UNITED
STATES
SECURITIES
AND EXCHANGE COMMISSION
Washington,
D.C. 20549
FORM
10-K
(Mark
One)
☒
ANNUAL
REPORT UNDER SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
FOR
THE FISCAL YEAR ENDED DECEMBER 31 , 2021
☐
TRANSITION
REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
FOR
THE TRANSITION PERIOD FROM__________ TO__________
Commission
File Number 001-37603
BIORESTORATIVE
THERAPIES, INC.
(Exact
name of registrant as specified in its charter)
Delaware
91-1835664
(State
or other jurisdiction
of
incorporation or organization)
(I.R.S.
Employer
Identification
No.)
40
Marcus Drive , Suite 1 , Melville , New York
11747
(Address
of principal executive offices)
(Zip
Code)
(631)
760-8100
(Registrant’s
telephone number, including area code)
Securities
registered pursuant to Section 12(b) of the Act:
Title
of each class
Trading
Symbol(s)
Name
of each exchange on which registered
Common
Stock
$0.0001
par value
BRTX
Nasdaq
Capital Market
Securities
registered pursuant to Section 12(g) of the Act:
None
(Title
of Class)
Indicate
by check mark if the registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act. Yes ☐ No ☒
Indicate
by check mark if the registrant is not required to file reports pursuant to Section 13 or Section 15(d) of the Exchange Act. Yes ☐
No ☒
Indicate
by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange
Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2)
has been subject to such filing requirements for the past 90 days. Yes ☒ No ☐
Indicate
by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule
405 of Regulation S-T during the preceding 12 months (or for such shorter period that the registrant was required to submit such files).
Yes ☒ No ☐
Indicate
by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting
company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,”
“smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the Exchange Act.
Large
accelerated filer ☐
Accelerated
filer ☐
Non-accelerated
filer ☒
Smaller
reporting company ☒
Emerging
growth company ☐
If
an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying
with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☐
Indicate
by check mark whether the registrant has filed a report on and attestation to its management’s assessment of the effectiveness
of its internal control over financial reporting under Section 404(b) of the Sarbanes-Oxley Act (15 U.S.C. 7262(b)) by the registered
public accounting firm that prepared or issued its audit report. ☐
Indicate
by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes ☐ No ☒
State
the aggregate market value of the voting and non-voting common equity held by non-affiliates computed by reference to the price at which
the common equity was last sold, or the average bid and asked price of such common equity, as of the last business day of the registrant’s
most recently completed second fiscal quarter.
As
of June 30, 2021, the aggregate market value of the registrant’s common stock held by non-affiliates of the registrant was $ 19,923,800
based on the closing sale price as reported
on the OTC Market.
APPLICABLE
ONLY TO REGISTRANTS INVOLVED IN BANKRUPTCY
PROCEEDINGS
DURING THE PRECEDING FIVE YEARS:
Indicate
by check mark whether the registrant has filed all documents and reports required to be filed by Section 12, 13 or 15(d) of the Securities
Exchange Act of 1934 subsequent to the distribution of securities under a plan confirmed by a court. Yes ☒ No ☐
As of March 28, 2022, there were 3,626,603
shares of common stock outstanding.
DOCUMENTS
INCORPORATED BY REFERENCE
None
INDEX
Page
No.
Forward-Looking
Statements
3
PART
I
Item
1.
Business.
3
Item
1A.
Risk
Factors.
35
Item
1B.
Unresolved
Staff Comments.
35
Item
2.
Properties.
35
Item
3.
Legal
Proceedings.
35
Item
4.
Mine
Safety Disclosures.
35
PART
II
Item
5.
Market
for Registrant’s Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities.
36
Item
6.
[Reserved].
37
Item
7.
Management’s
Discussion and Analysis of Financial Condition and Results of Operations.
37
Item
7A.
Quantitative and Qualitative Disclosures About Market Risk.
74
Item
8.
Financial Statements and Supplementary Data.
74
Item
9.
Changes in and Disagreements With Accountants on Accounting and Financial Disclosure.
74
Item
9A.
Controls and Procedures.
75
Item
9B.
Other Information.
77
Item
9C.
Disclosure
Regarding Foreign Jurisdictions that Prevent Inspections.
77
PART III
Item
10.
Directors, Executive Officers and Corporate Governance.
78
Item
11.
Executive Compensation.
83
Item
12.
Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters.
86
Item
13.
Certain Relationships and Related Transactions, and Director Independence.
89
Item
14.
Principal Accountant Fees and Services.
89
PART IV
Item
15.
Exhibits and Financial Statement Schedules.
90
Item
16.
Form 10-K Summary.
92
Signatures
93
2
PART
I
Forward-Looking
Statements
This
Annual Report contains forward-looking statements as that term is defined in the federal securities laws. The events described in forward-looking
statements contained in this Annual Report may not occur. Generally these statements relate to business plans or strategies, projected
or anticipated benefits or other consequences of our plans or strategies, projected or anticipated benefits from acquisitions to be made
by us, or projections involving anticipated revenues, earnings or other aspects of our operating results. The words “may,”
“will,” “expect,” “believe,” “anticipate,” “project,” “plan,”
“intend,” “estimate,” and “continue,” and their opposites and similar expressions are intended to
identify forward-looking statements. We caution you that these statements are not guarantees of future performance or events and are
subject to a number of uncertainties, risks and other influences, many of which are beyond our control, that may influence the accuracy
of the statements and the projections upon which the statements are based. Factors which may affect our results include, but are not
limited to, the risks and uncertainties discussed in Item 7 of this Annual Report (“Management’s Discussion and Analysis
of Financial Condition and Results of Operations - “Factors That May Affect Future Results and Financial Condition”).
Any
one or more of these uncertainties, risks and other influences could materially affect our results of operations and whether forward-looking
statements made by us ultimately prove to be accurate. Our actual results, performance and achievements could differ materially from
those expressed or implied in these forward-looking statements. We undertake no obligation to publicly update or revise any forward-looking
statements, whether from new information, future events or otherwise.
Intellectual
Property
This
Annual Report includes references to our federally registered trademarks, BioRestorative Therapies and Dragonfly design,
BRTX-100 , and ThermoStem . We also own an allowed trademark application for BRTX . The Dragonfly logo
is also registered with the U.S. Copyright Office. This Annual Report also includes references to trademarks, trade names and service
marks that are the property of other organizations. Solely for convenience, trademarks and trade names referred to in this Annual Report
appear without the ®, SM or ™ symbols, and copyrighted content appears without the use of the symbol ©, but the absence
of use of these symbols does not reflect upon the validity or enforceability of the intellectual property owned by us or third parties.
ITEM
1. BUSINESS .
(a)
Business Development
As
used in this Annual Report on Form 10-K, or the Annual Report, references to the “Company”, “we”, “us”,
or “our” refer to BioRestorative Therapies, Inc. and its subsidiaries.
We
were incorporated in Nevada on June 13, 1997. On August 15, 2011, we changed our name from “Stem Cell Assurance, Inc.” to
“BioRestorative Therapies, Inc.” Effective January 1, 2015, we reincorporated in Delaware.
In
January 2017, we submitted an Investigational New Drug, or IND, application to the U.S. Food and Drug Administration, or the FDA, to
obtain authorization to commence a Phase 2 clinical trial investigating the use of BRTX-100 , our lead cell therapy candidate,
in the treatment of chronic lower back pain arising from degenerative disc disease. In February 2017, we received such authorization
from the FDA.
3
Material
Events During 2021
In
January 2021, a European patent related to our ThermoStem Program was issued to us. This European patent was validated in France,
Germany, Italy, Spain, and the United Kingdom.
Between
March and July 2021, two United States patents related to our ThermoStem Program were issued to us.
In
March 2021, Nickolay Kukekov, Ph.D. was elected as one of our directors.
In
June 2021, a Japanese patent related to our ThermoStem Program was issued to us.
In
August 2021, an Australian patent related to our ThermoStem Program was issued to us.
In September 2021, a notice
of allowance was issued for an Israeli patent application in our ThermoStem Program . The application is expected to issue as an
Israeli patent in the near future.
In
September 2021, we were awarded a National Institutes of Health Small Business Technology Transfer (STTR) Phase 1 grant for $256,000
to evaluate the therapeutic effects on our hypoxic cultured bone marrow derived mesenchymal stem cells ( BRTX-100 ) after encapsulation
with a PEG-peptide hydrogel. The work is being done in collaboration with Washington University of St. Louis.
In
October 2021, we effected a 1-for-4,000 reverse split of our common stock. All share and per share amounts in this Annual Report give
retroactive effect to such reverse split.
In November 2021, ten separate
United States patent applications were filed for our Disc/Spine Program .
In
November 2021, we completed a $23,000,000 underwritten public offering of units of securities pursuant to which an aggregate of 2,300,000
shares of our common stock and warrants for the purchase of an aggregate of 2,645,000 shares of our common stock were issued. We intend
to use the net proceeds from the offering as follows: (i) undertaking of clinical trials with respect to BRTX-100 and its related
collection and delivery procedure; (ii) pre-clinical research and development with respect to our ThermoStem Program ; and (iii)
for general corporate and working capital purposes. In connection with the public offering, our common stock was listed on the Nasdaq
Capital Market.
In
November 2021, concurrently with the consummation of the public offering, we issued an aggregate of 313,789 shares of our common
stock, 1,543,158 shares of our Series A preferred stock and warrants for the purchase of an aggregate of 1,856,938 shares of our common
stock in exchange for convertible promissory notes in the aggregate principal amount of $10,046,897, together with accrued interest thereon,
and warrants for the purchase of an aggregate of 3,677,997 shares of our common stock. Such indebtedness
and warrants were exchanged at a price of $10.00 per unit of securities, consistent with the public offering price of our units of common
stock and warrants. The newly issued warrants are exercisable for a period of five years at an exercise price of $10.00 per share.
4
In
November 2021, Patrick F. Williams and David Rosa were elected directors and Robert E. Kristal was elected as our Chief Financial Officer.
In
November 2021, we reduced the number of shares of common stock we are authorized to issue from 300,000,000,000 to 75,000,000 in a manner
consistent with our 1-for-4,000 reverse split.
In
December 2021, we entered into a Master Service Agreement with Professional Research Consulting Inc. d/b/a PRC Clinical, a contract research
organization, or CRO, specializing in clinical trial management, to conduct our Phase 2 clinical trial.
Materials
Events During 2022
In
January 2022, Robert Paccasassi was elected our Vice President of Quality Assurance/Regulatory Compliance.
In January 2022, a notice
of allowance was issued for a Japanese patent application in our ThermoStem Program . The application is expected to issue as a
Japanese patent in the near future.
In March 2022, a United States
patent related to BRTX-100, our lead cell therapy candidate, was issued. We have been granted license rights with regard to the patent.
See “Business – Disc/Spine Program – License” below.
(b)
Business
General
We
are a life sciences company focused on the development of regenerative medicine products and therapies using cell and tissue protocols,
primarily involving adult (non-embryonic) stem cells. Our two core developmental programs, as described below, relate to the treatment
of disc/spine disease and metabolic disorders:
●
Disc/Spine
Program (brtxDisc). Our lead cell therapy candidate, BRTX-100 , is a product formulated from autologous (or a person’s
own) cultured mesenchymal stem cells, or MSCs, collected from the patient’s bone marrow. We intend that the product will be
used for the non-surgical treatment of painful lumbosacral disc disorders or as a complimentary therapeutic to a surgical procedure.
The BRTX-100 production process involves collecting bone marrow and whole blood from a patient, isolating and culturing (in
a proprietary method) stem cells from the bone marrow and cryopreserving the cells in an autologous carrier. In an outpatient procedure,
BRTX-100 is to be injected by a physician into the patient’s painful disc. The treatment is intended for patients whose
pain has not been alleviated by non-surgical procedures or conservative therapies and who potentially face the prospect of highly
invasive surgical procedures. We submitted an IND application to the FDA to obtain authorization to commence a Phase 2 clinical trial
investigating the use of BRTX-100 in the treatment of chronic lower back pain arising from degenerative disc disease. We have
received such authorization from the FDA and have commenced such clinical trial through the execution of a CRO agreement with PRC
Clinical, the commencement of clinical trial site identification, the purchase of manufacturing equipment and the expansion of our
laboratory to include capabilities for clinical production. In March 2022, a United States
patent related to BRTX-100, was issued . We have been granted license rights with regard to the patent. See “Disc/Spine Program” below.
5
●
Metabolic
Program (ThermoStem) . We are developing a cell-based therapy candidate to target obesity and metabolic disorders using brown
adipose (fat) derived stem cells, or BADSC, to generate brown adipose tissue, or BAT. We refer to this as our ThermoStem Program .
BAT is intended to mimic naturally occurring brown adipose depots that regulate metabolic homeostasis in humans. Initial preclinical
research conducted by us and others indicates that increased amounts of brown fat in animals may be responsible for additional caloric
burning, as well as reduced glucose and lipid levels. Researchers have found that people with higher levels of brown fat may have
a reduced risk for obesity and diabetes. See “Metabolic Brown Adipose (Fat) Program” below.
We
have also licensed an investigational curved needle device designed to deliver cells and/or other therapeutic products or material to
the spine and discs (and other parts of the body). We anticipate that FDA approval or clearance will be necessary for this device prior
to commercialization. We do not intend to utilize this device in connection with our contemplated Phase 2 clinical trial with regard
to BRTX-100 . See “Curved Needle Device” below.
The
patents and patent applications for the Disc/Spine Program , the ThermoStem Program and the curved needle device are listed
below under “Technology; Research and Development.”
Overview
Every
human being has stem cells in his or her body. These cells exist from the early stages of human development until the end of a person’s
life. Throughout our lives, our body continues to produce stem cells that regenerate to produce differentiated cells that make up various
aspects of the body such as skin, blood, muscle and nerves. These are generally referred to as adult (non-embryonic) stem cells. These
cells are important for the purpose of medical therapies aiming to replace lost or damaged cells or tissues or to otherwise treat disorders.
Regenerative
cell therapy relies on replacing diseased, damaged or dysfunctional cells with healthy, functioning ones or repairing damaged or diseased
tissue. A great range of cells can serve in cell therapy, including cells found in peripheral and umbilical cord blood, bone marrow and
adipose (fat) tissue. Physicians have been using adult stem cells from bone marrow to treat various blood cancers for more than 65 years
(the first successful bone marrow transplant was performed in 1956). Recently, physicians have begun to use stem cells to treat various
other diseases. We intend to develop cell and tissue products and regenerative therapy protocols, primarily involving adult stem cells,
to allow patients to undergo cellular-based treatments.
We
are concentrating initially on therapeutic areas in which risk to the patient is low, recovery is relatively easy, results can be demonstrated
through sufficient clinical data, and patients and physicians will be comfortable with the procedure. We believe that there will be readily
identifiable groups of patients who will benefit from these procedures. We also believe that these procedures will be significantly less
expensive than the most common surgical procedure alternatives and will compare favorably, over the long-term, to conservative treatment
costs which may persist for years.
6
Accordingly,
we have focused our initial developmental efforts on cellular-based therapeutic products and clinical development programs in selective
areas of medicine for which the treatment protocol is minimally invasive. Such areas include the treatment of the disc and spine and
metabolic-related disorders. Upon regulatory approval, we will seek to obtain third party reimbursement for our products and procedures;
however; if we are not successful, patients may be required to pay for our products and procedures out of pocket in full and without
the ability to be reimbursed by any governmental and other third party payers, which would adversely impact our prospects.
We
have undertaken research and development efforts in connection with the development of investigational therapeutic products and medical
therapies using cell and tissue protocols, primarily involving adult stem cells. See “Disc/Spine Program,” “Metabolic
Brown Adipose (Fat) Program” and “Curved Needle Device” below. As a result of these programs, we have five United States
patents, nine foreign patents, three United States patent applications, and eight foreign patent applications related
to research regarding our ThermoStem Program , we have obtained licenses for eleven United States patent applications related to our Disc/Spine Program and we have obtained a license for one United States patent related to a curved needle device.
We
have established a research laboratory facility with Good Manufacturing Practice, or cGMP, capabilities to produce clinical grade products
and will seek to further develop cellular-based treatments, products and protocols, stem cell-related intellectual property, or IP, and
translational research applications. See “Laboratory” below.
We
have not generated any significant revenues to date. In November 2021, we completed a $23,000,000 public offering of our securities.
Such funds are sufficient for us to complete our Phase 2 clinical trial investigating the use of BRTX - 100 in the treatment
of chronic lower back pain arising from degenerative disc disease, as further described in this section, as well as to continue our pre-clinical
research and development efforts with respect to our ThermoStem Program and to satisfy our current working capital needs; however,
the implementation of our business plan, as discussed below, will require the receipt of additional financing to fund our research and
development efforts, including our contemplated Phase 3 clinical trial with regard to BRTX-100 and our contemplated clinical trials
relating to our ThermoStem Program , and otherwise fund our operations. We intend to seek to raise capital through investment
bankers and from biotech funds, strategic partners and other financial institutions. We anticipate that we will require approximately
$35,000,000 in additional financing to complete our contemplated Phase 3 clinical trial investigating the use of BRTX-100
(assuming the receipt of no revenues from operations). We will also require a substantial amount of additional funding to implement our
other programs described in this section, and fund general operations. No assurance can be given that the anticipated amount of required
funding is correct or that we will be able to accomplish our goals within the timeframes projected. In addition, no assurance can be
given that we will be able to obtain any required financing on commercially reasonable terms or otherwise. If we are unable to obtain
adequate funding, we may be required to significantly curtail or discontinue our proposed operations.
Disc/Spine
Program
General
Among
the initiatives that we are currently pursuing is our Disc/Spine Program , with our initial product candidate being called BRTX-100 .
We have obtained a license (see “ License ” below) that permits us to use technology for adult stem cell treatment of
disc and spine conditions. The technology is an advanced stem cell culture and injection procedure into the intervertebral disc, or IVD,
that may offer relief from lower back pain, buttock and leg pain, and numbness and tingling in the leg and foot.
7
Lower
back pain is the most common, most disabling, and most costly musculoskeletal ailment faced worldwide. According to a 2016 market report
from Trinity Partners, a global life sciences consulting firm, of the 250 million American adults, nearly 25 million have chronic lower
back pain of which approximately 12 million have been diagnosed with and treated for disc degeneration and approximately 5.6 million
have pain caused by a protruding or injured disc. We believe that between 500,000 and one million invasive surgical procedures are performed
each year to try to alleviate the pain associated with these lower back conditions and that such procedures cost approximately $40 billion.
Clinical studies have documented that the source of the pain is most frequently damage to the IVD. This can occur when forces, whether
a single load or repetitive microtrauma, exceed the IVD’s inherent capacity to resist those loads. Aging, obesity, smoking, lifestyle,
and certain genetic factors may predispose one to an IVD injury. Current surgical approaches to back pain are extremely invasive (often
altering the spine’s biomechanics unfavorably and predisposing it to further disc degeneration) and are associated with unacceptably
low success rates (with a second operation occurring 10% to 20% of the time). In addition, current surgical approaches are costly with
spinal fusion surgery costing approximately $110,000, discectomy costing approximately $20,000 to $50,000 and disc replacement surgery
costing approximately $80,000 to $150,000. Even conservative treatments can be costly, with oral medications costing between $1,000 and
$2,000 per year, injection treatments costing approximately $8,000 per year and physical therapy costing approximately $20,000 annually.
We anticipate that the cost of a single treatment using BRTX-100 will compare favorably to conservative treatments which may continue
for years and will be less expensive than the most common surgical procedures.
While
once thought to be benign, the natural history of lower back pain is often one of chronic recurrent episodes of pain leading to progressive
disability. This is believed to be a direct result of the IVD’s poor healing capacity after injury. The IVD is the largest avascular
(having few or no blood vessels) structure in the body and is low in cellularity. Therefore, its inherent capacity to heal after injury
is poor. The clinical rationale of BRTX-100 is to deliver a high concentration of the patient’s own cultured MSCs into the
site of pathology to promote healing and relieve pain.
We
have developed a mesenchymal stem cell product candidate, BRTX-100, derived from autologous (or a person’s own) human bone
marrow, cultured and formulated, in a proprietary method, specifically for introduction into a painful lumbar disc. The product candidate
was developed utilizing in part the license described below under “ License .” As described below under “ BRTX-100 ”
and “ Production and Delivery ,” BRTX-100 is a hypoxic (low oxygen) stem cell product developed through a culturing
process. In order to enhance the survivability of our bone marrow-derived MSCs in the avascular environment of the damaged disc, BRTX-100
is designed to expand under hypoxic conditions. This process is intended to result in a large cell count population with enhanced
viability and therapeutic potential following injection into the injured disc.
We
submitted an IND application to the FDA to obtain authorization to commence a Phase 2 clinical trial investigating the use of BRTX-100 ,
our lead cell therapy candidate, in the treatment of chronic lower back pain arising from degenerative disc disease. We received such
authorization from the FDA in February 2017. We have commenced our Phase 2 clinical trial through the execution of a CRO agreement with
PRC Clinical, the commencement of clinical trial site identification, the purchase of manufacturing equipment and the expansion of our
laboratory to include capabilities for clinical production. We believe that, based upon our periodic reports to the FDA as to the commencement
of the clinical trial, the existing IND remains effective.
8
In
addition to developing BRTX-100 , we may also seek to sublicense the technology to a strategic third party, who may assist in gaining
FDA approval for a lumbar disc indication, or third parties for use in connection with cellular-based developmental programs with regard
to disc and spine related conditions.
We
have established a laboratory, which includes a clean room facility, to perform the production of cell products (including BRTX-100 )
for use in our clinical trials, for third party cell products or for general research purposes. We may also use this laboratory to develop
our pipeline of future products and expand our stem cell-related IP. See “Laboratory” and “Technology; Research and
Development” below.
In March 2022, a United States
patent related to BRTX-100, was issued. We have been granted license rights with respect to the patent.
BRTX-100
Our
lead product candidate , BRTX-100, is an autologous hypoxic (low oxygen) cultured mesenchymal stem cell product derived from a
patient’s own bone marrow and formulated with a proprietary biomaterial carrier (platelet lysate) to increase potency, viability
and survivability. We have designed the cryopreserved sterile cellular product candidate to be provided in vials for injection into painful
lumbar discs. We anticipate the product candidate will be delivered using a standard 20 gauge 3.5 inch introducer needle and a 25 gauge
6 inch needle that will extend into the disc center upon delivery. Upon regulatory approval, we plan to provide training to medical practitioners
with regard to the approved injection procedure. It is anticipated that the delivery of the product candidate will be a 30 minute procedure.
Mesenchymal
stem cells used in BRTX-100 are similar to other MSCs under development by others; however, in order to enhance the survivability
of our bone marrow-derived MSCs in the avascular environment of the damaged disc, BRTX-100 is designed to expand under hypoxic
conditions for a period of approximately three weeks. This process is intended to result in an approximate 40 million cell count population
with enhanced viability and therapeutic potential following injection locally into injured spinal discs. Publications and scientific
literature have indicated that MSCs preconditioned in hypoxic environment show enhanced skeletal muscle regeneration properties and improved
impacts upon circulation and vascular formation compared to MSCs cultured under normoxic (normal oxygen) conditions.
In
August 2018, the Journal of Translational Medicine published the results of our study evaluating the benefits of long-term hypoxic
culturing of human bone marrow-derived MSCs.
In September 2021, we were
awarded a National Institutes of Health Small Business Technology Transfer (STTR) Phase 1 grant for $256,000 to evaluate the therapeutic
effects on our hypoxic cultured bone marrow derived mesenchymal stem cells ( BRTX-100 ) after encapsulation with a PEG-peptide hydrogel.
The work is being done in collaboration with Washington University of St. Louis.
9
Production
and Delivery
The
production of our product candidate, BRTX-100, begins with the physician collecting bone marrow from the patient under local anesthesia.
Peripheral blood is also collected from the patient. The physician will then send the patient’s bone marrow and blood samples to
our laboratory (or a contract laboratory) for culturing and formulation. The hypoxic culturing process is intended to result in the selection
of a cell population that is suitable for an improved possibility of survival in the internal disc environment. We anticipate that the
cell culturing process and product formulation will take approximately three weeks, with an additional two weeks required for quality
control testing required to meet product release criteria. We will then send the therapeutic cryopreserved stem cells ( BRTX-100 )
in a sterile vial back to the physician’s offices where it will undergo a controlled thaw prior to the procedure. The price structure
for the procedure and our services has not been determined and no assurances can be given as to the effect that such price structure
will have on the marketability of such procedure and services. The following illustrates the process:
License
Pursuant to our license agreement
with Regenerative Sciences, LLC, or Regenerative, that became effective in April 2012, or the Regenerative License Agreement, we obtained,
among other things, a worldwide (excluding Asia and Argentina), exclusive, royalty-bearing license from Regenerative to utilize or sublicense
a certain method for culturing cells for use in our developmental program involving disc and spine conditions, including protruding or
painful discs and the treatment of avascular zones. The investigational technology that has been licensed is an advanced stem cell culture
and injection procedure that may offer relief from lower back pain, buttock and leg pain, and numbness and tingling in the leg and foot.
Pursuant to the Regenerative License Agreement, we also obtained a worldwide, exclusive, royalty-bearing license from Regenerative to
utilize or sublicense a certain investigational curved needle device for the administration of specific cells and/or cell products to
the disc and/or spine (and other parts of the body). It will be necessary to advance the design of this investigational device to facilitate
the delivery of substances, including living cells, to specific locations within the body and minimize the potential for damage to nearby
structures.
The Regenerative License Agreement
provided for the requirement that we complete our Phase 2 clinical trial by a certain date in order to maintain the exclusive
nature of the licenses. Such date has passed and accordingly our rights are non-exclusive. We are currently in negotiations with Regenerative
with regard to a possible reinstatement of the exclusive nature of the licenses. No assurances can be given in this regard. The lack
of exclusivity will not impact our ability to conduct our Phase 2 clinical trial with regard to BRTX-100 . The Regenerative
License Agreement also provides for a royalty-bearing sublicense of certain aspects of the technology to Regenerative for use for certain
purposes, including in the United States and the Cayman Islands. Further, the Regenerative License Agreement requires that Regenerative
furnish certain training, assistance and consultation services with regard to the licensed technology. The patents that are the subject
of the Regenerative License Agreement have been assigned to Regenexx, LLC which we have been advised by Regenerative is an affiliate
of Regenerative.
10
Animal
Study
The
efficacy and safety of our product candidate, BRTX-100, has been tested in a degenerative intervertebral rabbit disc model. In
this study, 80 rabbits underwent surgery to create a puncture in the discs. Four weeks post-surgery, each rabbit had either contrast,
a biomaterial carrier or BRTX-100 injected into the discs. In order to study the biodistribution and efficacy of BRTX-100 ,
the rabbits were evaluated at day 56 and day 120.
The
key safety findings of the animal study are as follows:
●
There
was no evidence or observation of gross toxicity related to the administration of BRTX-100 at either time point. The clinical
pathology across both groups and time points were within expected normal historical ranges and under the conditions of the test.
No abnormalities (including fractures or overt signs of lumbar disc disease) were identified after review of the radiographic images
taken at both endpoints for both groups. No toxicity or adverse finding was evident in the systemic tissues or the discs of animals
receiving BRTX-100 .
●
There
was no detectable presence of human cells ( BRTX-100 ) observed at the day 56 interim time point. This is consistent with the
proposed mechanism of action that BRTX-100 acts through a paracrine effect of secreted growth and immunomodulation factors.
The
key efficacy findings of the animal study are as follows:
●
BRTX-100
showed a statistically significant DHI (disc height increase) over the control group at day 120.
●
BRTX-100
showed a statistically significant improvement in disc histology over the control group at day 120 as graded by a validated histology
scale. BRTX-100 showed a significant improvement in the cellularity and matrix of the disc when compared to the control at
day 120.
Clinical
Trial
We
submitted an IND application to the FDA to obtain authorization to commence a Phase 2 clinical trial investigating the use of BRTX-100 ,
our lead cell therapy candidate, in the treatment of chronic lower back pain arising from degenerative disc disease. We have received
such authorization from the FDA. We have commenced our Phase 2 clinical trial through the execution of a CRO agreement with PRC Clinical,
the commencement of clinical trial site identification, the purchase of manufacturing equipment and the expansion of our laboratory to
include capabilities for clinical production.
11
The
following describes the Phase 2 clinical trial authorized by the FDA:
A
Phase 2 Prospective, Double-Blinded, Placebo Controlled, Randomized Study
●
General
●
99
patients; randomized 2:1, BRTX-100 to control, 40 million cells/dose
●
10-20
clinical trial sites (we intend to utilize 15 clinical trial sites)
●
Primary
efficacy endpoint at 12 months
●
Patient
safety and efficacy follow up at 24 months
●
Included
subjects must have only one symptomatic diseased disc
●
Included
subjects must have current diagnosis of chronic lumbar disc disease typical pain with degeneration of a single disc confirmed by
history, exam, radiography, or other acceptable means
●
Included
subjects must have exhausted previous conservative non-operative therapies
●
Primary
Efficacy Endpoint
●
Responder
endpoint - percentage of patients that meet the improvement in function and reduction in pain threshold
●
Improvement
in function defined as at least a 30% increase in function based on the Oswestry questionnaires (ODI)
●
Reduction
of pain defined as at least a 30% decrease in pain as measured using the Visual Analogue Scale (VAS)
●
Additional
or Secondary Endpoints
●
Clinical
response at 12 months
●
Changes
from baseline in pain as assessed with the VAS score and ODI at weeks 2, 12, 26, 52 and 104
●
Changes
from baseline in function as assessed with the ODI at weeks 2, 12, 26, 52 and 104
●
Changes
from baseline in function as assessed by Roland Morris Disability Questionnaire (RMDQ) at weeks 26, 52 and 104
●
Changes
from baseline function as assessed by Functional Rating Index (FRI) at weeks 12, 52 and 104
●
Changes
from baseline Quality of Life assessment (SF-12 questionnaire) scores at weeks 2, 12, 26, 52 and 104
In
December 2021, we entered into a Master Service Agreement with Professional Research Consulting Inc. d/b/a PRC Clinical, a contract research
organization, or CRO, specializing in clinical trial management, to conduct our Phase 2 clinical trial.
The
FDA approval process can be lengthy, expensive and uncertain and there is no guarantee that the clinical trial(s) will be commenced or
completed or that the product will ultimately receive approval or clearance.
As
an alternative to undertaking any necessary clinical trials ourselves, we may explore the licensing of our rights with
respect to our product candidate, BRTX-100, to a strategic partner. Such an arrangement could possibly eliminate or significantly
reduce the need to raise the substantial capital needed to commence and complete the clinical trials and undertake the commercialization
of BRTX-100 and would provide licensing-related revenue to us in lieu of product sales revenue. No assurance can be given that
any licensing agreement will be entered into, whether upon commercially reasonable terms or otherwise.
12
Defined
Health Report
In
March 2018, we engaged Defined Health, a business development and strategy consulting firm, to conduct an independent review of BRTX-100 .
Defined Health has worked with many of the leading companies in the pharmaceutical, biotech and healthcare industries for over 25 years.
The
review was intended to collect informed, independent opinions regarding BRTX-100 among key opinion leaders, or KOLs (i.e., orthopedic
surgeons specializing in back and spine surgery with experience in stem cell therapy), who, upon studying applicable clinical material,
could offer opinions regarding the future therapeutic potential of BRTX-100 .
As
noted in the Defined Health report, the KOLs indicated that stem cell therapies have great potential to treat chronic lumbar disc disease
and other therapeutic areas. The KOLs reacted positively to the value proposition of our product candidate, BRTX-100, and were
optimistic that the clinical data presented to date is likely to be mirrored in future clinical investigations. Given the opportunity,
the KOLs indicated that they would likely participate in a clinical trial should it be offered at their center and that they would recommend
the study to appropriately eligible patients. The report indicated that, if BRTX-100 were to be granted FDA approval, the KOLs
anticipate that it would be integrated into the standard of care for eligible chronic lumbar disc disease patients.
Similar
Therapies
Human
data from studies of therapies comparative to BRTX-100 have shown reduced pain, increased function, and an absence of significant
safety issues with a durable response, as shown below:
13
Impact
on Public Health
The
United States is the world’s leading consumer of hydrocodone (99%) and oxycodone (83%) and leads the world in per capital consumption
of such drugs (twice as much as second ranked Canada). In 2020, 91,000 persons in the United States died from overdoses.
Total
annual healthcare and lost productivity costs in the United States related to pain, including headache, back pain and neck pain, are
estimated to be $600 billion, which is twice the annual costs related to heart disease and greater than the combined annual costs related
to cancer and diabetes.
Metabolic
Brown Adipose (Fat) Program
Since
June 2011, we have been engaging in pre-clinical research efforts with respect to an investigational platform technology utilizing brown
adipose (fat) derived stem cells, or BADSCs, for therapeutic purposes. We have labeled this initiative our ThermoStem Program .
Brown
fat is a specialized adipose (fat) tissue found in the human body that plays a key role in the evolutionarily conserved mechanisms underlying
thermogenesis (generation of non-shivering body heat) and energy homeostasis in mammals - long known to be present at high levels in
hibernating mammals and human newborns. Recent studies have demonstrated that brown fat is present in the adult human body and may be
correlated with the maintenance and regulation of healthy metabolism, thus potentially being involved in caloric regulation. The pre-clinical
ThermoStem Program involves the use of a cell-based (brown adipose tissue construct) treatment for metabolic disease, such as
type 2 diabetes, obesity, hypertension and other metabolic disorders, as well as cardiac deficiencies. The diseases, disorders and syndromes
that may be targeted by our ThermoStem Program are as follows:
14
We
have had initial success in transplanting the brown adipose tissue construct in animals, and we are currently exploring ways to deliver
into humans. Even though present, BAT mass is very low in healthy adults and even lower in obese populations. Therefore, it may not be
sufficient to either naturally impact whole body metabolism, or to be targeted by drugs intended to increase its activity in the majority
of the population. Increasing BAT mass is crucial in order to benefit from its metabolic activity and this is what our ThermoStem
Program seeks to accomplish. We may also identify other naturally occurring biologics and chemically engineered molecules that may
enhance brown adipose tissue performance and activity.
Obesity,
the abnormal accumulation of white fat tissue, leads to a number of metabolic disorders and is the driving force behind the rise of type
2 diabetes and cardiovascular diseases worldwide. Pharmacological efforts to alter metabolic homeostasis through modulating central control
of appetite and satiety have had limited market penetration due to significant psychological and physiological safety concerns directly
attributed to modulating these brain centers. Adipose tissue is one of the largest organs in the human body and plays a key role in central
energy balance and lipid homeostasis. White and brown adipose tissues are found in mammals. White adipose tissue’s function is
to store energy, whereas BAT specializes in energy expenditure. As discussed in a 2020 article published in the International Journal
of Molecular Sciences , recent advancements in unraveling the mechanisms that control the induction, differentiation, proliferation,
and thermogenic activity of BAT, along with the application of imaging technologies for human BAT visualization, have generated optimism
that these advances may provide novel strategies for targeting BAT activation/thermogenesis, leading to efficacious and safe obesity
targeted therapies.
We
are developing a cell-based product candidate to target obesity and metabolic disorders using BADSCs. Our goal is to develop a bioengineered
implantable brown adipose tissue construct intended to mimic ones naturally occurring in the human body. We have isolated and characterized
a human multipotent stem cell population that resides within BAT depots. We have expanded these stem cells to clinically relevant numbers
and successfully differentiated them into functional brown adipocytes. We intend to use adult stem cells that may be differentiated into
progenitor or fully differentiated brown adipocytes, or a related cell type, which can be used therapeutically in patients. We are focusing
on the development of treatment protocols that utilize allogeneic cells (i.e., stem cells from a genetically similar but not identical
donor).
15
In
order to deliver these differentiated cells into target locations in vivo , we seeded BADSCs onto 3-dimensional biological scaffolds.
Pre-clinical animal models of diet-induced obesity, that were transplanted with differentiated BADSCs supported by a biological scaffold,
presented significant reductions in weight and blood glucose levels compared to scaffold only controls. We are identifying technology
for in vivo delivery in small animal models. Having completed our proof of concept using our BAT in small animals, we are currently
developing our next generation BAT. It is anticipated that this next version will contain a higher purity of BADSC and a greater percent
of functional brown adipocytes, which is expected to increase the therapeutic effect compared to our first generation product. In addition,
we are exploring the delivery of the therapeutic using encapsulation technology, which will only allow for reciprocal exchange of small
molecules between the host circulation and the BAT implant. We expect that encapsulation may present several advantages over our current
biological scaffolds, including prevention of any immune response or implant rejection that might occur in an immunocompetent host and
an increase in safety by preventing the implanted cells from invading the host tissues. We have developed promising data on the loading
of human stem cell-derived tissue engineered brown fat into an encapsulation device to be used as a cell delivery system for our metabolic
platform program for the treatment of type 2 diabetes, obesity, hyperlipidemia and hypertension. This advancement may lead to successful
transplantation of brown fat in humans. We are evaluating the next generation of BAT constructs that will first be tested in small animal
models. No assurance can be given that this delivery system will be effective in vivo in animals or humans. Our allogeneic brown
adipose derived stem cell platform potentially provides a therapeutic and commercial model for the cell-based treatment of obesity and
related metabolic disorders.
In
June 2012, we entered into an Assignment Agreement with the University of Utah Research Foundation, or the Foundation, and a Research
Agreement with the University of Utah, or the Utah Research Agreement. Pursuant to the Assignment Agreement, which provides for royalty
payments, we acquired the rights to two provisional patent applications that relate to human brown fat cell lines. No royalty amounts
are payable to date. The applications have been converted to a utility application in the United States and several foreign jurisdictions.
Pursuant to the Utah Research Agreement, the University of Utah provided research services relating to the identification of brown fat
tissue and the development and characterization of brown fat cell lines. The Utah Research Agreement provides that all inventions, discoveries,
patent rights, information, data, methods and techniques, including all cell lines, cell culture media and derivatives thereof, are owned
by us. In February 2019, we entered into a Services Agreement with the University of Utah pursuant to which the university has been retained
to provide research services with regard to the ThermoStem Program . Pursuant to this agreement, we will initiate preclinical models
to study the efficacy of our generation 2 encapsulated brown adipose tissue construct.
In
February 2014, our research with regard to the identification of a population of brown adipose derived stem cells was published in Stem
Cells , a respected stem cell journal.
