Item 1. Business
Item 1. Business
Our Strategy
Our objective is to develop
and commercialize our product candidates to treat diseases where the innate immune system is dysfunctional causing or contributing to
the patient’s disease. Innate immune dysfunction can occur for a variety of reasons including genetics, lifestyle, and other factors.
However, age plays a significant role in the development of immune dysfunction. Innate immune dysfunction can be seen in cancer where
Natural Killer (“NK”) cells are impaired and facilitate a tumor’s evasion of the immune system and subsequent disease
progression. Chronic inflammation is implicated in neurologic and metabolic diseases where it impairs the innate immune system. Our initial
focus continue to be treatment of cancer with INKmune and Alzheimer’s Disease (“AD”) and Treatment Resistant Depression
(“TRD”) with XPro1595. We have added CORDStrom, a pooled, human umbilical cord mesenchymal stem cell (“HucMSC”)
product to treat recessive dystrophic epidermolysis bullosa (“RDEB”), a pediatric orphan disease caused by mutations in the
COL7A1 gene that results in a debilitating disease of skin blistering, dysphagia and failure to thrive with chronic wound problems that
often results in fatal squamous cell carcinoma.
XPro1595 (“XPro”),
targets Alzheimer’s Disease and TRD. XPro for AD has completed Phase I trials and a Phase II trial has completed enrollment of patients
at clinical sites in the United Kingdom, EU, Australia and Canada. Patients are currently being treated with XPro for Early AD as part
of that clinical trial. TRD is being prepared for Phase II trials. We expect to start a pivotal global registration trial in patients
with AD after the results of the Phase II trial have been analyzed. The INKmune program is in an open label Phase II trial in metastatic
castrate resistant prostate cancer (“mCRPC”). CORDStrom for the treatment of children with RDEB has completed a pivotal blinded
randomized cross-over trial. The data will be submitted for a marketing authorization (“BLA”) in the US in the next 12-18
months.
The overall principal components
of our business strategy to achieve these objectives are to:
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Pursue a registration strategy for CORDStrom in RDEB that maximizes the value of the therapy and expand the CORDStrom platform;
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Pursue development strategies and regulatory approval pathways that allow the treatment of neurodegenerative diseases in patients with our lead product candidate, XPro;
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Pursue development strategies and regulatory approval pathways that allow the treatment cancer with our lead oncology platform, INKmune;
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Adopt a product development strategy that solidifies our existing intellectual property (“IP”) to prevent competition and expand our IP suite into related immunotherapeutic areas;
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Provide clear value propositions to third-party payers, such as managed care companies or government programs like Medicare, to merit reimbursement for our product candidates; and
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Collaborate with other pharmaceutical companies with respect to, among other things, our XPro, CORDStrom and INKmune product platforms.
Pursue development and
regulatory approval pathways. We believe INKmune and XPro may be approvable under pathways that are potentially shorter than those
typically available for drug products based on novel active ingredients, including as an orphan drug under the Orphan Drug Act and approval
under the Food and Drug Administration (the “FDA”) Accelerated Approval Program (see the section entitled “Government
Regulation”). We have not yet had a discussion with the United Kingdom Medicines and Healthcare Products Regulatory Agency (“MHRA”)
and/or FDA regarding such designation, but plan to do so in the future. We believe the INKmune program to treat castration resistant prostate
cancer may qualify for orphan status. We believe that it would take a minimum of six months to receive Orphan Drug status once we
apply for application and a minimum of 12 months to receive a designation once we submit an application. We might never have these discussions,
submit applications under the Orphan Drug Act or the FDA Accelerated Approval Program or have these applications approved if we do. We
have received Orphan Drug Designation (“ODD”) and Rare Pediatric Disease Designation (“RPDD”) for CORDStrom to
treat patients with epidermolysis bullosa (“EB”). We plan to file for Biologics License Application (“BLA”), an
approval document for full approval of CORDStrom with the FDA in late 2025 or early 2026. We also plan to file for Marketing Authorization
Application in the EU and United Kingdom in 2026 with CORDStrom for RDEB. Likewise, we plan to apply for an accelerated approval pathway
for the use of XPro to treat patients with AD in 2025.
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Adopt a two-pronged patent
strategy. We are pursuing a two-pronged product development strategy that will seek to solidify our existing IP to prevent competition
and expand our IP suite into related therapeutic areas. We are confident that our core in-licensed IP (see the section entitled “Intellectual
Property”) and IP generated by the Company will allow us both freedom-to-operate and provide robust protection from outside competition
across all of our drug platforms. We will continue to invest in expanding our patent suite. We will also seek to further strengthen our
IP position by looking to in-license IP related to our focus on the innate immune system. All of our products are biologic products eligible
for Biologic Exclusivity after first approval. In the US, Biologic Exclusivity currently allows for 12 years of marketing exclusivity.
Provide clear value propositions
to third-party payors to merit reimbursement for our product candidates . We are designing our clinical development programs to demonstrate
compelling, competitive advantages to patients and prescribers, and to demonstrate value propositions to third-party payors. We believe
the use of INKmune patients with a high risk of tumor progression and death from tumor should safely prolong survival, improve the patient’s
quality of life and decrease the total cost of care for patients with these lethal malignancies. For example, cancer patients relapse
frequently. Each relapse requires a complex treatment regimen that has decreasing benefits. Treatment with INKmune as an out-patient may
provide a more durable remission and limit the need for treatment-associated hospitalizations. At the patient level, we believe INKmune,
if approved, should improve survival and quality of life. At the payor level, we believe INKmune, if approved, should provide more predictable
costs and outcomes. Additional therapies are need for treatment of Alzheimer’s disease are needed for medical, societal and economic
reasons. The cost of Alzheimer’s disease to the government is large and growing. Recently approved therapies that target amyloid
have a modest impact on disease progression and are difficult to use due to side-effects in some patients. The cost of AD to families
and care givers is real and burdensome. We believe treatment of dementia patients with XPro, including Alzheimer’s disease, may
provide a strategy to alter the costly dynamic of this disease in society today. RDEB is a lethal and debilitating disease in children
that requires life-long care-giver and medical support. Available therapies for the diseases focus on wound closure. Itch, a clinical
symptom that occurs in all children with RDEB, is considered by patients to be the most important symptom with no therapy. CORDStrom decreases
itch considerably and safely, improves quality of life and may improve wound healing.
Collaborate to maximize
the value of our technology . We believe there are two reasons for us to enter collaborations with other companies. The first is the
further development of INKmune, XPro and CORDStrom by either providing additional innovations to the product, including combination therapy
strategies, and/or providing resources to improve the speed and breadth of the development process. The second is to optimize the commercialization
of our products either globally or regionally. The ideal partner will benefit us in both ways.
We have leveraged our unique
capabilities to optimize clinical application of cell medicines by developing CORDStrom for the treatment of RDEB. We believe that we
have developed a way to manufacture human mesenchymal stromal cells for the medical research and biotech community that offers large
volumes of high-quality, human umbilical cord mesenchymal stromal cells with minimal batch-to-batch variability. We have established
a reliable supply of human umbilical cords based on our agreement with the Anthony Nolan Cord Blood Bank in the United Kingdom and plan
to seek additional supplies from US sources in the future. We have developed a validated manufacturing process that reliably produces
clinical grade (“cGMP”) quality mesenchymal stromal cells that we call CORDStrom. The manufacturing process is currently
performed by INmune Bio staff at a contract manufacturing site under the direction of Mark Lowdell, the Company’s CSO. We supplied
CORDStrom for a multicenter academic clinical trial in in children with RDEB. This pivotal trial was sponsored by the Great Ormond Street
Children’s Hospital (“GOSH”) in London treating children with intermediate and severe- RDEB. The results of the pivotal
trial show that CORDStrom therapy decreases itch and pain and improves clinical scores in patients with RDEB. We have entered an exclusive
global license with GOSH for the clinical data. The Company plans to combine the clinical data and manufacturing process into a regulatory
dossier that seeks marketing authorization in the US via a BLA and in the United Kingdom and EU by MAA in 2026 or earlier if possible.
The program has received an ODD and RPD and may be eligible for a Priority Review Voucher if product approval occurs by September 26,
2026. The Company plans to seek scientific advice from the FDA, MHRA and EMA on the program during 2025 in preparation for regulatory
submissions. The regulatory path for therapeutic applications of the mesenchymal stem/stromal cell products is well established and similar
to the regulatory approval process for other cellular medicines. We will only be responsible for regulatory compliance related to manufacturing
of the mesenchymal stromal cells when the product is being developed by a third party. When developing a therapeutic product for the
Company’s commercial portfolio, the Company will be responsible for all aspects of the regulatory process.
CORDStrom is a patent-pending
cell medicine comprising aseptic, allogeneic, pooled HucMSCs in suspension for injection or infusion. The CORDStrom platform leverages,
among other things, proprietary screening, pooling and expansion techniques to create off-the-shelf, allogeneic, pooled HucMSCs as medicines
to treat complex inflammatory diseases. CORDStrom products are designed to provide high-quality, off-the-shelf, batch-to-batch consistent,
scalable, cGMP manufactured, potent cellular medicines that can be produced at low cost and with repeatable specification independent
of donor characteristics. Initially developed at the INKmune manufacturing facilities utilizing United Kingdom academic grant funding,
CORDStrom is a mesenchymal stromal cell (“MSC”) product platform that shows promise as a first systemic therapy for potentially
treating RDEB and many other debilitating conditions. While the first generation CORDStrom product is agnostic to disease indication,
the platform enables creation of indication-specific products, which can be tuned for optimization of anti-inflammatory, immunomodulatory,
homing, and other characteristics.
