstrating internal consistency and a statistically very persuasive finding of a clinically meaningful effect on
+Added: mortality, irreversible morbidity, or prevention of a disease with a potentially serious outcome and confirmation of the result in a
+Added: second trial would be practically or ethically impossible or (2) the single trial is supported by other confirmatory evidence.
+Added: on the basis of a single trial may be subject to a requirement for additional post-approval studies.
+Added: phases may overlap or be combined.
+Added: For example, a Phase 1/2 clinical trial may contain both a dose escalation stage and a dose expansion
+Added: stage, the latter of which may confirm tolerability at the recommended dose for expansion in future clinical trials (as in traditional
+Added: Phase 1 clinical trials) and provide insight into the anti-tumor effects of the investigational therapy in selected subpopulation(s).
+Added: Typically, during the development of oncology therapies, all subjects enrolled in Phase 1 clinical trials are disease-affected patients
+Added: and, as a result, considerably more information on clinical activity may be collected during such trials than during Phase 1 clinical
+Added: trials for non-oncology therapies.
+Added: addition, the manufacturer of an investigational drug in a Phase 2 or Phase 3 clinical trial for a serious or life-threatening disease
+Added: is required to make available, such as by posting on its website, its policy on evaluating and responding to requests for expanded access
+Added: to such investigational drug.
+Added: the IND is active, progress reports summarizing the results of the clinical trials and nonclinical studies performed since the last progress
+Added: report, among other information, must be submitted at least annually to the FDA, and written IND safety reports must be submitted to
+Added: the FDA and investigators for serious and unexpected suspected adverse events, findings from other studies suggesting a significant risk
+Added: to humans exposed to the same or similar drugs, findings from animal or in vitro testing suggesting a significant risk to humans, and
+Added: any clinically important increased incidence of a serious suspected adverse reaction compared to that listed in the protocol or investigator
+Added: completion of the required clinical testing, an NDA is prepared and submitted to the FDA.
+Added: FDA approval of the NDA is required before
+Added: marketing and distribution of the product may begin in the U.S.
+Added: The NDA must include the results of all preclinical, clinical, and other
+Added: testing and a compilation of data relating to the product’s pharmacology, chemistry, manufacture, and controls.
+Added: The cost of preparing
+Added: and submitting an NDA is substantial.
+Added: The submission of most NDAs is additionally subject to a substantial application user fee.
+Added: an approved NDA, the applicant is also subject to an annual program fee.
+Added: These fees typically increase annually.
+Added: The FDA has 60 days
+Added: from its receipt of an NDA to determine whether the application will be filed based on the FDA’s determination that it is adequately
+Added: organized and sufficiently complete to permit substantive review.
+Added: Once the submission is filed, the FDA begins an in-depth review.
+Added: FDA has agreed to certain performance goals to complete the review of NDAs.
+Added: Most applications are classified as Standard Review products
+Added: that are reviewed within ten months of the date the FDA files the NDA;
+Added: applications classified as Priority Review are reviewed within
+Added: six months of the date the FDA files the NDA.
+Added: An NDA can be classified for Priority Review when the FDA determines the drug has the potential
+Added: to treat a serious or life-threatening condition and, if approved, would be a significant improvement in safety or effectiveness compared
+Added: to available therapies.
+Added: The review process for both standard and priority reviews may be extended by the FDA for three or more additional
+Added: months to consider certain late-submitted information, or information intended to clarify information already provided in the NDA submission.
+Added: FDA may also refer applications for novel products, as well as products that present difficult questions of safety or efficacy, to be
+Added: reviewed by an advisory committee – typically a panel that includes clinicians, statisticians and other experts – for review,
+Added: evaluation, and a recommendation as to whether the NDA should be approved.
+Added: The FDA is not bound by the recommendation of an advisory
+Added: committee, but generally follows such recommendations.
+Added: Before approving an NDA, the FDA will typically inspect one or more clinical sites
+Added: to assure compliance with GCP.
+Added: Additionally, the FDA will inspect the facility or the facilities at which the drug product is manufactured.
+Added: The FDA will not approve the product unless compliance with current good manufacturing practices (“cGMP”) is satisfactory.
+Added: After the FDA evaluates the NDA and completes any clinical and manufacturing site inspections, it issues either an approval letter or
+Added: a complete response letter.
+Added: A complete response letter generally outlines the deficiencies in the NDA submission and may require substantial
+Added: additional testing or information in order for the FDA to reconsider the application for approval.
+Added: If, or when, those deficiencies have
+Added: been addressed to the FDA’s satisfaction in a resubmission of the NDA, the FDA will issue an approval letter.
+Added: The FDA has committed
+Added: to reviewing such resubmissions in two or six months depending on the type of information included.