16
In
March 2014, we entered into a Research Agreement with Pfizer Inc., a global pharmaceutical company. Pursuant to the Research Agreement
with Pfizer, we were engaged to provide research and development services with regard to a joint study of the development and validation
of a human brown adipose cell model. The Research Agreement with Pfizer provided for an initial payment to us of $250,000 and the payment
of up to an additional $525,000 during the two-year term of the Agreement, all of which has been received. The Research Agreement expired
upon completion of the services provided for therein.
In
August 2015, we entered into a one year research collaboration agreement with the University of Pennsylvania with regard to the understanding
of brown adipose biology and its role in metabolic disorders. In September 2018, we entered into a one year research collaboration agreement
with the University of Pennsylvania pursuant to which the university was provided access to our proprietary brown adipose tissue cells
for research purposes. No amounts were payable by or to us pursuant to either agreement.
In
September 2015, a United States patent related to the ThermoStem Program was issued to us.
In
April 2017, an Australian patent related to the ThermoStem Program was issued to us.
In
December 2017, a Japanese patent related to the ThermoStem Program was issued to us.
In
January 2019, a United States patent related to the ThermoStem Program was issued to us.
In
October 2019, an Australian patent related to the ThermoStem Program was issued to us.
In
October 2019, an Israeli patent related to the ThermoStem Program was issued to us.
In
March 2020, a United States patent related to our ThermoStem Program was issued to us.
In
March 2020, our collaboration with the University of Pennsylvania resulted in a publication in Cell Reports , a respected peer
reviewed journal, with regard to our ThermoStem Program .
In
April 2020, a European patent related to our ThermoStem Program was issued to us. This European patent was validated in Belgium,
France, Germany, Italy, Poland, Spain, Sweden, Switzerland, and the United Kingdom.
In
May 2020, an Israeli patent related to our ThermoStem Program was issued to us.
In
January 2021, a European patent related to our ThermoStem Program was issued to us. This European patent was validated in France,
Germany, Italy, Spain, and the United Kingdom.
In
March 2021, a United States patent related to our ThermoStem Program was issued to us.
17
In
June 2021, a Japanese patent related to our ThermoStem Program was issued to us.
In
July 2021, a United States patent related to our ThermoStem Program was issued to us.
In
August 2021, an Australian patent related to our ThermoStem Program was issued to us.
In
September 2021, a notice of allowance was issued for an Israeli patent application in our ThermoStem Program . The application
is expected to issue as an Israeli patent in the near future.
In January 2022, a notice
of allowance was issued for a Japanese patent application in our ThermoStem Program . The application is expected to issue as a
Japanese patent in the near future.
We
have completed proof of concept preclinical animal studies using our first generation brown adipose derived stem cells. We intend to
undertake additional preclinical animal studies in order to optimize delivery and explore the feasibility of targeting additional indications.
Such studies are planned to begin in 2022. Following the completion of such studies, if successful, we intend to file an IND with the
FDA and initiate a clinical trial. The FDA approval process can be lengthy, expensive and uncertain and there is no guarantee of ultimate
approval or clearance.
We
anticipate that much of our development work in this area will take place at our laboratory facility, outside core facilities at academic,
research or medical institutions, or contractors. See “Laboratory” below.
Curved
Needle Device
Pursuant
to the Regenerative License Agreement discussed under “Disc/Spine Program-License” above, we have licensed and further developed
an investigational curved needle device, or CND, that is a needle system with a curved inner cannula to allow access to difficult-to-locate
regions for the delivery or removal of fluids and other substances. The investigational CND is intended to deliver stem cells and/or
other therapeutic products or material to the interior of a human intervertebral disc, the spine region, or potentially other areas of
the body. The device is designed to rely on the use of pre-curved nested cannulae that allow the cells or material to be deposited in
the posterior and lateral aspects of the disc to which direct access is not possible due to outlying structures such as vertebra, spinal
cord and spinal nerves. We anticipate that the use of the investigational CND will facilitate the delivery of substances, including living
cells, to specific locations within the body and minimize the potential for damage to nearby structures. The investigational device may
also have more general use applications. In August 2015, a United States patent for the CND was issued to the licensor, Regenerative.
We anticipate that FDA approval or clearance will be necessary for the investigational CND prior to commercialization. We do not intend
to utilize the CND in connection with our contemplated Phase 2 clinical trial with regard to BRTX-100 . The FDA review and approval
process can be lengthy, expensive and uncertain and there is no guarantee of ultimate approval or clearance.
18
Laboratory
We
have established a laboratory in Melville, New York for research purposes and have built a cleanroom within the laboratory for the production
of cell-based product candidates, such as BRTX-100 , for use in a clinical trial, for third party cell products or general research
purposes.
In
2021 and 2022, we expanded our laboratory to include capabilities for the clinical production of our pipeline of clinical and investigational
cell therapy candidates. Our expanded cGMP facility is anticipated to include process development space, ISO 7 cleanrooms and state-of-the-art
equipment. We have expanded our research and development operations to include clinical manufacturing, a necessary step for our Phase
2 clinical trial for BRTX-100 . The new facility has been designed to provide cGMP manufacturing according to FDA and European
Medicines Agency regulations and guidelines to support clinical grade cell production. As we develop our business and our stem cell product
candidates and obtain regulatory approval, we will seek to establish ourselves as a key provider of adult stem cells for therapies and
expand to provide cells in other market areas for stem cell therapy. We may also use outside laboratories specializing in cell therapy
services and manufacturing of cell products.
Technology;
Research and Development
We
intend to utilize our laboratory or a third party laboratory in connection with cellular research activities. We also intend to obtain
cellular-based therapeutic technology licenses and increase our IP portfolio. We intend to seek to develop potential stem cell delivery
systems or devices. The goal of these specialized delivery systems or devices is to deliver cells into specific areas of the body, control
the rate, amount and types of cells used in a treatment, and populate these areas of the body with sufficient stem cells so that there
is a successful therapeutic result.
We
also intend to perform research to develop certain stem cell optimization compounds, media designed to enhance cellular growth and regeneration
for the purpose of improving pre-treatment and post-treatment outcomes.
In our Disc/Spine
Program , twelve patent applications have been filed with regard to technology that is the subject of the Regenerative
License Agreement (see “Disc/Spine Program-License” above). Regenerative has been issued a patent from one of these
applications with regard to its curved needle therapeutic delivery device. In addition, in March 2022, a United States patent related to BRTX- 100, was issued. The other ten applications remain pending. The patents that are the subject of the
Regenerative License Agreement have been assigned to Regenexx, LLC which we have been advised is an affiliate of Regenerative.
In
our ThermoStem Program , we have three pending United States patent applications and five United States patents within three patent
families. With regards to the first patent family, the ThermoStem Program, patent applications have been filed in five foreign
jurisdictions (of which four applications have been granted as foreign patents and one application, which is not listed in the table
below, has lapsed). With regards to the second patent family in the ThermoStem Program, patent applications have been filed in
four foreign jurisdictions (of which four applications have been granted as foreign patents). With regards to the third patent family
in the ThermoStem Program , patent applications have been filed in four foreign jurisdictions.
19
Our
patent applications and those of Regenexx, LLC are currently in prosecution (i.e., we and Regenexx, LLC are seeking issued patents).
A description of the active patent applications and issued patents is set forth in the table below:
Program
Patent
Family
I.D.
Jurisdiction
Title
Disc/Spine
(brtxDisc)
1
U.S.
Patent No. 11,278,573 B2 b
US
Methods
and compositions to facilitate repair of avascular tissue
1
17/527,489
a
US
1
17/527,494
a
US
1
17/527,498
a
US
1
17/527,503
a
US
1
17/527,505
a
US
1
17/527,510
a
US
1
17/527,512
a
US
1
17/527,516
a
US
1
17/527,523
a
US
1
17/527,527
a
US
1
U.S.
Patent No. 9,113,950 B2 b
US
Therapeutic
delivery device
Metabolic
(ThermoStem)
2
U.S.
Patent No. 9,133,438
US
Brown
fat cell compositions and methods
2
U.S.
Patent No. 10,597,638
US
2
U.S.
Patent No. 11,066,646
US
2
17/348,218
US
2
AU
Patent No. 2012275335
Australia
2
EP
Patent No. 2726603
Europe
(validated
in Belgium, France, Germany, Italy, Poland, Spain, Sweden, Switzerland, and the United Kingdom)
2
IL
Patent No. 230237
Israel
2
JP
Patent No. 6243839
Japan
3
U.S.
Patent No. 10,167,449
US
Human
brown adipose derived stem cells and uses
3
U.S.
Patent No. 10,941,383
US
3
17/165,074
US
3
AU
Patent No. 2014253920
Australia
3
AU
Patent No.
2019240634
Australia
3
EP
Patent No. 2986714
(validated
in France, Germany, Italy, Spain, and the United Kingdom)
Europe
3
20204990.4
Europe
3
IL
Patent No. 242150
Israel
3
274995
c
Israel
3
JP
Patent No. 6887249
Japan
3
2021-123173
c
Japan
3
2022-15511
Japan
4
16/862,226
US
Non-naturally
occurring three-dimensional (3D) brown adipose-derived stem cell aggregates, and methods of generating and using the same
4
PCT/US2020/030520
PCT
4
2020265664
Australia
4
20798130.9
Europe
4
287557
Israel
4
2021-564135
Japan
a
Patent application filed by licensor assignee,
Regenexx, LLC
b
Patent issued to licensor assignee, Regenexx,
LLC
c
Application has been allowed, but not yet issued as a patent
In
March 2014, we entered into a Research and Development Agreement with Rohto Pharmaceutical Co., Ltd., a Japanese pharmaceutical company,
or Rohto. Pursuant to the Research and Development Agreement with Rohto, we were engaged to provide research and development services
with regard to stem cells. The agreement with Rohto expired upon the completion of the services provided for therein.
20
We
have secured registrations in the U.S. Patent and Trademark Office for the following trademarks:
●
●
BRTX-100
●
THERMOSTEM
We
own an allowed application in the U.S. Patent and Trademark Office for the trademark BRTX . The Dragonfly Logo is also registered
with the U.S. Copyright Office.
We
also have federal common law rights in the trademark BioRestorative Therapies and other trademarks and trade names used in the
conduct of our business that are not registered.
Our
success will depend in large part on our ability to develop and protect our proprietary technology. We intend to rely on a combination
of patent, trade secret and know-how, copyright and trademark laws, as well as confidentiality agreements, licensing agreements, non-compete
agreements and other agreements, to establish and protect our proprietary rights. Our success will also depend upon our ability to avoid
infringing upon the proprietary rights of others, for if we are judicially determined to have infringed such rights, we may be required
to pay damages, alter our services, products or processes, obtain licenses or cease certain activities.
During
the years ended December 31, 2021 and 2020, we incurred $729,058 and $876,829, respectively, in research and development expenses.
Scientific
Advisors
We
have established a Scientific Advisory Board whose purpose is to provide advice and guidance in connection with scientific matters relating
to our business. The Scientific Advisory Board has established a Disc Advisory Committee which focuses on matters relating to our Disc/Spine
Program . Our Scientific Advisory Board members are Dr. Wayne Marasco (Chairman), Dr. Wayne Olan, Dr. Joy Cavagnaro, Dr. Jason Lipetz,
Dr. Harvinder Sandhu, Dr. Christopher Plastaras and Dr. Gerard A. Malanga. The Disc Advisory Committee members are Dr. Lipetz (Chairman),
Dr. Olan, Dr. Sandhu, Dr. Plastaras and Dr. Malanga. See “Management” for a listing of the principal positions for Drs. Marasco,
Olan, Cavagnaro, Lipetz, Sandhu, Plastaras and Malanga.
21
Competition
We
will compete with many pharmaceutical, biotechnology and medical device companies, as well as other private and public stem cell companies
involved in the development and commercialization of cell-based medical technologies and therapies.
Regenerative
medicine is rapidly progressing, in large part through the development of cell-based therapies or devices designed to isolate cells from
human tissues. Most efforts involve cell sources, such as bone marrow, adipose tissue, embryonic and fetal tissue, umbilical cord and
peripheral blood and skeletal muscle.
Companies
working in the area of regenerative medicine with regard to the disc and spine include, among others, Mesoblast, SpinalCyte, DiscGenics
and Isto Biologics. Companies that are developing products and therapies to combat obesity and diabetes, including through the use of
brown fat, include, among others, Novo Nordisk, Sanofi, Merck, Eli Lilly, Roche, Pfizer and Regeneron.
Many
of our competitors and potential competitors have substantially greater financial, technological, research and development, marketing
and personnel resources than we do. We cannot, with any accuracy, forecast when or if these companies are likely to bring their products
and therapies to market in competition with those that we are pursuing.
The Biologics Price Competition
and Innovation Act, or the BPCIA, sets forth an abbreviated pathway for the approval of biosimilar and interchangeable biological
products that could be used by future competitors, if any, of our product candidates are approved by the FDA as a biologic. For
the FDA to approve a biosimilar product, it must find that there are no clinically meaningful differences between the reference product
and the proposed biosimilar product. Interchangeability requires that a product is biosimilar to the reference product, and the product
must demonstrate that it can be expected to produce the same clinical results as the reference product and, for products administered
multiple times, the biologic and the reference biologic may be switched after one has been previously administered without increasing
safety risks or risks of diminished efficacy relative to exclusive use of the reference biologic. Under the BPCIA, an application for
a biosimilar product cannot be submitted to the FDA until four years following approval of the reference product, and it may not be approved
by the FDA until 12 years after the original branded product is approved under a biologics license application, or BLA.
We
believe that, if any of our product candidates are approved as a biological product under a BLA, it should qualify for the 12-year period
of exclusivity. However, there is a risk that the FDA could permit biosimilar applicants to reference approved biologics other than our
therapeutic candidates, thus circumventing our exclusivity and potentially creating the opportunity for competition sooner than anticipated.
Additionally, this period of regulatory exclusivity does not apply to companies pursuing regulatory approval via their own traditional
BLA, rather than via the abbreviated pathway. Moreover, the extent to which a biosimilar, once approved, will be substituted for any
one of our reference products in a way that is similar to traditional generic substitution for non-biological products is not yet clear,
and will depend on a number of marketplace and regulatory factors that are still developing.
22
Set
forth below is a comparison of BRTX-100 to Mesoblast’s adult stem cell biologic:
We
believe that BRTX-100 has competitive advantages to Mesoblast’s product for the following reasons:
●
The
use of autologous cells results in low to no risk of rejection, greater safety profile (introduction of viral/genetic) and streamlined
regulatory path
●
Hypoxic
culturing creates increased cell proliferation, greater plasticity, increased paracrine effect and increased cell survival after
application
●
Autologous
platelet lysate provides growth factors that interact with the cells, allowing for better cell survival
●
Low
to no risk of safety concerns related to immunological and zoonotic (animal to human) transmission
●
Strong
runway for value creation with successful clinical results
Customers
Upon
regulatory approval, our cell product candidates are intended to be marketed to physicians, other health care professionals, hospitals,
research institutions, pharmaceutical companies and the military. It is anticipated that physicians who are trained and skilled in performing
spinal injections will be the physicians most likely to treat discs with injections of BRTX-100 upon regulatory approval. These
physicians would include interventional physiatrists (physical medicine physicians), pain management anesthesiologists, interventional
radiologists and neurosurgeons.
23
Governmental
Regulation
U.S.
Government Regulation
The
health care industry is highly regulated in the United States. The federal government, through various departments and agencies, state
and local governments, and private third-party accreditation organizations, regulate and monitor the health care industry, associated
products, and operations. The FDA and comparable regulatory agencies in state and local jurisdictions and in foreign countries impose
substantial requirements upon the clinical development, approval, manufacture, distribution and marketing of medical products, including
drugs, biologics, and medical devices. These agencies and other federal, state and local entities regulate research and development activities
and the testing, manufacture, quality control, safety, effectiveness, labeling, packaging, storage, distribution, record keeping, approval,
post-approval monitoring, advertising, promotion, sampling and import and export of medical products. The following is a general overview
of the laws and regulations pertaining to our business.
FDA
Regulation of Stem Cell Treatment and Products
The
FDA regulates the manufacture of human stem cell treatments and associated products under the authority of the Public Health Service
Act, or PHSA, and the Federal Food, Drug, and Cosmetic Act, or FDCA. Stem cells can be regulated under the FDA’s Human Cells, Tissues,
and Cellular and Tissue-Based Products Regulations, or HCT/Ps, or may also be subject to the FDA’s drug, biologic, or medical device
regulations, each as discussed below.
Human
Cells, Tissues, and Cellular and Tissue-Based Products Regulation
Under
Section 361 of the PHSA, the FDA issued specific regulations governing the use of HCT/Ps in humans. Pursuant to Part 1271 of Title 21
of the Code of Federal Regulations, or CFR, or the HCT/P Regulations, the FDA established a unified registration and listing system for
establishments that manufacture and process HCT/Ps. The regulations also include provisions pertaining to donor eligibility determinations;
current good tissue practices covering all stages of production, including harvesting, processing, manufacture, storage, labeling, packaging,
and distribution; and other procedures to prevent the introduction, transmission, and spread of communicable diseases.
The
HCT/P Regulations define HCT/Ps as articles “containing or consisting of human cells or tissues that are intended for implantation,
transplantation, infusion or transfer into a human recipient.” The HCT/P Regulations strictly constrain the types of products that
may be regulated solely as HCT/P. Factors considered include the degree of manipulation, whether the product is intended for a homologous
function, whether the product has been combined with noncellular or non-tissue components, and the product’s effect or dependence
on the body’s metabolic function. In those instances where cells, tissues, and cellular and tissue-based products have been only
minimally manipulated, are intended strictly for homologous use, have not been combined with noncellular or nontissue substances, and
do not depend on or have any effect on the body’s metabolism, the manufacturer is only required to register with the FDA, submit
a list of manufactured products, and adopt and implement procedures for the control of communicable diseases. If one or more of the above
factors has been exceeded, the product would be regulated as a drug, biological product, or medical device rather than an HCT/P.
24
Because
we are an enterprise in the early stages of operations and have not generated significant revenues from operations, it is difficult to
anticipate the likely regulatory status of the array of products and services that we may offer. We believe that some of the adult autologous
(self-derived) stem cells that will be used in our cellular therapy products and services, including the brown adipose (fat) tissue that
we intend to use in our ThermoStem Program , may be regulated by the FDA as HCT/Ps under the HCT/P Regulations. However, the FDA
may disagree with this position or conclude that some or all of our stem cell therapy products or services do not meet the applicable
definitions and exemptions to the regulation. In July 2020, the FDA issued an updated guidance document entitled “Regulatory Considerations
for Human Cells, Tissues, and Cellular and Tissue-Based Products: Minimal Manipulation and Homologous Use” that provides additional
guidance on how FDA interprets the HCT/P Regulations, particularly the definition of the terms “minimally manipulated” and
“homologous use.” In the guidance, FDA stated it will exercise enforcement discretion until May 31, 2021 for products that
do not comply with the HCT/P Regulations. As of that date, manufacturers of products marketed as HCT/Ps that do not comply with the HCT/P
Regulations are subject to immediate FDA enforcement action. If we are not regulated solely under the HCT/P Regulations, we would need
to expend significant resources to comply with the FDA’s broad regulatory authority under the FDCA. The U.S. federal courts
have upheld the FDA’s authority to regulate stem cell products under the FDCA that do not comply with the HCT/P Regulations. For
example, in June 2021, the U.S. Court of Appeals for the 11 th Circuit upheld the FDA’s regulation of stem cells obtained
from fat as a “drug” because the cells were not used for a “homologous” use. United States of America v. US
Stem Cell Clinic, LLC , 998 F.3d 1302 (2021).
If
regulated solely under the FDA’s HCT/P statutory and regulatory provisions, once our laboratory in the United States becomes operational,
it will need to satisfy the following requirements, among others, to process and store stem cells:
●
registration
and listing of HCT/Ps with the FDA;
●
donor
eligibility determinations, including donor screening and donor testing requirements;
●
current
good tissue practices, specifically including requirements for the facilities, environmental controls, equipment, supplies and reagents,
recovery of HCT/Ps from the patient, processing, storage, labeling and document controls, and distribution and shipment of the HCT/Ps
to the laboratory, storage, or other facility;
●
tracking
and traceability of HCT/Ps and equipment, supplies, and reagents used in the manufacture of HCT/Ps;
●
adverse
event reporting;
●
FDA
inspection; and
●
abiding
by any FDA order of retention, recall, destruction, and cessation of manufacturing of HCT/Ps.
Non-reproductive
HCT/Ps and non-peripheral blood stem/progenitor cells that are offered for import into the United States and regulated solely under Section
361 of the PHSA must also satisfy the requirements under 21 C.F.R. § 1271.420. Section 1271.420 requires that the importer of record
of HCT/Ps notify the FDA prior to, or at the time of, importation and provide sufficient information for the FDA to make an admissibility
decision. In addition, the importer must hold the HCT/P intact and under conditions necessary to prevent transmission of communicable
disease until an admissibility decision is made by the FDA.
25
If
the FDA determines that we have failed to comply with applicable regulatory requirements, it can impose a variety of enforcement actions
including public warning letters, fines, consent decrees, orders of retention, recall or destruction of product, orders to cease manufacturing,
and criminal prosecution. If any of these events were to occur, it could materially adversely affect us.
To
the extent that our cellular therapy activities are limited to developing products and services outside the United States, as described
in detail below, the products and services would not be subject to FDA regulation, but will be subject to the applicable requirements
of the foreign jurisdiction. We intend to comply with all applicable foreign governmental requirements.
Drug
and Biological Product Regulation
An
HCT/P product that does not meet the criteria for being solely regulated under Section 361 of the PHSA will be regulated as a drug, device
or biological product under the FDCA and/or Section 351 of the PHSA, and applicable FDA regulations. The FDA has broad regulatory authority
over drugs and biologics marketed for sale in the United States. The FDA regulates the research, clinical testing, manufacturing, safety,
effectiveness, labeling, storage, recordkeeping, promotion, distribution, and production of drugs and biological products. The FDA also
regulates the export of drugs and biological products manufactured in the United States to international markets in certain situations.
The
process required by the FDA before a drug or biologic may be marketed in the United States generally involves the following:
●
completion of non-clinical laboratory tests, animal studies and formulation studies conducted according to Good Laboratory Practice,
or GLP, or other applicable regulations;
●
submission of an IND, which allows clinical trials to begin unless the FDA objects within 30 days;
●
performance of adequate and well-controlled human clinical trials to establish the safety and efficacy of the proposed drug or biologic
for its intended use or uses conducted in accordance with FDA regulations and Good Clinical Practices, or GCP, which are international
ethical and scientific quality standards meant to ensure that the rights, safety and well-being of trial participants are protected and
that the integrity of the data is maintained;
●
registration of clinical trials of FDA-regulated products and certain clinical trial information;
●
preparation and submission to the FDA of a new drug application, or NDA, in the case of a drug or BLA in the case of a biologic;
●
review of the product by an FDA advisory committee, where appropriate or if applicable;
●
satisfactory completion of pre-approval inspection of manufacturing facilities and clinical trial sites at which the product, or components
thereof, are produced to assess compliance with cGMP requirements and of selected clinical trial sites to assess compliance with GCP
requirements; and
●
FDA approval of an NDA or BLA which must occur before a drug or biologic can be marketed or sold.
26
Approval
of an NDA requires a showing that the drug is safe and effective for its intended use and that the methods, facilities, and controls
used for the manufacturing, processing, and packaging of the drug are adequate to preserve its identity, strength, quality, and purity.
To obtain a BLA, a manufacturer must show that the proposed product is safe, pure, and potent and that the facility in which the product
is manufactured, processed, packed, or held meets established quality control standards.
For
purposes of an NDA or BLA approval by the FDA, human clinical trials are typically conducted in the following phases (which may overlap):
●
Phase 1: The investigational product is initially given to healthy human subjects or patients and tested for safety, dosage tolerance,
absorption, metabolism, distribution and excretion. These trials may also provide early evidence on effectiveness. During Phase 1 clinical
trials, sufficient information about the investigational product’s pharmacokinetics and pharmacologic effects may be obtained to
permit the design of well-controlled and scientifically valid Phase 2 clinical trials.
●
Phase 2: These clinical trials are conducted in a limited number of human subjects in the target population to identify possible adverse
effects and safety risks, to determine the efficacy of the investigational product for specific targeted diseases and to determine dosage
tolerance and dosage levels. Multiple Phase 2 clinical trials may be conducted by the sponsor to obtain information prior to beginning
larger and more costly Phase 3 clinical trials.
●
Phase 3: Phase 3 clinical trials are undertaken after Phase 2 clinical trials demonstrate that a dosage range of the investigational
product appears effective and has a tolerable safety profile. The Phase 2 clinical trials must also provide sufficient information for
the design of Phase 3 clinical trials. Phase 3 clinical trials are conducted to provide statistically significant evidence of clinical
efficacy and to further test for safety risks in an expanded human subject population at multiple clinical trial sites. These clinical
trials are intended to further evaluate dosage, effectiveness and safety, to establish the overall benefit-risk profile of the investigational
product and to provide an adequate basis for product labeling and approval by the FDA. In most cases, the FDA requires two adequate and
well-controlled Phase 3 clinical trials to demonstrate the efficacy of an investigational drug or biologic.
All
clinical trials must be conducted in accordance with FDA regulations, GCP requirements and their protocols in order for the data to be
considered reliable for regulatory purposes. Progress reports detailing the results of the clinical trials must be submitted at least
annually to the FDA and more frequently if serious adverse events occur. Phase 1, Phase 2 and Phase 3 clinical trials may not be completed
successfully within any specified period, or at all. These government regulations may delay or prevent approval of product candidates
for a considerable period of time and impose costly procedures upon our business operations.
27
The
FDA may require, or companies may pursue, additional clinical trials, referred to as Phase 4 clinical trials, after a product is approved.
Such trials may be made a condition to be satisfied for continuing drug approval. The results of Phase 4 clinical trials can confirm
the effectiveness of a product candidate and can provide important safety information. In addition, the FDA has authority to require
sponsors to conduct post-marketing trials to specifically address safety issues identified by the agency.
Under
the Pediatric Research Equity Act, or PREA, certain NDAs and BLAs and certain supplements to an NDA or BLA must contain data to assess
the safety and efficacy of the drug for the claimed indications in all relevant pediatric subpopulations and to support dosing and administration
for each pediatric subpopulation for which the product is safe and effective. The FDA may grant deferrals for submission of pediatric
data or full or partial waivers. The Food and Drug Administration Safety and Innovation Act, or FDASIA, amended the FDCA to require that
a sponsor who is planning to submit a marketing application for a drug that includes a new active ingredient, new indication, new dosage
form, new dosing regimen, or new route of administration submit an initial Pediatric Study Plan, or PSP, within 60 days of an end-of-Phase
2 meeting or, if there is no such meeting, as early as practicable before the initiation of the Phase 3 or Phase 2/3 study. The initial
PSP must include an outline of the pediatric study or studies that the sponsor plans to conduct, including study objectives and design,
age groups, relevant endpoints and statistical approach, or a justification for not including such detailed information, and any request
for a deferral of pediatric assessments or a full or partial waiver of the requirement to provide data from pediatric studies along with
supporting information. The FDA and the sponsor must reach an agreement on the PSP. A sponsor can submit amendments to an agreed-upon
initial PSP at any time if changes to the pediatric plan need to be considered based on data collected from preclinical studies, early
phase clinical trials, and/or other clinical development programs.
Changes
to some of the conditions established in an approved application, including changes in indications, labeling, manufacturing processes
or facilities, require submission and FDA approval of a new NDA or BLA, or an NDA or BLA supplement, before the change can be implemented.
An NDA or BLA supplement for a new indication typically requires clinical data similar to that in the original application, and the FDA
uses the same procedures and actions in reviewing NDA and BLA supplements as it does in reviewing NDAs and BLAs.
Drug
and biological products must also comply with applicable requirements, including monitoring and recordkeeping activities, manufacturing
requirements, reporting to the applicable regulatory authorities of adverse experiences with the product, providing the regulatory authorities
with updated safety and efficacy information, product sampling and distribution requirements, and complying with promotion and advertising
requirements, which include, among others, standards for direct-to-consumer advertising, restrictions on promoting drugs for uses or
in patient populations that are not described in the drug’s approved labeling, or off-label use, limitations on industry-sponsored
scientific and educational activities and requirements for promotional activities involving the internet. Although physicians may, in
their independent professional medical judgment, prescribe legally available drugs for off-label uses, manufacturers typically may not
market or promote such off-label uses. Modifications or enhancements to the product or its labeling, or changes of the site of manufacture,
are often subject to the approval of the FDA and other regulators, who may or may not grant approval or may include a lengthy review
process.
28
In
the event that the FDA does not regulate our product candidates in the United States solely under the HCT/P regulation, our products
and activities could be regulated as drug or biological products under the FDCA. If regulated as drug or biological products, we will
need to expend significant resources to ensure regulatory compliance. If an IND and NDA or BLA are required for any of our product candidates,
there is no assurance as to whether or when we will receive FDA approval of the product candidate. The process of designing, conducting,
compiling and submitting the non-clinical and clinical studies required for NDA or BLA approval is time-consuming, expensive and unpredictable.
The process can take many years, depending on the product and the FDA’s requirements.
In
addition, even if a product candidate receives regulatory approval, the approval may be limited to specific disease states, patient populations
and dosages, or might contain significant limitations on use in the form of warnings, precautions or contraindications, or in the form
of onerous risk management plans, restrictions on distribution or use, or post-marketing trial requirements. Further, even after regulatory
approval is obtained, later discovery of previously unknown problems with a product may result in restrictions on the product, including
safety labeling or imposition of a Risk Evaluation and Mitigation Strategy, or REMS, the requirement to conduct post-market studies or
clinical trials or even complete withdrawal of the product from the market. Delay in obtaining, or failure to obtain, regulatory approval
for our products, or obtaining approval but for significantly limited use, would harm our business. Further, we cannot predict what adverse
governmental regulations may arise from future United States or foreign governmental action.
If
the FDA determines that we have failed to comply with applicable regulatory requirements, it can impose a variety of enforcement actions
from public warning letters, fines, injunctions, consent decrees and civil penalties to suspension or delayed issuance of approvals,
seizure of our products, total or partial shutdown of our production, withdrawal of approvals, and criminal prosecutions. If any of these
events were to occur, it could materially adversely affect us.
FDA
Expedited Review Programs
The
FDA is authorized to expedite the review of NDAs and BLAs in several ways. Under the Fast Track program, the sponsor of a drug or biologic
product candidate may request the FDA to designate the product for a specific indication as a Fast Track product concurrent with or after
the filing of the IND. Drug and biologic products are eligible for Fast Track designation if they are intended to treat a serious or
life-threatening condition and demonstrate the potential to address unmet medical needs for the condition. Fast Track designation applies
to the combination of the product candidate and the specific indication for which it is being studied.
In
addition to other benefits, such as the ability to have greater interactions with the FDA, the FDA may initiate review of sections of
a Fast Track NDA or BLA before the application is complete, a process known as rolling review.
29
Any
product submitted to the FDA for marketing, including under a Fast Track program, may also be eligible for the following other types
of FDA programs intended to expedite development and review:
●
Breakthrough therapy designation. To qualify for the breakthrough therapy program, product candidates must be intended to treat a serious
or life-threatening disease or condition, and preliminary clinical evidence must indicate that such product candidates may demonstrate
substantial improvement on one or more clinically significant endpoints over existing therapies. The FDA will seek to ensure the sponsor
of a breakthrough therapy product candidate receives intensive guidance on an efficient drug development program, intensive involvement
of senior managers and experienced staff on a proactive, collaborative and cross-disciplinary review, and rolling review.
●
Priority review. A product candidate is eligible for priority review if it treats a serious condition and, if approved, it would be a
significant improvement in the safety or effectiveness of the treatment, diagnosis or prevention of a serious condition compared to marketed
products. The FDA aims to complete its review of priority review applications within six months as opposed to ten months for standard
review.
●
Accelerated approval. Drug or biologic products studied for their safety and effectiveness in treating serious or life-threatening illnesses
and that provide meaningful therapeutic benefit over existing treatments may receive accelerated approval. Accelerated approval means
that a product candidate may be approved on the basis of adequate and well-controlled clinical trials establishing that the product candidate
has an effect on a surrogate endpoint that is reasonably likely to predict a clinical benefit, or on the basis of an effect on a clinical
endpoint other than survival or irreversible morbidity or mortality or other clinical benefit, taking into account the severity, rarity
and prevalence of the condition and the availability or lack of alternative treatments. As a condition of approval, the FDA may require
that a sponsor of a drug or biologic product candidate receiving accelerated approval perform adequate and well-controlled post-marketing
clinical trials. In addition, the FDA currently requires as a condition for accelerated approval pre-approval of promotional materials.
The FDA’s recent use of the accelerated approval pathway for an Alzheimer’s drug (aducanumab) has been controversial and
has attracted Congressional scrutiny. As a result, it is possible that future legislation or regulatory policy changes could make it
more difficult to use the accelerated approval pathway.
Fast
Track designation, breakthrough therapy designation, priority review and accelerated approval do not change the standards for approval
but may expedite the development or approval process.
Further,
with the passage of the 21st Century Cures Act, or the Cures Act, in December 2016, Congress authorized the FDA to accelerate review
and approval of products designated as regenerative advanced therapies. A product is eligible for this designation if it is a regenerative
medicine advanced therapy, or RMAT (which may include a cell therapy), that is intended to treat, modify, reverse or cure a serious or
life-threatening disease or condition, and preliminary clinical evidence indicates that the drug has the potential to address unmet medical
needs for such disease or condition. The benefits of a RMAT designation include early interactions with the FDA to expedite development
and review, benefits available to breakthrough therapies, potential eligibility for priority review and accelerated approval based on
surrogate or intermediate endpoints.
Medical
Device Regulation
The
FDA also has broad authority over the regulation of medical devices marketed for sale in the United States. The FDA regulates the research,
clinical testing, manufacturing, safety, labeling, storage, recordkeeping, premarket clearance or approval, promotion, distribution,
and production of medical devices. The FDA also regulates the export of medical devices manufactured in the United States to international
markets.
30
Under
the FDCA, medical devices are classified into one of three classes, Class I, Class II, or Class III, depending upon the degree of risk
associated with the medical device and the extent of control needed to ensure safety and effectiveness. Class I devices are subject to
the lowest degree of regulatory scrutiny because they are considered low risk devices and need only comply with the FDA’s General
Controls. The General Controls include compliance with the registration, listing, adverse event reporting requirements, and applicable
portions of the Quality System Regulation as well as the general misbranding and adulteration prohibitions.
Class
II devices are subject to the General Controls as well as certain Special Controls such as 510(k) premarket notification. Class III devices
are subject to the highest degree of regulatory scrutiny and typically include life supporting and life sustaining devices and implants.
They are subject to the General Controls and Special Controls that include a premarket approval application, or PMA. “New”
devices are automatically regulated as Class III devices unless they are shown to be low risk, in which case they may be subject to de
novo review to be moved to Class I or Class II. Clinical research of an investigational device is subject to the FDA’s Investigational
Device Exemption, or IDE, regulations. Nonsignificant risk devices are subject to abbreviated requirements that do not require a submission
to the FDA but must have Institutional Review Board (IRB) approval and comply with other requirements pertaining to informed consent,
labeling, recordkeeping, reporting, and monitoring. Significant risk devices require the submission of an IDE application to the FDA
and the FDA’s approval of the IDE application.
The
FDA premarket clearance and approval process can be lengthy, expensive and uncertain. It generally takes three to twelve months from
submission to obtain 510(k) premarket clearance, although it may take longer. Approval of a PMA could take one to four years, or more,
from the time the application is submitted and there is no guarantee of ultimate clearance or approval. Securing FDA clearances and approvals
may require the submission of extensive clinical data and supporting information to the FDA. Additionally, the FDA actively enforces
regulations prohibiting marketing and promotion of devices for indications or uses that have not been cleared or approved by the FDA.
In addition, modifications or enhancements of products that could affect the safety or effectiveness or effect a major change in the
intended use of a device that was either cleared through the 510(k) process or approved through the PMA process may require further FDA
review through new 510(k) or PMA submissions.
In
the event we develop processes, products or services which qualify as medical devices subject to FDA regulation, we intend to comply
with such regulations. If the FDA determines that our products are regulated as medical devices and we have failed to comply with applicable
regulatory requirements, it can impose a variety of enforcement actions from public warning letters, application integrity proceedings,
fines, injunctions, consent decrees and civil penalties to suspension or delayed issuance of approvals, seizure of our products, total
or partial shutdown of our production, withdrawal of approvals, and criminal prosecutions. If any of these events were to occur, it could
materially adversely affect us.
Current
Good Manufacturing Practices and other FDA Regulations of Cellular Therapy Products
Products
that fall outside of the HCT/P regulations and are regulated as drugs, biological products, or devices must comply with applicable cGMP
regulations. These cGMPs and related quality standards are designed to ensure the products that are processed at a facility meet the
FDA’s applicable requirements for identity, strength, quality, sterility, purity, and safety. In the event that our domestic United
States operations are subject to the FDA’s drug, biological product, or device regulations, we intend to comply with the applicable
cGMPs and quality regulations.
31
If
the FDA determines that we have failed to comply with applicable regulatory requirements, it can impose a variety of enforcement actions
from public warning letters, fines, injunctions, consent decrees and civil penalties to suspension or delayed issuance of approvals,
seizure of our products, total or partial shutdown of our production, withdrawal of approvals, and criminal prosecutions. If any of these
events were to occur, it could materially adversely affect us.
Promotion
of Foreign-Based Cellular Therapy Treatment— “Medical Tourism”
We
may establish, or license technology to third parties in connection with their establishment of, adult stem cell therapy facilities outside
the United States. We also intend to work with hospitals and physicians to make the stem cell-based therapies available for patients
who travel outside the United States for treatment. “Medical tourism” is defined as the practice of traveling across international
borders to obtain health care.
The
Federal Trade Commission, or the FTC, has the authority to regulate and police advertising of medical treatments, procedures, and regimens
in the United States under the Federal Trade Commission Act, or the FTCA. The FTC has regulatory authority to prevent unfair and deceptive
practices and false advertising. Specifically, the FTC requires advertisers and promoters to have a reasonable basis to substantiate
and support claims. The FTC has many enforcement powers, one of which is the power to order disgorgement by promoters deemed in violation
of the FTCA of any profits made from the promoted business and can order injunctions from further violative promotion. Advertising that
we may utilize in connection with our medical tourism operations will be subject to FTC regulatory authority, and we intend to comply
with such regulatory régime. Similar laws and requirements are likely to exist in other countries and we intend to comply with
such requirements.