The CORDStrom product platform
shares many similarities, including reagents, and procedures, with the Company’s INKmune oncology product, enabling the Company
to leverage economies of scale, experienced staff, and other resources to strategically manufacture both products in a rotational campaign
with resource and environmental efficiencies.
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Overview of Immunotherapy for Cancer
The immune system has two
parts, innate and adaptive. The innate immune system is the body’s first line of defense against an infection, providing immediate,
non-specific responses to eliminate harmful cells in the body. Components of the innate immune system include cytokines, chemokines, macrophages,
neutrophils and NK cells, among others.
The adaptive immune system
is often initially triggered by the innate immune system, mounts a delayed response against diseased cells and plays a role protecting
against re-infection. An adaptive immune response is highly specific to a pathogen or antigen and is developed or learned from prior exposure.
Key components of the adaptive immune system include antibodies which bind to antigens and mark them for destruction by other immune cells,
B-cells which produce these antibodies upon exposure to antigens, and T-cells which attack and eliminate the diseased cells.
The biopharmaceutical industry
has made significant advances in harnessing specific components of innate and adaptive immune systems for therapeutic use. Some of these
approaches are summarized below.
Cytokines. Tumor
Necrosis Factor alpha (“TNF”) is the focus of XPro and INB03. TNF biology has four elements that include two cytokines, soluble
TNF and trans-membrane TNF (“sTNF” and “tmTNF,” respectively), and two receptors, TNF Receptor 1 and 2 (“TNFR1”
and “TNFR2”). The biology of TNF ligation of TNFR varies dramatically based on what elements of the TNF system that are used.
sTNF binding to TNFR1 is responsible for inflammation and cell death while sTNF binding to TNFR2 promotes proliferation of regulatory
T cells (“Treg”). In patients with advanced cancers, increased sTNF is not favorable to long-term survival because it promotes
epithelial-mesenchymal transformation and metastasis while making the tumor microenvironment more immunosuppressive promoting resistance
to therapy. In the CNS, sTNF promotes neuronal cell death, demyelination and synaptic pruning while tmTNF promotes nerve cell survival,
improves synaptic function and stimulates remyelination. In brief, sTNF is the “bad” TNF and tmTNF is the “good”
TNF. In patients with cancer, infection or neurologic disease, blockade of tmTNF function has negative consequences such as immunosuppression,
increased infection, synaptic dysfunction and demyelination.
One of the early applications
of immunotherapy is the use of cytokines, including interferons and interleukin-2 (“IL-2”). Interferons are molecules that
inhibit the growth and replication of diseased cells and stimulate innate immune cells to attack them. They have been used as standard
of care for hepatitis B and C and multiple sclerosis, and to a lesser extent, as treatment for certain cancers, including chronic myeloid
leukemia, cutaneous T-cell lymphoma, myeloma and non-Hodgkin’s lymphoma. However, the use of interferons has generally decreased
over the years due to serious adverse events ( e.g. , flu-like symptoms and dramatic weight loss) and introduction of new therapies
with higher efficacy, better safety profiles and more convenient administration although Alpha-interferon remains the treatment of choice
for some hematological conditions such as polycythemia. IL-2 activates T-cells and NK cells to attack diseased cells. IL-2 has been used
to treat select cancers, but due to its relatively poor safety profile, physicians often only resort to this therapy for the most advanced
settings.
Antibody therapy.
Antibodies exist in three formats: monoclonals (“mAbs”), oligo/polyclonal and antibody-drug conjugates. mAbs represent an
effective therapeutic modality and are important to the treatment paradigm of various diseases. Drug manufacturers have leveraged mAbs’
ability to induce an antibody-dependent cell-mediated cytotoxicity, or ADCC effect to develop better treatments that prolong survival
and quality of life of patients. In addition, mAbs designed to inhibit specific checkpoints in the immune system have overcome in vivo
immune suppression and the resulting immune responses have led to profound therapeutic benefit in some patients. However, the degree of
efficacy of these therapies is heavily reliant on the immune system of patients, many of whom are severely immuno-compromised. In addition,
mAbs are manufactured through a complex process that requires purification of cell products created from a cell line. Polyspecific antibodies,
for example bi-specific antibodies, are able to target more than one antigen. These are often used to bring and effector T cell in contact
with a target cell. Antibody drug conjugates are mAbs attached to a toxin, chemotherapy or radio therapy that delivers the cancer killing
payload directly to the cancer.
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Dendritic Cell Therapies.
This approach is designed to indirectly stimulate a patient’s T-cells by leveraging the role of dendritic cells in presenting antigens
to T-cells. Cancer vaccines are the most common application of dendritic cells. FDA-approved dendritic cell therapies such as PROVENGE,
which entails collecting monocytes from the patient, maturing them into dendritic cells, “loading” ex vivo with the
patient’s cancer antigens, and then re-infusing in the patient. Currently, this process is cumbersome and expensive, and again,
relies on an intact and effective immune system of the patient. There are additional ongoing preclinical studies and clinical trials being
conducted by our competitors aimed at addressing certain of the limitations associated with this approach. To date, current clinical results
of dendritic cell therapies have been mixed.
CAR-T and TCR Therapies.
T-cells recognize diseased cells by receptors engaging with antigens that are present on or inside the diseased cells. CAR-T therapy entails
genetically engineering T-cells to express synthetic CARs that direct T-cells to antigens on the surface of cancer cells. TCR therapy
modifies T-cells to express high-affinity tumor specific TCRs that recognize intra-cellular antigens that must be presented on the surface
of target cells. In early clinical trials, CAR-T and TCR therapies have demonstrated impressive anti-tumor activity in a narrow spectrum
of hematologic cancers and garnered significant attention by research institutions and biopharmaceutical companies. We believe a key limitation
of adaptive autologous immunotherapy is the need to retrieve non-compromised immune cells from a cancer patient which requires a complex
and costly manufacturing process to develop the therapy. The complexity of this personalized process is reflected in the price of the
two approved therapies. CAR-T therapies - tisagenlecleucel and axicabtagene ciloleucel for advanced leukemia and lymphoma respectively.
The cost of a single therapy is many hundreds of thousands of dollars. As a consequence of this need to harvest active T-cells, current
Phase I clinical trials for autologous CAR-T cell therapy in large part enroll patients from highly selected, often relatively early-stage
disease in a narrow spectrum of cancers, including bulky hematological cancers. In addition, Phase I clinical trials of CAR-T cell immunotherapy
have reported severe adverse toxicities of cytokine release syndrome and neurotoxicity, requiring hospitalization, pre-conditioning and,
in some instances, intensive care unit admission following side effects associated with cytokine release syndrome. As a result, though
our competitors continue to develop their CAR-T and TCR product candidates with the goal of addressing certain of the limitations associated
with these approaches, we believe these serious challenges may limit their potential and use in a variety of indications, including solid
tumors.
Checkpoint Inhibitors.
Immune cells express proteins that are immune checkpoints that control and down-regulate the immune response. These are best defined
in T lymphocytes and include PD-1, CTLA-4, TIM-3 and LAG3. Tumor cells express the ligands to these receptors. When T cells bind the ligand
to these proteins on the tumor cells, the T cell is turned off and does not attempt to attack the tumor cell. Thus, checkpoint inhibitors
(“CPI”) are part of the complex strategy used by the tumor to evade the patient’s immune system and are responsible
for resistance to immunotherapy. Biopharmaceutical companies have successfully developed CPI that block the receptor/ligand interaction
to promote the adaptive immune response to the tumor. Six CPI are currently approved, pembrolizumab, nivolumab, atezolizumab, avelumab,
durvalumab, and ipilimumab for a wide variety of solid tumors including melanoma, lung, bladder, gastric cancers and others. More CPI
are in development and more tumor types will be added to the list of sensitive tumors over the next years. CPI have become the backbone
of cancer therapy and are expected to be the best -selling class of drugs in the future.
NK Cells. NK
cells typically represent approximately 2% to 13% of circulating lymphocytes and are a critical component of the immune system responsible
for innate immunity. Unlike adaptive immune cells, they are ever present and ready to attack, having the inherent ability to detect and
eliminate diseased cells without the need for antigen presentation, which is why they are called “natural killers.”
NK cells bind to stress ligands
expressed by the diseased cells and directly eliminate them. This binding induces NK cells to release cytokines, including interferons
and GM-CSF, which are integral in recruiting additional innate and adaptive immune responses by the host. NK cells also represent a critical
effector cell for ADCC, whereby target cells bound with human antibodies, whether made by the patient’s body or administered, are
selectively destroyed by the NK cells.
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Our Innate Immune Dominant-Negative
TNF (“DN-TNF”) product candidate
XPro1595, XPro or Pegipanermin
was originally licensed from Xencor.
XPro neutralizes sTNF in the
brain without affecting tmTNF or TNF receptors. Soluble TNF is a cause of the destructive neuroinflammation in the brain are microglial
and astroglial cells (“glial cells”). Glial cell are two of four cells in the neural unit that also includes oligodendrocytes
and nerve cells. Activated microglial cells are considered the resident macrophages of the brain. The primary role of microglial cells
is to protect the neural unit from infection. When innate immune dysfunction causes chronic inflammation, activated microglial cells produce
soluble TNF that activates astrocytes. Activated glial cells cause nerve cell and oligodrocyte dysfunction that results in synaptic pruning,
nerve cell death and demyelination of neurons. These pathologies contribute, in part, to neurodegenerative diseases such as AD, Parkinson’s
disease, ALS, MS, Huntington’s disease, glaucoma and TBI (traumatic brain injury) may contribute to neuropsychiatric diseases such
as depression, bi-polar disease, sleep disorders, autism, schizophrenia and PTSD. In the setting of AD, microglial activation causes synaptic
dysfunction and nerve cell death that contributes to cognitive decline and the behavioral manifestations of AD including depression, aggressiveness,
sleep disorders, hallucinations and anhedonia. Elimination of microglial activation should reverse these symptoms. Because soluble TNF
is the apex cytokine in the inflammatory cytokine cascade, neutralization of soluble TNF with XPro should prevent glial activation and
normalizes function of the neural unit.