+Added: An approval letter authorizes commercial
+Added: marketing and distribution of the drug with specific prescribing information for specific indications.
+Added: As a condition of NDA approval,
+Added: the FDA may require a risk evaluation and mitigation strategy (“REMS”) to help ensure that the benefits of the drug outweigh
+Added: the potential risks to patients.
+Added: A REMS can include medication guides, communication plans for healthcare professionals, and elements
+Added: to assure a product’s safe use (“ETASU”).
+Added: ETASU can include, but are not limited to, special training or certification
+Added: for prescribing or dispensing the product, dispensing the product only under certain circumstances, special monitoring, and the use of
+Added: patient-specific registries.
+Added: The requirement for a REMS can materially affect the potential market and profitability of the product.
+Added: Moreover, the FDA may require substantial post-approval testing and surveillance to monitor the product’s safety or efficacy.
+Added: granted, product approvals may be withdrawn if compliance with regulatory standards is not maintained or problems are identified following
+Added: initial marketing.
+Added: Changes to some of the conditions established in an approved NDA, including changes in indications, product labeling,
+Added: manufacturing processes, or facilities, require submission and FDA approval of a new NDA, or a supplement to an approved NDA, before
+Added: the change can be implemented.
+Added: An NDA supplement for a new indication typically requires clinical data similar to that in the original
+Added: application, and the FDA uses the same procedures and actions in reviewing NDA supplements as it does in reviewing original NDAs.
+Added: of Clinical Trial Information
+Added: of clinical trials of FDA-regulated products, including diagnostic and drugs products, are required to register and disclose certain
+Added: clinical trial information on the website www.clinicaltrials.gov.
+Added: Information related to the product, patient population, phase of investigation,
+Added: trial sites, and investigators, and other aspects of a clinical trial are then made public as part of the registration.
+Added: also obligated to disclose the results of their clinical trials after completion.
+Added: Disclosure of the results of clinical trials can be
+Added: delayed in certain circumstances for up to two years after the date of completion of the trial.
+Added: Competitors may use this publicly available
+Added: information to gain knowledge regarding the progress of clinical development programs as well as clinical trial design.
+Added: Post-Approval
+Added: an NDA is approved, a product will be subject to certain post-approval requirements.
+Added: For instance, the FDA closely regulates the post-approval
+Added: marketing and promotion of drugs, including standards and regulations for direct-to-consumer advertising, off-label promotion, industry-sponsored
+Added: scientific and educational activities, and promotional activities involving the internet.
+Added: A drug may be marketed only for the approved
+Added: indications and in accordance with the provisions of the approved labeling.
+Added: event reporting and submission of periodic safety summary reports is required following FDA approval of an NDA.
+Added: The FDA also may require
+Added: postmarket testing, known as Phase 4 testing, REMS, and surveillance to monitor the effects of an approved product, or the FDA may place
+Added: conditions on an approval that could restrict the distribution or use of the product.
+Added: In addition, quality control, product manufacture,
+Added: packaging, and labeling procedures must continue to conform to cGMP after approval.
+Added: Drug manufacturers and certain of their subcontractors
+Added: are required to register their establishments with the FDA and certain state agencies.
+Added: with the FDA subjects entities to periodic unannounced inspections by the FDA, during which the agency inspects a drug product’s
+Added: manufacturing facilities to assess compliance with cGMP.
+Added: Accordingly, manufacturers must continue to expend time, money, and effort in
+Added: the areas of production and quality control to maintain compliance with cGMP.
+Added: Regulatory authorities may withdraw product approvals or
+Added: request product recalls if a company fails to comply with required regulatory standards, if it encounters problems following initial
+Added: marketing, or if previously unrecognized problems are subsequently discovered.
+Added: medical device or diagnostic test must be CE marked to be sold in the EU.
+Added: The In Vitro Diagnostic Device Regulation (“IVDR”)
+Added: of the EU defines the necessary pre-conditions that must be fulfilled to CE mark an IVD test or in vitro medical device in the EU.
+Added: manufacture of the test and/or device must fulfill all applicable regulatory requirements in the IVDR.
+Added: Objective evidence of fulfilment
+Added: of these requirements must be provided by the manufacturer prior to placing a test on the EU market.
+Added: The manufacturer is required to
+Added: establish a Quality Management System (“QMS”) as well as processes for manufacturing, importing, distribution, post-market
+Added: surveillance, and vigilance.
+Added: Regulations also require that the product is fully documented.
+Added: In addition, it is likely that our CyPath ®
+Added: Lung test is classified in a risk class that requires a review by an external party, a Notified Body, prior to placing the test
+Added: on the EU market.
+Added: This process is expected to require an additional six to 12 months after required documents and systems are in place.