Federal
Regulation of Clinical Laboratories
Congress
passed the Clinical Laboratory Improvement Amendments, or CLIA, in 1988, which provided the Centers for Medicare and Medicaid Services,
or CMS, authority over all laboratory testing, except research, that is performed on humans in the United States. The Division of Laboratory
Services, within the Survey and Certification Group, under the Center for Medicaid and State Operations, or CMSO, has the responsibility
for implementing the CLIA program.
The
CLIA program is designed to establish quality laboratory testing by ensuring the accuracy, reliability, and timeliness of patient test
results. Under CLIA, a laboratory is a facility that does laboratory testing on specimens derived from humans and used to provide information
for the diagnosis, prevention, treatment of disease, or impairment of, or assessment of health. Laboratories that handle stem cells and
other biologic matter are, therefore, included under the CLIA program. Under the CLIA program, laboratories must be certified by the
government, satisfy governmental quality and personnel standards, undergo proficiency testing, be subject to inspections, and pay fees.
To the extent that our business activities require CLIA certification, we intend to obtain and maintain such certification. If we are
subject to CLIA, the failure to comply with CLIA standards could result in suspension, revocation, or limitation of a laboratory’s
CLIA certificate. In addition, fines or criminal penalties could also be levied. If any of these events were to occur, it could impact
our business operations.
32
Health
Insurance Portability and Accountability Act—Protection of Patient Health Information
We
may be subject to data privacy and security regulation by both the federal government and the states in which we conduct our business.
The Health Insurance Portability Act of 1996, or HIPAA, as amended by the Health Information Technology for Economic and Clinical Health
Act, or HITECH, and their respective implementing regulations, including the Final Omnibus Rule published on January 25, 2013, imposes
specified requirements relating to the privacy, security and transmission of individually identifiable health information on certain
types of individuals and organizations. In addition, certain state laws govern the privacy and security of health information in certain
circumstances, many of which differ from each other and from HIPAA in significant ways and may not have the same effect, thus complicating
compliance efforts. Further, we may need to also comply with additional federal or state privacy laws and regulations that may apply
to certain diagnoses, such as HIV/AIDS, to the extent that they apply to us.
The
Department of Health and Human Services, or HHS, through its Office for Civil Rights, investigates breach reports and determines whether
administrative or technical modifications are required and whether civil or criminal sanctions should be imposed. Companies failing to
comply with HIPAA and the implementing regulations may also be subject to civil money penalties or in the case of knowing violations,
potential criminal penalties, including monetary fines, imprisonment, or both. In some cases, the State Attorneys General may seek enforcement
and appropriate sanctions in federal court.
Other
Applicable U.S. Laws
In
addition to the above-described regulation by United States federal and state government, the following are other federal and state laws
and regulations that could directly or indirectly affect our ability to operate the business:
●
state
and local licensure, registration, and regulation of the development of pharmaceuticals and biologics;
●
state
and local licensure of medical professionals;
●
state
statutes and regulations related to the corporate practice of medicine;
●
laws
and regulations administered by U.S. Customs and Border Protection related to the importation of biological material into the United
States;
●
other
laws and regulations administered by the FDA;
●
other
laws and regulations administered by HHS;
●
state
and local laws and regulations governing human subject research and clinical trials;
●
the
federal physician self-referral prohibition, also known as Stark Law, and any state equivalents to Stark Law;
●
the
federal False Claims Act, or FCA;
●
the
federal Anti-Kickback Statute, or AKS, and any state equivalent statutes and regulations;
●
federal
and state coverage and reimbursement laws and regulations;
33
●
state
and local laws and regulations for the disposal and handling of medical waste and biohazardous material;
●
Occupational
Safety and Health Administration, or OSHA, regulations and requirements;
●
the
Intermediate Sanctions rules of the IRS providing for potential financial sanctions with respect to “excess benefit transactions”
with tax-exempt organizations;
●
the
Physician Payments Sunshine Act (in the event that our products are classified as drugs, biologics, devices or medical supplies and
are reimbursed by Medicare, Medicaid or the Children’s Health Insurance Program);
●
state
and other federal laws addressing the privacy of health information; and
●
state
and foreign law equivalents of each of the above federal laws, such as anti-kickback and false claims laws which may apply to items
or services reimbursed by any third-party payer, including commercial insurers, state laws that require pharmaceutical companies
to comply with the pharmaceutical industry’s voluntary compliance guidelines and the relevant compliance guidance promulgated
by the federal government or otherwise restrict payments that may be made to healthcare professionals and other potential referral
sources, state laws that require drug manufacturers to report information related to payments and other transfers of value to physicians
and other healthcare professionals or marketing expenditures, and state laws governing the privacy and security of health information
in certain circumstances, many of which differ from each other in significant ways and may not have the same effect, thus complicating
compliance efforts.
Violation
of any of the laws described above or any other governmental laws and regulations may result in penalties, including civil and criminal
penalties, damages, fines, the curtailment or restructuring of operations, the exclusion from participation in federal and state healthcare
programs and imprisonment. Furthermore, efforts to ensure that business activities and business arrangements comply with applicable healthcare
laws and regulations can be costly for manufacturers of branded prescription products.
Foreign
Government Regulation
In
general, we will need to comply with the government regulations of each individual country in which our therapy centers are located and
products are to be distributed and sold. These regulations vary in complexity and can be as stringent, and on occasion even more stringent,
than FDA regulations in the United States. Due to the fact that there are new and emerging cell therapy regulations that have recently
been drafted and/or implemented in various countries around the world, the application and subsequent implementation of these new and
emerging regulations have little to no precedence. Therefore, the level of complexity and stringency is not always precisely understood
for each country, creating greater uncertainty for the international regulatory process. Furthermore, government regulations can change
with little to no notice and may result in up-regulation of our product(s), thereby creating a greater regulatory burden for our cell
processing technology products. We have not yet thoroughly explored the applicable laws and regulations that we will need to comply with
in foreign jurisdictions. It is possible that we may not be permitted to expand our business into one or more foreign jurisdictions.
We
do not have any definitive plans or arrangements with respect to the establishment by us of stem cell therapy clinics in any country.
We intend to explore any such opportunities as they arise.
34
Offices
Our
principal executive offices are located at 40 Marcus Drive, Suite One, Melville, New York, and our telephone number is (631) 760-8100.
Our website is www.biorestorative.com. Our internet website and the information contained therein or connected thereto are not intended
to be incorporated by reference into this Annual Report.
Employees
We
currently have seven employees, all of whom are full-time employees. We believe that our employee relations are good.
ITEM
1A .
RISK
FACTORS .
Not
applicable. See, however, Item 7 of this Annual Report (“Management’s Discussion and Analysis of Financial Condition and
Results of Operations - Factors That May Affect Future Results and Financial Condition”).
ITEM
1B .
UNRESOLVED
STAFF COMMENTS .
Not
applicable.
ITEM
2.
PROPERTIES .
Our
principal executive offices and laboratory are located at 40 Marcus Drive, Suite One, Melville, New York. We occupy 6,800 square feet
of space at the premises pursuant to a lease that expires in December 2024. The lease provides for an annual base rental during the five
year period ending in December 2024 ranging between $153,748 and $173,060. Our premises are suitable and adequate for our current operations.
ITEM
3.
LEGAL
PROCEEDINGS .
None.
ITEM
4.
MINE
SAFETY DISCLOSURES.
Not
applicable.
35
PART
II
ITEM
5.
MARKET
FOR REGISTRANT’S COMMON EQUITY, RELATED STOCKHOLDER MATTERS AND ISSUER PURCHASES OF EQUITY SECURITIES .
Market
Information
Transactions
in our common stock are currently reported under the symbol “BRTX” on the Nasdaq Capital Market.
Holders
As
of March 28, 2022, there were 359 record holders of our shares of common stock.
Dividends
Not
applicable.
Recent
Sales of Unregistered Securities
During
the three months ended December 31, 2021, we issued the following securities in transactions not involving any public offering. For each
of the following transactions, we relied upon Section 4(a)(2) of the Securities Act of 1933, as amended, or the Securities Act, as transactions
by an issuer not involving any public offering, Section 3(a)(9) of the Securities Act as a security exchanged by an issuer with its existing
security holders exclusively where no commission or other renumeration was paid or given directly or indirectly for soliciting such exchange,
or Section 1145 of the Bankruptcy Code as a security exchanged by an issuer for a claim against the issuer in a bankruptcy plan of reorganization.
For each such transaction, we did not use general solicitation or advertising to market the securities, the securities were offered to
a limited number of persons, the investors had access to information regarding us (including information contained in our Annual Report
on Form 10-K for the year ended December 31, 2020, Quarterly Reports on Form 10-Q for the periods ended March 31, 2021, June 30, 2021
and September 30, 2021 and Current Reports on Form 8-K filed with the Securities and Exchange Commission and press releases made by us),
and we were available to answer questions by prospective investors. We reasonably believe that each of the investors is an accredited
investor. No proceeds were received from any of the issuances.
Warrants
Date Issued
Common Stock
Shares
Exercise
Price
Term
(Years)
Purchaser(s)
Consideration (1)
10/21/2021
22,917
-
-
-
(2)
$ 339,172 (3)
11/03/2021
6,490
-
-
-
(2)
$ 84,402 (3)
11/29/2021
2,500
-
-
-
(2)
$ 15,425 (4)
12/29/2021
2,500
-
-
-
(2)
$ 10,050 (4)
(1)
The
value of the non-cash consideration was estimated to be the fair value of our restricted common stock. Since our shares are thinly
traded in the open market, the fair value of our equity instruments was estimated by management based on observations of the cash
sale prices of both restricted shares and freely tradeable shares.
(2)
Accredited
investor.
(3)
Issued
on a cashless net exercise basis pursuant to the exercise of warrants.
(4)
Issued
in lieu of cash for consulting services rendered.
36
Issuer
Purchases of Equity Securities
The
following table sets forth certain information with respect to purchases of common stock made by affiliated purchasers during the quarter
ended December 31, 2021:
Period
Total
Number
of Shares Purchased(1)
Average
Price
Paid
per
Share
Total
Number of Shares Purchased as Part of Publicly Announced Plans or Programs
Maximum
Number of Shares that May Be Purchased Under the Plans or Programs
10/1/21
– 10/31/21
-
-
-
-
11/1/21
– 11/30/21
19,222
$ 6.60
-
-
12/1/21
– 12/31/21
799
$ 5.50
-
-
Total
20,021
$ 6.56
-
-
(1) Purchases
were made by affiliated purchasers in open market transactions.
ITEM
6 .
[RESERVED]
ITEM
7 .
MANAGEMENT’S
DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS .
The
following discussion and analysis of the consolidated results of operations and financial condition of BioRestorative Therapies, Inc.
and its subsidiary as of December 31, 2021 and 2020 and for the years ended December 31, 2021 and 2020 should be read in conjunction
with our financial statements and the notes to those financial statements that are included elsewhere in this Annual Report following
Item 16 (“Form 10-K Summary”). References in this “Management’s Discussion and Analysis of Financial Condition
and Results of Operations” to “us,” “we,” “our,” and similar terms refer to BioRestorative
Therapies, Inc.. This Annual Report contains forward-looking statements as that term is defined in the federal securities laws. The events
described in forward-looking statements contained in this Annual Report may not occur. Generally these statements relate to business
plans or strategies, projected or anticipated benefits or other consequences of our plans or strategies, projected or anticipated benefits
from acquisitions that may be made by us, or projections involving anticipated revenues, earnings or other aspects of our operating results.
The words “may,” “will,” “expect,” “believe,” “anticipate,” “project,”
“plan,” “intend,” “estimate,” and “continue,” and their opposites and similar expressions,
are intended to identify forward-looking statements. We caution you that these statements are not guarantees of future performance or
events and are subject to a number of uncertainties, risks and other influences, many of which are beyond our control, which may influence
the accuracy of the statements and the projections upon which the statements are based. Reference is made to “Factors That May
Affect Future Results and Financial Condition” in this Item 7 for a discussion of some of the uncertainties, risks and assumptions
associated with these statements.
37
Overview
We develop therapeutic products
and medical therapies using cell and tissue protocols, primarily involving adult (non-embryonic) stem cells. We are currently pursuing
our Disc/Spine Program with our initial investigational therapeutic product being called BRTX-100 . In March 2022, a United States patent issued in our Disc/ Spine Program.
We submitted an IND application to the FDA to obtain authorization to commence a Phase 2 clinical trial investigating the use of
BRTX-100 , our lead cell therapy candidate, in the treatment of chronic lower back pain arising from degenerative disc disease.
We have received such authorization from the FDA and have commenced such clinical trial through the execution of a CRO agreement with
PRC Clinical, the commencement of clinical trial site identification, the purchase of manufacturing equipment and the expansion of our
laboratory to include capabilities for clinical production. We have obtained a license to use technology for investigational adult stem
cell treatment of disc and spine conditions, including protruding and bulging lumbar discs. The technology is an advanced stem cell injection
procedure that may offer relief from lower back pain, buttock and leg pain, and numbness and tingling in the leg and foot. We are also
developing our ThermoStem Program . This pre-clinical program involves the use of brown adipose (fat) in connection with the cell-based
treatment of type 2 diabetes and obesity as well as hypertension, other metabolic disorders and cardiac deficiencies. United States patents
related to the ThermoStem Program were issued in September 2015, January 2019, March 2020, March 2021, and July 2021; Australian
patents related to the ThermoStem Program were issued in April 2017, October 2019 and August 2021; Japanese patents related to
the ThermoStem Program were issued in December 2017 and June 2021; a notice of allowance also issued in January 2022 for a
separate Japanese application in our ThermoStem Program and is expected to issue in the near future; Israeli patents related
to our ThermoStem Program were issued in October 2019 and May 2020; a notice of allowance also issued in September 2021
for a separate Israeli application in our ThermoStem Program and is expected to issue in the near future; and European patents
related to the ThermoStem Program were issued in April 2020 and January 2021.
We
have licensed a patented curved needle device that is a needle system designed to deliver cells and/or other therapeutic products or
materials to the spine and discs or other potential sites. We anticipate that FDA approval or clearance will be necessary for this device
prior to commercialization. We do not intend to utilize this device in connection with our contemplated Phase 2 clinical trial with regard
to BRTX-100 .
Our
offices are located in Melville, New York where we have established a laboratory facility in order to increase our capabilities for the
further development of possible cellular-based treatments, products and protocols, stem cell-related intellectual property and translational
research applications.
As
of December 31, 2021, our accumulated deficit was $134,146,129. We have historically only generated a modest amount of revenue,
and our losses have principally been operating expenses incurred in research and development, marketing and promotional activities in
order to commercialize our products and services, plus costs associated with meeting the requirements of being a public company. We expect
to continue to incur substantial costs for these activities over at least the next year.
On
March 20, 2020, we filed a voluntary petition commencing a case under Chapter 11 of Title 11 of the U.S. Code in the United States Bankruptcy
Court for the Eastern District of New York. On October 30, 2020, the Bankruptcy Court entered an order confirming the Plan of Reorganization
and, on November 16, 2020, the plan became effective. As a result of the confirmed Plan of Reorganization, $14,796,000 in outstanding
debt and liabilities were exchanged for (i) shares of common stock, (ii) new convertible debt or (iii) new convertible debt and warrants
to purchase common stock.
38
In
November 2021, we completed a $23,000,000 underwritten public offering of units of securities pursuant to which an aggregate of 2,300,000
shares of our common stock and warrants for the purchase of an aggregate of 2,645,000 shares of our common stock were issued. We intend
to use the net proceeds from the offering as follows: (i) undertaking of clinical trials with respect to BRTX-100 and its related
collection and delivery procedure; (ii) pre-clinical research and development with respect to our ThermoStem Program ; and (iii)
for general corporate and working capital purposes. In connection with the public offering, our common stock was listed on the Nasdaq
Capital Market.
In November 2021, concurrently
with the consummation of the public offering, we issued an aggregate of 313,789 shares of our common stock, 1,543,158 shares of
our Series A preferred stock and warrants for the purchase of an aggregate of 1,856,938 shares of our common stock in exchange for convertible
promissory notes in the aggregate principal amount of $10,046,897, together with accrued interest thereon, and warrants for the purchase
of an aggregate of 3,677,997 shares of our common stock. Such indebtedness and warrants were exchanged at a price of $10.00 per unit
of securities, consistent with the public offering price of our units of common stock and warrants. The newly issued warrants are exercisable
for a period of five years at an exercise price of $10.00 per share.
The
net proceeds received from our November 2021 public offering are sufficient for us to complete our Phase 2 clinical trial with regard
to BRTX-100; however, we anticipate that we will require approximately $35,000,000 in additional funding to complete our
contemplated Phase 3 BRTX-100 clinical trial (assuming the receipt of no revenues). We will also require a substantial amount
of additional funding to implement our other programs as discussed in this Annual Report under the caption Item 1 (“Business”),
including our metabolic ThermoStem Program , and fund general operations. No assurance can be given that the anticipated amount
of required funding is correct or that we will be able to accomplish our goals within the timeframes projected. In addition, no assurance
can be given that we will be able to obtain any required financing on commercially reasonable terms or otherwise.
Consolidated
Results of Operations
Year
Ended December 31, 2021 Compared with Year Ended December 31, 2020
The
following table presents selected items in our consolidated statements of operations for the years ended December 31, 2021 and
2020, respectively:
For
The Years Ended
December
31,
2021
2020
Revenues
$ 46,000
$ 77,000
Operating
Expenses:
Marketing
and promotion
12,290
28,281
Consulting
74,992
137,250
Research
and development
729,058
876,829
General
and administrative
25,537,533
1,786,716
Total
Operating Expenses
26,353,873
2,829,076
Loss
From Operations
(26,307,873 )
(2,752,076 )
Other
(Expense) Income:
Interest
expense
(1,815,366 )
(1,640,145 )
Loss
on extinguishment of notes payable, net
(16,180,056 )
(658,152 )
Change
in fair value of derivative liabilities
-
(2,141,069 )
Reorganization
items, net
-
(4,081,245 )
Total
Other Expense
(17,995,422 )
(8,520,611 )
Net
Loss
$ (44,303,295 )
$ (11,272,687 )
39
Revenues
For
the years ended December 31, 2021 and 2020, we generated $46,000 and $77,000, respectively, of royalty revenue in connection with our
sublicense agreement.
Marketing
and promotion
Marketing and promotion expenses
include advertising and promotion, marketing and seminars, meals, entertainment and travel expenses. For the year ended December 31,
2021, marketing and promotion expenses decreased by $15,991, or 57%, from $28,281 to $12,290 as compared to the year ended December 31,
2020. The decrease is due to our reduced marketing plan during the first half of 2021 due to our emergence from our Chapter
11 reorganization.
We
expect that marketing and promotion expenses will increase in the future as we increase our marketing activities following full commercialization
of our products and services.
Consulting
Consulting
expenses consist of consulting fees and stock-based compensation to consultants. For the year ended December 31, 2021, consulting expenses
decreased by $62,258, or 45%, from $137,250 to $74,992, as compared to the year ended December 31, 2020, due to our reduced usage of
consultants during the first half of 2021 due to our emergence from our Chapter 11 reorganization.
Research
and development
Research and development expenses
include cash and non-cash compensation of (a) our Vice President of Research and Development; (b) our Scientific Advisory Board members;
and (c) laboratory staff and costs related to our brown fat and disc/spine initiatives. Research and development expenses are expensed
as they are incurred. For the year ended December 31, 2021, research and development expenses decreased by $147,771, or 17%, from
$876,829 to $729,058, as compared to the year ended December 31, 2020. The decrease was primarily due to a decrease in stock
compensation allocated to our research and development activities of $95,765.
We
expect that our research and development expenses will increase with the continuation of the aforementioned initiatives.
40
General
and administrative
General and administrative expenses
consist primarily of salaries, bonuses, payroll taxes, severance costs and stock-based compensation to employees (excluding any cash
or non-cash compensation of our Vice President of Research and Development and our laboratory staff), as well as corporate expenses such
as legal and professional fees, investor relations and occupancy related expenses. For the year ended December 31, 2021, general and
administrative expenses increased by $23,750,817, or 1,329%, from $1,786,716 to $25,537,533, as compared to the
year ended December 31, 2020. The increase is primarily due to an increase of approximately $22,417,254 in stock-based compensation resulting
from the issuance of 838,550 stock options and 293,479 RSUs.
We
expect that our general and administrative expenses related to operations will continue to increase as we expand our staff, develop our
infrastructure and incur additional costs to support the growth of our business.
Interest
expense
For
the year ended December 31, 2021, interest expense increased $175,221, or 11%, as compared to the year ended December 31, 2020. The increase
was due to the increase in both interest expense, due to the issuance of an additional $715,303 in convertible debt, and amortization
of debt discount on outstanding notes payable.
Loss
on extinguishment of notes payable, net
For
the year ended December 31, 2021, we recorded a loss on extinguishment of notes payable, net of $16,180,056 as compared to a loss
on extinguishment of notes payable, net of $658,152 for the year ended December 31, 2020. The increase is associated with the conversion
of $10,046,897 in outstanding convertible debt principal pursuant to exchange agreements with noteholders in connection with
our public offering.
Change
in fair value of derivative liabilities
For
the year ended December 31, 2021, we did not record a gain (loss) related to the change in fair value of derivative liabilities, as compared
to a loss related to the change in fair value of derivative liabilities of $2,141,069 for the year ended December 31, 2020.
Reorganization
items, net
Reorganization
items, net consists primarily of costs associated the post-petition Chapter 11 bankruptcy. For the year ended December 31, 2021, we did
not record reorganization items, net, as compared to reorganization items, net of $4,081,245 for the year ended December 31, 2020.
41
Liquidity
and Capital Resources
Liquidity
We
measure our liquidity in a number of ways, including the following:
December
31,
2021
2020
Cash
$ 21,026,727
$ 3,064,610
Working
Capital
$ 21,104,086
$ 2,142,229
Notes
Payable (Gross)
$ 250,000
$ 9,637,102
Availability
of Additional Funds
Based
upon our accumulated deficit of $134,146,129 as of December 31, 2021, along with our forecast for continued operating losses and
our need for financing to fund our contemplated clinical trials, as of such date, we required additional equity and/or debt financing
to continue our operations.
On
November 9, 2021, we completed a public offering of units, each consisting of one share of common stock and a warrant for the purchase
of one share of common stock. Pursuant to the public offering, we issued and sold 2,300,000 units at a public offering price of $10.00
per unit (resulting in gross proceeds of $23,000,000) and, pursuant to the exercise of an option granted to the underwriters, warrants
for the purchase of 345,000 shares of common stock at a public offering price of $0.01 per warrant, less underwriting discounts and commissions.
The net proceeds of the public offering are sufficient for us to complete our Phase 2 clinical trial investigating the use of BRTX-100 .
Management believes that we have sufficient cash to fund operations for the twelve months from the issuance of the financial
statements included in this Annual Report.
Our
operating needs include the planned costs to operate our business, including amounts required to fund our clinical trials, working capital
and capital expenditures. Our future capital requirements and the adequacy of our available funds will depend on many factors, including
our ability to successfully commercialize our products and services, competing technological and market developments, and the need to
enter into collaborations with other companies or acquire other companies or technologies to enhance or complement our product and service
offerings.
We
may be unable to raise sufficient additional capital when we need it or raise capital on favorable terms. Future financing may require
us to pledge certain assets and enter into covenants that could restrict certain business activities or our ability to incur further
indebtedness and may contain other terms that are not favorable to our stockholders or us. If we are unable to obtain adequate funds
on reasonable terms, we may be required to significantly curtail or discontinue operations or obtain funds by entering into financing
agreements on unattractive terms.
42
During
the years ended December 31, 2021 and 2020, our sources and uses of cash were as follows:
Net
Cash Used in Operating Activities
We experienced negative cash
flows from operating activities for the years ended December 31, 2021 and 2020 in the amounts of $3,329,908 and $1,964,265,
respectively. The net cash used in operating activities for the year ended December 31, 2021 was primarily due to cash used to fund a
net loss of $44,303,296, adjusted for non-cash expenses in the aggregate amount of $40,648,702 and partially offset by $67,921
of cash generated by changes in the levels of operating assets and liabilities, primarily as a result of decreases in accounts payable
and accrued expenses. The net cash used in operating activities for the year ended December 31, 2020 was primarily due to cash used to
fund a net loss of $11,272,687, adjusted for non-cash expenses in the aggregate amount of $8,736,072 and partially offset by $572,350
of cash generated by changes in the levels of operating assets and liabilities, primarily as a result of increases in accrued expenses.
Net
Cash Used in Investing Activities
Net
cash used in investing activities during the year ended December 31, 2021 was $30,658, due to the purchase of manufacturing equipment.
There were no investing activities during the year ended December 31, 2020.
Net
Cash Provided by Financing Activities
Net
cash provided by financing activities during the years ended December 31, 2021 and 2020 was $21,322,683 and $5,027,211, respectively.
During the year ended December 31, 2021, $21,072,683 of net proceeds were from equity financings. During the year ended December
31, 2020, $5,517,211 of net proceeds were from debt financings.
Critical
Accounting Policies and Estimates
Impairment
of Long-lived Assets
We
review for the impairment of long-lived assets whenever events or changes in circumstances indicate that the carrying amount of an asset
may not be recoverable. An impairment loss would be recognized when estimated future cash flows expected to result from the use of the
asset and its eventual disposition are less than its carrying amount. While our near term liquidity is tight, historically we have been
successful in raising capital as needed (although there can be no assurance that we will continue to be successful in raising capital
as needed). We continue to progress our scientific agenda. We have not identified any impairment losses.
43
Stock-Based
Compensation
We
measure the cost of services received in exchange for an award of equity instruments based on the fair value of the award. For employees
and directors, the fair value of the award is measured on the grant date and for non-employees, the fair value of the award is generally
re-measured on vesting dates and interim financial reporting dates until the service period is complete. Awards granted to directors are treated on the same basis as awards granted to employees.
44
Recently
Issued Accounting Pronouncements
See
Note 3 to our consolidated financial statements for the years ended December 31, 2021 and 2020 included elsewhere in this Annual Report
following Item 16 (“Form 10-K Summary”).
Off-Balance
Sheet Arrangements
We
have no off-balance sheet arrangements that have or are reasonably likely to have a current or future effect on our financial condition,
changes in financial condition, revenues or expenses, results of operations, liquidity, capital expenditures or capital resources that
is material to investors.
Factors
That May Affect Future Results and Financial Condition
The
risk factors listed in this section provide examples of risks, uncertainties and events that may cause our actual results to differ materially
from the expectations we describe in our forward-looking statements. Readers should be aware that the occurrence of any of the events
described in these risk factors could have a material adverse effect on our business, results of operations and financial condition.
We undertake no obligation to update or revise publicly any forward-looking statements, whether as a result of new information, future
events, or otherwise.
Risks
Related to Our Business Generally
We
have a limited operating history; we have incurred substantial losses since inception; we expect to continue to incur losses for the
near term.
We
have a limited operating history. Since our inception, we have incurred net losses. As of December 31, 2021, our accumulated deficit
was $134,146,129.
We
will need to obtain a significant amount of financing to complete our clinical trials and implement our business plan.
Since
our inception, we have not generated revenues from our operations and have funded our operations through the sale of our equity securities
and debt securities. The implementation of our business plan, as discussed in this Annual Report under Item 1 (“Business”),
will require the receipt of sufficient equity and/or debt financing to purchase necessary equipment, technology and materials, fund our
clinical trials and other research and development efforts and otherwise fund our operations. We anticipate that we will require approximately
$35,000,000 in additional funding to complete our clinical trials using BRTX-100 (assuming the receipt of no revenues).
We will also require a substantial amount of additional funding to implement our other programs described in this Annual Report under
Item 1 (“Business”), including our metabolic ThermoStem Program, and fund general operations. No assurance can be
given that the anticipated amount of required funding is correct or that we will be able to accomplish our goals within the timeframes
projected. In addition, no assurance can be given that we will be able to obtain any required financing on commercially reasonable terms
or otherwise. In the event we do not obtain the financing required for the above purposes, we may have to curtail our development, marketing
and promotional activities, which would have a material adverse effect on our business, financial condition and results of operations,
and ultimately we could be forced to discontinue our operations and liquidate.
45
Our
business strategy is high risk.
We
are focusing our resources and efforts primarily on the development of cellular-based products and services which will require extensive
cash for research, development and commercialization activities. This is a high-risk strategy because there is no assurance that our
products and services, including our Disc/Spine Program and our ThermoStem metabolic brown fat research initiative, will
ever become commercially viable (commercial risk), that we will prevent other companies from depriving us of market share and profit
margins by offering services and products based on our inventions and developments (legal risk), that we will successfully manage a company
in a new area of business, regenerative medicine, and on a different scale than we have operated in the past (operational risk), that
we will be able to achieve the desired therapeutic results using stem and regenerative cells (scientific risk), or that our cash resources
will be adequate to develop our products and services until we become profitable, if ever (financial risk). We are using our cash in
one of the riskiest industries in the economy (strategic risk). This may make our securities an unsuitable investment for many investors.
We
will need to enter into agreements in order to implement our business strategy.
Except
for a certain license agreement with Regenerative Sciences, LLC and a master services agreement with PRC Clinical with regard to CRO
services discussed in this Annual Report under Item 1 (“Business”), we do not have any material agreements or understandings
in place with respect to the implementation of our business strategy. No assurances can be given that we will be able to enter into any
necessary agreements with respect to the development of our business. Our inability to enter into any such agreements would have a material
adverse effect on our results of operations and financial condition.
We
depend on our executive officers and on our ability to attract and retain additional qualified personnel.
Our
performance is substantially dependent on the performance of Lance Alstodt, our Chief Executive Officer. We rely upon him for strategic
business decisions and guidance. We are also dependent on the performance of Francisco Silva, our Vice President of Research and Development.
Each of Messrs. Alstodt and Silva is subject to an employment agreement with us. We do not have any key-man insurance policies on the
lives of either of our executive officers. We believe that our future success in developing marketable products and services and achieving
a competitive position will depend in large part upon whether we can attract and retain additional qualified management and scientific
personnel. Competition for such personnel is intense, and there can be no assurance that we will be able to attract and retain such personnel.
The loss of the services of Mr. Alstodt and/or Mr. Silva or the inability to attract and retain additional personnel and develop expertise
as needed would have a substantial negative effect on our results of operations and financial condition.
46
The
impact of COVID-19 and related risks could materially affect our results of operations and prospects .
Beginning
in March 2020, the global pandemic related to the novel coronavirus COVID-19 began to impact the global economy. Because of the size
and breadth of this pandemic, all of the direct and indirect consequences of COVID-19 are not yet known and may not emerge for some time.
Risks presented by the ongoing effects of COVID-19 include, among others, the following:
Clinical
Trials. We anticipate that the COVID-19 pandemic may negatively impact our contemplated clinical trials. Due to the worldwide efforts
being taken to combat COVID-19 and the increased clinical work being done in this respect, we believe that it may be difficult for certain
needed laboratory supplies, equipment and other materials to be obtained in order to conduct our clinical trials. We also anticipate
that, due to a fear of COVID-19 transmission, there may be a hesitancy on the part of certain individuals to become clinical trial participants.
We hope that these possible negative effects will lessen as more of the population becomes vaccinated; however, the impact that the vaccinations
will have is uncertain at this time.
Adverse
Legislative and/or Regulatory Action. Federal, state and local government actions to address and contain the impact of COVID-19 may
adversely affect us. For example, we may be subject to legislative and/or regulatory action that negatively impacts the manner in which
the clinical trials may be conducted.
Operational
Disruptions and Heightened Cybersecurity Risks. Our operations could be disrupted if key members of our senior management or a significant
percentage of our workforce are unable to continue to work because of illness, government directives or otherwise. In addition, in connection
with increased remote working arrangements, we face a heightened risk of cybersecurity attacks or data security incidents and are more
dependent on internet and telecommunications access and capabilities.
Risks
Related to Our Cell Therapy Product Development Efforts
Our
future success is significantly dependent on the timely and successful development and commercialization of BRTX-100, our lead product
candidate for the treatment of chronic lumbar disc disease; if we encounter delays or difficulties in the development of this product
candidate, as well as any other product candidates, our business prospects would be significantly harmed.
We
are dependent upon the successful development, approval and commercialization of our product candidates. Before we are able to seek regulatory
approval of our product candidates, we must conduct and complete extensive clinical trials to demonstrate their safety and efficacy in
humans. Our lead product candidate, BRTX-100 , is in early stages of development and we have not yet commenced a Phase 2 clinical
trial using BRTX-100 to treat chronic lower back pain due to degenerative disc disease related to protruding/bulging discs.
47
Clinical
testing is expensive, difficult to design and implement, and can take many years to complete. Importantly, a failure of one or more of
these or any other clinical trials can occur at any stage of testing. We may experience numerous unforeseen events during, or as a result
of, clinical trials that could delay or prevent our ability to complete our clinical studies, receive regulatory approval or commercialize
our cell therapy product candidates, including the following:
●
suspensions,
delays or changes in the design, initiation, enrollment, implementation or completion of required clinical trials; adverse changes
in our financial position or significant and unexpected increases in the cost of our clinical development program; changes or uncertainties
in, or additions to, the regulatory approval process that require us to alter our current development strategy; clinical trial results
that are negative, inconclusive or less than desired as to safety and/or efficacy, which could result in the need for additional
clinical studies or the termination of the product’s development; delays in our ability to manufacture the product in quantities
or in a form that is suitable for any required clinical trials;
●
intellectual
property constraints that prevent us from making, using, or commercializing any of our cell therapy product candidates;
●
the
supply or quality of our product candidates or other materials necessary to conduct clinical trials of these product candidates may
be insufficient or inadequate; the inability to generate sufficient pre-clinical, toxicology, or other in vivo or in vitro data,
to support the initiation of clinical studies;
●
delays
in reaching agreement on acceptable terms with our CRO and prospective clinical study sites, the terms of which can be subject to
extensive negotiation and may vary significantly among different clinical study sites;
●
delays
in obtaining required Institutional Review Board, or IRB, approval at each clinical study site;
●
imposition
of a temporary or permanent clinical hold by regulatory agencies for a number of reasons, including after review of an IND application
or amendment, or equivalent application or amendment; as a result of a new safety finding that presents unreasonable risk to clinical
trial participants; a negative finding from an inspection of our clinical study operations or study sites; developments on trials
conducted by competitors or approved products post-market for related technology that raise FDA concerns about risk to patients of
the technology broadly; or if the FDA finds that the investigational protocol or plan is clearly deficient to meet its stated objectives;
●
difficulty
collaborating with patient groups and investigators;
●
failure
by our CRO, other third parties, or us to adhere to clinical study requirements;
●
failure
to perform in accordance with the FDA’s current Good Clinical Practices, or GCP, requirements, or applicable regulatory guidelines
in other countries;
●
delays
in having patients qualify for or complete participation in a study or return for post-treatment follow-up;
●
patients
dropping out of a study;
●
occurrence
of adverse events associated with the product candidate that are viewed to outweigh its potential benefits;
●
changes
in the standard of care on which a clinical development plan was based, which may require new or additional trials;
●
transfer
of manufacturing processes from any academic collaborators to larger-scale facilities operated by either a contract manufacturing
organization, or CMO, or by us, and delays or failure by our CMOs or us to make any necessary changes to such manufacturing process;
●
delays
in our clinical trials caused by the COVID-19 pandemic;
●
delays
in manufacturing, testing, releasing, validating, or importing/exporting sufficient stable quantities of our product candidates for
use in clinical studies or the inability to do any of the foregoing;
●
the
FDA may not accept clinical data from trials that are conducted at clinical sites in countries where the standard of care is potentially
different from the United States; and
●
failure
to raise sufficient funds to complete our clinical trials.
48
Any
inability to successfully complete pre-clinical and clinical development could result in additional costs to us or impair our ability
to generate revenue. In addition, if we make manufacturing or formulation changes to our product candidates, we may be required, or we
may elect, to conduct additional studies to bridge our modified product candidates to earlier versions. Clinical study delays could also
shorten any periods during which our products have patent protection and may allow our competitors to bring products to market before
we do, which could impair our ability to successfully commercialize our product candidates and may harm our business and results of operations.
Even
if we are able to successfully complete our clinical development program for our product candidates, and ultimately receive regulatory
approval to market one or more of the products, we may, among other things:
●
obtain
approval for indications that are not as broad as the indications we sought;
●
have
the product removed from the market after obtaining marketing approval;
●
encounter
issues with respect to the manufacturing of commercial supplies;
●
be
subject to additional post-marketing testing requirements; and/or
●
be
subject to restrictions on how the product is distributed or used.
We
anticipate that we will not be able to commercialize our BRTX-100 product candidate for at least five years.
We
may experience delays and other difficulties in enrolling a sufficient number of patients in our clinical trials which could delay or
prevent the receipt of necessary regulatory approvals.
We
may not be able to initiate or complete as planned any clinical trials if we are unable to identify and enroll a sufficient number of
eligible patients to participate in the clinical trials required by the FDA or other regulatory authorities. We also may be unable to
engage a sufficient number of clinical trial sites to conduct our trials.
We
may face challenges in enrolling patients to participate in our clinical trials due to the novelty of our cell-based therapies, the size
of the patient populations and the eligibility criteria for enrollment in the trial, and potential subjects’ concern over the
COVID-19 pandemic. In addition, some patients may have concerns regarding cell therapy that may negatively affect their perception
of therapies under development and their decision to enroll in the trials. Furthermore, patients suffering from diseases within target
indications may enroll in competing clinical trials, which could negatively affect our ability to complete enrollment of our trials.
Enrollment challenges in clinical trials often result in increased development costs for a product candidate, significant delays and
potentially the abandonment of the clinical trial.
49
We
may have other delays in completing our clinical trials and we may not complete them at all.
We
have not commenced the clinical trials necessary to obtain FDA approval to market our product candidate, BRTX-100 , or any of our
other product candidates in development. Since we lack significant experience in completing clinical trials and bringing a drug through
commercialization, we have hired outside consultants with such experience. Clinical trials for BRTX-100 and other product candidates
in development may be delayed or terminated as a result of many factors, including the following:
●
patients
failing to complete clinical trials due to dissatisfaction with the treatment, side effects, concerns over COVID-19, or other
reasons;
●
failure
by regulators to authorize us to commence a clinical trial;
●
suspension
or termination by regulators of clinical research for many reasons, including concerns about patient safety, the failure of study
sites and/or investigators in our clinical research program to comply with GCP requirements, or our failure, or the failure of our
contract manufacturers, to comply with current cGMP requirements;
●
delays
or failure to obtain clinical supply for our products necessary to conduct clinical trials from contract manufacturers;
●
treatment
candidates demonstrating a lack of efficacy during clinical trials;
●
treatment
candidates demonstrating significant safety signals; and/or
●
inability
to continue to fund clinical trials or to find a partner to fund the clinical trials.