The Company has completed
a Phase I trial using XPro to reverse neuroinflammation in patients with Alzheimer’s disease. The trial was performed in Australia
and was partially funded by a $1M USD Part-the-Cloud Award from the Alzheimer’s Association. The clinical trial was the first in
the Company’s development program for the treatment of dementia. The open label, dose escalation trial in patients with Alzheimer’s
disease with biomarkers of peripheral inflammation (one of CRP>1.5mg/L, HgbA1c>6.0, ESR>10sec or have ApoE4) treats the patients
with XPro as a once-a-week subcutaneous injection for 3 months. AD patients with one biomarker of inflammation are classified as having
AD with neuroinflammation (“Adi”). The company estimates this group of patients includes at least 40% of patients with AD.
Patients have multiple biomarkers of neuroinflammation tested before and during therapy including soluble biomarkers in blood and cerebral
spinal fluid, behavioral biomarkers (neuropsychiatric symptoms of AD), EEG and neuroimaging biomarkers using MRI. The primary goal of
this short, open label study was to demonstrate that treatment with XPro decreases neuroinflammation safely and to define the dose of
XPro to use in the Phase II trial.
The Company has enrolled a
global blinded randomized Phase II trial in ADi patients with Early AD in Australia, Canada, the United Kingdom, Spain, France, Germany,
Poland, the Czech Republic, and Slovakia. Early AD is patients that have Mild Cognitive Impairment or mild AD. There is an Expanded Access
Scheme in patients who completed the Phase I trial in Australia that can request XPro of which two patients from the Phase I remain on
the drug as of this writing. The goal of the Phase II trial will be to demonstrate the prolonged control of neuroinflammation in patients
with dementia will help control cognitive decline.
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The Phase I trial enrolled 18 patients at three
dose cohorts of 0.3, 0.6 and 1.0mg/kg given once a week as subcutaneous injection for three months. Patients in the 1.0mg/kg group were
offered extended use of the drug for up to 12 months. Three patients remained on XPro for 12 months. Preliminary data was presented in
a webinar on 13 July 2020. Additional data was presented on January 21, 2021CSF cytokine/chemokines were measured in 9 patients before
and after 12 weeks of weekly therapy with XPro using a panel from OLINK Target 48 Cytokine (Figure below).
In the 6 patients in the 1mg/kg
per week dose, only one cytokine and chemokine, interferon gamma (“INFg”) did not change in the CSF of patients, the remainder
all decreased on average of 15%. The data analyzed provides evidence that XPro decreases neuroinflammation in patients with Alzheimer’s
disease.
We believe these data support
the use of XPro to treat other diseases where neuroinflammation is a part of the pathophysiology of the disease. The company studied the
consequences of decreasing neuroinflammation in the 6 patients from target dose group (XPro 1mg/kg for 12 weeks) be looking at the CSF
proteome using technology for Proteome Sciences using their TMT Calibrator™ platform. A large data set of proteins were identified.
Early analysis of the data focusing on 26 AD related proteins demonstrated changes in inflammation, neuronal and synaptic proteins caused
by decreasing neuroinflammation after treatment with XPro (Figure below). The proteome also demonstrated a clear dose response with a
greater number of proteins being affected by the target dose compared to low dose XPro therapy (0.3 vs 1.0 mg/kg/week for 12 weeks) (Figure
below). The CSF proteome data is only partially analyzed. Additional data may result from these ongoing analytics.
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The results of the Phase I
study demonstrated that XPro safely decreases neuroinflammation in patients with AD and elevated neuroinflammation with biomarkers of
peripheral inflammation or are ApoE4 positive when given for at least 3 months at the 1mg/kg once a week dose. Decreasing neuroinflammation
with XPro appears to decrease neurodegeneration and improve synaptic function and promote remyelination. The effect of XPro on the biology
and immunology of the brain in patients with AD suggest XPro therapy in patients with peripheral biomarkers of inflammation or ApoE4 allele(s)
may impact cognitive decline. Although there were anecdotes of improved cognitive function in patients receiving the target dose of XPro,
this cannot be verified because the trial was not a blinded, randomized trial. The impact on cognition of controlling neuroinflammation
with XPro will be studied in the Phase II program which is a blinded randomized, placebo controlled clinical trial.
AD02 is the ongoing blinded
randomized global Phase II trial in patients with early AD enrolled 208 patients in a 2:1 ratio (XPro:placebo) at 1mg/kg once a week.
The trial enrolled the last patient in November 2024. Patients are treated for 6 months of therapy. The primary end-point is Early/Mild
Alzheimer’s Cognitive Composite (“EMACC”), a sensitive cognitive end-point validated for use in patients with early
AD. Secondary cognitive (CDR-SB and NPI) and functional (GAS, ADCS-ADL) end-points will be measured. Exploratory structural and function
biomarkers of brain function and structural integrity using EEG and MRI DTI will be used in some or all patients. Top line cognitive data,
EMACC, will be presented around June of 2025. All additional cognitive, functional, neuroimaging and biomarker data will be presented
approximately 8 weeks later.
Effective therapy for TRD
is a large unmet need. Twenty percent of patients with a Major Depressive Disorder have TRD. Once third of TRD patients have peripheral
biomarkers to inflammation (elevated CRP). This is a large patient population. The role of TNF and anti-TNF therapeutics was explored
in a small open label clinical trial by Prof. Andrew Miller, MD of Emory University whereby it was demonstrated that patients which have
elevated TNF levels responded to treatment with infliximab (Miller, 2011).
The blinded, randomized Phase
II trial will use biomarkers of peripheral inflammation to select patients with TRD for enrollment. Patients will be treated for 6 weeks.
Primary endpoints include both clinical and neuroimaging measures.
XPro, is delivered as a subcutaneous
injection, similar to an insulin treatment or anti-obesity GLP-1 drugs, is given once a week. More frequent treatment cannot be ruled
out for future indications. Because this is a simple subcutaneous injection similar to an insulin injection (the therapy patients give
themselves for treatment of Type 1 diabetes mellitus), we expect patients to administer the therapy by themselves or caregivers and not
require expensive or logistically challenging clinic visits to receive the therapy.
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Release of XPro drug supply
GMP DN-TNF product (XPro)
used in the oncology Phase I, AD Phase I and COVID-19 Phase II trial were manufactured by Lonza at a site in New Hampshire. The supply
of Lonza DN-TNF product is limited but allowed completion of the Phase I study in Alzheimer’s disease and support of patients in
the extension study for 12 months. New batches of XPro have been produced for ongoing clinical trials. The Company engaged KBI Biopharma
to manufacture 6 lots of XPro at the Boulder, Colorado facility using the original master cell bank and updated manufacturing process.
One lot has been converted into drug product using the US fill/finish facility of Vetter Pharma. Half of the first lot is frozen as drug
substance at -80C with a plan to convert to drug product as clinical supplies are needed to support the AD and TRD Phase II trials. The
unfrozen drug product is being used in the ongoing AD02 AD trial. The remainder of the original fermentation runs is frozen as a cell
paste with a plan to process to drug substance. The company expects to convert the drug substance to drug product during 2025. Downstream
processing to drug product and fill/finish to drug product of the cell paste will occur in 2025 as needed to support the clinical trials.
We plan to use a two-step approach to improve the yield of the drug substance from the fermentation process. The Company is working on
the yield of the drug product using the existing E.coli-based system. A second program is focused on down-stream process improvements
in the drug manufacturing program. Once the new strain and process is validated and functional, we will perform a manufacturing campaign
drug for future clinical trials. In the future, the Company may consider a strain change to improve yield of the fermentation step further.
The decision for strain improvements and strain change will be made in the future as clinical development programs proceed.
Interaction with Regulatory Authorities Regarding
XPro Development
We have completed a Phase
I trial with DN-TNF in oncology. At this time we do not plan additional clinical trials with DN-TNF in oncology. A Phase II trial with
XPro in patients with Alzheimer’s disease is underway. Dosing of patients in the Phase II trial will complete in May 2025. The Phase
I trial with XPro in patients with Alzheimer’s disease was performed in Australia under the regulatory authority of the TGA using
the Clinical Trials Exemption (“CTX”) scheme. Our first interaction with the regulatory body occurred in March 2018. The Company
received approval to initiate the Phase I trial in patients with advanced solid tumors on May 21, 2018. The second interaction with
the regulatory body occurred in March 2019. The Company received approval to initiate the Phase I trial with XPro in patients with
Alzheimer’s disease in May 2019 and received authorization to start the Phase II trial in patients with mild AD on January 5, 2022.
Our first interaction with the FDA occurred in July 2020 as part of the Phase II Quellor program to treat respiratory failure in patients
hospitalized with COVID-19 infection. The newly manufactured XPro is being used to support the Phase II AD trial, the TRD Phase II trial
and the Expanded Access Scheme.
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XPro Regulatory Strategy
Drugs from the DN-TNF platform
will be developed using adequately powered, well designed studies with the goal to demonstrate a meaningful clinical benefit to patients.
Beyond Phase I, these will most often be blinded, randomized clinical trials using validated end-points that have been authorized by a
regulatory authority – the FDA, TGA, MHRA, EMA, Health Canada, etc. Currently, all planned studies will be performed in North America,
Australia, EU and/or the United Kingdom. Because there are no therapies similar to XPro approved in any market, we plan to take advantage
of the regulatory opportunities afforded to therapies that treat markets with a high unmet need. In the U.S., this includes Orphan Drug
Designation and expedited programs for approval including Accelerated Approval, Breakthrough Therapy Designation, Fast Track Designation,
and priority review (see the section entitled “Government Regulation”). We cannot predict which, if any, of these programs
we will benefit from without further discussions with the FDA, EMA and other competent regulatory authorities.