+Added: There currently is a general shortage in the EU of available Notified Bodies designated for IVDR devices.
+Added: Further, we will need to contract
+Added: a European Authorized Representative (“EAR”) that acts as the Company’s legal representative in the EU.
+Added: Medical devices
+Added: also must be registered with the competent authority in the country in which they are based.
+Added: In addition to the CE mark and the registration
+Added: done by the EAR, there is a need for an administrative national notification with certain member states of the EU.
+Added: Data Collection
+Added: collection and use of personal data (including health data) in the European Economic Area (the “EEA”) are governed by the
+Added: EU General Data Protection Regulations (the “EU GDPR”) and national implementing legislation in EEA member states.
+Added: GDPR applies to any company established in the EEA and to companies established outside the EEA that process personal data in connection
+Added: with the offering of goods or services to data subjects in the EEA or the monitoring of the behavior of data subjects in the EEA.
+Added: EU GDPR establishes stringent requirements applicable to the processing of personal data, including strict requirements relating to the
+Added: validity of consent of data subjects, expanded disclosures about how personal data is used, requirements to conduct data protection impact
+Added: assessments for “high risk” processing, limitations on retention of personal data, special provisions for “special
+Added: categories of personal data” including health and genetic information of data subjects, mandatory data breach notification (in
+Added: certain circumstances), “privacy by design” requirements, and direct obligations on service providers acting as processors.
+Added: The EU GDPR also prohibits the international transfer of personal data from the EEA to countries outside of the EEA unless made to a
+Added: country deemed to have adequate data privacy laws by the European Commission or a data transfer mechanism has been put in place.
+Added: to comply with the requirements of the EU GDPR and the related national data protection laws of the EEA states may result in fines up
+Added: to 20 million euros or 4% of a company’s global annual revenues for the preceding financial year, whichever is higher.
+Added: the EU GDPR affords various data protection rights to individuals (i.e., the right to erasure of personal data) in certain circumstances,
+Added: and the ability for data subjects to claim material and non-material damages resulting from infringements of the EU GDPR.
+Added: Given the breadth
+Added: and depth of changes in data protection obligations, maintaining compliance with the EU GDPR will require significant time, resources,
+Added: and expense, and we may be required to put in place additional mechanisms ensuring compliance with the evolving data protection rules.
+Added: This may be onerous and adversely affect our business, financial condition, results of operations, and prospects.
+Added: of the World Regulation
+Added: other countries outside of the EU (or in some cases, EEA) and the U.S., such as China, Southeast Asia, and Australia, the requirements
+Added: governing the conduct of clinical trials, product licensing, pricing, and reimbursement vary from country to country.
+Added: Additionally, the
+Added: clinical trials must be conducted in accordance with GCP requirements and the applicable regulatory requirements, and the ethical principles
+Added: that have their origin in the Declaration of Helsinki.
+Added: we fail to comply with applicable foreign regulatory requirements, we may be subject to, among other things, fines, suspension or withdrawal
+Added: of regulatory approvals, product recalls, seizure of products, operating restrictions, and criminal prosecution.
+Added: We employ 75 employees at the time of this filing, 22 employed by bioAffinity
+Added: and 53 employed by PPLS.
+Added: place significant emphasis on the recruitment, development, and retention of our employees who include award-winning scientists dedicated
+Added: to advancing scientific discovery from bench to bedside.
+Added: Of our nine employees engaged in research and development, all of whom are employed
+Added: full-time, one holds an M.D.
+Added: and six hold Ph.Ds in biology or medicinal chemistry.
+Added: Of the 53 employees at PPLS, nearly half have worked
+Added: at our clinical laboratory for more than five years.
+Added: Executive Vice President and Chief Medical and Science Officer, Vivienne Rebel, holds an M.D.
+Added: Business development is led by
+Added: our Chief Operating Officer, Xavier Reveles, who has 25 years of experience as a clinical geneticist skilled in the creation and management
of CLIA clinical laboratories, coding, and CPT reimbursement valuations.
1 unchanged sentence
Pathology as a clinical specialist in cytogenetics who has successfully launched multiple diagnostics and commercial laboratories.
−Removed: innovative and collaborative culture at bioAffinity is in part responsible for the high degree of retention and professional advancement.
−Removed: Of those employees hired prior to 2022, most have been with the Company for more than five years of its nine-year history.
−Removed: Outside partnerships
−Removed: and collaborations that advance business and scientific research are encouraged, allowing the Company to multiply workforce efforts without
−Removed: expending significant capital.
+Added: have recently attracted experienced salespeople with a proven record in the pulmonary field.
+Added: In November 2023, we hired Dallas Coleman
+Added: as National Sales Director who has more than 15 years of experience in medical sales and marketing, most recently as Executive Account
+Added: Manager for the respiratory portfolio of Olympus America’s therapeutic solutions division.