Any
delay or failure to complete clinical trials and obtain FDA approval for our product candidates could have a material adverse effect
on our cost to develop and commercialize, and our ability to generate revenue from, a particular product candidate.
The
development of our cell therapy product candidates is subject to uncertainty because autologous cell therapy is inherently variable.
When
manufacturing an autologous cell therapy, the number and composition of the cell population varies from patient to patient. Such variability
in the number and composition of these cells could adversely affect our ability to manufacture autologous cell therapies in a cost-effective
or profitable manner and meet acceptable product release specifications for use in a clinical trial or, if approved, for commercial sale.
As a consequence, the development and regulatory approval process for autologous cell therapy products could be delayed or may never
be completed.
Any
disruption to our access to the media (including cell culture media) and reagents we are using in the clinical development of our cell
therapy product candidates could adversely affect our ability to perform clinical trials and seek future regulatory submissions.
Certain
media (including cell culture media) and reagents, as well as devices, materials and systems, that we intend to use in our planned clinical
trials, and that we may need or use in commercial production, are provided by unaffiliated third parties. Any lack of continued availability
of these media, reagents, devices, materials and systems for any reason would have a material adverse effect on our ability to complete
these studies and could adversely impact our ability to achieve commercial manufacture of our planned therapeutic products. Although
other available sources for these media, reagents, devices, materials and systems may exist in the marketplace, we have not evaluated
their cost, effectiveness, or intellectual property foundation and therefore cannot guarantee the suitability or availability of such
other potential sources.
50
Products
that appear promising in research and development may be delayed or may fail to reach later stages of clinical development.
The
successful development of cellular based products is highly uncertain. Product candidates that appear promising in preclinical and early
research and development may be delayed or fail to reach later stages of development. Decisions regarding the further development of
product candidates must be made with limited and incomplete data, which makes it difficult to ensure or even accurately predict whether
the allocation of limited resources and the expenditure of additional capital on specific product candidates will result in desired outcomes.
Pre-clinical and clinical data can be interpreted in different ways, and negative or inconclusive results or adverse events during a
clinical trial could delay, limit or prevent the development of a product candidate. Positive preclinical data may not continue or occur
for future subjects in our clinical studies and may not be repeated or observed in ongoing or future studies involving our product candidates.
Furthermore, our product candidates may also fail to show the desired safety and efficacy in later stages of clinical development despite
having successfully advanced through initial clinical studies. In addition, regulatory delays or rejections may be encountered as a result
of many factors, including changes in regulatory policy during the period of product development.
Our
clinical trials may fail to demonstrate adequately the safety and efficacy of our product candidates, which would prevent or delay regulatory
approval and commercialization.
The
clinical trials of our product candidates are, and the manufacturing and marketing of our products will be, subject to extensive and
rigorous review and regulation by numerous government authorities in the United States and in other countries where we intend to test
and market our product candidates. Before obtaining regulatory approvals for the commercial sale of any of our product candidates, we
must demonstrate through lengthy, complex and expensive preclinical testing and clinical trials that our product candidates are both
safe and effective for use in each target indication. In particular, because some of our product candidates are subject to regulation
as biological drug products, we will need to demonstrate that those products are safe, pure, and potent for use in their target
indications. Each product candidate must demonstrate an adequate risk versus benefit profile in its intended patient population and for
its intended use. The risk/benefit profile required for product licensure will vary depending on these factors and may include decrease
or elimination of pain, adequate duration of response, a delay in the progression of the disease, an improvement in function and/or decrease
in disability.
In
addition, even if such trials are successfully completed, we cannot guarantee that the FDA will interpret the results as we do, and more
trials could be required before we submit our product candidates for approval. To the extent that the results of the trials are not satisfactory
to the FDA for support of a marketing application, we may be required to expend significant resources, which may not be available to
us, to conduct additional trials in support of potential approval of our product candidates.
51
Even
if we complete the necessary clinical trials, we cannot predict when, or if, we will obtain regulatory approval to commercialize a product
candidate, and the approval may be for a narrower indication than we seek.
We
cannot commercialize a product candidate until the appropriate regulatory authorities have reviewed and approved the product candidate.
Even if our product candidates meet their safety and efficacy endpoints in clinical trials, the regulatory authorities may not complete
their review processes in a timely manner, or we may not be able to obtain regulatory approval. Additional delays may result if an FDA
Advisory Committee or other regulatory authority recommends non-approval or restrictions or conditions on approval. In addition, we may
experience delays or rejections based upon additional government regulation from future legislation or administrative action, or changes
in regulatory authority policy during the period of product development, clinical trials and the review process. Regulatory authorities
also may approve a product candidate for more limited indications than requested or they may impose significant limitations in the form
of narrow indications, contraindications or a Risk Evaluation and Mitigation Strategy, or REMS. These regulatory authorities may require
warnings or precautions with respect to conditions of use or they may grant approval subject to the performance of costly post-marketing
clinical trials. In addition, regulatory authorities may not approve the labeling claims or allow the promotional claims that are necessary
or desirable for the successful commercialization of our product candidates. Any of the foregoing scenarios could materially harm the
commercial prospects for our product candidates and materially and adversely affect our business, financial condition, results of operations
and prospects.
We
may never obtain FDA approval for any of our product candidates in the United States and, even if we do, we may never obtain approval
for or commercialize any of our product candidates in any foreign jurisdiction, which would limit our ability to realize our full market
potential.
In
order to eventually market any of our product candidates in any particular foreign jurisdiction, we must establish and comply with numerous
and varying regulatory requirements regarding safety and efficacy on a jurisdiction-by-jurisdiction basis. Approval by the FDA in the
United States, if obtained, does not ensure approval by regulatory authorities in other countries or jurisdictions. In addition, preclinical
studies and clinical trials conducted in one country may not be accepted by regulatory authorities in other countries, and regulatory
approval in one country does not guarantee regulatory approval in any other country.
Approval
processes vary among countries and can involve additional product testing and validation and additional administrative review periods.
Seeking foreign regulatory approval could result in difficulties and costs for us and require additional preclinical studies or clinical
trials which could be costly and time consuming. Regulatory requirements can vary widely from country to country and could delay or prevent
the introduction of our product candidates in those countries. The foreign regulatory approval process involves similar risks to those
associated with FDA approval. We do not have any product candidates approved for sale in any jurisdiction, including international markets,
nor have we attempted to obtain such approval. If we fail to comply with regulatory requirements in international markets or to obtain
and maintain required approvals, or if regulatory approvals in international markets are delayed, our target market will be reduced and
our ability to realize the full market potential of our products may be unrealized.
52
We
presently lack manufacturing capabilities to produce our product candidates at commercial scale quantities and do not have an alternate
manufacturing supply, which could negatively impact our ability to meet any future demand for the products.
Currently,
we expect our laboratory (or a contract laboratory) to provide the cell processing services necessary for clinical production of BRTX-100
for our disc clinical trial. To date, we have not produced any products at our laboratory. We expect that we would need to significantly
expand our manufacturing capabilities to meet potential commercial demand for BRTX-100 and any other of our product candidates,
if approved, as well as any of our other product candidates that might attain regulatory approval. Such expansion would require additional
regulatory approvals. Even if we increase our manufacturing capabilities, it is possible that we may still lack sufficient capacity to
meet demand. Ultimately, if we are unable to supply our products to meet commercial demand, whether because of processing constraints
or other disruptions, delays or difficulties that we experience, sales of the products and their long-term commercial prospects could
be significantly damaged.
We
do not presently have a third-party manufacturer for BRTX-100 or any of our other product candidates. If our facilities at which
these product candidates would be manufactured or our equipment were significantly damaged or destroyed, or if there were other disruptions,
delays or difficulties affecting manufacturing capacity, our planned and future clinical studies and commercial production for these
product candidates would likely be significantly disrupted and delayed. It would be both time consuming and expensive to replace this
capacity with third parties, particularly since any new facility would need to comply with the regulatory requirements.
Ultimately,
if we are unable to supply our cell therapy product candidates to meet commercial demand (assuming commercial approval is obtained),
whether because of processing constraints or other disruptions, delays or difficulties that we experience, our production costs could
dramatically increase and sales of the product and its long-term commercial prospects could be significantly damaged.
The
commercial potential and profitability of our products are unknown and subject to significant risk and uncertainty.
Even
if we successfully develop and obtain regulatory approval for our cell therapy product candidates, the market may not understand or accept
the products, which could adversely affect both the timing and level of future sales. Ultimately, the degree of market acceptance of
our product candidates (or any of our future product candidates) will depend on a number of factors, including:
●
the
clinical effectiveness, safety and convenience of the product particularly in relation to alternative treatments;
●
our
ability to distinguish our products (which involve adult cells) from any ethical and political controversies associated with stem
cell products derived from human embryonic or fetal tissue; and
●
the
cost of the product, the reimbursement policies of government and third-party payors and our ability to obtain sufficient third-party
coverage or reimbursement.
53
Even
if we are successful in achieving sales of our product candidates, it is not clear to what extent, if any, the products will be profitable.
The costs of goods associated with production of cell therapy products are significant. In addition, some changes in manufacturing processes
or procedures generally require FDA or foreign regulatory authority review and approval prior to implementation. We may need to conduct
additional pre-clinical studies and clinical trials to support approval of any such changes. Furthermore, this review process could be
costly and time-consuming and could delay or prevent the commercialization of product candidates.
We
may have difficulties in sourcing brown adipose (fat) tissue.
We
use brown adipose (fat) tissue to identify and characterize brown adipose derived stem cells for use in our pre-clinical ThermoStem
Program. There is no certainty that we will be able to continue to collect brown adipose samples through any relationships that we
have, have had or may establish with potential sources of brown adipose tissue. The inability to procure brown fat tissue would have
a material adverse effect upon our ability to advance our ThermoStem Program.
We do not have exclusive
license rights with regard to the disc/spine technology. The lack of such exclusive rights could have a material adverse
effect upon us.
Pursuant to our
license agreement with Regenerative Sciences, LLC, we were required to complete our Phase 2 clinical trial by a certain date in
order to maintain our exclusive rights with regard to the disc/spine technology. Such time has passed and accordingly our license
rights are currently non-exclusive. We are in negotiations with the licensor with regard to a possible reinstatement of the exclusive
nature of our rights. No assurances can be given in this regard. The lack of such exclusive rights will not affect our ability
to conduct our Phase 2 clinical trial with regard to BRTX-100 but could have a material adverse effect upon our business,
results of operations and financial condition. See “Item 1 (“Business-Disc/Spine Program – License”).
If
safety problems are encountered by us or others developing new stem cell-based therapies, our stem cell initiatives could be materially
and adversely affected.
The
use of stem cells for therapeutic indications is still in the very early stages of development. If an adverse event occurs during clinical
trials related to one of our proposed products and/or services or those of others, the FDA and other regulatory authorities may halt
clinical trials or require additional studies. The occurrence of any of these events would delay, and increase the cost of, our development
efforts and may render the commercialization of our proposed products and/or services impractical or impossible.
We
are vulnerable to competition and technological change, and also to physicians’ inertia.
We
will compete with many domestic and foreign companies in developing our technology and products, including biotechnology, medical device
and pharmaceutical companies. Many current and potential competitors have substantially greater financial, technological, research and
development, marketing, and personnel resources. There is no assurance that our competitors will not succeed in developing alternative
products and/or services that are more effective, easier to use, or more economical than those which we may develop, or that would render
our products and/or services obsolete and non-competitive. In general, we may not be able to prevent others from developing and marketing
competitive products and/or services similar to ours or which perform similar functions or which are marketed before ours.
54
Competitors
may have greater experience in developing products, therapies or devices, conducting clinical trials, obtaining regulatory clearances
or approvals, manufacturing and commercialization. It is possible that competitors may obtain patent protection, approval or clearance
from the FDA or achieve commercialization earlier than we can, any of which could have a substantial negative effect on our business.
We
will compete against cell-based therapies derived from alternate sources, such as bone marrow, adipose tissue, umbilical cord blood and
potentially embryos. Doctors historically are slow to adopt new technologies like ours, whatever the merits, when older technologies
continue to be supported by established providers. Overcoming such inertia often requires very significant marketing expenditures or
definitive product performance and/or pricing superiority.
We
expect that physicians’ inertia and skepticism will also be a significant barrier as we attempt to gain market penetration with
our future products and services. We may need to finance lengthy time-consuming clinical studies (so as to provide convincing evidence
of the medical benefit) in order to overcome this inertia and skepticism.
We
may form or seek collaborations or strategic alliances or enter into additional licensing arrangements in the future, and we may not
realize the benefits of such alliances or licensing arrangements.
We
may form or seek strategic alliances, create joint ventures or collaborations, or enter into additional licensing arrangements with third
parties that we believe will complement or augment our development and commercialization efforts with respect to our product candidates
and any future product candidates that we may develop. Any of these relationships may require us to incur non-recurring and other charges,
increase our near and long-term expenditures, issue securities that dilute the shares of our existing stockholders, or disrupt our management
and business. In addition, we face significant competition in seeking appropriate strategic partners and the negotiation process is time-consuming
and complex. Moreover, we may not be successful in our efforts to establish a strategic partnership or other alternative arrangements
for our product candidates because they may be deemed to be at too early of a stage of development for collaborative effort and third
parties may not view our product candidates as having the requisite potential to demonstrate safety and efficacy. To date, such efforts
have not been successful.
55
Further,
collaborations involving our product candidates, such as our collaborations with third-party research institutions, are subject to numerous
risks, which may include the following:
●
collaborators
have significant discretion in determining the efforts and resources that they will apply to a collaboration;
●
collaborators
may not pursue development and commercialization of our product candidates or may elect not to continue or renew development or commercialization
programs based on clinical trial results, changes in their strategic focus due to the acquisition of competitive products, availability
of funding, or other external factors, such as a business combination that diverts resources or creates competing priorities;
●
collaborators
may delay clinical trials, provide insufficient funding for a clinical trial, stop a clinical trial, abandon a product candidate,
repeat or conduct new clinical trials, or require a new formulation of a product candidate for clinical testing;
●
collaborators
could independently develop, or develop with third parties, products that compete directly or indirectly with our products or product
candidates;
●
a
collaborator with marketing and distribution rights to one or more products may not commit sufficient resources to their marketing
and distribution;
●
collaborators
may not properly maintain or defend our intellectual property rights or may use our intellectual property or proprietary information
in a way that gives rise to actual or threatened litigation that could jeopardize or invalidate our intellectual property or proprietary
information or expose us to potential liability;
●
disputes
may arise between us and a collaborator that cause the delay or termination of the research, development or commercialization of
our product candidates, or that result in costly litigation or arbitration that diverts management attention and resources;
●
collaborations
may be terminated and, if terminated, may result in a need for additional capital to pursue further development or commercialization
of the applicable product candidates; and
●
collaborators
may own or co-own intellectual property covering our products that results from our collaborating with them, and in such cases, we
would not have the exclusive right to commercialize such intellectual property.
As
a result, if we enter into collaboration agreements and strategic partnerships or license our products or businesses, we may not be able
to realize the benefit of such transactions if we are unable to successfully integrate them with our existing operations and company
culture, which could delay our timelines or otherwise adversely affect our business. We also cannot be certain that, following a strategic
transaction or license, we will achieve the revenue or specific net income that justifies such transaction. Any delays in entering into
new collaborations or strategic partnership agreements related to our product candidates could delay the development and commercialization
of our product candidates in certain geographies for certain indications, which would harm our business prospects, financial condition,
and results of operations.
We
have limited experience in the development and marketing of cell therapies and may be unsuccessful in our efforts to establish a profitable
business.
Our
business plan has been focused historically on capturing a piece of the burgeoning field of cell therapy. We have limited experience
in the areas of cell therapy product development and marketing, and in the related regulatory issues and processes. Although we have
recruited a team that has experience with designing and conducting clinical trials and have hired FDA consultants, as a company, we have
limited experience in conducting clinical trials and no experience in conducting clinical trials through to regulatory approval of any
product candidate. In part because of this lack of experience, we cannot be certain that planned clinical trials will begin or be completed
on time, if at all. We cannot assure that we will successfully achieve our clinical development goals or fulfill our plans to capture
a piece of the cell therapy market.
56
Our
cell therapy business is based on novel technologies that are inherently expensive, risky and may not be understood by or accepted in
the marketplace, which could adversely affect our future value.
The
clinical development, commercialization and marketing of cell and tissue-based therapies are at an early-stage, substantially research-oriented,
and financially speculative. To date, very few companies have been successful in their efforts to develop and commercialize a cell therapy
product. In general, cell-based or tissue-based products may be susceptible to various risks, including undesirable and unintended side
effects, unintended immune system responses, inadequate therapeutic efficacy, or other characteristics that may prevent or limit their
approval or commercial use. In addition, BRTX-100 is a cell-based candidate that is produced by using a patient’s own stem
cells derived from bone marrow. Regulatory approval of novel product candidates such as BRTX-100 , which is manufactured using
novel manufacturing processes, can be more complex and expensive and take longer than other, more well-known or extensively studied pharmaceutical
or biopharmaceutical products, due to the FDA’s lack of experience with them. To our knowledge, the FDA has not yet approved a
disc related stem cell therapy product. This lack of experience may lengthen the regulatory review process, require us to conduct additional
studies or clinical trials, which would increase our development costs, lead to changes in regulatory positions and interpretations,
delay or prevent approval and commercialization of these product candidates or lead to significant post-approval limitations or restrictions.
Furthermore, the number of people who may use cell or tissue-based therapies is difficult to forecast with accuracy. Our future success
is dependent on the establishment of a large global market for cell- and tissue-based therapies and our ability to capture a share of
this market with our product candidates.
Our
cell therapy product candidates for which we intend to seek approval as biologic products may face competition sooner than anticipated.
The
enactment of the Biologics Price Competition and Innovation Act of 2009, or BPCIA, created an abbreviated regulatory pathway for the
approval of products demonstrated to be biosimilar, or “highly similar,” to or “interchangeable” with an FDA-approved
innovator (original) biologic product. The abbreviated regulatory pathway establishes legal authority for the FDA to review and approve
biosimilar biologics, including the possible designation of a biosimilar as “interchangeable” based on its similarity to
an existing reference product. Under the BPCIA, an application for a biosimilar product cannot be approved by the FDA until 12 years
after the original branded product is approved under a biologics license application, or BLA. The FDA has developed considerable experience
with the biosimilar and interchangeable biosimilar processes since the enactment of the BPCIA in 2009. Should any of our product candidates
be approved via the BLA pathway, we expect that biosimilar applicants will seek approval of biosimilar, and/or interchangeable, versions
of our product that could result in lower prices for our products.
57
We
believe that, if any of our product candidates are approved as a biological product under a BLA, it should qualify for the 12-year period
of exclusivity. However, there is a risk that the FDA could approve biosimilar applicants for other reference products that no longer
have such exclusivity, thus potentially creating the opportunity for greater competition sooner than anticipated.
The
FDA’s regulation of regenerative medicine products remains unpredictable and we are not certain what impact this will have on the
potential approval of our products.
The
FDA’s regulation of therapies derived from stem cell products and technologies is evolving and may continue to evolve. In December
2016, the 21st Century Cures Act, or the Cures Act, was signed into law in the United States to advance access to medical innovations.
Among other things, the Cures Act established a new FDA regenerative medicine advanced therapy, or RMAT, designation. This designation
offers a variety of benefits to product candidates, including enhanced FDA support during clinical development, priority review on application
filing, accelerated approval based on potential surrogate endpoints, and the potential use of patient registry data and other forms of
real world evidence for post-approval confirmatory studies. There is no certainty that any of our product candidates will receive RMAT
designation or any other type of expedited review program designation from the FDA. In any event, the receipt of an FDA RMAT designation
or other expedited review program designation may not result in a faster development process, review or approval compared to products
considered for approval under conventional FDA procedures and does not assure ultimate approval by the FDA.
We
may be subject to significant product liability claims and litigation, including potential exposure from the use of our product candidates
in human subjects, and our insurance may be inadequate to cover claims that may arise.
Our
business exposes us to potential product liability risks inherent in the testing, processing and marketing of cell therapy products.
Such liability claims may be expensive to defend and result in large judgments against us. We face an inherent risk of product liability
exposure related to the testing of our current and any future product candidates in human clinical trials and will face an even greater
risk with respect to any commercial sales of our products should they be approved. No product candidate has been widely used over an
extended period of time, and therefore safety data is limited. Cell therapy companies derive the raw materials for manufacturing of product
candidates from human cell sources, and therefore the manufacturing process and handling requirements are extensive, which increases
the risk of quality failures and subsequent product liability claims.
We
will need to maintain insurance coverage adequate to cover our clinical trials and increase that coverage before commercializing product
candidates, if ever. At any time during our clinical trials or after commercialization, if that occurs, we may not be able to obtain
or maintain product liability insurance on acceptable terms with adequate coverage or at all, or if claims against us substantially exceed
our coverage, then our financial position could be significantly impaired.
Whether
or not we are ultimately successful in any product liability litigation that may arise, such litigation could consume substantial amounts
of our financial and managerial resources, result in decreased demand for our products and injure our reputation.
58
We
seek to maintain errors and omissions, directors and officers, workers’ compensation and other insurance at levels we believe to
be appropriate to our business activities. If, however, we were subject to a claim in excess of this coverage or to a claim not covered
by our insurance and the claim succeeded, we would be required to pay the claim from our own limited resources, which could have a material
adverse effect on our financial condition, results of operations and business. Additionally, liability or alleged liability could harm
our business by diverting the attention and resources of our management and damaging our reputation.
Our
internal computer systems, or those that are expected to be used by our clinical investigators, clinical research organizations or other
contractors or consultants, may fail or suffer security breaches, which could result in a material disruption of development programs
for our product candidates.
We
rely on information technology systems to keep financial records, maintain laboratory and corporate records, communicate with staff and
external parties and operate other critical functions. Any significant degradation or failure of these computer systems could cause us
to inaccurately calculate or lose data. Despite the implementation of security measures, these internal computer systems and those used
by our clinical investigators, clinical research organizations, and other contractors and consultants are vulnerable to damage from computer
viruses, unauthorized access, natural disasters, terrorism, war, and telecommunication and electrical failures. The techniques that could
be used by criminal elements or foreign governments to attack these computer systems are sophisticated, change frequently and may originate
from less regulated and remote areas of the world. While we have not experienced any such system failure, theft of information, accident
or security breach to date, if such an event were to occur and cause interruptions in our operations, it could result in a material disruption
of our clinical development activities. For example, the loss of clinical trial data from historical or future clinical trials could
result in delays in regulatory approval efforts and significantly increase costs to recover or reproduce the data. To the extent that
any disruption, theft of information, or security breach were to result in a loss of or damage to data or applications, or inappropriate
disclosure of confidential or proprietary information, we could incur liability and the clinical development and the future development
of our product candidates could be delayed.
To
operate and sell in international markets carries great risk.
We
intend to market our products and services both domestically and in foreign markets. A number of risks are inherent in international
transactions. In order for us to market our products and services in non-U.S. jurisdictions, we need to obtain and maintain required
regulatory approvals or clearances in these countries and must comply with the country specific regulations regarding safety, manufacturing
processes and quality. These regulations, including the requirements for approvals or clearances to market, may differ from the FDA regulatory
scheme. International operations and sales also may be limited or disrupted by political instability, price controls, trade restrictions
and changes in tariffs. Additionally, fluctuations in currency exchange rates may adversely affect demand for our services and products
by increasing the price of our products and services in the currency of the countries in which the products and services are offered.
There
can be no assurance that we will obtain regulatory approvals or clearances in all of the countries where we intend to market our products
and services, that we will not incur significant costs in obtaining or maintaining foreign regulatory approvals or clearances, or that
we will be able to successfully commercialize our products and services in various foreign markets. Delays in receipt of approvals or
clearances to market our products and services in foreign countries, failure to receive such approvals or clearances or the future loss
of previously received approvals or clearances could have a substantial negative effect on our results of operations and financial condition.
59
Our
inability to obtain reimbursement for our products and services from private and governmental insurers could negatively impact demand
for our products and services.
Market
acceptance and sales of our product candidates may depend on coverage and reimbursement policies and health care reform measures. Decisions
about formulary coverage as well as levels at which government authorities and third-party payors, such as private health insurers and
health maintenance organizations, reimburse patients for the price they pay for our product candidates, as well as levels at which these
payors pay directly for our product candidates, where applicable, could affect whether we are able to successfully commercialize these
products. We cannot guarantee that reimbursement will be available for any of our product candidates. We also cannot guarantee that coverage
or reimbursement amounts will not reduce the demand for, or the price of, our product candidates.
If
coverage and reimbursement are not available or are available only at limited levels, we may not be able to successfully commercialize
our products. The Patient Protection and Affordable Care Act, or PPACA, and other health reform proposals include measures that would
limit or prohibit payments for certain medical treatments or subject the pricing of drugs to government control. In addition, in many
foreign countries, particularly the countries of the European Union, or the EU, the pricing of drugs and biologics is subject to government
control. If our products are or become subject to government regulation that limits or prohibits payment for our products, or that subjects
the price of our products to government control, we may not be able to generate revenue, attain profitability or commercialize our products.
In
addition, third-party payors are increasingly limiting both coverage and the level of reimbursement of new drugs and biologics. They
may also impose strict prior authorization requirements and/or refuse to provide any coverage of uses of approved products for medical
indications other than those for which the FDA has granted market approvals. As a result, significant uncertainty exists as to whether
and how much third-party payors will reimburse patients for their use of newly-approved drugs and biologics. If we are unable to obtain
adequate levels of reimbursement for our product candidates, our ability to successfully market and sell our product candidates will
be harmed.
Risks
Related to Our Intellectual Property
We
may not be able to protect our proprietary rights.
Our
commercial success will depend in large part upon our ability to protect our proprietary rights. There is no assurance, for example,
that any additional patents will be issued based on our or our licensor’s pending applications or, if issued, that such patents
will not become the subject of a re-examination, will provide us with competitive advantages, will not be challenged by any third parties,
or that the patents of others will not prevent the commercialization of products and services incorporating our technology. Furthermore,
there can be no guarantee that others will not independently develop similar products and services, duplicate any of our products and
services, or design around any patents we obtain.
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Our
commercial success will also depend upon our ability to avoid infringing patents issued to others. If we were judicially determined to
be infringing on any third-party patent, we could be required to pay damages, alter our products, services or processes, obtain licenses,
or cease certain activities. If we are required in the future to obtain any licenses from third parties for some of our products and/or
services, there can be no guarantee that we would be able to do so on commercially favorable terms, if at all. United States and foreign
patent applications are not immediately made public, so we might be surprised by the grant to someone else of a patent on a technology
we are actively using. Although we conducted a freedom to operate, or FTO, search years ago on the licensed technology associated with
our Disc/Spine Program , modifications made, and/or further developments that may be made, to that technology may not be covered
by the initial FTO. No FTO has been undertaken with respect to our ThermoStem brown fat initiative.
Litigation,
which would result in substantial costs to us and the diversion of effort on our part, may be necessary to enforce or confirm the ownership
of any patents issued or licensed to us, or to determine the scope and validity of third-party proprietary rights. If our competitors
claim technology also claimed by us and prepare and file patent applications in the United States, we may have to participate in interference
proceedings declared by the U.S. Patent and Trademark Office, or the Patent Office, or a foreign patent office to determine priority
of invention, which could result in substantial costs and diversion of effort, even if the eventual outcome is favorable to us. Any such
litigation or interference proceeding, regardless of outcome, could be expensive and time-consuming.
Successful
challenges to our patents through oppositions, re-examination proceedings or interference proceedings could result in a loss of patent
rights in the relevant jurisdiction. If we are unsuccessful in actions we bring against the patents of other parties, and it is determined
that we infringe upon the patents of third parties, we may be subject to litigation, or otherwise prevented from commercializing potential
products and/or services in the relevant jurisdiction, or may be required to obtain licenses to those patents or develop or obtain alternative
technologies, any of which could harm our business. Furthermore, if such challenges to our patent rights are not resolved in our favor,
we could be delayed or prevented from entering into new collaborations or from commercializing certain products and/or services, which
could adversely affect our business and results of operations.
Furthermore,
because of the substantial amount of discovery required in connection with intellectual property litigation, there is a risk that some
of our confidential or sensitive information could be compromised by disclosure in the event of litigation. In addition, during the course
of litigation there could be public announcements of the results of hearings, motions or other interim proceedings or developments. If
securities analysts or investors perceive these results to be negative, it could have a substantial adverse effect on the price of our
common stock.
In
addition to patents, we rely on unpatented trade secrets and proprietary technological expertise. Some of our intended future cell-related
therapeutic products and/or services may fit into this category. We also rely, in part, on confidentiality agreements with our partners,
employees, advisors, vendors, and consultants to protect our trade secrets and proprietary technological expertise. There can be no guarantee
that these agreements will not be breached, or that we will have adequate remedies for any breach, or that our unpatented trade secrets
and proprietary technological expertise will not otherwise become known or be independently discovered by competitors.
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Failure
to obtain or maintain patent protection, failure to protect trade secrets, third-party claims against our patents, trade secrets, or
proprietary rights or our involvement in disputes over our patents, trade secrets, or proprietary rights, including involvement in litigation,
could divert our efforts and attention from other aspects of our business and have a substantial negative effect on our results of operations
and financial condition.
We
may not be able to protect our intellectual property in countries outside of the United States.
Intellectual
property law outside the United States is uncertain and, in many countries, is currently undergoing review and revisions. The laws of
some countries do not protect our patent and other intellectual property rights to the same extent as United States laws. Third parties
may attempt to oppose the issuance of patents to us in foreign countries by initiating opposition proceedings. Opposition proceedings
against any of our patent filings in a foreign country could have an adverse effect on our corresponding patents that are issued or pending
in the United States. It may be necessary or useful for us to participate in proceedings to determine the validity of our patents or
our competitors’ patents that have been issued in countries other than the United States. This could result in substantial costs,
divert our efforts and attention from other aspects of our business, and could have a material adverse effect on our results of operations
and financial condition.
Changes
to United States patent law may have a material adverse effect on our intellectual property rights.
The
Leahy-Smith America Invents Act, or AIA, which was signed into law in 2011, significantly changes United States patent law. It may take
some time to establish what the law means, since it is just being interpreted by the lower courts, Federal Circuit Courts of Appeal,
and the Supreme Court. The effects of these decisions are still not known. The first major change is that AIA switches the United States
patent system from a “first to invent” system to a “first to file” system. Now that the first to file system
is in effect, there is a risk that another company may independently develop identical or similar patents at approximately the same time,
and be awarded the patents instead of us. Further, for the second major change, AIA abolished interference proceedings, and establishes
derivation proceedings to replace interference proceedings in all cases in which the time period for instituting an interference proceeding
has not lapsed where an inventor named in an earlier application derived the claimed invention from a named inventor. Now that the derivation
proceedings are in effect, there is a risk that the inventorship of any pending patent application can be challenged for reasons of derivation.
The third major change is that AIA established post-grant opposition proceedings that will apply only to patent applications filed after
“first to file” became effective. Post-grant opposition will enable a person who is not the patent owner to initiate proceedings
in the Patent Office within nine months after the grant of a patent that can result in cancellation of a patent as invalid. In addition
to AIA, recent court decisions have created uncertainty with regard to our ability to obtain and maintain patents. Therefore there is
a risk that any of our patents once granted may be subject to post-grant opposition, which will increase uncertainty on the validity
of any newly granted patent or may ultimately result in cancellation of the patent.
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In
addition, the Supreme Court has recently taken more limiting positions as to what constitutes patentable subject matter. As a result,
many patents covering what were previously patentable inventions are now determined to cover inventions which are deemed non-statutory
subject matter and are now invalid. As a result of this and subsequent opinions by the Court of Appeals for the Federal Circuit, the
Patent Office is now applying more stringent limitations to claims in patent applications and is refusing to grant patents in areas of
technology where patents were previously deemed available. Therefore there is a risk that we will be unable to acquire patents to cover
our products and if such patents are granted they may subsequently be found to be invalid.
In
certain countries, patent holders may be required to grant compulsory licenses, which would likely have a significant and detrimental
effect on any future revenues in such country.
Many
countries, including some countries in Europe, have compulsory licensing laws under which a patent owner may be compelled to grant licenses
to third parties. In addition, most countries limit the enforceability of patents against government agencies or government contractors.
In these countries, the patent owner may be limited to monetary relief and may be unable to enjoin infringement, which could materially
diminish the value of the patent. Compulsory licensing of life-saving products is also becoming increasingly common in developing countries,
either through direct legislation or international initiatives. Such compulsory licenses could be extended to our product candidates,
which may limit our potential revenue opportunities, including with respect to any future revenues that may result from our product candidates.
Risks
Related to Government Regulation
Even
if we obtain regulatory approval for a product candidate, our products will remain subject to regulatory oversight.
Our
product candidates for which we obtain regulatory approval will be subject to ongoing regulatory requirements for manufacturing, labeling,
packaging, storage, advertising, promotion, record-keeping and submission of safety and other post-market information. Any regulatory
approvals that we receive for our product candidates also may be subject to a REMS or the specific obligations imposed as a condition
for marketing authorization by equivalent authorities in a foreign jurisdiction, limitations on the approved indicated uses for which
the product may be marketed or to the conditions of approval, or contain requirements for potentially costly post-marketing testing,
including Phase 4 clinical trials, and surveillance to monitor the quality, safety and efficacy of the product. For example, in the United
States, the holder of an approved new drug application, or NDA, or BLA is obligated to monitor and report adverse events and any failure
of a product to meet the specifications in the NDA or BLA. The holder of an approved NDA or BLA also must submit new or supplemental
applications and obtain FDA approval for certain changes to the approved product, product labeling or manufacturing process. Advertising
and promotional materials must comply with the Federal Food, Drug and Cosmetic Act, or FDCA, and implementing regulations and are subject
to FDA oversight and post-marketing reporting obligations, in addition to other potentially applicable federal and state laws.
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In
addition, product manufacturers and their facilities may be subject to payment of application and program fees and are subject to continual
review and periodic inspections by the FDA and other regulatory authorities for compliance with cGMP requirements and adherence to commitments
made in the NDA, BLA or foreign marketing application. If we or a regulatory authority discover previously unknown problems with a product,
such as adverse events of unanticipated severity or frequency, or problems with the facility where the product is manufactured, or if
a regulatory authority disagrees with the promotion, marketing or labeling of our product, a regulatory authority may impose restrictions
relative to that product, the manufacturing facility or us, including requiring recall or withdrawal of the product from the market or
suspension of manufacturing.
If
we fail to comply with applicable regulatory requirements for any product candidate following approval, a regulatory authority may:
●
issue
a warning or untitled letter asserting that we are in violation of the law;
●
seek
an injunction or impose administrative, civil or criminal penalties or monetary fines;
●
suspend
or withdraw regulatory approval;
●
suspend
any ongoing clinical trials;
●
refuse
to approve a pending BLA or comparable foreign marketing application (or any supplements thereto) submitted by us or our strategic
partners;
●
restrict
the marketing or manufacturing of the product;
●
seize
or detain the product or otherwise demand or require the withdrawal or recall of the product from the market;
●
refuse
to permit the import or export of products;
●
request
and publicize a voluntary recall of the product; or
●
refuse
to allow us to enter into supply contracts, including government contracts.
Any
government enforcement action or investigation of alleged violations of law could require us to expend significant time and resources
in response and could generate negative publicity. The occurrence of any event or penalty described above may inhibit our ability to
commercialize our product candidates and adversely affect our business, financial condition, results of operations and prospects.
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We
may be subject, directly or indirectly, to federal and state healthcare fraud and abuse laws, false claims laws and health information
privacy and security laws. If we are unable to comply, or have not fully complied, with such laws, we could face substantial penalties.
In
the United States, the research, manufacturing, distribution, sale, and promotion of drugs and biologic products are subject to regulation
by various federal, state, and local authorities, including the FDA, the Centers for Medicare and Medicaid Services, or CMS, other divisions
the Department of Health and Human Services, or HHS (e.g., the Office of Inspector General), the United States Department of Justice
offices of the United States Attorney, the Federal Trade Commission and state and local governments. Our operations are directly, or
indirectly through our prescribers, customers and purchasers, subject to various federal and state fraud and abuse laws and regulations,
including the federal Anti-Kickback Statute, or AKS, the federal civil and criminal False Claims Act, or FCA, the Physician Payments
Sunshine Act and regulations and equivalent provisions in other countries. In addition, we may be subject to patient privacy laws by
both the federal government and the states in which we conduct our business.
State
and federal regulatory and enforcement agencies continue actively to investigate violations of health care laws and regulations, and
the United States Congress continues to strengthen the arsenal of enforcement tools. Most recently, the Bipartisan Budget Act of 2018
increased the criminal and civil penalties that can be imposed for violating certain federal health care laws, including the AKS. Enforcement
agencies also continue to pursue novel theories of liability under these laws. Government agencies have recently increased regulatory
scrutiny and enforcement activity with respect to programs supported or sponsored by pharmaceutical companies, including reimbursement
and co-pay support, funding of independent charitable foundations and other programs that offer benefits for patients. Several investigations
into these programs have resulted in significant civil and criminal settlements.
Because
of the breadth of these laws and the narrowness of the statutory exceptions and safe harbors available, it is possible that some of our
business activities could be subject to challenge under one or more of such laws. If our operations are found to be in violation of any
of the laws described above or any other government regulations that apply to us, we may be subject to penalties, including civil and
criminal penalties, damages, fines, exclusion from participation in government health care programs, such as Medicare and Medicaid, imprisonment
and the curtailment or restructuring of our operations, any of which could adversely affect our ability to operate our business and our
results of operations. Even if we are not determined to have violated these laws, government investigations into these issues typically
require the expenditure of significant resources and generate negative publicity, which could harm our financial condition and divert
the attention of our management from operating our business.