Immunotherapy for Treatment of Alzheimer’s Disease
XPro is being developed for
the treatment of Alzheimer’s disease. Microglial activation and neuroinflammation are important causes of the synaptic dysfunction
and nerve cell death that causes cognitive decline in patient with dementia and Alzheimer’s disease. The relationship between β
amyloid plaques and tau neurofibrillary tangles, the traditional targets in AD drug development and neuroinflammation is complex. We believe
targeting plaques and tangles will have limited benefit. Targeting neuroinflammation, the common pathway leading to synaptic dysfunction
and nerve cell death, may be an effective treatment strategy. Substantial pre-clinical data supports the use of XPro in murine models
of AD. Substantial indirect data supports use of XPro in humans including a decreased risk of AD in patients treated with non-selective
TNF inhibitors for rheumatoid arthritis and treatment using direct injection into paraspinous venous plexus. Because of different mechanism
of action of XPro compared to the non-selective TNF inhibitors, we expect a lower risk of immunosuppression and demyelinating complications
such as multiple sclerosis (“MS”). The Company reported preliminary data on July 13, 2020 and January 21, 2021 supporting
the use of XPro to decrease neuroinflammation in patients with Alzheimer’s disease and biomarkers of peripheral inflammation (see
above).
We completed enrollment of
patients into an open label, biomarker directed, Phase I clinical trial in Australia that approaches AD as an immunologic disease. Patients
with dementia with the diagnosis of AD with biomarkers of chronic inflammation that includes at least one of a hs-CRP>1.5 mg/L, a ESR>10
mm/h, a HbgA1C>6.0% or are ApoE4 positive were treated with XPro for 12 weeks. Three dosing cohorts were preformed – 0.3, 0.6
and 1.0 mg per week as a subcutaneous injection. Patients had multiple inflammatory biomarkers test before therapy, at 6 weeks and at
12 weeks. Biomarkers were reported in blood and cerebral spinal fluid. Experient biomarkers including MRI measures of white matter tract
neuroinflammation, axonal quality and axon myelin, and MRI measures of gray matter quality were included. Cognitive end-points were not
the focus of the Phase 1 clinical trial because of the wide range of disease severity enrolled and lack of a placebo group. Patients enrolled
in the Phase I trial had MMSE ranging from 24 to 12. This wide range of disease severity at the time of enrollment and the lack of a blinded
concurrent control group did not allow for determination of cognitive benefit beyond several anecdotal reports. The first patient was
enrolled in the low dose 0.3mg/kg/week cohort in the last week of November 2019. The Safety Review Committee met by teleconference on
January 7, 2020, to review the course of the patients in the first cohort and voted to open the second cohort, 1.0mg/kg/week, to enrollment.
The first patients were enrolled in the cohort the second week of February 2020. Based on preliminary data released on July 13, 2020,
and January 21, 2021, we closed after completion of a 0.6mg/kg treatment group. We canceled plans to treat patients with 3.0mg/kg. The
data from the Phase I trial informed the design of the Phase II trials described above. Mindful, the blinded randomized placebo control
trial in patients with Early AD began enrollment in 2022. The final patient was enrolled in the trial in November 2024. Top line cognition
data will be available June 2025. Patient enrollment criteria included one inflammatory biomarker plus and MMSE between 27 and 22. During
the 6 month trial, patients received XPro or placebo once-a-week by subcutaneous injection. Two-thirds of the patients were randomized
to XPro. Overall, 56% and 44% of the 208 patients had mild AD and MCI, respectively.
XPro Registration Studies and/or Partnering
We plan to aggressively pursue
an efficient registration strategy using XPro to improve the lives of patients with ADi. We define ADi as Alzheimer’s disease with
biomarkers of inflammation. We believe ADi is not the only indication for XPro in neurodegenerative and neuropsychiatric diseases. We
plan to pursue other indications in neurodegenerative diseases as resources become available. We have received NIMH funding to support
a Phase II TRD program that will start patient enrollment during 2025. We have an active partnering position as it relates to XPro development
in neurodegenerative and neuropsychiatric diseases, although limited partnering discussions are underway at this time. There are two partnering
opportunities with this novel immunotherapy for the treatment of neurologic and psychiatric diseases. The first is a traditional partnership
focused on the developing the drug for all neurodegenerative and neuropsychiatric applications. The second is a more focused partnership
developing XPro as part of a combination therapy for a company’s existing therapy. After completion of proof-of-concept Phase II
studies, we will decide what the most efficient registration strategy is available to the company with XPro.
9
INKmune: Our NK cell Directed Product Candidate
INKmune is our product candidate that converts the patient’s resting
NK cells into cancer memory like NK cells, an essential step to allow them to participate in the immune control of the patient’s
cancer. We have shown this works ex vivo in human tissue cell cultures, and we believe that this will work in vivo which is the purpose
of our planned clinical trials.
Cancers grow and relapse because
they evade the immune system. In many cancers, NK cells are the most important cell for the elimination of residual disease that causes
cancer relapse. NK cells target cells based on a series of complex antigens on the cancer cell surface that signal the NK cells to activate
and kill the cancer cell. NK cells develop a memory like NK cell phenotype to enhance killing of cancer cells. This phenotype requires
multiple simultaneous signals to be delivered to the NK cells. A cocktail of three cytokines, IL12, IL15 and IL18 can be used to convert
a resting NK cell to cytokine induced memory like NK cells (“CIML”) [Fehneger 2016] or by INKmune priming with INB16 (TpNK
– tumor primed NK cells). Although the intracellular biology of these two strategies has yet to be worked out, they do not appear
to be identical. In summary, INKmune converts resting NK cells into tumor killing memory like NK cells that function well in the hostile
environment of the TME. (Figure 1 below).
10
The ability of NK cells to
kill tumor cells depends on the strength and duration of the cell-cell interaction. This is called avidity. The higher the avidity the
greater the tumor cell killing. Cytokine stimulation may increase avidity of NK binding to some cancer cells whereas, in all experiments
to date, INKmune priming enhances NK binding to all cancer cells tested. The relative increase in avidity to specific cancer cells is
cytokine specific; as shown below, IL15 increases NK avidity for the ovarian cancer line SKOV-3 whereas IL2 has a limited effect. IL15
primed NK cells lyse SKOV-3 cells whereas IL2 primed NK do not. INKmune primed NK (TpNK) showed the highest avidity for the tumor cells
and the highest level of cytotoxicity. It is likely that the use of multiple cytokines will achieve the same level of avidity and cytotoxicity
as INKmune but studies with multiple cytokines have not yet been performed (Figure below).
We have demonstrated TpNK killing of many tumor types in laboratory studies.
Tumor priming is effective regardless of the source of the NK cells (normal volunteers or patients with cancer) and in many types of tumors
– both cell lines and primary tumors from patients. The principle of TpNK killing has also been demonstrated in two Phase I trials
in patient with acute myelogenous leukemia (“AML”). These trials were not supported by us and used a first-generation personalized
cell therapy product and treatment strategy that is different from the INKmune product and treatment strategy. In these trials, haplo-identical
NK cells obtained from a first degree relative by leukapheresis were primed ex-vivo using a lysate of the parent cell line from which
we derived INB16 - INKmune. Once the TpNK therapy has been produced and passed quality testing, the patient received conditioning therapy
with chemotherapy (cyclophosphamide and fludarabine), the primed haplo-identical NK cells were given to patients by intravenous infusion.
Two Phase I clinical trials have been performed using that first-generation adoptive cell therapy treatment strategy. An investigator-initiated
trial performed at the Royal Free Hospital in London 2009 was funded by a United Kingdom charity. Fifteen patients with relapsed, high-risk
AML were enrolled in the trial. Because of drop-out due to disease progression, delays in product production and complications of conditioning
therapy, only 7 of the fifteen patients were treated with the TpNK cell product. Four of seven patients showed clear benefit from the
treatment with the TpNK product with prolonged relapse free remission and, in one patient, conversion of a partial remission to full remission.
None of the remissions were durable; all patients ultimately died from disease progression. The safety of the product was found to be
a combination of toxicity from the chemotherapy/radiotherapy conditioning regimen and the TpNK therapy. In general, the complications
were well tolerated although did require medical intervention including prolonged periods of aplasia in two heavily pretreated patients
that resolved with supportive care. The results of this study have been published in a medical journal (PLoS One. 2015 Jun 10;10(6):e0123416.
doi: 10.1371/journal.pone.0123416. eCollection 2015). In 2013, a second open label, multi-center trial was performed in the US using the
same product and procedures but targeting a slightly different patient population. In the second trial, 12 patients in first remission
with AML were treated with the haplo-identical TpNK product produced using the first generation ex-vivo priming process. After conditioning
with chemotherapy alone, the patients received TpNK in three dosing cohorts – 3x10^5, 1x10^6 or 3x10^6 TpNK per kilogram. Patients
were followed for safety and relapse free survival. This trial confirmed the safety of the TpNK treatment in patients with AML and reinforced
many of the efficacy findings seen in the first trial with none of the previously experienced side effects. Patients benefited from haplo-identical
TpNK therapy with prolonged relapse free survival including two patients that remain in remission more than 42 months after treatment.
This trial has been published. (Biol Blood Marrow Transplant. 2018 Mar 26. pii: S1083-8791(18)30132-0. doi: 10.1016/j.bbmt.2018.03.019.)
The results of the laboratory and Phase I studies provide evidence that our strategy for treating residual disease is sensible but unproven.