+Added: In February 2024, Cole Koeppen joined
+Added: us as Pulmonary Sales Executive for CyPath ® Lung in North Texas.
+Added: Previously, he was Territory Sales Associate for Pulmonx
+Added: Corporation, a provider of treatments for patients with COPD.
+Added: Our innovative and collaborative culture is in part responsible for our
+Added: ability to attract and retain highly skilled professionals seeking professional advancement.
+Added: Outside partnerships and collaborations
+Added: that advance business and scientific research are encouraged, allowing us to multiply workforce efforts without expending significant
+Added: of Being an Emerging Growth Company and a Smaller Reporting Company
+Added: qualify as an “emerging growth company” as defined in the Jumpstart Our Business Startups Act of 2012, or the JOBS Act.
+Added: as long as we remain an emerging growth company, we may take advantage of specified reduced reporting requirements and other burdens
+Added: that are otherwise applicable generally to other public companies.
+Added: These provisions include, but are not limited to:
+Added: obligations with respect to financial data, including presenting only two years of audited
+Added: financial statements and selected financial data, and only two years of related Management’s
+Added: Discussion and Analysis of Financial Condition and Results of Operations disclosure in our
+Added: initial registration statement;
+Added: exemption from the auditor attestation requirement in the assessment of our internal control
+Added: over financial reporting pursuant to the Sarbanes-Oxley Act of 2002, as amended (“SOX”);
+Added: disclosure about executive compensation arrangements in our periodic reports, registration
+Added: statements, and proxy statements;
+Added: from the requirements to seek non-binding advisory votes on executive compensation or stockholder
+Added: approval of any golden parachute arrangements.
+Added: may take advantage of some or all of these provisions until we are no longer an emerging growth company.
+Added: We will remain an emerging growth
+Added: company until the earliest of (1) the last day of the fiscal year following the fifth anniversary of the completion of our initial public
+Added: offering, (2) the last day of the first fiscal year in which our annual gross revenues exceed $1.235 billion, (3) the date on which we
+Added: have, during the immediately preceding three-year period, issued more than $1.0 billion in non-convertible debt securities and (4) the
+Added: date on which we are deemed to be a large accelerated filer under the rules of the SEC.
+Added: We may choose to take advantage of some but not
+Added: all of these reduced burdens.
+Added: For example, we have taken advantage of the reduced reporting requirements with respect to disclosure regarding
+Added: our executive compensation arrangements, have presented only two years of audited financial statements and only two years of related
+Added: “Management’s Discussion and Analysis of Financial Condition and Results of Operations” disclosure in this Annual Report,
+Added: and have taken advantage of the exemption from auditor attestation on the effectiveness of our internal control over financial reporting.
+Added: To the extent that we take advantage of these reduced burdens, the information that we provide stockholders may be different than you
+Added: might obtain from other public companies in which you hold equity interests.
+Added: addition, the JOBS Act permits emerging growth companies to take advantage of an extended transition period to comply with new or revised
+Added: accounting standards applicable to public companies.
+Added: We have elected to use this extended transition period.
+Added: As a result of this election,
+Added: our timeline to comply with new or revised accounting standards will in many cases be delayed as compared to other public companies that
+Added: are not eligible to take advantage of this election or have not made this election.
+Added: Therefore, our financial statements may not be comparable
+Added: to those of companies that comply with the public company effective dates for these accounting standards.
+Added: are also a “smaller reporting company” as defined in the Securities Exchange Act of 1934, as amended, (“the Exchange
+Added: Act”) and have elected to take advantage of certain of the scaled disclosures available to smaller reporting companies.
+Added: extent that we continue to qualify as a “smaller reporting company” as such term is defined in Rule 12b-2 under the Exchange
+Added: Act, after we cease to qualify as an emerging growth company, certain of the exemptions available to us as an “emerging growth
+Added: company” may continue to be available to us as a “smaller reporting company,” including exemption from compliance with
+Added: the auditor attestation requirements pursuant to SOX and reduced disclosure about our executive compensation arrangements.
+Added: We will continue
+Added: to be a “smaller reporting company” until we have $250 million or more in public float (based on our Common Stock) measured
+Added: as of the last business day of our most recently completed second fiscal quarter or in the event we have no public float (based on our
+Added: Common Stock) or a public float (based on our Common Stock) that is less than $700 million, annual revenues of $100 million or more during
+Added: the most recently completed fiscal year.
Compared sentence by sentence after normalising whitespace, quotation marks, case and digits, so re-formatting and restated figures do not read as changed language. Wording changes appear as one removal and one addition. The current filing and the prior one are authoritative.