Further,
in the event we determine to operate in foreign jurisdictions, including conducting clinical trials, we will need to comply with the
United States Foreign Corrupt Practices Act of 1977, or the FCPA. The FCPA prohibits a corporation, including its subsidiaries, third-party
contractors, distributors, consultants and employees, from corruptly making or offering to make payments to foreign officials for the
purpose of obtaining or enhancing business. Under the law, “foreign officials” include employees of health systems operated
by government entities. The FCPA also establishes specific record-keeping and internal accounting controls. Violations of the FCPA can
result in the imposition of civil penalties or criminal prosecution. Failure to comply with the FCPA will adversely affect our business.
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In
addition to the FCPA, we will also need to comply with the foreign government laws and regulations of each individual country in which
any therapy centers that we may establish are located and products are to be distributed and sold. These regulations vary in complexity
and can be as stringent, and on occasion even more stringent, than FDA regulations in the United States. Due to the fact that there are
new and emerging stem cell and cell therapy regulations that have recently been drafted and/or implemented in various countries around
the world, the application and subsequent implementation of these new and emerging regulations have little to no precedence. Therefore,
the level of complexity and stringency is not always precisely understood today for each country, creating greater uncertainty for the
international regulatory process. Furthermore, there can be no guarantee that laws and regulations will not be implemented, amended and/or
reinterpreted in a way that will negatively affect our business. Likewise, there can be no assurance that we will be able, or will have
the resources, to maintain compliance with all such healthcare laws and regulations. Failure to comply with such healthcare laws and
regulations, as well as the costs associated with such compliance or with enforcement of such healthcare laws and regulations, may have
a material adverse effect on our operations or may require restructuring of our operations or impair our ability to operate profitably.
Our
current and future employees, consultants and advisors and our future principal investigators, medical institutions and commercial partners
may engage in misconduct or other improper activities, including non-compliance with regulatory standards and requirements.
We
are exposed to the risk of fraud or other misconduct by our current and future employees, consultants and advisors and our future principal
investigators, medical institutions and commercial partners, including contract laboratories, and CROs. Misconduct by these parties could
include intentional failures to comply with FDA regulations or the regulations applicable in other jurisdictions, provide accurate information
to the FDA and other regulatory authorities, comply with healthcare fraud and abuse laws and regulations in the United States and abroad,
report financial information or data accurately or disclose unauthorized activities to us.
We
currently do not and in the future may not independently conduct all aspects of our product candidate research and preclinical and clinical
testing and product candidate manufacturing. If we rely on third parties, including CROs, medical institutions, and contract laboratories
to monitor and manage data for our ongoing preclinical and clinical programs, we will still maintain responsibility for ensuring their
activities are conducted in accordance with the applicable study protocol, legal, regulatory and scientific standards. We and our third-party
vendors will be required to comply with current cGMP, GCP, and Good Laboratory Practice, or GLP, requirements, which are a collection
of laws and regulations enforced by the FDA, the EU and comparable foreign authorities for all of our product candidates in clinical
development.
In
addition, sales, marketing and business arrangements in the healthcare industry are subject to extensive laws and regulations intended
to prevent fraud, misconduct, kickbacks, self-dealing and other abusive practices. These laws and regulations restrict or prohibit a
wide range of pricing, discounting, marketing and promotion, sales commission, customer incentive programs and other business arrangements.
Such misconduct also could involve the improper use of information obtained in the course of clinical trials or interactions with the
FDA or other regulatory authorities, which could result in regulatory sanctions and cause serious harm to our reputation.
The
precautions we take to detect and prevent employee and third-party misconduct may not be effective in controlling unknown or unmanaged
risks or losses or in protecting us from government investigations or other actions or lawsuits stemming from a failure to comply with
these laws or regulations. If any such actions are instituted against us, and we are not successful in defending ourselves or asserting
our rights, those actions could have a significant impact on our business, financial condition, results of operations and prospects,
including the imposition of significant fines or other sanctions.
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The
failure to receive regulatory approvals for our cell therapy product candidates would likely have a material and adverse effect on our
business and prospects.
To
date, we have not received regulatory approval to market any of our product candidates in any jurisdiction. If we seek approval of any
of our cell therapy product candidates, we will be required to submit to the FDA and potentially other regulatory authorities extensive
pre-clinical and clinical data supporting its safety and efficacy, as well as information about the manufacturing process and to undergo
inspection of our manufacturing facility or other contract manufacturing facilities, if utilized, among other things. The process of
obtaining FDA and other regulatory approvals is expensive, generally takes many years and is subject to numerous risks and uncertainties,
particularly with complex and/or novel product candidates such as our cell-based product candidates. Changes in regulatory approval requirements
or policies may cause delays in the approval or rejection of an application or may make it easier for our competitors to gain regulatory
approval to enter the marketplace. Ultimately, the FDA and other regulatory agencies have substantial discretion in the approval process
and may refuse to accept any application or may decide that our product candidate data are insufficient for approval without the submission
of additional preclinical, clinical or other studies. In addition, varying agency interpretations of the data obtained from preclinical
and clinical testing could delay, limit or prevent regulatory approval of a product candidate. Any difficulties or failures that we encounter
in securing regulatory approval for our product candidates would likely have a substantial adverse impact on our ability to generate
product sales, and could make any search for a collaborative partner more difficult. Similarly, any regulatory approval we ultimately
obtain may be limited or subject to restrictions or post-approval commitments that render the approved product not commercially viable.
If
we are unable to conduct clinical studies in accordance with regulations and accepted standards, we may be delayed in receiving, or may
never receive, regulatory approvals of our product candidates from the FDA and other regulatory authorities.
To
obtain marketing approvals for our product candidates in the United States and abroad, we must, among other requirements, complete adequate
and well-controlled clinical trials sufficient to demonstrate to the FDA and other regulatory bodies that the product candidate is safe
and effective for each indication for which approval is sought. If the FDA finds that patients enrolled in the trial are or would be
exposed to an unreasonable and significant risk of illness or injury, due to, among other things, occurrence of a serious adverse event
in an ongoing clinical trial, the FDA can place one or more of our clinical trials on hold. If safety concerns develop, we may, or the
FDA or an institutional review board may require us to, stop the affected trials before completion.
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The
completion of our clinical trials also may be delayed or terminated for a number of other reasons, including if:
●
third-party
clinical investigators do not perform the clinical trials on the anticipated schedule or consistent with the clinical trial protocol,
good clinical practices required by the FDA and other regulatory requirements, or other third parties do not perform data collection
and analysis in a timely or accurate manner;
●
inspections
of clinical trial sites by the FDA or other regulatory authorities reveal violations that require us to undertake corrective action,
suspend or terminate one or more sites, or prohibit use of some or all of the data in support of marketing applications; or
●
the
FDA or one or more institutional review boards suspends or terminates the trial at an investigational site, or precludes enrollment
of additional subjects.
Our
development costs will increase if there are material delays in our clinical trials, or if we are required to modify, suspend, terminate
or repeat a clinical trial. If we are unable to conduct our clinical trials properly, we may never receive regulatory approval to market
our product candidates.
Health
care companies have been the subjects of federal and state investigations, and we could become subject to investigations in the future.
Both
federal and state government agencies have heightened civil and criminal enforcement efforts. There are numerous ongoing investigations
of health care companies, as well as their executives and managers. In addition, amendments to the federal FCA, including under healthcare
reform legislation, have made it easier for private parties to bring “ qui tam ” (or whistleblower) lawsuits against
companies under which the whistleblower may be entitled to receive a percentage of any money paid to the government. The FCA provides,
in part, that an action can be brought against any person or entity that has knowingly presented, or caused to be presented, a false
or fraudulent request for payment from the federal government, or who has made a false statement or used a false record to get a claim
approved. The government has taken the position that claims presented in violation of the federal AKS, Stark Law or other healthcare-related
laws, including laws enforced by the FDA, may be considered a violation of the FCA. Penalties include substantial fines for each false
claim, plus three times the amount of damages that the federal government sustained because of the act of that person or entity and/or
exclusion from the Medicare program. In addition, a majority of states have adopted similar state whistleblower and false claims provisions.
We
are not aware of any government investigations involving any of our facilities or management. While we believe that we are in compliance
with applicable governmental healthcare laws and regulations, any future investigations of our business or executives could cause us
to incur substantial costs, and result in significant liabilities or penalties, as well as damage to our reputation.
It
is uncertain to what extent the government, private health insurers and third-party payors will approve coverage or provide reimbursement
for the therapies and products to which our services relate. Availability for such reimbursement may be further limited by reductions
in Medicare, Medicaid and other federal healthcare program funding in the United States.
To
the extent that health care providers cannot obtain coverage or reimbursement for our products and therapies, they may elect not to provide
such products and therapies to their patients and, thus, may not need our services. Further, as cost containment pressures are increasing
in the health care industry, government and private payors may adopt strategies designed to limit the amount of reimbursement paid to
health care providers.
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Similarly,
the trend toward managed health care and bundled pricing for health care services in the United States, could significantly influence
the purchase of healthcare products and services, resulting in lower prices and reduced demand for our therapeutic products under development.
We
may directly or indirectly receive revenues from federal health care programs, such as Medicare. Federal health care programs are subject
to changes in coverage and reimbursement rules and procedures, including retroactive rate adjustments. These contingencies could materially
decrease the range of services covered by such programs or the reimbursement rates paid directly or indirectly for our products and services.
To the extent that any health care reform favors the reimbursement of other therapies over our therapeutic products under development,
such reform could affect our ability to sell our services, which may have a material adverse effect on our revenues.
The
limitation on reimbursement available from private and government payors may reduce the demand for, or the price of, our products and
services, which could have a material adverse effect on our revenues. Additional legislation or regulation relating to the health care
industry or third-party coverage and reimbursement may be enacted in the future which could adversely affect the revenues generated from
the sale of our products and services.
Furthermore,
there has been a trend in recent years towards reductions in overall funding for Medicare, Medicaid and other federal health care programs.
There has also been an increase in the number of people who are not eligible for or enrolled in Medicare, Medicaid or other governmental
programs. The reduced funding of governmental programs could have a negative impact on the demand for our services to the extent it relates
to products and services which are reimbursed by government and private payors.
Unintended
consequences of healthcare reform in the United States may adversely affect our business.
The
healthcare industry is undergoing fundamental changes resulting from political, economic and regulatory influences. In the United States,
the PPACA was signed into law in 2010 under the Obama administration. By implementing comprehensive reforms, the law seeks to, among
other things, increase access to healthcare for the uninsured and control the escalation of healthcare expenditures within the economy.
While we do not believe this law will have a direct impact on our business, the law requires the adoption of various implementing regulations,
which may have unintended consequences or indirectly impact our business.
In addition, other
legislative changes have been adopted since the PPACA was enacted. These changes include aggregate reductions in Medicare payments to
providers of 2% per fiscal year, which went into effect on April 1, 2013 and, following passage of the Bipartisan Budget Act of 2018,
will remain in effect through 2027 unless additional Congressional action is taken. The 2% reduction was paused pursuant to The Coronavirus
Aid, Relief, and Economic Security (CARES) Act and subsequent legislation, but will resume on a graduated basis beginning in April 2022.
In January 2013, President Obama signed into law the American Taxpayer Relief Act of 2012, which, among other things, further reduced
Medicare payments to several types of providers and increased the statute of limitations period for the government to recover overpayments
to providers from three to five years. Congress has since considered additional reductions in Medicare reimbursement for drugs
and devices as part of legislation to reduce the budget deficit. Similar legislation could be enacted in the future. The Medicare regulations
and interpretive determinations that determine how drugs, devices and services are covered and reimbursed also are subject to change.
These laws, regulations, and interpretive determinations may result in additional reductions in Medicare and other health care
funding, which could impact our business.
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Healthcare reform
measures that may be adopted in the future, may result in more rigorous coverage criteria and decreased reimbursement. In recent years,
Congress passed certain legislation to alter aspects of the PPACA. In addition, Congress and select states have continued
to propose legislation to alter and/or repeal the PPACA and/or transform certain aspects of existing federal and state health programs.
The implementation of cost containment measures or other healthcare reforms may prevent us from being able to generate revenue, attain
profitability or commercialize our product candidates. It is difficult to predict how enforcement initiatives under the PPACA and/or
additional legislation or regulation enacted in the future may impact our business. If the PPACA and/or additional legislation or regulation
enacted in the future cause such unintended consequences or indirect impact, they could have a material adverse effect on our business,
financial condition and results of operations.
Competitor
companies or hospitals in the EU may be able to take advantage of EU rules permitting sales of unlicensed medicines for individual patients
to sell competing products without a marketing authorization.
The
EU medicines rules allow individual member states to permit the supply of a medicinal product without a marketing authorization to fulfill
special needs, where the product is supplied in response to a bona fide unsolicited order, formulated in accordance with the specifications
of a healthcare professional and for use by an individual patient under his direct personal responsibility. This may, in certain countries,
also apply to products manufactured in a country outside the EU and imported to treat specific patients or small groups of patients.
In addition, advanced therapy medicinal products do not need a marketing authorization if they are prepared on a non-routine basis and
are used within the same EU member state in a hospital in accordance with a medical prescription for an individual patient.
These
exemptions could allow our competitors to make sales in the EU without having obtained a marketing authorization and without undergoing
the expense of clinical trials, especially if those competitors have cell processing facilities in the relevant EU member state. Similarly,
certain hospitals may be able to compete with us on the basis of these rules.
Risks
Related to Our Common Stock
We
pay no dividends.
We
have never paid cash dividends in the past, and currently do not intend to pay any cash dividends in the foreseeable future. We intend
to retain earnings, if any, to finance the development and expansion of our business. Our future dividend policy will be subject to the
discretion of our Board of Directors and will be contingent upon future earnings, if any, our financial condition, capital requirements,
general business conditions, and other factors. Therefore, we can give no assurance that any dividends of any kind will ever be paid
to holders of our common stock.
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There
is no assurance that an active trading market for our common stock will be sustained.
Our
common stock is listed on Nasdaq. However, no assurance can be given that an active market for our common stock will be sustained. In
addition, although there have been market makers in our common stock, we cannot assure that these market makers will continue to make
a market in our securities or that other factors outside of our control will not cause them to stop market making in our securities.
Making a market in securities involves maintaining bid and ask quotations and being able to effect transactions in reasonable quantities
at those quoted prices, subject to various securities laws and other regulatory requirements. Furthermore, the development and maintenance
of a public trading market depends upon the existence of willing buyers and sellers, the presence of which is not within our control
or that of any market maker. Market makers are not required to maintain a continuous two-sided market, are required to honor firm quotations
for only a limited number of securities, and are free to withdraw firm quotations at any time. Even with a market maker, factors such
as our past losses from operations and the small size of our company mean that there can be no assurance of an active and liquid market
for our securities developing in the foreseeable future. Even if there is a market for our securities, we cannot assure that securityholders
will be able to resell their securities at any price.
Stockholders
who hold unregistered shares of our common stock are subject to resale restrictions pursuant to Rule 144 due to our former status as
a “shell company.”
We
previously were a “shell company” pursuant to Rule 144, promulgated under the Securities Act, or Rule 144, and, as such,
sales of our securities pursuant to Rule 144 cannot be made unless, among other things, we continue to remain subject to Section 13 or
15(d) of the Exchange Act, and we file all of our required periodic reports with the SEC under the Exchange Act. Because our unregistered
securities cannot be sold pursuant to Rule 144 unless we continue to meet such requirements, any unregistered securities we sell in the
future or issue to consultants or employees, in consideration for services rendered or for any other purpose, will have no liquidity
unless we continue to comply with such requirements. As a result, it may be more difficult for us to obtain financing to fund our operations
and pay our consultants and employees with our securities instead of cash.
We
have incurred, and will continue to incur, increased costs as a result of being an SEC reporting company.
The
Sarbanes-Oxley Act of 2002 (the “Sarbanes-Oxley Act”), as well as a variety of related rules implemented by the SEC,
have required changes in corporate governance practices and generally increased the disclosure requirements of public companies. As a
reporting company, we incur significant legal, accounting and other expenses in connection with our public disclosure and other obligations.
Based upon SEC regulations currently in effect, we are required to establish, evaluate and report on our internal control over financial
reporting. We believe that compliance with the myriad of rules and regulations applicable to reporting companies and related compliance
issues will continue to require a significant amount of time and attention from our management.
Material
weaknesses in our internal control over financial reporting may cause us to fail to timely and accurately report our financial results
or result in a material misstatement of our consolidated financial statements.
We
identified control deficiencies in the design and operation of our internal control over financial reporting that constituted a
material weakness, as further described in Item 9A of this Annual Report (“Controls and Procedures”). A material weakness is a deficiency, or a combination of deficiencies, in internal control over financial reporting such
that there is a reasonable possibility that a material misstatement of our consolidated financial statements will not be prevented
or detected on a timely basis. Our material weakness related to the following control deficiencies:
● Lack
of adherence to formal policies and procedures post-bankruptcy;
● Lack
of risk assessment procedures on internal controls to detect financial reporting risks on
a timely manner; and
● Lack
of sufficient formal procedures and controls to achieve complete and accurate financial reporting
and disclosures, including controls over the preparation and review of journal entries and
account reconciliations. Additionally, we did not design and maintain controls to ensure
appropriate segregation of duties.
The
deficiencies described above, if not remedied, could result in a misstatement of one or more account balances or disclosures in our annual
or interim consolidated financial statements that would not be prevented or detected, and, accordingly, we determined that these control
deficiencies constitute a material weakness.
To
address our material weakness, we have added accounting and finance personnel and implemented new financial accounting processes. We
intend to continue to take steps to remediate the material weakness described above through implementing enhancements and controls within
our accounting systems, hiring additional qualified accounting and finance resources and further evolving our accounting and quarterly
and annual close processes. We will not be able to remediate these control deficiencies until these steps have been completed and have
been operating effectively for a sufficient period of time. The redesign and implementation of improvements to our accounting and proprietary
systems and controls may be costly and time consuming and the cost to remediate may impair our results of operations in the future.
If
we fail to remediate our material weakness, identify future material weaknesses in our internal control over financial reporting or fail
to meet the demands that have been placed upon us as a public company, including the requirements of the Sarbanes-Oxley Act, we may be
unable to accurately report our financial results or report them within the timeframes required by law or stock exchange regulations.
Failure to comply with Section 404 of the Sarbanes-Oxley Act could also potentially subject us to sanctions or investigations by the
SEC or other regulatory authorities. If additional material weaknesses exist or are discovered in the future, and we are unable to remediate
any such material weakness, our reputation, results of operations and financial condition could suffer.
71
Our
stock price may fluctuate significantly and be highly volatile and this may make it difficult for a securityholder to resell our securities
at the volume, prices and times the securityholder finds attractive.
The
market price of our common stock may be subject to significant fluctuations and be highly volatile, which may make it difficult for a
securityholder to resell our securities at the volume, prices and times the securityholder finds attractive. There are many factors that
will impact our stock price and trading volume, including, but not limited to, the factors listed above under “Risks Related to
Our Business Generally,” “Risks Related to Our Cell Therapy Product Development Efforts,” “Risks Related to Our
Intellectual Property,” “Risks Related to Government Regulation,” “Risks Related to Our Common Stock” and
“Risks Associated with Our Nasdaq Listing.”
Stock
markets, in general, experience significant price and volume volatility, and the market price of our securities may continue to be subject
to such market fluctuations that may be unrelated to our operating performance and prospects. Increased market volatility and fluctuations
could result in a substantial decline in the market price of our securities.
There
may be significant future issuances or resales of our common stock which may materially and adversely dilute stockholders’ ownership
interest and affect the market price of our securities.
We
currently have authorization to issue up to 75,000,000 shares of common stock of which, as of March 28, 2022, 3,626,603
shares were issued and outstanding. We are not restricted from issuing additional shares of our common stock in the future, including
securities convertible into, or exchangeable or exercisable for, shares of our common stock. In addition, there are 1,543,158 shares
of Series A preferred stock issued and outstanding. Such shares are convertible under certain circumstances into an equal number of shares
of common stock.
Pursuant
to our Chapter 11 Plan of Reorganization, an aggregate of 262,432 shares of common stock were issued to holders of unsecured claims.
Such shares are freely tradeable in the public market, except for shares held by affiliates.
Pursuant
to our November 2021 public offering of securities, we issued warrants for the purchase of an aggregate of 2,645,000 shares of common
stock as well as underwriter warrants for the purchase of 235,970 shares of common stock. We have an effective registration statement
on Form S-1 under the Securities Act registering the issuance of such shares. The shares issuable pursuant to the registration statement
on Form S-1 will be freely tradable in the public market, except for shares held by affiliates. In addition, in connection with the public
offering and pursuant to exchange agreements entered into with holders of convertible notes and warrants, we issued an aggregate of 313,789
shares of common stock and warrants for the purchase of an aggregate of 1,856,938 shares of common stock. The shares of common stock
issued to such holders are eligible for resale in the open market (subject to Rule 144 volume limitations applicable to affiliates),
potentially causing sales in the market to increase and our stock price to decline. We have agreed to register the resale of the shares
of common stock issuable upon exercise of such warrants. The issuance of shares of common stock upon exercise of the above warrants would
dilute the ownership of our stockholders.
We
also have an effective registration statement on Form S-8 under the Securities Act registering 1,175,000 shares of our common stock issuable
under our 2021 Stock Incentive Plan, or the 2021 Plan. As of March 28, 2022, options to purchase 838,550 shares of our
common stock were outstanding under the 2021 Plan. In addition, as of such date, 220,528 RSUs were outstanding under the 2021
Plan. The shares issuable pursuant to the registration statement on Form S-8 will be freely tradable in the public market, except for
shares held by affiliates. We intend to include a resale prospectus in our registration statement on Form S-8 with regard to the 2021
Plan covering the resale of the shares issuable to Messrs. Alstodt and Silva (and other affiliates) upon their exercise of options held
by them and the vesting of the above described RSUs. The resale of such shares will be currently subject to the volume limitations imposed
by Rule 144.
72
The
sale of a substantial number of shares of our common stock or securities convertible into, or exchangeable or exercisable for, shares
of our common stock, whether directly by us in future offerings or by our existing stockholders in the secondary market, the perception
that such issuances or resales could occur or the availability for future issuances or resale of shares of our common stock or securities
convertible into, or exchangeable or exercisable for, shares of our common stock could materially and adversely affect the market price
of our securities and our ability to raise capital through future offerings of equity or equity-related securities on attractive terms
or at all.
In
addition, our Board of Directors is authorized to designate and issue 18,456,842 shares of preferred stock without further stockholder
approval, containing such rights and preferences as our Board of Directors shall determine. We may also issue other equity and equity-related
securities that are senior to our common stock in the future for a number of reasons, including, without limitation, to support operations
and growth, and to comply with any future changes in regulatory standards.
Anti-takeover
provisions and the regulations to which we may be subject may make it more difficult for a third party to acquire control of us, even
if the change in control would be beneficial to our securityholders.
We
are currently incorporated in Delaware. Anti-takeover provisions in Delaware law and our certificate of incorporation and bylaws could
make it more difficult for a third party to acquire control of us and may prevent stockholders from receiving a premium for their securities.
Our certificate of incorporation provides that our Board of Directors may issue up to 20,000,000 shares of preferred stock, in one or
more series, without stockholder approval and with such terms, preferences, rights and privileges as the Board of Directors may deem
appropriate. Of such 20,000,000 authorized shares, 1,543,158 shares of Series A preferred stock are issued and outstanding. These provisions
and other factors may hinder or prevent a change in control, even if the change in control would be perceived as beneficial to, or sought
by, our other stockholders.
Our
common stock is classified as a “penny stock;” the restrictions of the penny stock regulations of the Securities and Exchange
Commission, or SEC, may result in less liquidity for our common stock.
The
SEC has adopted regulations which define a “penny stock” to be any equity security that has a market price (as therein defined)
of less than $5.00 per share or an exercise price of less than $5.00 per share, subject to certain exceptions. Unless exempt, the rules
require the delivery, prior to any transaction involving a penny stock by a retail customer, of a disclosure schedule prepared by the
SEC relating to the penny stock market. Disclosure is also required to be made about commissions payable to both the broker/dealer and
the registered representative and current quotations for the securities. Finally, monthly statements are required to be sent disclosing
recent price information for the penny stock held in the account and information on the limited market in penny stocks. The market price
for shares of our common stock is currently below $5.00 and we do not satisfy any of the exceptions to the SEC’s definition of
penny stock. Accordingly, our common stock is currently classified as a penny stock. As a result of the penny stock restrictions, brokers
or potential investors may be reluctant to trade in our securities, which may result in less liquidity for our securities.
73
Risks
Associated with Our Nasdaq Listing
We
cannot assure you that we will be able to continue to comply with the minimum bid price requirement of Nasdaq .
Although
the market price of our common stock satisfied the initial listing minimum bid price requirement for Nasdaq, there can be no assurance
that the market price of our common stock will remain at the $1.00 per share level required for continuing compliance with that requirement.
There are many factors, such as negative financial or operational results, that could adversely affect the market price of our common
stock and jeopardize our ability to maintain Nasdaq’s minimum bid price requirement.
The
market price of our common stock may not attract new investors, including institutional investors, and may not satisfy the investing
requirements of those investors. Consequently, the trading liquidity of our common stock may not improve .
Although
we believe that our Nasdaq listing may help generate greater or broader investor interest, including institutional investors, there can
be no assurances in that regard. In addition, there can be no assurance that the market price of our common stock will satisfy the investing
requirements of those investors. As a result, the trading liquidity of our common stock may not necessarily improve.
ITEM
7A .
QUANTITATIVE
AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK .
Not
applicable.
ITEM
8.
FINANCIAL
STATEMENTS AND SUPPLEMENTARY DATA .
The
financial statements required by this Item 8 of this Annual Report are included in this Annual Report following Item 16 (“Form
10-K Summary”). As a smaller reporting company, we are not required to provide supplementary financial information.
ITEM
9.
CHANGES
IN AND DISAGREEMENTS WITH ACCOUNTANTS ON ACCOUNTING AND FINANCIAL DISCLOSURE .
None.
74
ITEM
9A.
CONTROLS
AND PROCEDURES .
Evaluation
of Disclosure Controls and Procedures
We
maintain disclosure controls and procedures (as that term is defined in Rules 13a-15(e) and 15d-15(e) under the Securities Exchange Act
of 1934, as amended, or the Exchange Act), that are designed to ensure that information required to be disclosed in our
reports under the Exchange Act is recorded, processed, summarized and reported within the time periods specified in the SEC’s rules
and forms, and that such information is accumulated and communicated to our management, including our principal executive officer and
principal financial officer, as appropriate, to allow timely decisions regarding required disclosures. In designing disclosure controls
and procedures, our management necessarily was required to apply its judgment in evaluating the cost-benefit relationship of possible
disclosure controls and procedures. The design of any disclosure controls and procedures also is based in part upon certain assumptions
about the likelihood of future events, and there can be no assurance that any design will succeed in achieving its stated goals under
all potential future conditions. Any controls and procedures, no matter how well designed and operated, can provide only reasonable,
not absolute, assurance of achieving the desired control objectives.
Under
the supervision and with the participation of our management, including our principal executive officer and principal financial officer,
we are required to perform an evaluation of our disclosure controls and procedures, as such term is defined in Rule 13a-15(e) under the
Exchange Act, as of December 31, 2021.
Management
has completed such evaluation and has concluded that our disclosure controls and procedures were not effective to provide
reasonable assurance that information required to be disclosed by us in reports we file or submit under the Exchange Act is appropriate
to allow timely decisions regarding required disclosures. As a result of the material weakness in internal controls over financial reporting
described below, we concluded that our disclosure controls and procedures as of December 31, 2021 were not effective.
Management’s
Annual Report on Internal Control Over Financial Reporting
Management
is responsible for establishing and maintaining adequate internal control over financial reporting. Our internal control over financial
reporting is a process designed under the supervision of our principal executive and principal financial officer and effected by our
Board of Directors, management and other personnel, to provide reasonable assurance regarding the reliability of financial reporting
and the preparation of our consolidated financial statements for external reporting purposes in accordance with GAAP.
Because
of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements. In addition, projections
of any evaluation of effectiveness to future periods are subject to the risk that controls may become inadequate because of changes in
conditions or that the degree of compliance with the policies or procedures may deteriorate.
Material
Weaknesses in Internal Control over Financial Reporting
Management
assessed the effectiveness of our internal control over financial reporting as of December 31, 2021 based on the framework established
in Internal Control—Integrated Framework (2013) issued by the Committee of Sponsoring Organizations of the Treadway Commission.
Based on this assessment, management has determined that our internal control over financial reporting as of December 31, 2021 was not
effective.
75
A
material weakness, as defined in the standards established by the Sarbanes-Oxley is a deficiency, or a combination of deficiencies, in
internal control over financial reporting such that there is a reasonable possibility that a material misstatement of our annual or interim
consolidated financial statements will not be prevented or detected on a timely basis.
The
ineffectiveness of our internal control over financial reporting was due to the following material weaknesses:
●
Lack
of adherence to formal policies and procedures post-bankruptcy; and
●
Lack
of risk assessment procedures on internal controls to detect financial reporting risks on a timely manner.
●
Lack of sufficient formal procedures and controls to
achieve complete and accurate financial reporting and disclosures, including controls over the preparation and review of journal entries
and account reconciliations.
Management’s
Plan to Remediate the Material Weaknesses
Management
has been implementing and continues to implement measures designed to ensure that control deficiencies contributing to the material weakness
are remediated, such that these controls are designed, implemented, and operating effectively. The remediation actions include:
●
New
management personnel, including our new Chief Financial Officer, who is overseeing the financial reporting process
and implementation of enhanced controls and governance;
●
Engagement
of external financial consulting firm to continue to enhance financial reporting, financial operations and internal controls; and
●
Documentation
of key procedures and controls using a risk-based approach.
Management
will continue to monitor and evaluate the effectiveness of our internal controls and procedures over financial reporting on an ongoing
basis and is committed to taking further action and implementing additional enhancements or improvements, as necessary and as funds allow.
This
Annual Report does not include an attestation report of our independent registered public accounting firm regarding internal control
over financial reporting. Management’s report was not subject to attestation by our independent registered public accounting firm
pursuant to rules of the Securities and Exchange Commission that exempt smaller reporting companies from this requirement.
Changes
in Internal Control Over Financial Reporting
Other
than described above there have been no changes in our internal control over financial reporting that occurred during our fourth quarter
of 2021 that have materially affected, or that are reasonably likely to materially affect, our internal control over financial reporting.
Remediation of Material Weakness
in Internal Control over Financial Reporting
We
had previously reported that, as of December 31,
2020, we had identified the following material weakness in our internal control over financial reporting:
●
Inadequate
segregation of duties due to limited personnel consistent with control objectives;
76
During the year ended
December 31, 2021, we took corrective action and/or placed in operation controls to address the material weaknesses described
above by engaging an outsourced financial consulting firm and hiring a CFO to ensure that segregation of duties
is maintained.
Based on the corrective
actions described above, it is management’s conclusion that the material weakness noted above that existed as of December
31, 2020 has been remediated.
ITEM
9B.
OTHER
INFORMATION .
None.
ITEM
9C.
DISCLOSURE
REGARDING FOREIGN JURISDICTIONS THAT PREVENT INSPECTIONS .
Not
applicable.
77
PART
III
ITEM
10.
DIRECTORS,
EXECUTIVE OFFICERS AND CORPORATE GOVERNANCE .
Directors
and Executive Officers
Information
regarding our directors and executive officers is set forth below. Each of our officers devotes his full business time in providing services
on our behalf.
Name
Age
Positions
Held
Lance
Alstodt
51
Chief
Executive Officer, President and Chairman of the Board
Francisco
Silva
47
Vice
President of Research and Development, Secretary and Director
Robert
E. Kristal
55
Chief
Financial Officer
Robert
Paccasassi
53
Vice
President of Quality Assurance/Regulatory Compliance
Nickolay
Kukekov, Ph.D.
48
Director,
Compensation Committee Chair
Patrick
F. Williams
49
Director,
Audit Committee Chair
David
Rosa
58
Director,
Nominating Committee Chair
Lance
Alstodt
Lance
Alstodt has served as our Chief Executive Officer, President and Chairman of the Board since November 2020. He served as our Executive
Vice President and Chief Strategy Officer from October 2018 to February 2020. Since 2013, Mr. Alstodt has served as Chief Executive Officer
of MedVest Consulting Corporation, an advisory and capital firm that focuses exclusively on the healthcare industry. Prior to MedVest,
he was an investment banker with over 23 years of experience with respect to healthcare investment banking, including mergers and acquisitions.
From 2011 to 2013, Mr. Alstodt was a Managing Director at Leerink Partners where he helped lead its medical technology sector. From 2009
to 2011, he was a Managing Director and Head of Medical Technology at Oppenheimer & Co. From 2000 to 2009, Mr. Alstodt was a Managing
Director in the Healthcare Group and Global Mergers and Acquisitions Group at Bank of America Merrill Lynch. He previously spent seven
years as a Vice President in the Global Mergers and Acquisitions Group at J.P. Morgan Chase, where he worked extensively on acquisitions,
leveraged buyouts, private and public financings, exclusive sales and general advisory assignments. Mr. Alstodt received a degree in
Economics from the State University of New York at Albany, with a secondary concentration in Finance and Marketing. We believe that Mr.
Alstodt’s executive-level management experience with us and other healthcare businesses and his extensive experience in the investment
banking field relating to the healthcare sector give him the qualifications to serve as one of our directors.
78
Francisco
Silva
Francisco
Silva has served as our Vice President of Research and Development since March 2013, having also previously served in such position from
April 2011 until March 2012. Mr. Silva was elected our Secretary and a director in November 2020. He served as our Research Scientist
from March 2012 to June 2012 and as our Chief Scientist from June 2012 to March 2013. From 2007 to 2011, Mr. Silva served as Chief Executive
Officer of DV Biologics LLC, and as President of DaVinci Biosciences, LLC, companies engaged in the commercialization of human based
biologics for both research and therapeutic applications. From 2003 to 2007, Mr. Silva served as Vice President of Research and Development
for PrimeGen Biotech LLC, a company engaged in the development of cell based platforms. From 2002 to 2003, he was a Research Scientist
with PrimeGen Biotech and was responsible for the development of experimental designs that focused on germ line reprogramming stem cell
platforms. Mr. Silva has taught courses in biology, anatomy and advanced tissue culture at California State Polytechnic University. He
has obtained a number of patents relating to stem cells and has had numerous articles published with regard to stem cell research. Mr.
Silva graduated from California State Polytechnic University with a degree in Biology. He also obtained a Graduate Presidential Fellowship
and MBRS Fellowship from California State Polytechnic University. We believe that Mr. Silva’s executive-level management experience
with us since April 2011 and his extensive knowledge of the science related to our business give him the qualifications to serve as one
of our directors.
Robert
E. Kristal
Robert
E. Kristal has served as our Chief Financial Officer since November 2021. Mr. Kristal is an experienced Wall Street and Bay Street professional
who has served in various management roles within multiple business lines of investment banks. From 2016 to 2020, he was Head of Equity
Research at H.C. Wainwright. Mr. Kristal provided investment banking and merchant banking services from 2013 to 2016 at H.C. Wainwright
and T.R. Winston. He is a Charted Financial Analyst. Mr. Kristal received a Bachelor of Arts degree in Economics from Wilfrid Laurier
University and a Bachelor of Commerce (Honors) degree in Finance from the University of Windsor.
Robert
Paccasassi
Robert
Paccasassi has served as our Vice President of Quality Assurance/Regulatory Compliance since December 2021, having previously served
in such position from August 2016 to September 2020, and having previously served as our Director of Quality and Compliance from September
2015 to August 2016. Mr. Paccasassi has over 20 years of experience in highly regulated product operations, with specific expertise in
GMP (large and small molecule) clinical and commercial quality assurance and regulatory compliance leadership roles. He was the Director
of Quality Systems (GMP) at Merck KGaA (Dermstadt, Germany) from 2011 to 2014. In this role, Mr. Paccasassi was responsible for leading
the ongoing development and implementation of the Corporate Quality Unit’s global GMP policies, processes and directives. He held
key quality and compliance management roles at EMD Serono, Biogen Idec, Millennium Pharmaceuticals and Regeneron Pharmaceuticals. Mr.
Paccasassi was a Chief Technologist/Site Head overseeing all day to day technical and quality operations of two cGMP biologic production
laboratories for Curative Health Services. He was also a Medical Technologist working in the field of immunohematology at Brigham &
Women’s Hospital, Boston, Massachusetts. Mr. Paccasassi received a Masters in Business Administration (MBA) degree from Johnson
& Wales University and a Bachelor of Science degree in Medical Technology/Biology from the University of Rhode Island.
79
Nickolay
Kukekov, Ph.D.
Nickolay
Kukekov, Ph.D. has served as one of our directors since March 2021. For more than the past fifteen years, Dr. Kukekov has held a number
of healthcare investment banking positions. He has served as Senior Managing Director of Paulson Investment Company, LLC since 2020.
From 2012 to 2020, Dr. Kukekov was a founding partner of Highline Research Advisors LLC. He served as a Managing Director of Summer Street
Research Partners from 2010 to 2012. From 2007 to 2009, Dr. Kukekov was a Managing Director of Paramount Capital. He served as a Vice
President of Rodmen & Renshaw from 2006 to 2007. He serves as a director of Brain Scientific, Inc. and Omnia Wellness Inc. whose
shares are publicly traded. Dr. Kukekov received a Bachelor of Arts degree in molecular, cellular and developmental biology from the
University of Colorado at Boulder and a Ph.D. in neuroscience from Columbia University College of Physicians and Surgeons. We believe
that Dr. Kukekov’s extensive experience in the investment banking field relating to the healthcare sector and his strong background
in regenerative medicine give him the qualifications to serve as one of our directors.
Patrick
F. Williams
Patrick
F. Williams has served as one of our directors since November 2021. Mr. Williams has more than 20 years of experience across medical
device, consumer product goods and technology sectors. Appointed as Chief Financial Officer of STAAR Surgical Company, or STAAR, in July
2020, Mr. Williams is responsible for optimizing the financial performance of STAAR and ensuring the scalability of various functions
to support high growth expansion. From 2016 to 2019, he served as the Chief Financial Officer of Sientra, Inc. before transitioning to
General Manager for its miraDry® business unit. From 2012 to 2016, Mr. Williams served as Chief Financial Officer of ZELTIQ Aesthetics,
Inc., a publicly-traded medical device company that was acquired by Allergan. Previously, he served as Vice President in finance, strategy
and investor relations roles from 2007 to 2012 at NuVasive, Inc., a San-Diego based medical device company servicing the spine sector.