11
Because INKmune primes NK cells to target naturally occurring antigens,
we believe INKmune can be used to treat a wide variety of cancers including hematologic malignancy (AML, MM, CML, high risk MDS) and solid
tumors (renal, prostate, breast, ovarian, pancreas and lung). We expect the list of INKmune sensitive tumors to continue to expand.
The primary role for INKmune
will be an immunotherapy targeting residual disease in patients after debulking cancer therapies such as cytotoxic chemotherapy and surgery.
At this time, we plan to give INKmune as monotherapy. We do not rule out the possibility of using INKmune as part of combination therapy
in the future. We do not expect to need to modify INKmune to treat these additional types of cancer, because we believe INKmune is a universal
cancer therapy where “one size fits all”. We believe for INKmune to receive regulatory approval for each cancer indication,
clinical trials will need to be performed which demonstrate its safety and effectiveness as a treatment for each such cancer. We believe
the difficulty and cost of achieving these labels extensions will decline with each successive approval, if and when achieved. For example,
if INKmune is proven to be effective therapy in patients with castration resistant prostate cancer, we will need to perform separate pivotal
trials for approval in lung, prostate or renal cancer.
Three step process to preparation for INKmune
human clinical trials:
INKmune GMP scale-up for Phase I/II clinical
material
The working cell banks and
individual INKmune product to be used in the patients for the clinical trial have been produced at the Centre for Cell, Gene & Tissue
Therapeutics at Royal Free Hospital / University College London to full cGMP (MHRA MIA(IMP)11149). All manufacturing has been under the
direction of Professor Mark Lowdell. The Company can produce enough INKmune to complete its Phase I clinical trial in men with metastatic
castrate resistant prostate cancer (“mCRPC”). We have validated storage of INKmune for up over 3 years in vapor phase nitrogen
and have a fully scalable, closed system manufacturing process in validation which can produce up to 6 patient doses per week during phase
I and II trials. At intermediate scale we can manufacture 40 doses per week in a single 15-liter bioreactor. Importantly, we have validated
the storage of INKmune at -80 o C for up to 27 days which greatly facilitates the delivery and local storage of the drug for
clinical trials and post commercialization use. In contrast, as far as we know all other NK cell therapies and T cell therapies require
complex shipping of drug products in vapor phase nitrogen below -150 o C and specialized arrangements for ongoing storage at
the clinical sites. We may need additional INKmune for future clinical trials.
Interaction with Regulatory Authorities Regarding
INKmune Development
The INKmune Phase I studies in high-risk MDS were performed in the United
Kingdom and Greece. We met with the Medicines and Healthcare Products Regulatory Agency (“MHRA”), the United Kingdom version
of the FDA as part of a Scientific Advice Meetings in preparation for submitting the CTA for our first planned program. During March 2024,
the Company decided to terminate further enrollment in the MDS trial due to recruitment difficulties in the European trial sites.
12
INKmune Product Development Path Proposed Phase
I Study in patients with high-risk MDS
During 2021, we initiated
an open label Phase I cancer study in patients with high-risk myelodysplastic syndrome (“MDS”). The first patient was enrolled
in the first quarter of 2021. In the Phase I trial, we planned to treat patients with detectable residual disease in bone marrow and/or
peripheral blood (<15% blasts by conventional tests) with intravenous infusions of INKmune and monitored for changes in peripheral
blood NK activation, NK function and changes in residual blast counts in blood and bone marrow. We and others have previously shown that
MDS patients with inadequate NK function have statistically significantly poorer prognosis than matched patients with normal levels of
NK function (Tsirogianni et al 2019) and we have shown in laboratory experiments that the functional activity of NK cells from MDS patients
can be enhanced by exposure to INKmune. Moreover, INKmune-primed NK cells are not inhibited by the hypoxic conditions of the diseased
bone marrow microenvironment.
The first patient was treated in the second quarter of 2021. The patient,
part of the first cohort, received 1x10^8 INKmune cells on day 1,8 and 15 as an in-patient. The patient did not require any type of conditioning
therapy or cytokine support. The patient tolerated the three infusions without any problems. The patient underwent intensive monitoring
over 120 days. There are 4 observations from this first patient. The patient has dramatically increased the number of activated, “memory-like”
NK cells in circulation. Memory-like NK cells (mlNK) are activated NK cells with a unique cell surface protein phenotype and which show
enhanced lysis of tumor cell in vitro. Post treatment with INKmune, elevated levels of mlNK cells were present in the patients in the
peripheral blood for more than 119 days when trial follow-up ceased. The patient mlNK actively kill NK resistant cancer targets in vitro.
Finally, the patient had a significant clinical improvement with a reduction of his ECOG score from 2 to 0 and a significant reduction
in blood product support.
Three compassionate use cases have also been treated. Two were young patients
with AML who had failed previous hematopoietic stem cell transplants (“HSCT”). The first compassionate-treatment patient showed
such improved neutrophil and platelet counts that she was discharged from hospital for the first time in six months. The second patient
treated compassionately had failed two high risk HSCT and entered the course of INKmune therapy with high percentage of blasts in his
bone marrow. His blood NK cells responded in differentiation into mlNK as hoped but it is too early to determine if INKmune has provide
any clinical benefit. Due to market opportunities, the Company closed the high-risk MDS trial to focus on solid tumors. The Company plans
to put all of its INKmune development efforts into the on-going US Phase I/II trial in men with mCRPC.
13
INKmune Registration Studies and/or Partnering
During March 2023 the Company
opened an Investigational New Drug (“IND”) application for a Phase I/II trial of INKmune in mCPRC. The clinical trial is an
open label Phase I/II trial in men with metastatic castrate resistant prostate cancer. The trial has a modified Baysian design that allows
for a 3 patient Phase I for each dose level followed by a 6 patient Phase II trial. All patients will receive 3 infusions of INKmune on
days 1, 8 and 15. The three doses of INKmune at low, medium and high dose of INKmune is 1x10^8, 3x10^8 or 5 x10^8 cells per infusion respectively.
INKmune infusions are given as an out-patient with the use of pre-medication or additional cytokines. Patients are carefully monitored
for 6 months after the first dose of INKmune. There are four goals of the trial – determine safety in the target population; immunologic
efficacy, anti-tumor effects and select a dose for the pivotal trial. Immunologic efficacy is determined by an increase in the numbers
of memory like NK cells in the circulation of the patient and how long that increase lasts. In general, we are expecting the number of
mlNK to double and to persist in the circulation of the patient for more than 120 days. Anti-tumor effects will be monitored by serial
testing of blood prostatic surface antigen level (blood PSA), prostate-specific membrane antigen
nuclear medicine scan ( PMSA scan with piflufolastat F18; Pylarify®) and circulating tumor DNA. The Company enrolled the first
patient in the open label low, medium and high dose Phase I cohorts in DEC23, JUN24 and OCT24 respectively. All patients in the phase
I dose escalation part of the trial have now been treated and the final patient in the Phase II cohorts is expected to be enrolled in
1H25 with data lock 2H25. As an open label trial, there may be opportunities to see patient data during 2025. Other solid cancers are
of interest including nasopharyngeal cancer (“NPC”) which is a known target for NK cells and an important unmet clinical need
in emerging markets such as mainland China. Renal cell carcinoma is also a known target for INKmune. We may seek to partner or sell INKmune.
Although our development strategy is focused on North America and Europe, we believe INKmune will also be attractive for markets on the
Pacific Rim, South Asia and South America, but will wait for partners to help with the development in those regions, however, at this
time, we are not negotiating with any potential partners.
Importantly, we have published
data demonstrating INKmune efficacy at priming allogeneic NK cells ex-vivo (described above) and this includes priming of NK cells differentiated
from cord-blood derived hematopoietic stem cells (Domogala et al Cytotherapy 2017: 19:710-720). Numerous companies are developing
therapeutic strategies using cord blood derived NK cell products and one or more may wish to partner with us to potentiate their product
by co-incubation or co-administration with INKmune. We are also aware of companies developing cytokine primed NK cells (CIML) for the
treatment of cancer. We believe tumor primed NK cells are superior to ex vivo or in vivo cytokine strategies.
Challenges in the Market for Our Product Candidates
The market for new oncology
therapies is competitive, complicated, and rapidly evolving. We will be competing with companies that are older, larger, better financed
and have greater experience. There are two types of drug companies – development companies and commercial companies. Development
companies take the risk of developing new products to proof-of-concept. Once proof-of-concept has been achieved, if the drug provides
clinical benefit, the product is usually acquired by a commercial company, which completes the drug’s clinical development and markets
the product. We are a development company which will seek to develop products such as INKmune from the bench to the bedside to demonstrate
proof-of-concept. The goal for us is to successfully develop such products to the point where they are attractive targets for potential
partners/acquirers.
According to a recent Markets
and Markets report, the immunotherapy market is growing rapidly at an annual rate of over 13%. Recently, the market is biased towards
T cell-based immunotherapies including bi-specific antibody therapies, checkpoint inhibitors and CAR-T cell-based therapies. There are
substantial numbers of clinical trials that are focused on the adaptive immune system versus clinical trials that are focused on the innate
immune system for the treatment of cancer. Our challenge will be to educate partners on the value of NK cell-based therapeutic strategies.
The need to educate people of the importance of INB03 is equally challenging. At the academic and investor level, there is little recognition
of the role MUC4 plays in causing resistance to immunotherapy. The concept of adding a drug to modify the immunosuppressive environment
of the TME to allow immunotherapy to be effective is also new. We will be responsible for educating them on the importance of MUC4 expression,
TAM, MDSC and why INB03 may be an important addition to the oncologist’s armamentarium. We believe educating investors and partners
about new therapeutic opportunities is an easier task than trying to differentiate our company from the many other cancer immunotherapy
companies. We plan to use a combination of publication, presentation and investor relations to discuss INKmune and INB03 and to educate
the clinical, biopharma and investor community on the value of these novel therapeutic approaches.
14
DN-TNF Competition
To our knowledge, there are
no other companies developing a therapy to treat patients with MUC4+HER2+ tumors. This set of biomarkers predicts a tumor that will be
resistant to therapy. We believe MUC4 expression means that patient will be resistant to first line trastuzumab based immunotherapy and
will be resistant to CPI. INB03 is a unique category of cancer therapies. It is does not kill cancer cells. INB03 modulates the immunology
of the TME to make existing therapies more effective. The advantage of this strategy is that it can be used prospectively, and it does
not add toxicity to existing therapy.
INKmune Competition
Our industry is highly competitive
and subject to rapid and significant technological change. Our potential competitors include large pharmaceutical and biotechnology companies,
specialty pharmaceutical and generic drug companies, academic institutions, government agencies and research institutions. We believe
that key competitive factors that will affect the development and commercial success of our product candidates are efficacy, safety, tolerability,
reliability, price, and reimbursement level. Many of our potential competitors, including many of the organizations named below, have
substantially greater financial, technical, and human resources than we do and significantly greater experience in the discovery and development
of product candidates, obtaining FDA and other regulatory approvals of products and the commercialization of those products. Accordingly,
our competitors may be more successful than us in obtaining FDA approval for and achieving widespread market acceptance of their drugs.
Our competitors’ drugs may be more effective, or more effectively marketed and sold, than any drug we may commercialize and may
render our product candidates obsolete or non-competitive before we can recover the expenses of developing and commercializing any of
our product candidates. We anticipate that we will face intense and increasing competition as new drugs enter the market and advanced
technologies become available. Further, the development of new treatment methods for the conditions we are targeting could render our
drugs non-competitive or obsolete.
INKmune is an immunotherapy
that harnesses the biology of NK cells for the treatment of cancer. There is a long list of immunotherapy strategies for the treatment
of cancer and the immunotherapy for cancer market is growing rapidly. There are at least three ways to classify immunotherapy for cancer.
The list below classifies immunotherapy strategies beginning with those that are most closely related to INKmune:
1.
Companies in the NK cell therapy business;
2.
Companies in the personalized immune-oncology business; and
3.
Companies in the precision immuno-oncology business.
15
We are not aware of any approved
treatments that are classified as NK cell therapies. We are aware of public companies in the NK cell therapy business such as Century
Therapeutics, Immunity Bio, Nkarta, Fate Therapeutics, Glycostem and others. These companies are developing products that involve replacing
or supplementing NK cells of the patient for the treatment cancer. Their products require extensive ex-vivo cell manipulations which,
with respect to Century Therapeutics and Fate Therapeutics, may include gene therapy. The next larger group of companies are in the personalized
immuno-oncology business with products focused on T cell activation strategies. The most popular are the CAR-T cell therapies which are
a patient specific ex-vivo gene therapy approach. CAR-T therapy has become wildly popular of late and includes many private companies,
public companies such as Bluebird, Juno Therapeutics and Mustang Bio as well as established companies such as Novartis and Gilead. For
many of the companies, CAR-T cell therapies is their only business. For the latter two, CAR-T cell therapies is a newly in-licensed program
with marketing authorization in the US. Finally, the precision immune-oncology category also includes companies with anti-cancer antibody
products and the newer “check-point” inhibitors. Antibody therapies are all about “illuminating” the cancer to
the innate immune system (NK cells). Monoclonal antibodies were the original immunotherapy that drove the growth of well-known biopharma
companies including Genentech/Roche, Amgen, Merck and others. Each of these products is disease specific (ie: treat only HER2+ breast
cancer). Modern therapeutic antibodies are much more complicated bi-specific and tri-specific antibodies that attempt to connect the cancer
with activated T-cells of the adaptive immune system. Check-point inhibitors are currently the most rapidly expanding product category
in immuno-oncology. These CTLA-4 (ipilimumab) and PD-1 inhibitors (pembrolizumab and nivolumab) specifically block a mechanism that shields
cancers from T-cell killing. The two companies in this business are Merck (pembrolizumab) and GSK (ipilimumab and nivolumab). There are
many others trying to join this promising therapeutic area including large companies such as BMS and Roche.
There are several FDA approved
drugs that improve the ability of the innate immune system (NK-cells) to treat cancer including mono-clonal antibody therapies (for example:
Rituximab®; Avastin® and Herceptin® marketed by Roche/Genentech); and “check-point” inhibitors (Yervoy® and
Opdivo®, BMS, Keytruda®, Merck and others). There is a large amount of development activity in the immune checkpoint inhibitor
field from both pharmaceutical giants including AstraZeneca, Merck & Co, Pfizer, Merck KGaA, Roche, GSK, Novartis and Amgen and many
start-ups, small companies and university spin-offs which have emerged in the past two years. Examples (in alphabetical order) include
Agenus, Alligator Bioscience, Ambrx, AnaptysBio, argenx, Bioceros, BioNovion, Cellerant Therapeutics, Checkpoint Therapeutics, Compugen,
CureTech, Enumeral, Five Prime Therapeutics, Genmab, GITR, ImmuNext, IOmet Pharma, iTeos Therapeutics, Jounce Therapeutics, KAHR Medical,
Multimeric Biotherapeutics, Nativis, Orega Biotech, Pelican Therapeutics, Pieris Pharmaceuticals, Prima BioMed, Redx Pharma, Sorrento
Therapeutics, Tesaro, TG Therapeutics, Theravectys and ToleroTech active in the field. The list of companies with poly-specific antibodies
that attempt to link the cancer with a cytotoxic T cell is long, includes both private and public companies (Amgen, Xencor, F-Star, Merus
and many others). Finally, two CAR-T cell therapies were recently approved for the treatment of ALL – Kymriah™ (Novartis)
and Yescarta™ (Gilead). We expect additional drugs to gain marketing authorization in the immune-oncology space.
To our knowledge, there are
no innate immune check-point inhibitors in development that have the unique characteristics of INB03 that neutralize sTNF to: i) decreases
the proliferation of MDSC; ii) decreasing local and systemic immunosuppression caused by MDSC by stopping production of immunosuppressive
cytokines and iii) improving NK/DC cross-talk to recruit the adaptive immune system to fight the cancer.
16
Intellectual Property
We seek to protect our therapeutic
programs by continuously developing patent properties covering novel compositions, formulations, purpose-limited compositions, combination
treatments, methods of medical treatment, and other inventions, whether created internally or in-licensed, in the United States Patent
& Trademark Office (the “USPTO”), the World Intellectual Property Organization (“WIPO”) under the Patent Cooperation
Treaty (“PCT”), and in patent offices for various foreign jurisdictions. While each invention is unique and territories for
protection are decided on a case-by-case basis, we generally pursue patents in Australia, Canada, Europe, Japan, and the United States,
and sometimes in Brazil, China and/or Korea. We currently have in our portfolio fifteen (15) issued patents and thirty (30) pending patent
applications, including both company-owned and in-licensed properties. The following sections and corresponding tables summarize, for
each of our current therapeutic programs, our pending and granted patent positions, to the extent publicly available, as of the time of
preparing this document:
DN-TNF Platform Technology (Oncology, Central
Nervous System Disorders, Acute and Chronic Peripheral Diseases)
The DN-TNF Platform Technology
covers a variety of dominant negative tumor necrosis factor (“DN-TNF”) variant proteins, including the pegylated DN-TNF protein
variants known as XPro and INB03. These DN-TNF protein variants can be considered a platform technology for treating the underlying immune
dysfunction associated with many disease manifestations. Unlike approved anti-TNF therapeutics, DNTNF selectively targets and neutralizes
soluble TNF, and is therefore not immunosuppressive. Additionally, XPro has been shown to cross the blood brain barrier after peripheral
administration, making it attractive for use in treating CNS disorders. The following table summarizes current IP covering our DN-TNF
platform technology:
Subject Matter / Compound
# Pending
Applications
# Issued
Patents
Geographical
Scope
Nominal Patent
Term
DNTNF compositions and formulations
2
0
global
2044-2045
Use of DNTNF for treating disease
19
10
global
2033-2041
DNTNF manufacturing/CMC
1
0
global
2045
INB-16 / INKmune (Oncology)
INKmune is a replication-incompetent
derivative of our proprietary INB-16 cell line. One commercial application of INKmune includes use as a therapeutic composition designed
to enhance the ability of a patient’s own NK cells to seek, recognize and eliminate cancer. Another commercial application of INKmune
includes use as a cytokine-like (“pseudokine”) agent for enhancing NK cell killing specificity, potency, and efficacy of NK
cell -based therapeutics. INKmune, as a therapeutic, is intended for provision as an I.V. -infused product containing replication-incompetent
bio substrate units, each of which is adapted to present an aggregate of protein ligands and/or receptors to a patient’s own NK
cells, in vivo . Upon contacting the patient’s NK cells, INKmune converts resting NK cells into what we call “primed”
NK cells (“pNKs”). Data suggests that pNKs demonstrate enhanced killing of tumor cells, thus INKmune may indirectly improve
a patient’s own immune response to cancer. As a pseudokine agent, INKmune can be used to contact the NK cells of an NK cell therapeutic
product in vitro , e.g., during manufacturing, for enhancing characteristics of the NK cell therapeutic and rendering an improved
product. The following table summarizes current IP covering INB-16 / INKmune:
Subject Matter / Compound
# Pending
Applications
# Issued
Patents
Geographical
Scope
Nominal Patent
Term
INB-16 / INKmune compositions
5
0
global
2043
Use of INKmune for treating disease
4
5
global
2036-2043
17
CORDStrom (MSCs)
CORDstrom is a cell suspension
for intravenous infusion or injection comprising aseptic, allogeneic, pooled HucMSCs. CORDStrom solves certain manufacturing and CMC limitations
known to affect mesenchymal stem/stromal cell products, namely, improved batch-to-batch consistency and scalable manufacturing. We have
filed patent applications directed to CORDStrom including claims covering composition of matter, formulation, and methods of treating
various disease indications. In addition, we protect manufacturing trade secrets with a series of confidentiality provisions in various
agreements. The following table summarizes current IP covering our CORDStrom platform technology:
Subject Matter / Compound
# Pending
Applications
# Issued
Patents
Geographical
Scope
Nominal Patent
Term
CORDStrom compositions and formulations
1
0
global
2045
Use of CORDStrom for treating disease
1
0
global
2045
General IP Disclosures
Our commercial success depends
in part on obtaining and maintaining patent and trade secret protections, where applicable, of our current and future product candidates
and the methods used to manufacture them, as well as successfully defending our patents against third-party challenges.