He has also held finance roles with Callaway Golf and Kyocera Wireless. Mr. Williams received an MBA in Finance and Management from San
Diego State University and a Bachelor of Arts in Economics from the University of California, San Diego. We believe that Mr. Williams’
executive-level management experience with healthcare-related businesses, including his financial management expertise, give him the
qualifications to serve as one of our directors.
David
Rosa
David
Rosa has served as one of our directors since November 2021. Mr. Rosa has served as the Chief Executive Officer, President and a director
of NeuroOne Medical Technologies Corporation, or NeuroOne (Nasdaq: NMTC), since July 2017 and served as Chief Executive Officer and a
director of NeuroOne, Inc., formerly its wholly-owned subsidiary, from October 2016 until December 2019, when NeuroOne, Inc. merged with
and into NeuroOne. NeuroOne is committed to providing minimally invasive and hi-definition solutions for EEG recording, brain stimulation
and ablation solutions for patients suffering from epilepsy, Parkinson’s disease, dystonia, essential tremors, chronic pain due
to failed back surgeries and other related neurological disorders that may improve patient outcomes and reduce procedural costs. From
November 2009 to November 2015, Mr. Rosa served as the Chief Executive Officer and President of Sunshine Heart, Inc., n/k/a CHF Solutions,
Inc. (Nasdaq: CHFS), a publicly-held early-stage medical device company. From 2008 to November 2009, he served as Chief Executive Officer
of Milksmart, Inc., a company that specializes in medical devices for animals. From 2004 to 2008, Mr. Rosa served as the Vice President
of Global Marketing for Cardiac Surgery and Cardiology at St. Jude Medical, Inc. He serves as a director on the board of directors of
Biotricity Inc (OTCMKTS: BTCY). We believe that Mr. Rosa’s senior leadership experience in the medical device industry and his
strong technical, strategic, and operational expertise give him the qualifications to serve as one of our directors.
80
Scientific
Advisory Board
The
following persons are the members of our Scientific Advisory Board:
Name
Principal
Positions
Wayne
Marasco, M.D., Ph.D.
Chairman
Professor,
Department of Cancer Immunology & AIDS, Dana-Farber Cancer Institute;
Professor
of Medicine, Harvard Medical School;
Principal
Faculty Member, Harvard Stem Cell Institute
Wayne
J. Olan, M.D.
Director,
Interventional and Endovascular Neurosurgery;
Associate
Professor, Neurosurgery and Radiology, George Washington University Medical Center;
Consulting
Physician, Department of Radiology, National Institutes of Health
Joy
Cavagnaro, Ph.D., DABT, RAC
President
and Founder, Access BIO, L.C.; Fellow, Academy of Toxicological Sciences and the Regulatory
Professional Society;
Formerly
Senior Pharmacologist and Director of Quality Assurance, Food and Drug Administration’s Center for Biologics Evaluation and
Research
Jason
Lipetz, M.D.
Chairman,
Disc Advisory Committee
Founder,
Long Island Spine Rehabilitation Medicine;
Chief
of Spine Medicine, Northwell Health Spine Center;
Clinical
Assistant Professor, Department of Physical Medicine and Rehabilitation, Zucker School of Medicine at Hofstra/Northwell
Harvinder
Sandhu, M.D.
Orthopedic
Spine Surgeon, Hospital for Special Surgery;
Formerly
Chief of Spinal Surgery Service, UCLA Medical Center
Christopher
Plastaras, M.D.
Clinical
Director of Musculoskeletal Spine and Sports Rehabilitation Medicine and Physiatrist, MossRehab;
Formerly
Director of The Penn Spine and Rehabilitation Center;
Formerly
Director of Spine, Sports and Musculoskeletal Medicine Fellowship, University of Pennsylvania
Gerard
A. Malanga, M.D.
Founder,
Partner and Physiatrist, New Jersey Sports Medicine, LLC and New Jersey Regenerative Institute;
Chair,
American Academy of Physical Medicine and Rehabilitation Task Force on Regenerative Medicine;
Past
President, Interventional Orthopedic Foundation
81
Family
Relationships
There
are no family relationships among any of our executive officers, directors and Scientific Advisory Board members.
Term
of Office
We
have a classified Board of Directors. The directors will hold office until the respective annual meetings of stockholders indicated below
and until their respective successors are elected and qualified or until their earlier resignation or removal.
Name
Class
Term
Expires
Lance
Alstodt
III
2023
Francisco
Silva
II
2022
Nickolay
Kukekov
I
2024
Patrick
F. Williams
III
2023
David
Rosa
II
2022
Each
executive officer will hold office until the initial meeting of the Board of Directors following the next annual meeting of stockholders
and until his successor is elected and qualified or until his or her earlier resignation or removal.
Audit
Committee
The
Audit Committee of the Board of Directors is responsible for overseeing our accounting and financial reporting processes and the audits
of our financial statements. The members of the Audit Committee are Mr. Williams (Chair), Dr. Kukekov and Mr. Rosa.
Audit
Committee Financial Expert
Our
Board has determined that Mr. Williams qualifies as an “audit committee financial expert,” as that term is defined in Item
407(d)(5) of Regulation S-K.
Delinquent
Section 16(a) Beneficial Ownership Reports
Section
16 of the Exchange Act requires that reports of beneficial ownership of common stock and changes in such ownership be filed with the
Securities and Exchange Commission by Section 16 “reporting persons,” including directors, certain officers, holders of more
than 10% of the outstanding common stock and certain trusts of which reporting persons are trustees. We are required to disclose in this
Annual Report each reporting person whom we know to have failed to file any required reports under Section 16 on a timely basis during
the fiscal year ended December 31, 2021. To our knowledge, based solely on a review of copies of Forms 3, 4 and 5 filed with the Securities
and Exchange Commission, during the fiscal year ended December 31, 2021, our officers, directors and 10% stockholders complied with all
Section 16(a) filing requirements applicable to them, except that Mr.. Kristal filed his Form 3 and one Form 4 (reporting one transaction)
late.
82
Code
of Ethics for Senior Financial Officers
Our
Board of Directors has adopted a Code of Ethics for our principal executive officer, principal financial officer, principal accounting
officer or controller, or persons performing similar functions. A copy of the Code of Ethics is posted on our website, www.biorestorative.com.
We intend to satisfy the disclosure requirement under Item 5.05(c) of Form 8-K regarding an amendment to, or a waiver from, our Code
of Ethics by posting such information on our website, www.biorestorative.com.
ITEM
11.
EXECUTIVE
COMPENSATION .
Summary
Compensation Table
The
following Summary Compensation Table sets forth all compensation earned in all capacities during the fiscal years ended December 31,
2021 and 2020 by (i) our principal executive officer, and (ii) our most highly compensated executive officer, other than our principal
executive officer, who was serving as an executive officer as of December 31, 2021 and whose total compensation for the 2021 fiscal year,
as determined by Regulation S-K, Item 402, exceeded $100,000 (the individuals falling within categories (i) and (ii) are collectively
referred to as the Named Executive Officers):
Name and
Principal Position
Year
Salary
Bonus
Stock Awards (1)
Option Awards (1)
All Other Compensation
Total
Lance Alstodt
2021
$ 275,000
$ -
$ 6,984,812
$ 14,081,677
$ -
$ 21,341,489
Chief Executive Officer (2)
2020
$ 64,317
$ -
$ -
$ -
$ -
$ 64,317
Francisco Silva
2021
$ 259,375
$ -
$ 6,984,812
$ 14,081,677
$ -
$ 21,325,864
VP, Research and Development
2020
$ 207,553
$ -
$ -
$ -
$ -
$ 207,553
(1)
Amounts
reflect the aggregate grant date fair value of grants made in the fiscal year computed in accordance with stock-based accounting
rules (FASB ASC Topic 718-Stock Compensation). Assumptions used in the calculations
of these amounts are included in Note 8 to our consolidated financial statements included in this Annual Report.
(2)
Mr.
Alstodt served as our Executive Vice President and Chief Strategy Officer from October 15, 2018 through February 24, 2020. Mr. Alstodt
has been serving as our President, Chief Executive Officer and Chairman of the Board since November 16, 2020.
83
Outstanding
Equity Awards at Fiscal Year-End
The
following table provides information on outstanding equity awards as of December 31, 2021 to the Named Executive Officers:
Option
Awards
Stock
Awards
Name
Number
of securities underlying unexercised options exercisable
Number
of securities underlying unexercised options unexercisable
Equity
incentive plan awards: Number of securities underlying unexercised unearned options
Option
exercise price
Option
expiration date
Number
of shares or units of stock that have not vested
Market
value of
shares of units that have not vested
Equity
incentive plan awards: Number of unearned shares, units or other rights that have not vested
Equity
incentive plan awards: Market or payout value of unearned shares, units or other rights that have not vested
Lance
Alstodt
201,767
91,712 (1)
-
$ 13.50
3/18/2031
-
$ -
-
$ -
Lance
Alstodt
21,030
21,029 (2)
-
$ 13.50
11/4/2031
-
$ -
-
$ -
Lance
Alstodt
-
-
-
$ -
-
146,740 (3)
$ 636,852
-
$ -
Francisco
Silva
201,767
91,712 (1)
-
$ 13.50
3/18/2031
-
$ -
-
$ -
Francisco
Silva
21,030
21,029 (2)
-
$ 13.50
11/4/2031
-
$ -
-
$ -
Francisco
Silva
-
-
-
$ -
-
146,740 (3)
$ 636,852
-
$ -
Francisco
Silva
1
-
$ 18,800
2/10/2022
-
$ -
-
$ -
Francisco
Silva
1
1 (4)
-
$ 18,800
5/2/2022
-
$ -
-
$ -
Francisco
Silva
1
-
-
$ 18,800
12/7/2022
-
$ -
-
$ -
Francisco
Silva
1
-
-
$ 18,800
10/4/2023
-
$ -
-
$ -
Francisco
Silva
3
-
-
$ 18,800
2/18/2024
-
$ -
-
$ -
Francisco
Silva
1
-
-
$ 18,800
3/12/2024
-
$ -
-
$ -
Francisco
Silva
9
-
-
$ 18,800
10/23/2024
-
$ -
-
$ -
Francisco
Silva
6
-
-
$ 18,800
9/4/2025
-
$ -
-
$ -
Francisco
Silva
15
-
-
$ 14,920
6/10/2026
-
$ -
-
$ -
Francisco
Silva
20
-
-
$ 11,200
7/12/2027
-
$ -
-
$ -
Francisco
Silva
25
-
-
$ 4,920
10/29/2028
-
$ -
-
$ -
(1)
Option
becomes exercisable in five nearly equal quarterly installments beginning on March 18, 2022.
(2)
Option
becomes exercisable in eight nearly equal quarterly installments beginning on November 4, 2022.
(3)
Restricted
stock vests in three nearly equal annual installments beginning on March 18, 2022.
(4)
Option
is exercisable commencing on the date (provided that such date is during Mr. Silva’s employment with us), if any, on which
either (i) the FDA approves a biologics license application made by us with respect to any biologic product or (ii) a 510(k) Premarket
Notification submission is made by us to the FDA with respect to a certain device.
84
Employment
Agreements
Lance
Alstodt
Effective November
16, 2020, Mr. Alstodt was elected our Chief Executive Officer, President and Chairman of the Board. On March 18, 2021, we entered into
an employment agreement with Mr. Alstodt which provides for a term ending on March 18, 2026. Pursuant to the employment agreement, Mr.
Alstodt currently is entitled to receive an annual salary of $400,000 (giving effect to a $150,000 performance salary increase
received in November 2021). Concurrently with the execution of the employment agreement, we granted to Mr. Alstodt pursuant to
the 2021 Plan (i) a ten year option for the purchase of 293,479 shares of our common stock at an exercise price of $47.60 per share (which
exercise price was subsequently reduced to $13.50 per share and further reduced, subject to stockholder approval, to $5.08 per share)
and (ii) 146,740 restricted stock units, or RSUs. The option vests to the extent of 50% thereof on the date of grant, 12.5% on November
4, 2021 and the balance in six equal quarterly installments commencing on December 18, 2021. The RSUs vest in three equal annual installments
on the first, second and third anniversaries of the date of grant. In the event that Mr. Alstodt’s employment is terminated by
us without “cause”, or Mr. Alstodt terminates his employment for “good reason” (each as defined in the employment
agreement), Mr. Alstodt will be entitled to receive severance in an amount up to one time his then annual base salary. If Mr. Alstodt’s
employment with us is terminated without cause, the option granted to Mr. Alstodt will vest and become exercisable and such option will
remain exercisable until its expiration date notwithstanding such termination of employment with us. In addition, the RSUs granted to
Mr. Alstodt will vest in the event of the termination of his employment without cause. Further, in the event of a change in control (as
defined in the 2021 Plan), 50% of the unvested RSUs shall vest as of the date of the change in control and the remainder shall vest upon
the earlier of the one year anniversary of the change in control or the date on which the RSU was scheduled to vest, subject to earlier
vesting in the event Mr. Alstodt’s employment is terminated without cause. In March 2022, we and Mr. Alstodt agreed that, in
lieu of a $50,000 increase in his annual salary (as provided for in his employment agreement), we issued to Mr. Alstodt 12,438 RSUs
(having a value of $50,000), which RSUs will vest in twelve equal monthly installments. Such grant was in consideration of Mr. Alstodt
deferring his right to receive the $50,000 increase in his salary for one year. Effective in March 2023, pursuant to his employment agreement,
Mr. Alstodt will be entitled to his annual increase of $50,000 in his salary (plus, in March 2023, the $50,000 salary increase deferral
discussed above).
Francisco
Silva
On March 18, 2021,
we and Mr. Silva entered into an employment agreement which provides for a term ending on March 18, 2026. Pursuant to the employment
agreement, Mr. Silva is currently entitled to receive an annual salary of $375,000 (giving effect to a $150,000 performance salary
increase received in November 2021). Concurrently with the execution
of the employment agreement, we granted to Mr. Silva pursuant to the 2021 Plan (i) a ten year option for the purchase of 293,479 shares
of our common stock at an exercise price of $47.60 per share (which exercise price was subsequently reduced to $13.50 per share and further
reduced, subject to stockholder approval, to $5.08 per share) and (ii) 146,740 RSUs. The option vests to the extent of 50% thereof on
the date of grant, 12.5% on November 4, 2021 and the balance in six equal quarterly installments commencing on December 18, 2021. The
RSUs vest in three equal annual installments on the first, second and third anniversaries of the date of grant. In the event that Mr.
Silva’s employment is terminated by us without “cause”, or Mr. Silva terminates his employment for “good reason”
(each as defined in the employment agreement), Mr. Silva will be entitled to receive severance in an amount up to one time his then annual
base salary. If Mr. Silva’s employment with us is terminated without cause, the option granted to Mr. Silva will vest and become
exercisable and such option will remain exercisable until its expiration date notwithstanding such termination of employment with us.
In addition, the RSU’s granted to Mr. Silva will vest in the event of the termination of his employment without cause. Further,
in the event of a change in control (as defined in the 2021 Plan), 50% of the unvested RSUs shall vest as of the date of the change in
control and the remainder shall vest upon the earlier of the one year anniversary of the change in control or the date on which the RSU
was scheduled to vest, subject to earlier vesting in the event Mr. Silva’s employment is terminated without cause. In March
2022, we and Mr. Silva agreed that, in lieu of a $50,000 increase in his annual salary (as provided for in his employment agreement),
we issued to Mr. Silva 12,438 RSUs (having a value of $50,000), which RSUs will vest in twelve equal monthly installments. Such grant
was in consideration of Mr. Silva deferring his right to receive the $50,000 increase in his salary for one year. Effective in March
2023, pursuant to his employment agreement, Mr. Silva will be entitled to his annual increase of $50,000 in his salary (plus, in March
2023, the $50,000 salary increase deferral discussed above).
85
Director
Compensation
The
following table sets forth certain information concerning the compensation of our non-employee directors for the fiscal year ended December
31, 2021:
Name
Fees
Earned or Paid in Cash
Stock
Awards
Option
Awards (1)
Non-Equity
Incentive Plan Compensation
Nonqualified
Deferred Compensation Earnings
All
Other Compensation
Total
Nickolay
Kukekov
$ -
$ -
$ 128,194
(2)
$ -
$ -
$ -
$
128,194
Patrick
F. Williams
$ -
$ -
$ 53,287
(3)
$ -
$ -
$ -
$
53,287
David
Rosa
$ -
$ -
$ 53,287
(4)
$ -
$ -
$ -
$
53,287
(1)
Amounts
reflect the aggregate grant date fair value of grants made in the fiscal year computed in accordance with stock-based accounting
rules (FASB ASC Topic 718-Stock Compensation). Assumptions used in the calculations
of these amounts are included in Note 8 to our consolidated financial statements included in this Annual Report.
(2)
As
of December 31, 2021. Dr. Kukekov held options for the purchase of 25,236 shares of common stock.
(3)
As
of December 31, 2021, Mr. Williams held options for the purchase of 10,490 shares of common stock.
(4)
As
of December 31, 2021, Mr. Rosa held options for the purchase of 10,490 shares of common stock.
Dr.
Kukekov and Messrs. Williams and Rosa, our non-employee directors, as compensation for their services as a director, are granted stock
options by us from time to time.
ITEM
12.
SECURITY
OWNERSHIP OF CERTAIN BENEFICIAL OWNERS AND MANAGEMENT AND RELATED STOCKHOLDER MATTERS .
Principal
Stockholders
The
following table sets forth certain information regarding the beneficial ownership of our common stock, as of March 28, 2022, known
by us, through transfer agent records and reports filed with the SEC, to be held by: (i) each person who beneficially owns 5% or more
of the shares of common stock then outstanding; (ii) each of our directors; (iii) each of our Named Executive Officers (as defined above);
and (iv) all of our directors and executive officers as a group. The following table also sets forth certain information regarding the
beneficial ownership of our Series A preferred stock as of March 28, 2022.
86
The
information in this table reflects “beneficial ownership” as defined in Rule 13d-3 of the Exchange Act. To our knowledge,
and unless otherwise indicated, each stockholder has sole voting power and investment power over the shares listed as beneficially owned
by such stockholder, subject to community property laws where applicable. Percentage ownership is based on 3,626,603 shares of
common stock and 1,543,158 shares of Series A preferred stock outstanding as of March 28, 2022.
Name
and Address of Beneficial Owner
Number
of Shares of Common Stock Beneficially
Owned
Approximate
Percent of Class
Number
of Shares of Series A Preferred Stock Beneficially Owned
Approximate
Percent of Class
Directors
and Executive Officers
Lance
Alstodt (1)
306,396 (2)
7.9 %
-
-
Francisco
Silva (1)
304,074 (3)
7.9 %
-
-
Nickolay
Kukekov
12,618 (4)
*
-
-
Patrick
F. Williams
2,623 (4)
*
-
-
David
Rosa
2,623 (4)
*
-
-
All
directors and executive officers as a group (7 persons)
632,337 (5)
15.3 %
-
-
Certain
Beneficial Owners
Dale Broadrick (6)
508,484 (7)
14.0 %
-
-
Auctus
Fund, LLC (8)
180,967
(9)
4.99 %
1,543,158
(10)
100 %
*
Less
than 1%
(1)
Address
is 40 Marcus Drive, Suite One, Melville, New York 11747.
(2)
Includes
241,139 shares of common stock issuable upon the exercise of currently exercisable options.
(3)
Includes
241,223 shares of common stock issuable upon the exercise of currently exercisable options and 11,829 shares of common stock held
by Mr. Silva in a retirement account.
(4)
Represents
shares of common stock issuable upon the exercise of options that are exercisable currently or within 60 days.
(5)
Includes
504,229 shares of common stock issuable upon the exercise of options that are exercisable currently or within 60 days.
(6)
Address is 3003 Brick Church Pike, Nashville, Tennessee
(7)
Based upon Amendment No. 6 to Schedule 13D filed with
the Securities and Exchange Commission. Includes 1,359 shares common stock issuable upon the exercise of currently exercisable warrants.
(8)
Address
is 545 Boylston Street, 2 nd Floor, Boston, Massachusetts 02116.
(9)
Auctus
Fund, LLC, or Auctus, holds a warrant for the purchase of up to 1,676,580 shares of our common stock. In addition, Auctus’
shares of Series A preferred stock are convertible into an aggregate of 1,543,158 shares of our common stock. However, such warrant
is not exercisable, and such Series A preferred stock is not convertible into shares of our common stock, to the extent Auctus would
beneficially own, after such exercise and/or conversion, more than 4.99% of our outstanding shares of common stock. The number of
shares of common stock reflected in the table above as being beneficially owned by Auctus equals 4.99% of our outstanding common
stock as of March 28, 2022 as we are aware of the number of shares of common stock actually owned by Auctus as of such date.
87
(10)
Pursuant
to the Certificate of Designations of Preferred Stock with regard to the Series A preferred stock, Auctus, as the sole holder of
the 1,543,158 outstanding shares of Series A preferred stock, is entitled to vote such shares based on the number of shares
of common stock into which such shares are convertible (currently 1,543,158); however, pursuant to such Certificate of Designations
of Preferred Stock, the voting rights of the holder of the shares of Series A preferred stock is limited to 4.99% of our then outstanding
shares of common stock. Accordingly, as of March 28, 2022, based upon there being 3,626,603 shares of common stock
outstanding, the holder of the Series A preferred stock was entitled to 180,967 votes.
Securities
Authorized for Issuance Under Equity Compensation Plans
The
following table sets forth information as of December 31, 2021 with respect to compensation plans (including individual compensation
arrangements) under which our common stock are authorized for issuance, aggregated as follows:
●
All
compensation plans previously approved by security holders; and
●
All
compensation plans not previously approved by security holders.
EQUITY
COMPENSATION PLAN INFORMATION
Number
of securities to be issued upon exercise of outstanding options (a)
Weighted-average
exercise price of outstanding options (b)
Number
of securities remaining available for future issuance under equity compensation plans (excluding securities reflected in column (a))
Equity
compensation plans approved by security holders
839,639 (1)
$ 13.50
336,450 (2)
Total
839,639
$ 13.50
336,450
(1) Includes
options to purchase up to 1,089 shares of common stock under the Company’s 2010 Plan.
(2) Includes
293,480 unvested Restricted Stock Units outstanding at December 31, 2021.
88
ITEM
13.
CERTAIN
RELATIONSHIPS AND RELATED TRANSACTIONS, AND DIRECTOR INDEPENDENCE .
Director
Independence
Board
of Directors
Our
Board of Directors is comprised of Lance Alstodt (Chair), Francisco Silva, Nickolay Kukekov, Patrick F. Williams and David Rosa. Each
of Dr. Kukekov, Mr. Williams and Mr. Rosa is an “independent director” based on the definition of independence in Listing
Rule 5605(a)(2) of The Nasdaq Stock Market.
Audit
Committee
Mr.
Williams (Chair), Dr. Kukekov and Mr. Rosa are the members of our Board’s Audit Committee. Each of Mr. Williams, Dr. Kukekov and
Mr. Rosa is an “independent director” based on the definition of independence in Listing Rule 5605(a)(2) of The Nasdaq Stock
Market and Rule 10A-3(b)(1) under the Exchange Act. Our Board of Directors has determined that Mr. Williams qualifies as an “audit
committee financial expert,” as that term is defined in Item 407(d)(5) of Regulation S-K.
Nominating
Committee
Mr.
Rosa (Chair), Dr. Kukekov and Mr. Williams are the members of our Board’s Nominating Committee. Each of Mr. Rosa, Dr. Kukekov and
Mr. Williams is an “independent director” based on the definition of independence in Listing Rule 5605(a)(2) of The Nasdaq
Stock Market.
Compensation
Committee
Dr.
Kukekov (Chair), Mr. Williams and Mr. Rosa are the members of our Board’s Compensation Committee. Each of Dr. Kukekov, Mr. Williams
and Mr. Rosa is an “independent director” based on the definition of independence in Listing Rule 5605(a)(2) of The Nasdaq
Stock Market.
ITEM
14.
PRINCIPAL
ACCOUNTANT FEES AND SERVICES .
Friedman
LLP served as our independent registered public accountants for the years ended December 31, 2021 and 2020.
The
following is a summary of the fees billed or expected to be billed to us by Friedman LLP, our independent registered public accountants,
for professional services rendered with respect to the fiscal years ended December 31, 2021 and 2020:
Friedman LLP
2021
2020
Audit fees (1)
$ 95,000
$ 80,000
Audit-related fees (2)
40,500
-
Tax fees (3)
-
-
All other fees (4)
-
-
$ 135,500
$ 80,000
(1)
Audit
Fees consist of fees billed and expected to be billed for services rendered for the audit of our consolidated financial statements
for the fiscal years ended December 31, 2021 and 2020, and the review of our condensed consolidated financial statements included
in our Quarterly Reports on Form 10-Q.
(2)
Audit-Related
Fees consist of fees billed for assurance and related services that are reasonably related to the performance of the audit of our
financial statements and in connection with the filing of Forms S-1 and S-8 registration statements and are not reported under
“Audit Fees.”
(3)
Tax
Fees consist of fees billed for professional services related to preparation of our U.S. federal and state income tax returns and
tax advice.
(4)
All
Other Fees consist of fees billed for products and services provided by our independent registered public accountants, other than
those disclosed above.
The
Audit Committee is responsible for the appointment, compensation and oversight of the work of the independent registered public accountants,
and approves in advance any services to be performed by the independent registered public accountants, whether audit-related or not.
The Audit Committee reviews each proposed engagement to determine whether the provision of services is compatible with maintaining the
independence of the independent registered public accountants. The fees shown above were pre-approved either by our Board or our Audit
Committee.
89
PART
IV
ITEM
15.
EXHIBITS
AND FINANCIAL STATEMENT SCHEDULES .
Exhibit
No.
2.1
Order of the Bankruptcy Court for the Eastern District of New York Confirming Amended Joint Plan of Reorganization of BioRestorative Therapies, Inc., and Auctus Fund, LLC (the “Plan of Reorganization”), incorporated by reference to the registrant’s Current Report on Form 8-K for an event dated October 30, 2020, wherein such document is identified as Exhibit 2.1
2.2
Amended Disclosure Statement with respect to the Plan of Reorganization, together with exhibits thereto, including the Plan of Reorganization, incorporated by reference to the registrant’s Current Report on Form 8-K for an event dated October 30, 2020, wherein such document is identified as Exhibit 2.2
2.3
Plan Supplement to the Plan of Reorganization, together with forms of Secured Convertible Note, Unsecured Convertible Note, Class A Warrant, Class B Warrant, Intercreditor Agreement and Security Agreement attached as exhibits thereto, incorporated by reference to the registrant’s Current Report on Form 8-K for an event dated October 30, 2020, wherein such document is identified as Exhibit 2.3.
3.1
Certificate of Incorporation, as amended*
3.2
Bylaws, incorporated by reference to the registrant’s Current Report on Form 8-K for an event dated December 19, 2014, wherein such document is identified as Exhibit 3.4
10.1
License Agreement, dated as of January 27, 2012, between Regenerative Sciences, LLC and BioRestorative Therapies, Inc. (“License Agreement”), incorporated by reference to the registrant’s Annual Report on Form 10-K for the year ended December 31, 2011, wherein such document is identified as Exhibit 10.44
10.2
Amendment to License Agreement, dated March 21, 2012, incorporated by reference to the registrant’s Annual Report on Form 10-K for the year ended December 31, 2011, wherein such document is identified as Exhibit 10.45
10.3
Amendment to License Agreement, dated November 30, 2015, incorporated by reference to the registrant’s Annual Report on Form 10-K for the year ended December 31, 2015, wherein such document is identified as Exhibit 10.20
10.4
Lease, dated as of August 25, 2014, between BioRestorative Therapies, Inc. and 50 Republic Road, LLC, incorporated by reference to the registrant’s Current Report on Form 8-K for an event dated August 25, 2014, wherein such document is identified as Exhibit 99.1
10.5
Lease Amendment, dated as of June 4, 2019, between 50 Republic Road, LLC and BioRestorative Therapies, Inc., incorporated by reference to the registrant’s Annual Report on Form 10-K for the year ended December 31, 2019, wherein such document is identified as Exhibit 10.37
10.6
BioRestorative Therapies, Inc. 2021 Stock Incentive Plan, incorporated by reference to the registrant’s Current Report on Form 8-K for an event dated March 18, 2021, wherein such document is identified as Exhibit 99.1
10.7
Employment Agreement, dated as of March 18, 2021, by and between BioRestorative Therapies, Inc. and Lance Alstodt, incorporated by reference to the registrant’s Current Report on Form 8-K for an event dated March 18, 2021, wherein such document is identified as Exhibit 99.2
10.8
Employment Agreement, dated as of March 18, 2021, by and between BioRestorative Therapies, Inc. and Francisco Silva, incorporated by reference to the registrant’s Current Report on Form 8-K for an event dated March 18, 2021, wherein such document is identified as Exhibit 99.3
90
10.9
Non-Qualified Stock Option Award Agreement, dated as of March 18, 2021, between BioRestorative Therapies, Inc. and Lance Alstodt, incorporated by reference to the registrant’s Current Report on Form 8-K for an event dated March 18, 2021, wherein such document is identified as Exhibit 99.4
10.10
Non-Qualified Stock Option Award Agreement, dated as of March 18, 2021, between BioRestorative Therapies, Inc. and Francisco Silva, incorporated by reference to the registrant’s Current Report on Form 8-K for an event dated March 18, 2021, wherein such document is identified as Exhibit 99.5
10.11
Restricted Stock Unit Award Agreement, dated as of March 18, 2021, between BioRestorative Therapies, Inc. and Lance Alstodt, incorporated by reference to the registrant’s Current Report on Form 8-K for an event dated March 18, 2021, wherein such document is identified as Exhibit 99.6
10.12
Restricted Stock Unit Award Agreement, dated as of March 18, 2021, between BioRestorative Therapies, Inc. and Francisco Silva, incorporated by reference to the registrant’s Current Report on Form 8-K for an event dated March 18, 2021, wherein such document is identified as Exhibit 99.7
10.13
Non-Qualified Stock Option Award Agreement, dated as of November 4, 2021, between BioRestorative Therapies, Inc. and Lance Alstodt, incorporated by reference to the registrant’s Current Report on Form 8-K for an event dated November 4, 2021, wherein such document is identified as Exhibit 99.2
10.14
Non-Qualified Stock Option Award Agreement, dated as of November 4, 2021, between BioRestorative Therapies, Inc. and Francisco Silva, incorporated by reference to the registrant’s Current Report on Form 8-K for an event dated November 4, wherein such document is identified as Exhibit 99.3
10.15
Non-Qualified Stock Option Award Agreement, dated as of November 4, 2021, between BioRestorative Therapies, Inc. and Nickolay Kukekov*
10.16
Non-Qualified Stock Option Award Agreement, dated as of November 4, 2021, between BioRestorative Therapies, Inc. and Patrick F. Williams*
10.17
Non-Qualified Stock Option Award Agreement, dated as of November 4, 2021, between BioRestorative Therapies, Inc. and David Rosa*
10.18
Amendment No. 1 to Non-Qualified Stock Option Award Agreement, dated as of November 4, 2021, between BioRestorative Therapies, Inc. and Lance Alstodt*
10.19
Amendment No. 1 to Non-Qualified Stock Option Award Agreement, dated as of November 4, 2021, between BioRestorative Therapies, Inc. and Francisco Silva*
10.20
Common Stock Purchase Warrant, dated November 9, 2021, issued by BioRestorative Therapies, Inc. pursuant to public offering*
10.21
Common Stock Purchase Warrant, dated November 9, 2021, issued by BioRestorative Therapies, Inc. to Auctus Fund, LLC*
10.22
Amendment No. 2 to Non-Qualified Stock Option Award Agreement, dated as of December 10, 2021, between BioRestorative Therapies, Inc. and Lance Alstodt*
10.23
Amendment No. 2 to Non-Qualified Stock Option Award Agreement, dated as of December 10, 2021, between BioRestorative Therapies, Inc. and Francisco Silva*
10.24
Amendment No. 1 to Non-Qualified Stock Option Award Agreement, dated as of December 10, 2021, between BioRestorative Therapies, Inc. and Nickolay Kukekov*
10.25
Amendment No. 1 to Non-Qualified Stock Option Award Agreement, dated as of December 10, 2021, between BioRestorative Therapies, Inc. and Patrick F. Williams*
10.26
Amendment No. 1 to Non-Qualified Stock Option Award Agreement, dated as of December 10, 2021, between BioRestorative Therapies, Inc. and David Rosa*
91
14
Code of Ethics, incorporated by reference to the registrant’s Annual Report on Form 10-K for the year ended December 31, 2011, wherein such document is identified as Exhibit 14
21
Subsidiaries, incorporated by reference to the registrant’s Annual Report on Form 10-K for the year ended December 31, 2018, wherein such document is identified as Exhibit 21
23
Independent Registered Public Accounting Firm’s Consent*
31.1
Principal Executive Officer Certification*
31.2
Principal Financial Officer Certification*
32
Section 1350 Certification**
101.INS
Inline
XBRL Instance Document *
101.SCH
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ITEM
16.
FORM
10-K SUMMARY .
Not
applicable
92
SIGNATURES
Pursuant
to the requirements of Section 13 or 15(d) of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed
on its behalf by the undersigned, thereunto duly authorized.
BIORESTORATIVE
THERAPIES, INC.
Dated:
March 30, 2022
By:
/s/
Lance Alstodt
Lance
Alstodt
Chief
Executive Officer
Pursuant
to the requirements of the Securities Exchange Act of 1934, this report has been signed below by the following persons on behalf of the
registrant and in the capacities and on the dates indicated.
Signature
Capacity
Date
/s/
Lance Alstodt
Chief
Executive Officer, President, Chairman of the Board and Director
March
30, 2022
Lance
Alstodt
(Principal
Executive Officer)
/s/
Francisco Silva
Vice
President, Research and
Development
and Director
March
30, 2022
Francisco
Silva
/ s/
Robert E. Kristal
Chief
Financial Officer
March
30, 2022
Robert
E. Kristal
(Principal
Financial Officer and
Principal
Accounting Officer)
/s/
Nickolay Kukekov
Director
March
30, 2022
Nickolay
Kukekov
/s/
Patrick F. Williams
Director
March
30, 2022
Patrick
F. Williams
/s/
David Rosa
Director
March
30, 2022
David
Rosa
93
ITEM 8. FINANCIAL STATEMENTS AND SUPPLEMENTARY DATA
BIORESTORATIVE
THERAPIES, INC. AND SUBSIDIARY
CONSOLIDATED
FINANCIAL STATEMENTS
TABLE
OF CONTENTS
Page
REPORT
OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM (PCAOB FIRM ID: 711 )
F-2
CONSOLIDATED
FINANCIAL STATEMENTS:
Consolidated
Balance Sheets as of December 31, 2021 and December 31, 2020
F-4
Consolidated
Statements of Operations For the Years Ended December 31, 2021 and December 31, 2020
F-5
Consolidated
Statements of Stockholders’ Equity (Deficit) For the Years Ended December 31, 2021 and December 31, 2020
F-6
Consolidated
Statements of Cash Flows For the Years Ended December 31, 2021 and December 31, 2020
F-7
Notes
to Consolidated Financial Statements For the Years Ended December 31, 2021 and December 31, 2020
F-8
- F-32
F- 1
REPORT
OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
To
the Board of Directors and
Shareholders of BioRestorative Therapies, Inc. & Subsidiary.
Opinion
on the Consolidated Financial Statements
We
have audited the accompanying consolidated balance sheets of BioRestorative Therapies, Inc. & Subsidiary (the “Company”)
as of December 31, 2021 and 2020, and the related consolidated statements of operations, changes in equity (deficit), and cash flows for each
of the years in the two-year period ended December 31, 2021, and the related notes (collectively referred to as the “consolidated
financial statements”). In our opinion, the consolidated financial statements present fairly, in all material respects, the financial
position of the Company as of December 31, 2021 and 2020, and the results of its operations and its cash flows for each of the years
in the two-year period ended December 31, 2021, in conformity with accounting principles generally accepted in the United States of America.
Basis
for Opinion
These
consolidated financial statements are the responsibility of the Company’s management. Our responsibility is to express an opinion
on the Company’s consolidated financial statements based on our audits. We are a public accounting firm registered with the Public
Company Accounting Oversight Board (United States) (PCAOB) and are required to be independent with respect to the Company in accordance
with the U.S. federal securities laws and the applicable rules and regulations of the Securities and Exchange Commission and the PCAOB.
We
conducted our audits in accordance with the standards of the PCAOB. Those standards require that we plan and perform the audits to obtain
reasonable assurance about whether the consolidated financial statements are free of material misstatement, whether due to error or fraud.
The Company is not required to have, nor were we engaged to perform, an audit of its internal control over financial reporting. As part
of our audits, we are required to obtain an understanding of internal control over financial reporting, but not for the purpose of expressing
an opinion on the effectiveness of the Company’s internal control over financial reporting. Accordingly, we express no such opinion.
Our
audits included performing procedures to assess the risks of material misstatement of the consolidated financial statements, whether
due to error or fraud, and performing procedures that respond to those risks. Such procedures included examining, on a test basis, evidence
regarding the amounts and disclosures in the consolidated financial statements. Our audits also included evaluating the accounting principles
used and significant estimates made by management, as well as evaluating the overall presentation of the consolidated financial statements.
We believe that our audits provide a reasonable basis for our opinion.
Critical
Audit Matters
The
critical audit matters communicated below are matters arising from the current period audit of the consolidated financial statements
that were communicated or required to be communicated to the board of directors and that: (1) relate to accounts or disclosures that
are material to the consolidated financial statements and (2) involved our especially challenging, subjective, or complex judgments.
The communication of critical audit matters does not alter in any way our opinion on the consolidated financial statements, taken as
a whole, and we are not, by communicating the critical audit matters below, providing separate opinions on the critical audit matters
or on the accounts or disclosures to which they relate.
F- 2
Accounting
for debt conversions and warrant modifications
Description
of the Matter
As
described in Note 7 of the consolidated financial statements, the Company entered into various settlement agreements with lenders to
exchange convertible note payables and outstanding warrants for shares of the Company’s common and preferred stock and warrants
(“Settlements”). In connection with the settlements, the Company recognized a loss on extinguishment of debt of approximately
$16,000,000. We have identified the assessment of the accounting of the settlements to be a critical audit matter because of the judgements
necessary for management to determine if the settlements resulted in debt extinguishment. The interpretation and application of the relevant
accounting literature required significant auditor judgment due to the complexity of the agreement and required auditor judgment when
performing audit procedures to audit management’s assessment of the accounting treatment for the amendment.