Our ability to stop third
parties from making, using, selling, offering to sell or importing our products depends on the extent to which we have rights under valid
and enforceable patents or trade secrets that cover these activities, and whether we are able to enforce such rights. We cannot assure
you that our pending patent applications will result in issued patents, or that any or all rights will be enforceable in every jurisdiction
whether or not patent rights are sought.
International PCT patent applications
cover all 152 nations which are signatories of the PCT. However, our global IP strategy generally targets Australia, Canada, Europe, Japan,
and the United States, and sometimes Brazil, China and/or Korea, as targets for extending patent protection under the PCT. Decisions regarding
which countries to extend patent coverage under the PCT is taken on a case-by-case basis, subject to normal business considerations such
as value and return on investment. Given the markets for products we are developing, we consider the foregoing jurisdictions to amount
to “global” coverage as used herein as it relates to IP.
The above disclosures related
to patents and patent applications are subject to change based on strategic patent portfolio building decisions, which may include refiling
and reissue, certain abandonments, including those in favor of continuing patent applications, maturations from provisional to non-provisional
filings, and other regular patent prosecution activities.
Trademarks
The designations INMUNE BIO TM , INB16 TM , INKmune TM ,
PSEUDOKINE TM , and XPro TM are trademarks of INmune Bio Inc. Some or all these trademarks may be protected by applications
pending at the USPTO and other trademark registration authorities globally. As part of the trademark registration process, we may be required
to submit a statement of use evidencing bona fide use of each mark in commerce. By nature of being in the biopharmaceutical business,
certain regulatory requirements must be met in connection with certain products and/or services prior to receiving marketing authorization
from a regulatory agency, and thus it may take some time before products and/or services are offered for sale and a statement of use can
be submitted for perfecting trademark registration. For these reasons, we may be required to obtain extensions of time, or to refile applications,
seeking registration of trademarks. We cannot guarantee that a given trademark application will be allowed or issued in a respective office
for each jurisdiction.
IP License Agreements
Immune Ventures, LLC License Agreement
On October 29, 2015, the Company
entered into an exclusive license agreement (the “INKmune License Agreement”) with Immune Ventures, LLC (“Immune Ventures”).
Pursuant to the INKmune License Agreement, we were granted an exclusive worldwide, sub-licensable, royalty-bearing license to commercialize
INKmune (the “INKmune License”). In consideration for the INKmune License, we are obligated to pay Immune Ventures certain
milestone and royalty payments.
18
The term of the Immune Ventures
Agreement began on October 29, 2015, and, if not terminated sooner pursuant to the agreement, ends on a country-by-country basis on the
date of the expiration of the last to expire patent rights where patent rights exist. Subject to granting, prosecution-related patent
term adjustments, and requirements for maintenance and renewals, the latest to expire patent is scheduled to expire on March 15, 2038
(“Natural Expiration”). Upon Natural Expiration of the Immune Ventures Agreement, we shall have a fully paid up, perpetual,
royalty-free license without further obligation to Immune Ventures. The Immune Ventures Agreement can be terminated by Immune Ventures
if, after 60 days from our receipt of notice that we have not made a payment under the Immune Ventures Agreement we still do not make
this payment. On July 20, 2018 and October 30, 2020, the parties amended the agreement under which the Company was required achieve
milestones pursuant to the agreement.
On April 17, 2023, the parties
executed an additional amendment to the agreement under which the Company removed the due diligence requirements to achieve reasonable
commercial efforts to bring INKmune to market. This removed all requirements of clinical trial timelines and the filing timelines of an
NDA or equivalent. All other provisions in the INKmune License Agreement shall continue in full force and effect.
University of Pittsburg License Agreement
On October 3, 2017, the Company
entered into an Assignment and Assumption Agreement with Immune Ventures related to intellectual property licensed from the University
of Pittsburgh. Pursuant to the Assignment and Assumption Agreement (the “Assignment Agreement”), Immune Ventures assigned
all its rights, obligations and liabilities under an Exclusive License Agreement between the University of Pittsburgh – Of the Commonwealth
System of Higher Education (“Licensor”) and Immune Ventures to INmune Bio (“Licensee”), (the “PITT Agreement”).
As consideration under the
PITT Agreement, we are obligated to pay: (i) annual maintenance fees, (ii) royalty payments based on the sale of products making use of
the licensed technology, and (iii) milestone payments.
The PITT Agreement expires
upon the earlier of: (i) expiration of the last claim of the Patent Rights forming the subject matter of the PITT Agreement; or (ii) the
date that is 20 years from the effective date of the agreement (June 26, 2037).
The Company may terminate
the PITT Agreement upon 3 months prior written notice provided all payments under the license are current. Licensor may terminate the
PITT Agreement upon written notice if: (i) the Company defaults as to performance of material obligations which have not been cured within
60 days after receiving written notice; or (ii) the Company ceases to carry out its business, becomes bankrupt or insolvent, applies for
or consents to the appointment of a trustee, receiver or liquidator of its assets or seeks relief under any law for the aid of debtors.
19
Xencor License Agreement
On October 3, 2017, the Company
entered into a license agreement with Xencor, Inc. (“Xencor”), which has discovered and developed a proprietary biological
molecule that inhibits soluble tumor necrosis factor (the “Xencor Agreement”). During June 2021, the Company entered into
the First Amendment to License Agreement with Xencor. Pursuant to the Xencor Agreement, Xencor granted the Company an exclusive worldwide,
royalty-bearing license in licensed patent rights, licensed know-how and licensed materials (as defined in the Xencor Agreement) to make,
develop, use, sell and import any pharmaceutical product that comprises, contains, or incorporates Xencor’s proprietary protein
known as “XPro” that inhibits soluble tumor necrosis factor (or all modifications, formulations and variants of the licensed
protein that specifically bind soluble tumor necrosis factor) alone or in combination with one or more active ingredients, in any dosage
or formulation. The Xencor Agreement expires upon the later of: (a) the expiration of the last to expire valid claim covering any pharmaceutical
product that contains, comprises, or incorporates Xencor’s proprietary protein known as XPro alone or in combination with one or
more active ingredients, in any dosage or formulation. (“Licensed Product”) in such country or (b) ten years following the
first sale to a third party of the licensed product in such country. Net Sales with respect to any Licensed Product is the gross amounts
invoiced by us for sales of the Licensed Products less deductions actually incurred. A valid claim is an issued, unexpired or pending
claim with the patent rights that Xencor controls as of October 3, 2017 which patent rights are necessary to make, develop, use, sell,
have sold, offer for sale and import a Licensed Product in the Field (the Field means all applications for the treatment of diseases in
humans) or the Product Patent Rights, which claim has not lapsed, been abandoned, been revoked or been held to be unpatentable, invalid
or unenforceable by a final judgment of a court or other governmental agency or competent jurisdiction from which no appeal can be or
is taken within the time allowed for appeal and which has not been admitted to be invalid or unenforceable through reissue, re-examination,
disclaimer or otherwise. Product Patent Rights shall mean any and all our patent rights that are necessary to make, develop, use, sell,
have sold, offer for sale and import a Licensed Product in the Field, including any improvements or patent rights directed to the Licensed
Product. Either party may terminate the Xencor Agreement upon 60 days’ (10 days for any payment default) prior written notice to
the other party after the breach of any material provision of the agreement by the other party if the breaching party has not cured the
breach within the 60-day period (10-day period for any payment default) following written notice of termination by the non-breaching party.
We can terminate the Xencor Agreement upon 180 days prior written notice to Xencor. Xencor may terminate the Xencor Agreement in its entirety
or with respect to any specific Licensed Product upon written notice in the event that we contest, oppose or challenge or assist any party
in contesting, opposing or challenging, Xencor’s ownership of, or the enforceability or validity of the Patent Rights that Xencor
controls as of October 3, 2017 which Patent Rights are necessary to make develop, use, sell, have sold, offered for sale and import a
Licensed Product in the Field. Either party may terminate the Xencor Agreement upon written notice to the other party upon or after the
insolvency, bankruptcy, dissolution or winding up of such other party or the making or seeking to make or arrange an assignment for the
benefit of creditors of such other party or the initiation of proceedings in voluntary or involuntary bankruptcy which proceeding, or
action remains undismissed or unstayed for a period of more than 60 days.
In consideration of the Xencor
Agreement, we agreed to royalty payments and a percentage of any payments received in exchange for a sub-license.