How
We Addressed the Matter in Our Audit
We
obtained an understanding over managements process for assessing the accounting considerations of the settlements, specifically, management’s
assessment of the accounting treatment of the arrangement supporting the conclusion that the settlements were accounted for as a debt
extinguishment. To evaluate management’s accounting conclusion, we performed audit procedures that included, among others, assessing
the Company’s accounting memorandum and other documentation, including the application of the relevant accounting guidance. We
read the relevant documents and agreements and compared the terms to the Company’s accounting documentation. We also evaluated
the presentation of the transactions in the consolidated financial statements and the related footnote disclosure.
Stock
Based Compensation – Equity Transactions
Description
of the Matter
As
described in Note 8 of the consolidated financial statements, the Company entered into equity agreements which include stock based compensation.
These agreements include transactions, including the issuance of stock options and restricted stock awards, that are required to be recorded
at their estimated fair values. The Company’s determination of the estimated fair values involves the identification of related
financial instruments and a clear understanding of the terms of the agreements. Auditing management’s estimates of fair value requires
a high degree of auditor judgment and an increased extent of effort, including the need to carefully examine to understand the true nature
of the related agreements.
How
We Addressed the Matter in Our Audit
Our
audit procedures related to determination of the estimated fair values of these equity transactions included the following, among others;
● We
obtained an understanding of management’s process and methodology to develop the estimates.
● We
examined signed contracts and amendments.
● We
evaluated the reasonableness of the inputs and assumptions used by management in developing
the estimates.
● We
evaluated the adequacy of the disclosures related to these fair value measurements.
/s/
Friedman LLP
We
have served as the Company’s auditor since 2020.
Marlton,
New Jersey
March 30, 2022
F- 3
BIORESTORATIVE
THERAPIES, INC. AND SUBSIDIARY
CONSOLIDATED
BALANCE SHEETS
December
31, 2021
December
31, 2020
ASSETS
Current
Assets:
Cash
$ 21,026,727
$ 3,064,610
Accounts
receivable
5,000
17,000
Prepaid
expenses
436,181
105,407
Total
Current Assets
21,467,908
3,187,017
Property
and equipment, net
37,993
21,914
Right
of use asset
357,805
473,849
Intangible
assets, net
589,740
664,268
Total
Assets
$ 22,453,446
$ 4,347,048
LIABILITIES
AND STOCKHOLDERS’ EQUITY (DEFICIT)
Current
Liabilities:
Accounts
payable
$ 50,827
$ 118,851
Accrued
expenses and other current liabilities
134,970
767,566
Lease
liability, current portion
119,055
158,371
PPP
loan payable, current portion
58,970
-
Total
Current Liabilities
363,822
1,044,788
Lease
liability, net of current portion
301,645
363,519
Notes
payable, net of debt discount of $ - and $ 5,366,869 , respectively
-
4,270,233
PPP
loan payable, net of current portion
191,030
-
Total
Liabilities
856,497
5,678,540
Commitments
and Contingencies
-
-
Stockholders’
Equity (Deficit):
Preferred
stock, $ 0.01 par value; Authorized, 20,000,000 shares;
-
-
Series
A Convertible Preferred stock, $ 0.01 par value; 1,543,158 Authorized, 1,543,158 and 0 shares issued and outstanding at December 31,
2021 and December 31, 2020, respectively
15,432
-
Preferred Stock
Common
stock, $ 0.0001 par value; Authorized, 75,000,000 shares; 3,520,391 and 715,544 issued and outstanding at December 31, 2021 and December
31, 2020, respectively
353
72
Additional
paid in capital
155,727,292
88,511,269
Accumulated
deficit
( 134,146,128 )
( 89,842,833 )
Total
Stockholders’ Equity (Deficit)
21,596,949
( 1,331,492 )
Total
Liabilities and Stockholders’ Equity (Deficit)
$ 22,453,446
$ 4,347,048
The
accompanying notes are an integral part of these consolidated financial statements.
F- 4
BIORESTORATIVE
THERAPIES, INC. AND SUBSIDIARY
CONSOLIDATED
STATEMENTS OF OPERATIONS
December
31, 2021
December
31, 2020
For
the Years Ended
December
31, 2021
December
31, 2020
Revenues
$ 46,000
$ 77,000
Operating
expenses:
Marketing
and promotion
12,290
28,281
Consulting
74,992
137,250
Research
and development
729,058
876,829
General
and administrative
25,537,533
1,786,716
Total
operating expenses
26,353,873
2,829,076
Loss
from operations
( 26,307,873 )
( 2,752,076 )
Other expense:
Interest
expense
( 1,815,366 )
( 1,640,145 )
Loss
on extinguishment of notes payable, net
( 16,180,056 )
( 658,152 )
Change
in fair value of derivative liabilities
-
( 2,141,069 )
Reorganization
items, net
-
( 4,081,245 )
Total
other expense
( 17,995,422 )
( 8,520,611 )
Net
loss
$ ( 44,303,295 )
$ ( 11,272,687 )
Net
Loss Per Share - Basic and Diluted
$ ( 37.30 )
$ ( 28.56 )
Weighted
Average Number of Common Shares Outstanding - Basic and Diluted
1,187,741
394,705
The
accompanying notes are an integral part of these consolidated financial statements.
F- 5
BIORESTORATIVE
THERAPIES, INC. AND SUBSIDIARY
CONSOLIDATED
STATEMENTS OF STOCKHOLDERS’ EQUITY (DEFICIT)
Shares
Amount
Shares
Amount
Capital
Deficit
Equity
(Deficit)
Preferred
Stock
Common
Stock
Additional
Paid-in
Accumulated
Total
Shareholders’
Equity
Shares
Amount
Shares
Amount
Capital
Deficit
(Deficit)
Balance
at January 1, 2021
-
$ -
715,544
$ 72
$ 88,511,269
$ ( 89,842,833 )
$ ( 1,331,492 )
Shares
and warrants issued for cash related to public offering, net
-
-
2,300,000
230
21,072,453
-
21,072,683
Shares
issued in connection with the public offering in exchange for notes payable, accrued interest and outstanding warrants
1,543,158
15,432
313,789
31
22,611,982
-
22,627,445
Shares
issued in exchange of notes payable and accrued interest
-
-
8,069
1
317,376
-
317,377
Shares
issued in satisfaction of bankruptcy allowable claims
Shares
issued in satisfaction of bankruptcy allowable claims,shares
Shares
issued in cashless exercise of warrants
-
-
177,239
18
( 82,146 )
-
( 82,128 )
Shares
issued in litigation settlement
-
-
750
-
21,000
-
21,000
Fair
market value of beneficial conversion feature and warrants issued with convertible notes payable instruments
-
-
-
-
166,404
-
166,404
Stock-based
compensation:
-
restricted share units
-
-
-
-
3,671,503
-
3,671,503
-
options
-
-
-
-
19,411,976
-
19,411,976
-
common stock
-
-
5,000
1
25,475
-
25,476
Net
loss
-
-
-
-
-
( 44,303,295 )
( 44,303,295 )
Balance
as of December 31, 2021
1,543,158
$ 15,432
3,520,391
$ 353
$ 155,727,292
$ ( 134,146,128 )
$ 21,596,949
Balance
at January 1, 2020
-
$ -
19,463
$ 2
$ 65,793,998
$ ( 78,570,146 )
$ ( 12,776,146 )
Balance
-
$ -
19,463
$ 2
$ 65,793,998
$ ( 78,570,146 )
$ ( 12,776,146 )
Shares
and warrants issued for cash
-
-
250
-
10,000
-
10,000
Shares
issued in exchange for notes payable and accrued interest
-
-
378,950
39
2,558,893
-
2,558,932
Shares
issued in satisfaction of bankruptcy allowable claims
-
-
262,432
26
14,381,233
-
14,381,259
Shares
issued in cashless exercise of warrants
-
-
54,449
5
( 5 )
-
-
Fair
market value of beneficial conversion feature and warrants issued with convertible notes payable instruments
-
-
-
-
5,075,449
-
5,075,449
Stock-based
compensation:
-
options
-
-
-
-
691,701
-
691,701
Net
loss
-
-
-
-
-
( 11,272,687 )
( 11,272,687 )
Balance
as of December 31, 2020
-
$ -
715,544
$ 72
$ 88,511,269
$ ( 89,842,833 )
$ ( 1,331,492 )
Balance
-
$ -
715,544
$ 72
$ 88,511,269
$ ( 89,842,833 )
$ ( 1,331,492 )
The
accompanying notes are an integral part of these consolidated financial statements.
F- 6
BIORESTORATIVE
THERAPIES, INC. AND SUBSIDIARY
CONSOLIDATED
STATEMENTS OF CASH FLOWS
December
31, 2021
December
31, 2020
Years
Ended
December
31, 2021
December
31, 2020
Cash
flows from operating activities:
Net
Loss
$ ( 44,303,295 )
$ ( 11,272,687 )
Adjustments
to reconcile net loss to net cash used in operating activities:
Amortization
of debt discount
1,133,539
1,278,105
Accretion
of interest expense
-
2,810,973
Depreciation
and amortization
89,108
121,384
Stock-based
compensation
23,108,955
691,701
Shares
issued in settlement of litigation
21,000
Loss
on extinguishment of note payables, net
16,180,056
658,152
Reorganization
items, net
-
527,455
Change
in fair value of derivative liabilities
-
2,141,069
Professional
fees paid for services related to bankruptcy proceedings
476,653
Non-cash
lease expense
116,044
30,580
Changes
in operating assets and liabilities:
Accounts
receivable
12,000
15,000
Prepaid
assets and other current assets
( 330,774 )
( 70,208 )
Accounts
payable
( 68,024 )
84,631
Accrued
interest, expenses and other current liabilities
812,673
542,927
Lease
liability
( 101,190 )
-
Net
cash used in operating activities
( 3,329,908 )
( 1,964,265 )
Cash
flows from investing activities:
Purchases
of equipment
( 30,658 )
-
Net
cash used in investing activities
( 30,658 )
-
Cash
flows from financing activities:
Proceeds
from sale of units in public offering, net
21,072,683
-
Proceeds
from notes payable
-
4,290,310
Proceeds
from PPP Loan
250,000
-
Proceeds
from DIP Financing
-
1,226,901
Financing
costs
-
( 500,000 )
Sales
of common stock and warrants for cash
-
10,000
Net
cash provided by financing activities
21,322,683
5,027,211
Net
increase in cash and cash equivalents
17,962,117
3,062,946
Cash
- beginning of year
3,064,610
1,664
Cash
- end of year
$ 21,026,727
$ 3,064,610
Supplemental
cash flow information:
Cash
paid for:
Interest
$ -
$ -
Income taxes
$ -
$ -
Non-cash
investing and financing activities:
Shares
issued in exchange for notes payable and accrued interest
$ 317,377
$ 2,558,932
Accrued expense exchanged for convertible
notes
$ 715,303
$ -
Shares
issued in satisfaction of bankruptcy allowable claims
$ -
$ 14,381,259
Bifurcated
embedded conversion options and warrants recorded as derivative liability and debt discount
$ 166,404
$ 2,377,818
Fair
market value of beneficial conversion feature and warrants issued convertible notes payable instruments
$ -
$ 5,075,449
Sale
of warrants recorded as derivative liabilities
$ -
$ 10,000
Convertible
debt and accrued interest exchanged for common
and preferred shares and warrants in public offering
$ 10,046,897
$ -
Accrued
DIP expenses exchanged for convertible notes
$ 698,901
$ -
The
accompanying notes are an integral part of these consolidated financial statements.
F- 7
BIORESTORATIVE
THERAPIES, INC. AND SUBSIDIARY
NOTES
TO CONSOLIDATED FINANCIAL STATEMENTS
Note
1 – ORGANIZATION AND BUSINESS OPERATIONS
Corporate
History
BioRestorative
Therapies, Inc. has one wholly-owned subsidiary, Stem Pearls, LLC (“Stem Pearls”). BioRestorative Therapies, Inc. and its
subsidiary are referred to collectively as “BRT” or the “Company”.
On
March 20, 2020 (the “Petition Date”), the Company filed a voluntary petition commencing a case (the “Chapter 11 Case”)
under chapter 11 of title 11 of the U.S. Code in the United States Bankruptcy Court for the Eastern District of New York (the “Bankruptcy
Court”).
On
August 7, 2020, the Company and Auctus Fund, LLC (“Auctus”), the Company’s largest unsecured creditor and a stockholder
as of the Petition Date, filed an Amended Joint Plan of Reorganization (the “Plan”) and on October 30, 2020, the Bankruptcy
Court entered an order (the “Confirmation Order”) confirming the Plan, as amended. Amendments to the Plan are reflected in
the Confirmation Order. On November 16, 2020 (the “Effective Date”), the Plan became effective. See Note 7 – Notes
Payable – Chapter 11 Reorganization.
On
October 27, 2021, the Company effected a 1-for-4,000 reverse stock split of its common stock.
The Company has retroactively applied the reverse stock split made effective on October 27, 2021 to share and per share amounts on the
consolidated financial statements for the years ended December 31, 2021 and 2020. As a result, the Company’s authorized shares
of common stock was reduced from 300,000,000,000
to 75,000,000 .
The Company’s authorized shares of preferred stock were not affected by the reverse stock split.
On
November 9, 2021, the Company completed a $ 23,000,000 underwritten public offering of units of securities pursuant to which an aggregate
of 2,300,000 shares of the Company’s common stock and warrants for the purchase of an aggregate of 2,645,000 shares of the Company’s
common stock were issued. The Company intends to use the net proceeds from the offering as follows: (i) undertaking of clinical trials
with respect to BRTX-100 and its related collection and delivery procedure; (ii) pre-clinical research and development with respect to
the Company’s ThermoStem Program; and (iii) for general corporate and working capital purposes. In connection with the public offering,
the Company’s common stock was listed on the Nasdaq Capital Market.
On
November 9, 2021, concurrently with the consummation of the public offering, the Company issued an aggregate of 313,780
shares of the Company’s common stock, 1,543,158
shares of the Company’s Series A preferred
stock and warrants for the purchase of an aggregate of 1,856,938
shares of the Company’s common stock in
exchange for convertible promissory notes in the aggregate principal amount of $ 10,046,897 ,
together with accrued interest thereon, and warrants for the purchase of an aggregate of 3,677,997
shares of the Company’s common stock. Such
indebtedness and warrants were exchanged at a price of $ 10.00
per unit of securities, consistent with the public
offering price of the Company’s units of common stock and warrants. As a result of the exchange, the Company recorded a loss on
extinguishment of notes payable, net of $ 16,180,056
on the statement of operations for the year
ended December 31, 2021. The newly issued warrants are exercisable for a period of five
years at an exercise price of $ 10.00
per share.
Business
Operations
BRT
develops therapeutic products and medical therapies using cell and tissue protocols, primarily involving adult stem cells. BRT’s
website is at www.biorestorative.com. BRT is currently developing a Disc/Spine Program referred to as “brtxDISC”. Its lead
cell therapy candidate, BRTX-100 , is a product formulated from autologous (or a person’s own) cultured mesenchymal stem
cells collected from the patient’s bone marrow. The product is intended to be used for the non-surgical treatment of painful lumbosacral
disc disorders or as a complimentary therapeutic to a surgical procedure. BRT is also engaging in research efforts with respect to a
platform technology utilizing brown adipose (fat) for therapeutic purposes to treat type 2 diabetes, obesity and other metabolic disorders
and has labeled this initiative its ThermoStem Program. Further, BRT has licensed a patented curved needle device that is a needle system
designed to deliver cells and/or other therapeutic products or material to the spine and discs or other potential sites.
F- 8
NOTE
2 – LIQUIDITY
The
accompanying consolidated financial statements have been prepared on the basis that the Company will continue as a going concern, which
contemplates realization of assets and the satisfaction of liabilities in the normal course of business. At December 31, 2021, the Company
had an accumulated deficit of $ 134,146,128
and working capital surplus of approximately
$ 21,000,000 .
For the year ended December 31, 2021, the Company had negative cash flows from operations of $ 3,329,908 .
The Company’s operating activities consume
the majority of its cash resources. The Company anticipates that it will continue to incur operating losses as it executes its development
plans for 2022, as well as other potential strategic and business development initiatives. In addition, the Company has had and expects
to have negative cash flows from operations, at least into the near future. The Company has previously funded, and plans to continue
funding, these losses primarily through additional infusions of cash from equity and debt financing.
The
Company believes the following has been able to mitigate the above factors with regards to its ability to continue as a going concern:
on November 9, 2021, the Company received net proceeds of approximately $ 21,073,000
from its public offering. As a result of
the above, and cash on hand of approximately $ 19,530,625
as of March 28, 2022, the Company
believes it has sufficient cash to fund operations for the twelve months subsequent to the filing date.
Current
funds on hand will not be sufficient to enable the Company to fully complete its development activities or attain profitable operations.
If the Company is unable to obtain such additional financing on a timely basis, the Company may have to curtail its development, marketing
and promotional activities, which would have a material adverse effect on the Company’s business, financial condition and results
of operations, and ultimately the Company could be forced to discontinue its operations and liquidate.
NOTE
3 – SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
Basis
of Presentation
The
accompanying audited consolidated financial statements have been prepared in accordance with GAAP. The summary of significant accounting
policies presented below is designed to assist in understanding the Company’s consolidated financial statements. Such consolidated
financial statements and accompanying notes are the representations of Company’s management, who is responsible for their integrity
and objectivity.
Principles
of Consolidation
These
consolidated financial statements include the accounts of the Company and its wholly-owned subsidiary Stem Pearls. Intercompany accounts
and transactions have been eliminated upon consolidation.
Chapter
11 Case
Chapter
11 Accounting
Weak
industry conditions in 2019 negatively impacted the Company’s results of operations and cash flows and may continue to do so in
the future. In order to decrease the Company’s indebtedness and maintain the Company’s liquidity levels sufficient to meet
its commitments, the Company undertook a number of actions, including minimizing capital expenditures and further reducing its recurring
operating expenses. The Company believed that, even after taking these actions, it would not have sufficient liquidity to satisfy its
debt service obligations and meet its other financial obligations. On March 20, 2020 (the “Petition Date”), the Company filed
a voluntary petition commencing a case under chapter 11 of title 11 of the U.S. Code in the United States Bankruptcy Court for the Eastern
District of New York. On August 7, 2020, the Company and Auctus Fund LLC (“Auctus”), the Company’s largest unsecured
creditor and a stockholder as of the Petition Date, filed an Amended Joint Plan of Reorganization (the “Plan”). On November
16, 2020 (the “Effective Date”), the Plan became effective.
F- 9
Reorganization
Items, Net
The
Company incurred costs after the Petition Date associated with the reorganization, primarily unamortized debt discount, exchange of common
stock and unsecured convertible notes for allowable claims and post-petition professional fees. In accordance with applicable guidance,
costs associated with the bankruptcy proceedings have been recorded as reorganization items, net within the accompanying consolidated
statements of operations for the year ended December 31, 2020. Reorganization items, net for the year ended December 31, 2020, was $ ( 4,081,245 ) ,
representing cash used in operating activities.
Reorganization
items, net for the year ended December 31, 2020, consisted of the following:
SCHEDULE
OF REORGANIZATION ITEMS, NET
Year
Ended December 31, 2020
Professional
fees
$ ( 476,652 )
Write-off
of derivative liability
4,375,231
Default
interest and penalties
( 864,125 )
Exchange
of common stock for allowable claims
( 3,047,417 )
Exchange
of secured convertible debt for allowable claims
( 1,488,172 )
Unamortized
debt discount on convertible notes
( 2,580,110 )
Total
reorganization items, net
$ ( 4,081,245 )
Use
of Estimates
The
preparation of the consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that
affect the reported amounts of assets, liabilities, equity-based transactions, revenue and expenses and disclosure of contingent liabilities
at the date of the consolidated financial statements. The Company bases its estimates and assumptions on historical experience, known
or expected trends and various other assumptions that it believes to be reasonable. As future events and their effects cannot be determined
with precision, actual results could differ from these estimates which may cause the Company’s future results to be affected.
The
Company believes the following critical accounting policies affect its more significant judgments and estimates used in the preparation
of the accompanying consolidated financial statements. Significant estimates include the carrying value of intangible assets, and deferred
tax asset and valuation allowance.
Concentrations
Financial
instruments that potentially subject the Company to concentrations of credit risk consist principally of cash deposits. Accounts at each
institution are insured by the Federal Deposit Insurance Corporation (“FDIC”) up to $ 250,000 . As of December 31, 2021 and
2020, the Company had approximately $ 20,777,000 and $ 2,815,000 , respectively, in excess of the FDIC insured limit.
The
royalties related to the Company’s sublicense comprised all of the Company’s revenue during the years ended December 31,
2021 and 2020. See “Revenue” below.
During
the year ended December 31, 2021, the Company did not have any debt financings.
During
the year ended December 31, 2020, 84 % of the Company’s debt financings were from one lender.
Revenue
The
Company accounts for revenue in accordance with ASC Topic 606, Revenue from Contracts with Customers.
F- 10
The
Company derives all of its revenue pursuant to a license agreement between the Company and a stem cell treatment company (“SCTC”)
entered into in January 2012, as amended in November 2015. Pursuant to the license agreement, the SCTC granted to the Company a license
to use certain intellectual property related to, among other things, stem cell disc procedures and the Company has granted to the SCTC
a sublicense to use, and the right to sublicense to third parties the right to use, in certain locations in the United States and the
Cayman Islands, certain of the licensed intellectual property. In consideration of the sublicenses, the SCTC has agreed to pay the Company
royalties on a per disc procedure basis.
The
Company’s contracted transaction price is allocated to each distinct performance obligation and recognized as revenue when, or
as, the performance obligation is satisfied. The Company’s contracts have a single performance obligation which is not separately
identifiable from other promises in the contracts and is, therefore, not distinct. The Company’s performance obligation is satisfied
upon the transfer of risk of loss to the customer. All sales have fixed pricing and there are currently no variable components included
in the Company’s revenue. The timing of the Company’s revenue recognition may differ from the timing of receiving royalty
payments. A receivable is recorded when revenue is recognized prior to receipt of a royalty payment and the Company has an unconditional
right to the royalty payment. Alternatively, when a royalty payment precedes the provision of the related services, the Company records
deferred revenue until the performance obligations are satisfied. During the years ended December 31, 2021 and 2020, the Company recognized
$ 46,000 and $ 77,000 , respectively, of revenue related to the Company’s sublicenses.
Practical
Expedients
As
part of ASC Topic 606, the Company has adopted several practical expedients including:
●
Significant
Financing Component – the Company does not adjust the promised amount of consideration for the effects of a significant financing
component since the Company expects, at contract inception, that the period between when the Company transfers a promised good or
service to the customer and when the customer pays for that good or service will be one year or less.
●
Unsatisfied
Performance Obligations – all performance obligations related to contracts with a duration for less than one year, the Company
has elected to apply the optional exemption provided in ASC Topic 60 and therefore, is not required to disclose the aggregate amount
of transaction price allocated to performance obligations that are unsatisfied or partially satisfied at the end of the reporting
period.
●
Right
to Invoice – the Company has a right to consideration from a customer in an amount that corresponds directly with the value
to the customer of the Company’s performance completed to date the Company may recognize revenue in the amount to which the
entity has a right to invoice.
Contract
Modifications
There
were no contract modifications during the years ended December 31, 2021 and 2020. Contract modifications are not routine in the performance
of the Company’s contracts.
Cash
The
Company considers all highly liquid investments with maturities of three months or less at the time of purchase to be cash equivalents.
There were no cash equivalents as of December 31, 2021 or 2020.
Accounts
Receivable
Accounts
receivable are reported at their outstanding unpaid principal balances net of allowances for doubtful accounts. The Company periodically
assesses its accounts and other receivables for collectability on a specific identification basis. The Company provides for allowances
for doubtful receivables based on management’s estimate of uncollectible amounts considering age, collection history, and any other
factors considered appropriate. The Company writes off accounts receivable against the allowance for doubtful accounts when a balance
is determined to be uncollectible. The Company did no t record an allowance for doubtful accounts as of December 31, 2021 and 2020, respectively.
F- 11
Property
and Equipment
Property
and equipment are recorded at cost. Depreciation is computed using straight-line method over the estimated useful lives of the related
assets, generally three to fifteen years . Expenditures that enhance the useful lives of the assets are capitalized and depreciated. Computer
equipment costs are capitalized, as incurred, and depreciated on a straight-line basis over a range of 3 – 5 years.
Leasehold
improvements are amortized over the lesser of (i) the useful life of the asset, or (ii) the remaining lease term. Maintenance and repairs
are charged to expense as incurred. The Company capitalizes cost attributable to the betterment of property and equipment when such betterment
extends the useful life of the assets. At the time of retirement or other disposition of property and equipment, the cost and accumulated
depreciation will be removed from the accounts and the resulting gain or loss, if any, will be reflected in operations.
Impairment
of Long-Lived Assets
The
Company reviews long-lived assets, including definite-lived intangible assets, for impairment whenever events or changes in circumstances
indicate that the carrying amount of such assets may not be recoverable. Recoverability of these assets is determined by comparing the
forecasted undiscounted net cash flows of the operation to which the assets relate to the carrying amount. If the operation is determined
to be unable to recover the carrying amount of its assets, then these assets are written down first, followed by other long-lived assets
of the operation to fair value. Fair value is determined based on discounted cash flows or appraised values, depending on the nature
of the assets. For the years ended December 31, 2021 and 2020, we
determined that there was no impairment charge for our intangible assets.
Intangible
Assets
The
Company records its intangible assets at cost in accordance with Accounting Standards Codification (“ASC”) 350, Intangibles
– Goodwill and Other. Definite lived intangible assets are amortized over their estimated useful life using the straight-line method,
which is determined by identifying the period over which the cash flows from the asset are expected to be generated.
Advertising
and Marketing Costs
The
Company expenses advertising and marketing costs as they are incurred. Advertising and marketing expenses were $ 12,290 and $ 28,281 for
the years ended December 31, 2021 and 2020, respectively, and are recorded in marketing and promotion on the statement of operations.
Fair
Value Measurements
As
defined in ASC 820, “Fair Value Measurements and Disclosures,” fair value is the price that would be received to sell an
asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date (exit price). The
Company utilizes market data or assumptions that market participants would use in pricing the asset or liability, including assumptions
about risk and the risks inherent in the inputs to the valuation technique. These inputs can be readily observable, market corroborated,
or generally unobservable. ASC 820 establishes a fair value hierarchy that prioritizes the inputs used to measure fair value. The hierarchy
gives the highest priority to unadjusted quoted prices in active markets for identical assets or liabilities (level 1 measurement) and
the lowest priority to unobservable inputs (level 3 measurement). This fair value measurement framework applies at both initial and subsequent
measurement.
Level
1:
Quoted
prices are available in active markets for identical assets or liabilities as of the reporting date. Active markets are those in
which transactions for the asset or liability occur in sufficient frequency and volume to provide pricing information on an ongoing
basis. Level 1 primarily consists of financial instruments such as exchange-traded derivatives, marketable securities and listed
equities.
F- 12
Level
2:
Pricing
inputs are other than quoted prices in active markets included in Level 1, which are either directly or indirectly observable as
of the reported date. Level 2 includes those financial instruments that are valued using models or other valuation methodologies.
These models are primarily industry-standard models that consider various assumptions, including quoted forward prices for commodities,
time value, volatility factors and current market and contractual prices for the underlying instruments, as well as other relevant
economic measures. Substantially all of these assumptions are observable in the marketplace throughout the full term of the instrument,
can be derived from observable data or are supported by observable levels at which transactions are executed in the marketplace.
Instruments in this category generally include non-exchange-traded derivatives such as commodity swaps, interest rate swaps, options
and collars.
Level
3:
Pricing
inputs include significant inputs that are generally less observable from objective sources. These inputs may be used with internally
developed methodologies that result in management’s best estimate of fair value.
See
Note 9 – Derivative Liabilities for additional details regarding the valuation technique and assumptions used in valuing Level
3 inputs.
Fair
Value of Financial Instruments
The
carrying value of cash, accounts receivable, accounts payable and accrued expenses, and other current liabilities approximate their fair
values based on the short-term maturity of these instruments. The carrying amount of notes approximate the estimated fair value for these
financial instruments as management believes that such notes constitute substantially all of the Company’s debt and interest payable
on the notes approximates the Company’s incremental borrowing rate.
Net
Loss per Common Share
Net
loss per share is computed by dividing net loss by the weighted average number of shares of common stock outstanding during the year.
All vested outstanding options and warrants are considered potential common stock. The dilutive effect, if any, of stock options and
warrants are calculated using the treasury stock method. All outstanding convertible notes are considered common stock at the beginning
of the period or at the time of issuance, if later, pursuant to the if-converted method. Since the effect of common stock equivalents
is anti-dilutive with respect to losses, options, warrants, and convertible notes have been excluded from the Company’s computation
of net loss per common share for the years ended December 31, 2021 and 2020.
The
following table summarizes the securities that were excluded from the diluted per share calculation because the effect of including these
potential shares was antidilutive due to the Company’s net loss position even though the exercise price could be less than the
average market price of the common shares:
SCHEDULE
OF WEIGHTED AVERAGE DILUTIVE COMMON SHARES
Year
Ended December 31,
2021
2020
Options
839,639
1,215
Warrants
4,739,871
3,750,597
Unvested
RSUs
293,479
-
Convertible
notes
-
109,077 (1)
Total
5,872,989
3,860,889
(1)
As
of December 31, 2020 all of the convertible notes had variable conversion prices and the shares issuable were estimated based on
the market conditions. Pursuant to the note agreements, there were 13,073,094 shares of common stock reserved for future note conversions
as of December 31, 2020.
Stock-Based
Compensation
The
Company applies the provisions of ASC 718, Compensation—Stock Compensation (“ASC 718”), which requires the measurement
and recognition of compensation expense for all stock-based awards made to employees, including employee stock options, in the statements
of operations.
F- 13
For
stock options issued to employees and members of the board of directors for their services, the Company estimates the grant date fair
value of each option using the Black-Scholes option pricing model. The use of the Black-Scholes option pricing model requires management
to make assumptions with respect to the expected term of the option, the expected volatility of the common stock consistent with the
expected life of the option, risk-free interest rates and expected dividend yields of the common stock. For awards subject to service-based
vesting conditions, including those with a graded vesting schedule, the Company recognizes stock-based compensation expense equal to
the grant date fair value of stock options on a straight-line basis over the requisite service period, which is generally the vesting
term. Forfeitures are recorded as they are incurred as opposed to being estimated at the time of grant and revised.
Pursuant
to ASU 2018-07 Compensation – Stock Compensation (Topic 718): Improvements to Nonemployee Share-Based Payment Accounting, the Company
accounts for stock options issued to non-employees for their services in accordance ASC 718. The Company uses valuation methods and assumptions
to value the stock options that are in line with the process for valuing employee stock options noted above.
Convertible
Instruments
The
Company bifurcates conversion options from their host instruments and accounts for them as free standing derivative financial instruments
according to certain criteria. The criteria include circumstances in which (a) the economic characteristics and risks of the embedded
derivative instrument are not clearly and closely related to the economic characteristics and risks of the host contract, (b) the hybrid
instrument that embodies both the embedded derivative instrument and the host contract is not re-measured at fair value under otherwise
applicable generally accepted accounting principles with changes in fair value reported in earnings as they occur and (c) a separate
instrument with the same terms as the embedded derivative instrument would be considered a derivative instrument. An exception to this
rule is when the host instrument is deemed to be conventional.
When
the Company has determined that the embedded conversion options should not be bifurcated from their host instruments, the Company records,
when necessary, discounts to convertible notes for the intrinsic value of conversion options embedded in debt instruments (the beneficial
conversion feature) based upon the differences between the fair value of the underlying common stock at the commitment date of the note
transaction and the effective conversion price embedded in the note. Debt discounts under these arrangements are amortized over the term
of the related debt to their stated date of redemption.
Income
Taxes
Deferred
tax assets and liabilities are recognized for the future tax consequences attributable to differences between the consolidated financial
statement carrying amounts of existing assets and liabilities and their respective tax bases. Deferred tax assets, including tax loss
and credit carry forwards, and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which
those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in
tax rates is recognized in income in the period that includes the enactment date.
The
Company utilizes ASC 740, “Income Taxes,” which requires the recognition of deferred tax assets and liabilities for the expected
future tax consequences of events that have been included in the consolidated financial statements or tax returns. The Company accounts
for income taxes using the asset and liability method to compute the differences between the tax basis of assets and liabilities and
the related financial amounts, using currently enacted tax rates. A valuation allowance is recorded when it is “more likely-than-not”
that a deferred tax assets will not be realized.
For
uncertain tax positions that meet a “more likely than not” threshold, the Company recognizes the benefit of uncertain tax
positions in the consolidated financial statements. The Company’s practice is to recognize interest and penalties, if any, related
to uncertain tax positions in income tax expense in the consolidated statements of operations.
F- 14
Derivative
Financial Instruments
The
Company evaluates its convertible instruments to determine if those contracts or embedded components of those contracts qualify as derivative
financial instruments to be separately accounted for in accordance with Topic 815 of the Financial Accounting Standards Board (“FASB”)
ASC. The accounting treatment of derivative financial instruments requires that the Company record embedded conversion options (“ECOs”)
and any related freestanding instruments at their fair values as of the inception date of the agreement and at fair value as of each
subsequent balance sheet date. Any change in fair value is recorded as non-operating, non-cash income or expense for each reporting period
at each balance sheet date. Conversion options are recorded as a discount to the host instrument and are amortized as amortization of
debt discount on the consolidated financial statements over the life of the underlying instrument. The Company reassesses the classification
of its derivative instruments at each balance sheet date. If the classification changes as a result of events during the period, the
contract is reclassified as of the date of the event that caused the reclassification.
The
Multinomial Lattice Model and Black-Scholes Model were used to estimate the fair value of the ECOs of convertible notes payable, the
warrants, and stock options that are classified as derivative liabilities on the consolidated balance sheets. The models include subjective
input assumptions that can materially affect the fair value estimates. The expected volatility is estimated based on the actual volatility
during the most recent historical period of time equal to the weighted average life of the instruments.
Sequencing
Policy
Under
ASC 815-40-35 (“ASC 815”), the Company has adopted a sequencing policy, whereby, in the event that reclassification of contracts
from equity to assets or liabilities is necessary pursuant to ASC 815 due to the Company’s inability to demonstrate it has sufficient
authorized shares as a result of certain securities with a potentially indeterminable number of shares, shares will be allocated on the
basis of the earliest issuance date of potentially dilutive instruments, with the earliest grants receiving the first allocation of shares.
Pursuant to ASC 815, issuances of securities to the Company’s employees and directors, or to compensate grantees in a share-based
payment arrangement, are not subject to the sequencing policy.
Leases
A
lease is defined as a contract that conveys the right to control the use of identified property, plant or equipment for a period of time
in exchange for consideration. On January 1, 2019, the Company adopted ASC 842 and it primarily affected the accounting treatment for
operating lease agreements in which the Company is the lessee.
In
accordance with ASC 842, Leases , the Company recognized a right-of-use (“ROU”) asset and corresponding lease liability
on its balance sheets for its office space lease agreement. See Note 12 - Leases for further discussion, including the impact on the
Company’s financial statements and related disclosures.
ROU
assets include any prepaid lease payments and exclude any lease incentives and initial direct costs incurred. Lease expense for minimum
lease payments is recognized on a straight-line basis over the lease term. The lease terms may include options to extend or terminate
the lease if it is reasonably certain that the Company will exercise that option.
Leases
in which the Company is the lessee are comprised of office rental. All of the leases are classified as operating leases. The Company
has a lease agreement for office space with a remaining term of three years as of December 31, 2021.
NOTE
4 – PROPERTY AND EQUIPMENT
Property
and equipment consists of the following:
SCHEDULE
OF PROPERTY PLANT AND EQUIPMENT
December
31, 2021
December
31, 2020
Medical
equipment
$ 352,133
$ 352,133
Furniture
and fixtures
123,487
123,487
Computer
software and equipment
107,648
107,648
Office
equipment
12,979
12,979
Manufacturing
equipment
30,712
-
Leasehold
improvements
304,661
304,661
931,620
900,908
Less:
accumulated depreciation
( 893,627 )
( 878,994 )
Property
and equipment, net
$ 37,993
$ 21,914
Total
depreciation expense for the years ended December 31, 2021 and 2020 was $ 14,633 and $ 46,488 , respectively. Depreciation expense is reflected
in general and administrative expenses and research and development expenses in the consolidated statement of operations.
F- 15
NOTE
5 – INTANGIBLE ASSETS
The
Company is a party to a license agreement with the SCTC (as amended) (the “SCTC Agreement”). Pursuant to the SCTC Agreement,
the Company obtained, among other things, a worldwide, exclusive, royalty-bearing license from the SCTC to utilize or sublicense a certain
medical device patent for the administration of specific cells and/or cell products to the disc and/or spine (and other parts of the
body) and a worldwide (excluding Asia and Argentina), exclusive, royalty-bearing license to utilize or sublicense a certain method for
culturing cells. Pursuant to the license agreement with the SCTC, certain performance milestones (or payouts in lieu of performance milestones)
had to be satisfied in order for the Company to maintain its exclusive rights with regard to the disc/spine technology. The Company did
not timely satisfy the third of these performance milestones (which needed to be satisfied by February 2022). Accordingly, such rights
are currently non-exclusive. The Company and the SCTC are currently negotiating the terms of a possible reinstatement of the exclusive
nature of the license. In February 2017, the Company received authorization from the Food and Drug Administration (the “FDA”)
to proceed with a Phase 2 clinical trial. In February 2022, the Company announced that the United States Patent and Trademark Office
has issued a notice of allowance for a patent application relating to the Company’s BRTX-100 clinical program. This patent was
issued in March 2022.
Intangible
assets consist of the following:
SCHEDULE OF INTANGIBLE ASSETS BY MAJOR CLASS
Patents
and Trademarks
Licenses
Accumulated
Amortization
Total
Balance
as of January 1, 2020
$ 3,676
$ 1,301,500
$ ( 566,012 )
$ 739,164
Amortization
expense
-
-
( 74,896 )
( 74,896 )
Balance
as of December 31, 2020
3,676
1,301,500
( 640,908 )
664,268
Amortization
expense
-
-
( 74,528 )
( 74,528 )
Balance
as of December 31, 2021
$ 3,676
$ 1,301,500
$ ( 715,436 )
$ 589,740
Weighted
average remaining amortization period at December 31, 2021 (in years)
-
7.9
Amortization
of intangible assets consists of the following:
SCHEDULE OF FINITE LIVED INTANGIBLE ASSETS AMORTIZATION EXPENSES
Patents
and Trademarks
Licenses
Accumulated
Amortization
Balance
as of January 1, 2020
$ 3,312
$ 562,700
$ 566,012
Amortization
expense
364
74,532
74,896
Balance
as of December 31, 2020
3,676
637,232
640,908
Amortization
expense
-
74,528
74,528
Balance
as of December 31, 2021
$ 3,676
$ 711,760
$ 715,436
F- 16
NOTE
6 – ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES
Accrued
expenses and other current liabilities consist of:
SCHEDULE OF ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES
December
31, 2021
December
31, 2020
Accrued
payroll
$ 28,370
$ -
Accrued
research and development expenses
29,672
-
Accrued
general and administrative expenses
76,928
109,968
Accrued
DIP and Plan costs related to DIP Funding and Plan
-
657,598 (1)
Total
accrued expenses
$ 134,970
$ 767,566
(1) Amount
represents DIP and Plan costs associated with the Auctus DIP Funding and the Plan. As of December 31, 2020, these amounts were note finalized
and, as a result, were recorded as accrued expenses in the consolidated balance sheets. Subsequent to December 31, 2020, upon finalization,
the amount representing the costs associated with the DIP Funding and the Plan was converted into a Secured Convertible Note and subsequently,
in connection with the Company’s public offering, into shares of preferred and common stock and warrants to purchase common stock.
Note
7 – NOTES PAYABLE & CHAPTER 11 REORGANIZATION
A
summary of the notes payable activity during the years ended December 31, 2021 and 2020 is presented below:
SCHEDULE OF NOTES PAYABLE ACTIVITY
Related
Party Notes
Convertible
Notes
Other
Notes
Debt
Discount
Total
Outstanding,
December 31, 2019
$ 1,285,000
$ 6,768,326
$ 340,000
$ ( 1,247,420 )
$ 7,145,906
Issuances
353,762
3,936,548
-
-
4,290,310
Third-party
purchases
( 287,041 )
287,041
-
-
-
Exchanges
for equity
-
( 813,393 )
-
253,654
( 559,739 )
Exchanged
for equity pursuant to Chapter 11 Plan
( 998,139 )
( 3,592,395 )
( 340,000 )
-
( 4,930,534 )
Secured
and Unsecured convertible notes payable exchanged pursuant to Chapter 11 Plan, net
( 353,582 )
3,050,975
-
-
2,697,393
Recognition
of debt discount
-
-
-
( 8,534,245 )
( 8,534,245 )
Accretion
of interest expense
-
-
-
2,886,036
2,886,036
Amortization
of debt discount
-
-
-
1,275,106
1,275,106
Outstanding,
December 31, 2020
-
9,637,102
-
( 5,366,869 )
4,270,233
Issuances
-
715,303
250,000
( 182,805 )
782,498
Exchanges
for equity
-
( 10,352,405 )
-
4,416,135
( 5,936,270 )
Amortization
of debt discount
-
-
1,133,539
1,133,539
Outstanding,
December 31, 2021
$ -
$ -
$ 250,000
$ -
$ 250,000
Chapter
11 Reorganization
On
March 20, 2020, the Company filed a voluntary petition commencing a case under chapter 11 of title 11 of the U.S. Code in the United
States Bankruptcy Court for the Eastern District of New York. On August 7, 2020, the Company and Auctus, the Company’s largest
unsecured creditor and a stockholder as of the Petition Date, filed an Amended Joint Plan of Reorganization (the “Plan”).
Pursuant to the Bankruptcy, for any outstanding principal and interest at the date of the Company’s Chapter 11 petition (except
for creditors who provided additional debt financing in connection with the Bankruptcy), 100 shares of the Company’s common stock
were issued for each dollar of allowed claim, with such shares subject to leak-out restrictions prohibiting the holder from selling,
without the consent of the Company, more than 33% of the issued shares during each of the three initial 30 day periods following the
Effective Date . As a result of the Chapter 11 petition, the conversion rights for the then outstanding notes were rescinded and were
subject to the conversion rights outlined above.
F- 17
On
October 30, 2020, the Bankruptcy Court entered an order (the “Confirmation Order”) confirming the Plan, as amended. Amendments
to the Plan are reflected in the Confirmation Order. On November 16, 2020 (the “Effective Date”), the Plan became effective.
The
material features of the Plan, as amended and confirmed by the Confirmation Order, are as follows:
i.
Treatment
of the financing to the Company by Auctus of up to $ 7,000,000 which Auctus has provided or committed to provide consisting of the
debtor-in-possession loans made to the Company by Auctus during the Chapter 11 Case (the “DIP Funding”) and additional
funding as described below.
ii.
Auctus
has provided $ 3,500,000 in funding to the Company (the “Initial Auctus Funding”) and is to provide, subject to certain
conditions, additional funding to the Company, as needed, in an amount equal to $ 3,500,000 , less the sum of the debtor-in-possession
loans made to the Company by Auctus during the Chapter 11 Case (inclusive of accrued interest) (approximately $ 1,227,000 as of the
Effective Date) and the costs incurred by Auctus as the debtor-in-possession lender (the “DIP Costs”). The DIP Costs
and the additional Plan costs in the aggregate totaled $ 650,493 , of which $ 500,000 and $ 150,493 were recorded in debt discount and
accrued expenses, respectively, on the consolidated balance sheets. On September 27, 2021, these amounts were converted into secured
convertible promissory notes totaling an aggregate principal amount of $ 715,542 , 83,201 Class A Warrants (as described below) and
41,601 Class B Warrants (as described below). In addition, four other persons and entitles (collectively, the “Other Lenders”)
who held allowed general unsecured claims provided funding to the Company in the aggregate amount of approximately $ 348,000 (the
“Other Funding” and together with the Initial Auctus Funding, the “Funding”). In consideration of the Funding,
the Company issued the following:
a.
Secured
convertible notes of the Company (each, a “Secured Convertible Note”) in the principal amount equal to the Funding; the
payment of the Secured Convertible Notes was secured by the grant of a security interest in substantially all of the Company’s
assets; the Secured Convertible Notes had the following features:
●
Maturity
date of three years following the Effective Date;
●
Interest
at the rate of 7 % per annum;
●
The
right of the holder to convert the indebtedness into shares of common stock of the Company at a price equal to the volume weighted
average price for the common stock over the five trading days immediately preceding the conversion; and
●
Mandatory
conversion of all indebtedness at such time as the common stock is listed on the Nasdaq Capital Market or another senior exchange
on the same terms as provided to investors in connection with a public offering undertaken in connection with such listing;
b.
Warrants
(each, a “Class A Warrant”) to purchase a number of shares of common stock equal to the amount of the Funding provided
divided by $ 2.00 (a total of 1,750,000 Class A Warrants in consideration of the Initial Auctus Funding and a total of approximately
174,250 Class A Warrants in the aggregate in consideration of the Other Funding), such Class A Warrants having an exercise price
of $ 2.00 per share; and
c.
Warrants
(each, a “Class B Warrant” and together with the Class A Warrants, the “Plan Warrants”) to purchase a number
of shares of common stock equal to the Funding provided divided by $ 4.00 (a total of 875,000 Class B Warrants in consideration of
the Initial Auctus Funding and a total of approximately 87,125 Class B Warrants in the aggregate in consideration of the Other Funding),
such Class B Warrants having an exercise price of $ 4.00 per share.
F- 18
iii.
The
obligation to Auctus with respect to the DIP Funding was exchanged for the following:
a.
A
Secured Convertible Note in the principal amount of approximately $ 1,349,591 ( 110 % of the DIP Funding) with a maturity date of November
16, 2023;
b.
A
Class A Warrant to purchase 613,451 shares of common stock; and
c.
A
Class B Warrant to purchase 306,725 shares of common stock (as to which 181,571 shares of common stock have been exercised on a net
exercise basis, pursuant to the terms of the Class B Warrant, with respect to the issuance of 167,781 shares of common stock, of
which 54,449 and 113,332 were issued during 2020 and 2021, respectively).
The
claim arising from the secured promissory notes of the Company, dated February 20, 2020, and February 26, 2020, in the original principal
amounts of $ 320,200 and $ 33,562 , respectively, issued to John Desmarais (“Desmarais”) (collectively, the “Desmarais
Notes”), was treated as an allowed secured claim in the aggregate amount of $ 490,699 and was exchanged for a Secured Convertible
Note in such amount.
iv.
The
claim arising from the promissory note issued in June 2016 by the Company to Desmarais in the original principal amount of $ 175,000
was treated as an allowed general unsecured claim in the amount of $ 245,192 and was satisfied and exchanged for 6,130 shares of common
stock.
v.
The
claim arising from the promissory note issued in June 2016 by the Company to Tuxis Trust, an entity related to Desmarais, in the
original principal amount of $ 500,000 was treated as follows:
a.
$ 444,534
was treated as an allowed general unsecured claim in such amount and exchanged for 11,113 shares of common stock; and
b.
$ 309,301
was treated as an allowed secured claim in such amount and exchanged for a Secured Convertible Note in such amount with a maturity
date of November 16, 2023.
vi.
Holders
of allowed general unsecured claims (other than Auctus and the Other Lenders) received an aggregate of 262,432 shares of common stock
where were valued at the fair market value of the stock at issuance date of $ 14,381,259 with an associated loss of $ 3,883,991 recognized
in Reorganization Items, net on the accompanying consolidated statement of operations in exchange for approximately $ 10,497,268 outstanding
accounts payable and convertible debt (including accrued interest), with such shares being subject to a leak-out restriction prohibiting
each holder from selling, without consent of the Company, more than 33% of its shares during each of the three initial 30 day periods
following the Effective Date .
vii.
Auctus
and the Other Lenders were issued, in respect of their allowed general unsecured claims ($ 3,261,819 in the case of Auctus and an
aggregate of approximately $ 382,400 in the case of the Other Lenders), a convertible promissory note of the Company (each, an “Unsecured
Convertible Note”) in the allowed amount of the claim, which Unsecured Convertible Notes had the following material features:
a.
Maturity
date of three years from the Effective Date;
b.
Interest
at the rate of 5 % per annum;
c.
The
right of the holder to convert the indebtedness into shares of common stock at a price equal to the volume weighted average for the
common stock over the five trading days immediately preceding the conversion;
F- 19
d.
Mandatory
conversion of all outstanding indebtedness at such time as the common stock listed on the Nasdaq Capital Market or another senior
exchange on the same terms as provided to investors in connection with a public offering undertaken in connection with such listing;
and
e.
A
leak-out restriction prohibiting each holder from selling, without the consent of the Company, more than 16.6 % of the underlying
shares received upon conversion during each of the six initial 30-day periods following the Effective Date.
viii.
The
issuance of (a) the shares of common stock and the Unsecured Convertible Notes to the holders of allowed general unsecured claims
and (b) the Secured Convertible Notes and Plan Warrants to Auctus in exchange for the DIP Funding and any common stock into which
those Secured Convertible Notes and those Plan Warrants may be converted is exempt from the registration requirements of the Securities
Act of 1933, as amended, pursuant to the Bankruptcy Code Section 1145. Such securities shall be freely transferrable subject to Section
1145(b)(i) of the Bankruptcy Code.
Pursuant
to the Plan, on the Effective Date, the Company filed a Certificate of Amendment to its Certificate of Incorporation pursuant to which,
among other things, the number of shares of common stock authorized to be issued by the Company was increased to 300,000,000,000 and
the par value of the shares of common stock was reduced to $ 0.0001 per share. On October 27, 2021, in connection with the Company’s
1-for-4,000 reverse split (see Note 1 – Organization and Business Operations), the Company reduced the number of shares of common
stock authorized to be issued from 300,000,000,000 to 75,000,000 .
See
“Conversion, Exchanges and Other” for a discussion of the exchange and conversion of the convertible notes and warrants
issued pursuant to the Plan.
The
Company recorded $ 681,763
and $ 368,810
of interest expense related to notes payable
and convertible note payable for the years ended December 31, 2021 and 2020, respectively.
Convertible
Notes
Issuances
During
the year ended December 31, 2020, the Company issued to a certain lender a convertible note payable in the principal amount of $ 88,000
for aggregate cash proceeds of $ 85,000 . The difference was recorded as a debt discount and will be amortized over the term of the note.
The convertible note bore interest at 10 % per annum payable at maturity with an original maturity date of January 31, 2021 . The outstanding
principal and accrued interest was convertible after 180 days at a conversion price of 61 % of the lowest daily volume weighted average
price over the twenty days prior to the conversion date. The convertible note contained a cross-default provision and was in default
at issuance. As a result, the convertible note bore a default interest of 22 % per annum. Pursuant to the Bankruptcy (see Note 7 –
Notes Payable & Chapter 11 Reorganization), the convertible note, in the aggregate amount of $ 155,000 (including principal and accrued
interest), was exchanged for 3,875 shares of the Company’s common stock. See below within Note 9- Derivative Liabilities for additional
details regarding the ECO of the convertible note.
On
November 16, 2020, in connection with the Plan, the Company issued to Auctus and the Other Lenders (see Note 7 – Notes Payable
& Chapter 11 Reorganization) Secured Convertible Notes in the aggregate principal amount of $ 3,848,548 that bore interest at 7 % per
annum with a maturity date of November 16, 2023 . The outstanding principal and interest was convertible at the holders’ discretion
at any time at a conversion price equal to the average five-day daily volume weighted average price prior to the conversion date. At
the date of issuance, this resulted in a beneficial conversion feature in the aggregate of $ 124,147 and was being amortized over the
term of the respective Secured Convertible Notes. In connection with these Secured Convertible Notes, the Company issued five-year warrants
to purchase an aggregate of 3,806,587 shares of the Company’s common stock at exercise prices ranging between $ 2.00 and $ 4.00 per
share. The aggregate grant date fair value of the warrants was $ 152,263,470 . As a result, the Company recorded a debt discount related
to the fair market value of beneficial conversion feature and warrants issued of $ 5,075,449 was being amortized over the term of the
respective Secured Convertible Notes.
F- 20
See
“Conversion, Exchanges and Other” for a discussion of the exchange and conversion of the convertible notes and warrants
issued pursuant to the Plan.
Conversions,
Exchanges and Other
During
the year ended December 31, 2020, the Company and certain lenders exchanged convertible notes with bifurcated ECOs with an aggregate
net carrying amount of $ 1,580,587 (including an aggregate of $ 523,516 of principal less debt discount of $ 234,301 , $ 126,043 of accrued
interest and $ 1,165,329 related to the separated ECOs accounted for as derivative liabilities) for an aggregate of 378,950 shares of
the Company’s common stock at conversion prices ranging from $ 0.40 and $ 40.00 per share. In addition, prior to the Petition Date,
certain lenders intended to exchange outstanding debt (inclusive of accrued interest) for shares of the Company’s common stock;
however, the Company did not have sufficient shares authorized or reserved to effect the exchanges.
On
November 16, 2020, pursuant to the Plan, Auctus and the Other Lenders exchanged various convertible notes with an aggregate principal
amount of $ 2,742,895 for unsecured convertible promissory notes with an aggregate principal amount of $ 3,644,274 which bore interest
at 5 % per annum with a maturity date of November 16, 2023 . In connection with the exchanges, the Company recognized a loss on extinguishment
of debt of $ 1,488,172 recorded in reorganization items, net in the consolidated statements of operations.
During
the year ended December 31, 2021, the Company and certain lenders converted unsecured convertible notes with and aggregate amount of
$ 317,377
(including $ 6,314
of accrued interest) for an aggregate amount
of 8,069
shares of the Company’s common stock at
a conversion price of $ 40.00
per share.
During
October 2021, the Company entered into an Exchange Agreement (the “Auctus Agreement”) with Auctus to exchange outstanding
convertible promissory notes in the aggregate principal amount of $ 8,826,952 , $ 596,446 in accrued interest, and outstanding warrants
for the purchase of an aggregate of 3,441,586 shares of the Company’s common stock for units of common stock and warrants that
were issued by the Company in its underwritten public offering (the “Public Offering”), except that, to the extent the issuance
of common stock pursuant to the Auctus Agreement would result in Auctus being the beneficial owner of more than 4.99 % of the Company’s
outstanding common stock, the Company would instead issue to Auctus shares of Series A preferred stock. On November 9, 2021, in connection
with the Public Offering, the Company issued to Auctus 133,422 shares of the Company’s common stock, 1,543,158 shares of the Company’s
Series A preferred stock, and warrants for the purchase of 1,676,580 shares of the Company’s common stock. In connection with the
exchanges, the Company recognized a loss on extinguishment of debt of $ 6,293,317 recorded in the consolidated statements of operations.
In
addition, during October 2021, the Company entered into Exchange Agreements with the Other Lenders with regard to the exchange by the
Other Lenders of outstanding convertible promissory notes in the aggregate principal amount of $ 419,945 ,
$ 25,115
in accrued interest, and warrants to purchase
of an aggregate of 236,411
shares of the Company’s common stock for
the units that were to be issued in the Public Offering. On November 9, 2021, in connection with the Public Offering, the Company issued
the Other Lenders an aggregate of 94,951
shares of the Company’s common stock
and warrants for the purchase of an aggregate of 94,942
shares of common stock.
Effective
November 9, 2021, pursuant to the terms of their convertible notes, the Company issued to Desmarais and Tuxis Trust an aggregate
of 85,416
shares of common stock, with a fair value of
$ 10.00
per share, and warrants for the purchase of an
aggregate of 85,416
shares of common stock, upon the conversion of
an aggregate principal and accrued interest amount of $ 800,000
and $ 54,159 ,
respectively, upon the Company’s listing on the Nasdaq Capital Market.
Debtor-in-Possession
Financing
During
the year ended December 31, 2020, and subsequent to the Petition Date, in connection with the Chapter 11 Case, the Company received debtor-in-possession
loans of $ 1,189,413 in the aggregate from Auctus.
F- 21
The
proceeds from the DIP Funding were used (a) for working capital and other general purposes of the Company; (b) United States Trustee
fees; (c) Bankruptcy Court approved professional fees and other administrative expenses arising in the Chapter 11 Case; and (d) interest,
fees, costs and expenses incurred in connection with the DIP Funding, including professional fees.
Pursuant
to the Plan, the obligation to Auctus with respect to the DIP Funding was exchanged for two Secured Convertible Notes (see Note 7 –
Notes Payable & Chapter 11 Reorganization) for an aggregate principal amount of $ 1,349,591 which bore interest at 7 % per annum with
a maturity date of November 16, 2023 . In connection with the Secured Convertible Notes, Auctus received warrants to purchase an aggregate
of 920,176 shares of Company’s common stock with exercise prices ranging between $ 2.00 and $ 4.00 per share.
On
September 27, 2021, pursuant to the Plan, for 110 % of the DIP Costs, the Company issued to Auctus secured two convertible promissory
notes in the aggregate principal amount of $ 183,043 , with a maturity date of November 16, 2023 . The notes bore interest at 7 % per annum
which was payable on maturity. Amounts due under the notes were convertible into shares of the Company’s common stock at a conversion
price equal to the average five daily volume weighted average price on the latest day prior to the conversion date. In connection with
the notes, the Company granted to Auctus Class A Warrants to purchase up to 83,201 shares of the Company’s common stock at an exercise
price of $ 2.00 per share. The Class A Warrants were scheduled to expire on November 16, 2025 . In addition, in connection with the notes,
the Company granted to Auctus Class B Warrants to purchase up to 41,601 shares of the Company’s common stock at an exercise price
of $ 4.00 per share. The Class B Warrants were scheduled to expire on November 16, 2025 . The warrants had an aggregate grant date fair
value of $ 152,300 which was recorded as a debt discount and was being amortized over the term of the notes. In addition, the notes contained
a beneficial conversion feature with a relative fair value of $ 14,103 which was recorded as a debt discount and was being amortized over
the term of the notes. On November 9, 2021, the principal amount of and accrued interest on the notes was exchanged pursuant to the Auctus
Agreement. As of December 31, 2021, there was no principal outstanding.
On
September 27, 2021, pursuant to the Plan, for 110 % of the Plan Costs, the Company issued to Auctus a secured convertible promissory note
in the principal amount of $ 532,499 , with a maturity date of November 16, 2023 . The note bore interest at 7 % per annum which was payable
on maturity. Amounts due under the note were convertible into shares of the Company’s common stock at a conversion price equal
to the average five daily volume weighted average price on the latest day prior to the conversion date. On November 9, 2021, the principal
amount of and accrued interest on the note was exchanged pursuant to the Auctus Agreement. As of December 31, 2021, there was no principal
outstanding.
Public
Offering Exchange
On
November 9, 2021, in connection with the public offering all of the above outstanding convertible notes, associated accrued interest
and warrants held by Auctus, as well as outstanding convertible notes in the aggregate principal amount of $ 1,219,945 , associated accrued
interest and warrants for the purchase of an aggregate of 236,411 shares of common stock to other investors, were exchanged for an aggregate
amount of 1,856,938 units of common stock and warrants (of the type issued pursuant to the Company’s public offering) (except that
Auctus received shares of Series A preferred stock in lieu of common stock with regard to a portion of the exchanged amount, as described
in Note 8 – Stockholders’ Equity (Deficit)), ultimately resulting in the issuance of an aggregate of approximately 1,543,000
shares of Series A preferred stock, approximately 314,000 shares of common stock and approximately 1,857,000 warrants (see
Note 8 – Stockholders’ Equity (Deficit)).
Other
Loans
On
March 14, 2021, under the U.S. Small Business Administration’s Paycheck Protection Program, the Company entered into a note payable
with a financial institution for $ 250,000
at an interest rate of 1 %
per annum and a maturity date of March 14, 2026 . Pursuant
to the note, principal and interest payments are deferred for ten months. At that time the Company may apply for loan forgiveness. If
the Company does not apply for loan forgiveness, or if the loan forgiveness is denied, the Company will be required to make monthly payments
of $ 5,100
starting
on January 14, 2022. As of December 31, 2021, the Company has not applied for loan forgiveness. All remaining unpaid principal and interest
is due and payable at the maturity date. At December 31, 2021, $ 250,000
was
outstanding . The Company applied for loan forgiveness
on a timely basis, and subsequent to December 31, 2021, the total amount of $ 250,000 was forgiven (see Note 13).
F- 22
Future
minimum payments under the above notes payable following the year ended December 31, 2021 are as follows:
SCHEDULE
OF FUTURE MINIMUM PAYMENTS OF NOTES PAYABLE
2022
$ 58,970
2023
59,562
2024
60,161
Thereafter
71,307
Total
future minimum payments
250,000
Less:
discount
-
Less:payable
250,000
Less:
current
( 58,970 )
Notes
payable, non-current
$ 191,030
Note
8 - STOCKHOLDERS’ EQUITY (DEFICIT)
Authorized
Capital and Reverse Split
On
November 16, 2020, pursuant to the Chapter 11 plan of reorganization, the Company filed a Certificate of Amendment to its Certificate
of Incorporation pursuant to which, among other things, the number of shares of common stock authorized to be issued by the Company was
increased to 300,000,000,000 and the par value of the shares of its common stock was reduced to $ 0.0001 per share.
On
November 16, 2021, in connection with the Company’s October 27, 2021 1-for-4,000 reverse split (see Note 1 – Organization
and Business Operations), the Company reduced the number of shares of common stock authorized to be issued from 300,000,000,000 to 75,000,000 .
Series
A Preferred
On
November 8, 2021, in connection with with the Company’s public offering, the Company’s Board of Directors adopted a resolution
allowing for the authorization of and issuance of 1,543,458 shares of the Company’s Preferred Stock, $ .01 par value per share,
designated as Series A Preferred Stock (“Series A”). The Series A has a liquidation preference of $ 0.001 per share.
Dividends
Series
A holders shall be entitled to receive, when and as declared by the Board of Directors, dividends on a pari passu basis with the the
holders of the shares of the Company’s common stock based upon the number of shares of common stock into which the Series A is
then convertible.
Voting
Rights
Series
A holders shall be entitled to vote on all matters presented to the stockholders of the Company and shall be entitled to such number
of votes that equal the number of shares of common stock that each share of Series A held may be converted into; provided, however, that
in no event shall a Series A holder be entitled to vote more than 4.99 % of the then outstanding shares of common stock.
Conversion
Optional
Conversion - Each share of Series A is convertible, at any time, at the option of the Series A holder, into one share of common stock;
provided, however, that in no event shall a Series A holder be entitled to convert any shares of Series A to the extent that such conversion
would result in beneficial ownership by the Series A holder of more than 4.99 % of the outstanding shares of common stock.
Automatic
Conversion – In the event that an event occurs which has the effect of reducing a Series A holder’s beneficial ownership
of shares of common stock to less than 4.5 % of the then publicly disclosed outstanding shares of common stock, then within five business
days thereafter, the Series A holder shall provide notice to the Company to such effect. Such notice shall have the effect of a notice
of conversion such that the Series A holder’s post-conversion ownership of common stock will be 4.99 % of the then publicly disclosed
outstanding shares of common stock.
F- 23
Series
A Preferred Stock Issuance
On
November 9, 2021, pursuant to the Auctus Agreement (see Note 7 – Notes Payable & Chapter 11 Reorganization), the Company issued
Auctus approximately 1,543,000 shares of Series A preferred stock.
2021
Stock Incentive Plan
On
March 18, 2021, the Company’s Board of Directors adopted the BioRestorative Therapies, Inc. 2021 Stock Incentive Plan (the “2021
Plan”). Pursuant to the 2021 Plan, a total of 1,175,000 shares of common stock are authorized to be issued pursuant to the grant
of stock options, restricted stock units, restricted stock, stock appreciation rights and other incentive awards.
Compensatory
Common Stock Issuance
During
the year ended December 31, 2021, the Company issued 5,000
shares of immediately vested common stock value
at $ 25,476
to a consultant for services rendered.
Warrant
and Option Valuation
The
Company has computed the fair value of warrants and options granted using the Black-Scholes option pricing model. The expected term used
for warrants and options issued to non-employees is the contractual life and the expected term used for options issued to employees and
directors is the estimated period of time that options granted are expected to be outstanding. The Company utilizes the “simplified”
method to develop an estimate of the expected term of “plain vanilla” employee option grants. The Company is utilizing an
expected volatility figure based on a review of the historical volatilities, over a period of time, equivalent to the expected life of
the instrument being valued, of similarly positioned public companies within its industry. The risk-free interest rate was determined
from the implied yields from U.S. Treasury zero-coupon bonds with a remaining term consistent with the expected term of the instrument
being valued.
Common
Stock and Warrant Offerings
During
the year ended December 31, 2020, the Company issued 250
shares of the Company’s common stock and
a five -year
immediately vested warrant for the purchase of 250
shares of the Company’s common stock with
an exercise price of $ 60
per share to a certain investor for gross proceeds
of $ 10,000 .
The warrant had an aggregate grant date fair value of $ 10,000 .
The warrant was subject to the Company’s sequencing policy and, as a result, was initially recorded as a derivative liability.
See Note 9 - Derivative Liabilities for additional details.
During
the year ended December 31, 2020, the Company issued five -year immediately vested warrants to purchase an aggregate of 3,806,587 shares
of the Company’s common stock in association with the issuance of certain secured convertible debt pursuant to the Plan (See Note
7 – Convertible Notes – Issuances). The warrants had exercise prices ranging between $ 2.00 and $ 4.00 per share. The warrants
along with the beneficial conversion feature had an aggregate relative fair value of $ 5,075,449 and were recorded as a debt discount.
During
the year ended December 31, 2021, the Company issued 750 shares of the Company’s common stock in settlement of litigation proceedings
with a fair value of $ 21,000 .
F- 24
Warrant
Activity Summary
In
applying the Black-Scholes option pricing model to warrants granted or issued, the Company used the following assumptions:
SCHEDULE
OF WARRANTS GRANTED ASSUMPTIONS
For
the Years Ended
December
31,
2021
2020
Risk
free interest rate
0.98 %
0.41 %
- 1.63 %
Expected
term (years)
4.10
- 5.00
5.00
- 5.00
Expected
volatility
314 %
202 %
- 278 %
Expected
dividends
0.00 %
0.00 %
The
weighted average estimated fair value of the warrants granted during the years ended December 31, 2021 and 2020 was approximately $ 11.77
and $ 40.00
per share, respectively.
During
the year ended December 31, 2020, the Company issued an aggregate of 54,449
shares of the Company’s common stock, with
fair value range of $ 25.20
to $ 67.60 ,
as a result of the cashless exercise of 57,919
warrants by Auctus.
On
October 21, 2021, the Company issued 22,917 shares of common stock to a warrant holder, as a result of the cashless exercise of 25,000
warrants.
During
the year ended December 31, 2021, the Company issued an aggregate of 147,832 , shares of the Company’s common stock, as a result
of the cashless exercise of 170,473 warrants by Auctus.
A
summary of the warrant activity during the years ended December 31, 2021 and 2020 is presented below:
SCHEDULE
OF WARRANT ACTIVITY
Weighted
Weighted
Average
Average
Remaining
Aggregate
Number
of
Exercise
Life
Intrinsic
Warrants
Price
In
Years
Value
Outstanding,
January 1, 2020
2,095
$ 5,720
Granted
3,806,837
2.80
Exercised
( 57,919 )
4.00
Forfeited
( 415 )
8,560
Outstanding,
December 31, 2020
3,750,598
$ 4.40
Issued
4,862,710
9.91
Exercised
( 195,473 )
4.00
Exchanged
or forfeited
( 3,677,964 )
3.39
Outstanding,
December 31, 2021
4,739,871
$ 11.78
4.9
$ -
Exercisable,
December 31, 2021
4,739,871
$ 11.78
4.9
$ -
F- 25
The
following table presents information related to stock warrants at December 31, 2021:
SCHEDULE
OF STOCK WARRANTS
Warrants
Outstanding
Warrants
Exercisable
Outstanding
Weighted
Average
Exercisable
Exercise
Number
of
Remaining
Life
Number
of
Price
Warrants
In
Years
Warrants
$ 10
4,501,937
4.9
4,501,937
$ 12.50
235,970
4.9
235,970
$ 60
250
3.0
250
$ 800
869
2.8
869
$ 2,240
39
2.5
39
$ 3,400
264
2.2
264
$ 4,000
55
2.1
55
$ 8,000
19
1.8
19
$ 14,000
18
1.5
18
$ 16,000
435
1.5
435
$ 16,600
14
0.8
14
$ 20,000
1
0.5
1
4,739,871
4.9
4,739,871
Stock
Options
In
applying the Black-Scholes option pricing model to stock options granted, the Company used the following assumptions:
SCHEDULE
OF STOCK OPTION GRANTED ASSUMPTIONS
For
the Year Ended
December
31,
2021
Risk
free interest rate
1.25 %
- 1.48 %
Expected
term (years)
5.00
- 10.00
Expected
volatility
354 %
Expected
dividends
0.00 %
The
Company granted options for the purchase of 838,550 shares of common stock during the year ended December 31, 2021.
The
weighted average grant date fair value of the stock options granted during the years ended December 31, 2021 and 2020, was approximately
$ 26,571,050 and
$ - , respectively.
A
summary of the option activity during the years ended December 31, 2021 and 2020 is presented below:
SCHEDULE
OF STOCK OPTION ACTIVITY
Weighted
Weighted
Average
Average
Remaining
Aggregate
Number
of
Exercise
Life
Intrinsic
Options
Price
In
Years
Value
Outstanding,
January 1, 2020
1,220
$ 3,960
Granted
-
-
Forfeited
( 5 )
5,960
Outstanding,
December 31, 2020
1,215
$ 3,920
Granted
838,550
13.50
Expired
( 126 )
3,000
Outstanding,
December 31, 2021
839,639
$ 18.73
9.45
$ -
Exercisable,
December 31, 2021
349,237
$ 26.00
9.45
$ -
F- 26
The
following table presents information related to stock options at December 31, 2021:
SCHEDULE OF STOCK OPTION BY EXERCISE PRICE
Options
Outstanding
Options
Exercisable
Outstanding
Weighted
Average
Exercisable
Exercise
Number
of
Remaining
Life
Number
of
Price
Options
In
Years
Options
$ 13.50
838,550
9.5
348,156
$ 1,040
44
7.7
44
$ 3,000
1,026
5.0
1,018
$ 22,800
1
2.5
1
$ 48,200
- $ 52,000
9
2.0
9
$ 80,000
- $ 120,000
9
0.2
9
839,639
9.5
349,237
On
March 18, 2021, the Company, pursuant to two employment agreements, granted to its Chief Executive Officer, President and Chairman of
the Board and its Vice President, Research and Development options to purchase an aggregate of 586,959 shares of the Company’s
common stock (see Note 10 – Commitments and Contingencies). The options had an exercise price of $ 47.60 per share and vest to the
extent of 50% on the date of grant, 25% on the one-year anniversary of the grant date and 25% on the two-year anniversary of the grant
date. On November 4, 2021, the Company reduced the exercise price of these options from $ 47.60 per share to $ 13.50 per share and revised
the vesting period. On December 10, 2021, the Company further reduced the exercise price of these options from $ 13.50 per share to $ 5.08
per share, subject to stockholder approval. Per ASC 718 – Compensation – Stock Compensation, the Company accounted for these
changes as a modification and the net effect was immaterial to the financial statements as a whole.
On
November 4, 2021, the Company granted options to purchase an aggregate of 140,824
shares of its common stock (including
options to purchase 10,490
shares each granted to Robert Kristal, its Chief
Financial Officer, Patrick Williams, a director of the Company, and David Rosa, a director of the Company) to its officers and
directors at an exercise price of $ 13.50
per share. Also included within the 140,824
share option grants were grants to each of Mr.
Alstodt and Mr. Silva for the purchase of 42,059
shares of common stock and to Dr. Nickolay Kukekov,
a director of the Company, for the purchase of 25,236
shares of common stock. The option grants to
Mr. Alstodt, Mr. Silva, and Dr. Kukekov have a ten
year term and an exercise price of $ 13.50
per share. Such
options are exercisable to the extent of 50% on the date of grant and 50% quarterly over a period of two years commencing one year from
the date of grant. On December 10, 2021, the Company
reduced the exercise price of the options from $ 13.50
per share to $ 5.08
per share, subject to stockholder approval. Per
ASC 718 – Compensation – Stock Compensation, the Company accounted for these changes as a modification and the net effect
was immaterial to the financial statements as a whole.
On
November 4, 2021, the Company granted options to purchase an aggregate of 110,767 shares of the Company’s common stock to members
of its Scientific Advisory Board and various employees and consultants at an exercise price of $13.50 per share. On December 10, 2021,
the Company reduced the exercise price of the options from $13.50 per share to $5.08 per share, subject to stockholder approval. Per
ASC 718 – Compensation – Stock Compensation, the Company accounted for these changes as a modification and the net effect
was immaterial to the financial statements as a whole.
Restricted
Stock Units
Pursuant
to the 2021 Plan, the Company may grant restricted stock units (“RSUs”) to employees, consultants or non-employee
directors (“Eligible Individuals”). The number, terms and conditions of the RSUs that are granted to Eligible Individuals
are determined on an individual basis by the 2021 Plan administrator. On the distribution date, the Company shall issue to the Eligible
Individual one unrestricted, fully transferable share of the Company’s common stock (or the fair market value of one such share
in cash) for each vested and nonforfeitable RSU.
On
March 18, 2021, the Company, pursuant to two employment agreements, granted an aggregate of 293,479 RSUs to its Chief Executive Officer,
President, and Chairman of the Board and its Vice President, Research and Development (see Note 10 – Commitments and Contingencies)
with a fair value of $ 47.60 per share. The RSUs vest to the extent of one-third on the one-year anniversary of the grant date, one-third
on the two-year anniversary of the grant date, and one-third on the three-year anniversary of the grant date. The RSUs had a grant date
fair value of $13,969,624.
F- 27
A
summary of the unvested RSUs as of December 31, 2021 is as follows:
SCHEDULE OF UNVESTED RESTRICTED STOCK UNITS
Number
of
Shares
Outstanding,
January 1, 2021
-
Granted
293,479
Forfeited
-
Vested
-
Outstanding,
December 31, 2021
293,479
The
following table presents information related to stock compensation expense:
SCHEDULE OF STOCK OPTION EXPENSE
For
the Years Ended
Unrecognized
at
Weighted
Average
Remaining
Amortization
December
31,
December
31,
Period
2021
2020
2021
(Years)
Consulting
$ 25,476
$ 110,557
$ -
-
Research
and development
81,479
177,281
-
-
General
and administrative
23,002,000
403,863
9,698,130
2.3
$ 23,108,955
$ 691,701
$ 9,698,130
2.3
Note
9 – DERIVATIVE LIABILITIES
The
following table sets forth a summary of the changes in the fair value of Level 3 derivative liabilities that are measured at fair value
on a recurring basis:
SUMMARY OF CHANGES IN FAIR VALUE OF LEVEL 3 DERIVATIVE LIABILITIES
Beginning
balance as of January 1, 2020
$ 915,959
Issuance
of derivative liabilities
2,483,532
Extinguishment
of derivative liabilities in
connection with convertible note repayments and exchanges
( 1,165,329 )
Change
in fair value of derivative liabilities
2,141,069
Reclassification
of derivative liabilities to equity
( 4,375,231 )
Ending
balance as of December 31, 2020
$ -
In
applying the Multinomial Lattice and Black-Scholes option pricing models to derivatives issued and outstanding during the year ended
December 31, 2020, the Company used the following assumptions:
SUMMARY OF DERIVATIVE LIABILITIES FAIR VALUE ASSUMPTION
For
the Year Ended
December
31, 2020
Risk
free interest rate
0.06 %
- 2.16 %
Expected
term (years)
0.12
– 5.00
Expected
volatility
101 %
- 133 %
During
the year ended December 31, 2020, the Company recorded new derivative liabilities in the aggregate amount of $ 2,473,532 and $ 10,000 related
to the ECOs of certain convertible notes payable and warrants subject to sequencing, respectively. See Note 7 – Notes Payable &
Chapter 11 Reorganization - Convertible Notes for additional details. See Note 8 – Stockholders’ Equity (Deficit) for warrants
issued and deemed to be derivative liabilities.
F- 28
During
the year ended December 31, 2020, the Company extinguished an aggregate of $ 1,165,329 of derivative liabilities in connection with the
exchanges of certain convertible notes payable into shares of the Company’s common stock. See Note 7 – Notes Payable &
Chapter 11 Reorganization – Conversions, Exchanges and Other for additional details.
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