CORDStrom License Agreement – Clinical Trial Data
On February 6, 2025, the Company and Great Ormond Street Hospital NHS
Foundation Trust (“GOSH”) executed an exclusive commercial use license to clinical trial data associated with the MissionEB
trial (ISRCTN14409785). The Company owns the intellectual property covering the CORDStrom product, the investigational medicinal product
(“IMP”) used in the MissionEB trial. In addition, the Company owns IP and maintains trade secret protections covering the
manufacturing of CORDStrom. With this license to the clinical trial data, the Company intends to prepare applications seeking marketing
authorization of CORDStrom for treatment of pediatric recessive dystrophic epidermolysis bullosa (“RDEB”) in each of the FDA,
EMA, and MHRA. Terms of the GOSH license include an upfront payment of £250,000 (approximately $0.3 million at February 6, 2025)
and a single milestone payment of up to £6,000,000 (approximately $7.5 million at February 6, 2025) due on the first to occur marketing
authorization to be granted by the FDA, EMA or MHRA. While these things can be unpredictable, the Company is targeting a first marketing
authorization in 2026, which upon occurrence would render the single milestone obligation due for payment. In addition to these financial
terms, the Company has agreed to certain patient access obligations, including sponsoring the supply of CORDStrom to United Kingdom patients
enrolled in an open label continuation of the MissionEB trial.
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INKmune Research and Development
We expect to use third parties
to conduct our preclinical and clinical trials under the direct supervision of management.
INKmune Manufacturing
We intend to contract with
third parties for the manufacture of our compounds for investigational purposes, for preclinical and clinical testing and for any FDA
approved products for commercial sale. Pre-clinical and clinical material for the early clinical trials with INKmune has been manufactured
under the direction of Mark Lowdell at a licensed Good Manufacturing Practice (“GMP”) facility. The master cell bank, working
cell bank and individual product doses were completed in July 2018. This clinical material is planned for use in the Phase I/II clinical
trials. As we progress in our clinical programs, additional working cell banks and therapeutic product will be produced from the existing
master cell bank. This process takes approximately 6 months and is not anticipated to delay the initiation or enrollment of the Phase
I/II trials. We may transfer the manufacturing to a different commercial contract manufacturing organization after completion of these
Phase II studies.
Human Mesenchymal Stem
Cells
In November 2017 (amended
in October 2022), we entered into a Material Transfer and License Agreement with the Anthony Nolan Cord Blood Bank (“AN”),
the oldest and largest non-directed cord blood bank in the United Kingdom for the supply the starting material for the mesenchymal stem
cells - umbilical cords not used after cord blood harvest. Mark Lowdell’s research group developed and validated a methodology for
producing large numbers of clinical-grade pooled HucMSC. We believe we are well positioned to become a preferred manufacturing partner
for companies who need MSC for clinical programs. Manufacture of HucMSC is performed under the direction of Mark Lowdell in a licensed
GMP facility that is contracted to the Company as part of existing research and development agreements. The starting material for the
HucMSC product is provided by the AN. The HucMSC product produced in this facility are fully qualified to be used for either research
or clinical trials. We have developed a validated manufacturing process that reliably produces contract manufacturer of the clinical grade
(“cGMP”) quality mesenchymal stem cells that we call CORDStrom. To date, we are supporting one academic clinical trial with
CORDStrom in the United Kingdom treating children with recessive dystrophic erythematous bullosa (“RDEB”), a disfiguring skin
disease in children that is similar to a second-degree burn. INmune Bio supplied the clinical product for treatment of these patients.
The pivotal trial in RDEB has been completed. The Company reviewed the clinical data under CDA on October 7, 2024. A non-binding agreement
was executed with GOSH while the company determined if the clinical data could be used to support marketing authorization of CORDStrom
to treat RDEB in the US. The Company completed that review and licensed the clinical data from GOSH on February 6, 2025. The use of CORDStrom
to treat children with RDEB was announced publicly on February 10, 2025. Currently, we plan to supply CORDStrom to third parties for their
research use and in clinical trials as part of the development process for commercial products. We may decide to expand this agreement
in the future if the commercial and/or development opportunities warrant such expansion. At the current time, we expect this program to
be funded by revenues from commercial sales. The agreement with AN terminates on November 29, 2027. AN may terminate the license on written
notice to us, if a donor withdraws consent to the continued use of umbilical cord tissue samples that were obtained by AN. Additionally,
either party may terminate the agreement on 30 days prior written notice to the other if that other party materially breach any term of
the agreement and such breaches (to the extent it is remediable) is not remedied within 30 days of the written request to the other party
to do so.
21
Challenges in the Market for Immunotherapy
Products
Government Regulation
The FDA and other federal,
state, local and foreign regulatory agencies impose substantial requirements upon the clinical development, approval, labeling, manufacture,
marketing, and distribution of drug products. These agencies regulate, among other things, research and development activities and the
testing, approval, manufacture, quality control, safety, effectiveness, labeling, storage, record keeping, advertising and promotion of
our product candidates. The regulatory approval process is generally lengthy and expensive, with no guarantee of a positive result. Moreover,
failure to comply with applicable FDA or other requirements may result in civil or criminal penalties, recall or seizure of products,
injunctive relief including partial or total suspension of production, or withdrawal of a product from the market.
Various regulatory authorities
regulate, among other things, the research, manufacture, promotion, and distribution of drugs in the United States under the FDA and other
statutes and implementing regulations. The process required by the FDA before prescription drug product candidates may be marketed in
the United States generally involves the following:
●
completion of extensive nonclinical laboratory tests, animal studies and formulation studies, all performed in accordance with the FDA’s Good Laboratory Practice regulations;
●
submission to the FDA of an investigational new drug application, or IND, which must become effective before human clinical trials may begin;
●
for some products, performance of adequate and well-controlled human clinical trials in accordance with the FDA’s regulations, including Good Clinical Practices, to establish the safety and efficacy of the product candidate for each proposed indication;
●
submission to the FDA of a new drug application or NDA;
●
satisfactory completion of an FDA preapproval inspection of the manufacturing facilities at which the product is produced to assess compliance with current Good Manufacturing Practice, or cGMP, regulations; and
●
FDA review and approval of the NDA prior to any commercial marketing, sale or shipment of the drug.
The testing and approval process
requires substantial time, effort and financial resources, and we cannot be certain that any approvals for our product candidates will
be granted on a timely basis, if at all.
Preclinical tests include
laboratory evaluations of product chemistry, formulation and stability, as well as studies to evaluate toxicity in animals and other animal
studies. The results of preclinical tests, together with manufacturing information and analytical data, are submitted as part of an IND
to the FDA. Some preclinical testing may continue even after an IND is submitted. The IND also includes one or more protocols for the
initial clinical trial or trials and an investigator’s brochure. An IND automatically becomes effective 30 days after receipt by
the FDA, unless the FDA, within the 30-day time period, raises concerns or questions relating to the proposed clinical trials as outlined
in the IND and places the clinical trial on a clinical hold. In such cases, the IND sponsor and the FDA must resolve any outstanding concerns
or questions before any clinical trials can begin. Clinical trial holds also may be imposed at any time before or during studies due to
safety concerns or non-compliance with regulatory requirements. An independent institutional review board, or IRB, at each of the clinical
centers proposing to conduct the clinical trial must review and approve the plan for any clinical trial before it commences at that center.
An IRB considers, among other things, whether the risks to individuals participating in the trials are minimized and are reasonable in
relation to anticipated benefits. The IRB also approves the consent form signed by the trial participants and must monitor the study until
completed.
The FDA offers several regulatory
mechanisms that provide expedited or accelerated approval procedures for selected drugs in the indications on which we are focusing our
efforts. These include accelerated approval under Subpart H of the agency’s NDA approval regulations, fast track drug development
procedures and priority review.
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The United States, European
Union and other jurisdictions may grant orphan drug designation to drugs intended to treat a “rare disease or condition,”
which, in the United States, is generally a disease or condition that affects no more than 200,000 individuals. In the European Union,
orphan drug designation can be granted if: the disease is life threatening or chronically debilitating and affects no more than 50 in
100,000 persons in the European Union; without incentive it is unlikely that the drug would generate sufficient return to justify the
necessary investment; and no satisfactory method of treatment for the condition exists or, if it does, the new drug will provide a significant
benefit to those affected by the condition. If a product that has an orphan drug designation subsequently receives the first regulatory
approval for the indication for which it has such designation, the product is entitled to orphan exclusivity, meaning that the applicable
regulatory authority may not approve any other applications to market the same drug for the same indication, except in limited circumstances,
for a period of seven years in the United States and 10 years in the European Union Orphan drug designation does not prevent competitors
from developing or marketing different drugs for the same indication or the same drug for different indications. Orphan drug designation
must be requested before submitting an NDA. After orphan drug designation is granted, the identity of the therapeutic agent and its potential
orphan use are publicly disclosed. Orphan drug designation does not convey an advantage in, or shorten the duration of, the review and
approval process. However, this designation provides an exemption from marketing and authorization (“NDA”) fees. We plan to follow a similar
path with INB03 or XPro, although the precise indication cannot be determined until we are farther along in the development process.
Clinical Trials
Phase 1 clinical trials typically
involve the initial introduction of the product candidate into healthy human volunteers. In Phase 1 clinical trials, the product candidate
is typically tested for safety, dosage tolerance, absorption, metabolism, distribution, excretion and pharmacodynamics.
Phase 2 clinical trials are
conducted in a limited patient population to gather evidence about the efficacy of the product candidate for specific, targeted indications;
to determine dosage tolerance and optimal dosage; and to identify possible adverse effects and safety risks.
Phase 3 clinical trials are
undertaken to evaluate clinical efficacy and to test for safety in an expanded patient population at geographically dispersed clinical
trial sites. The size of Phase 3 clinical trials depends upon clinical and statistical considerations for the product candidate and disease,
but sometimes can include several thousand patients. Phase 3 clinical trials are intended to establish the overall risk-benefit ratio
of the product candidate and provide an adequate basis for product labeling.
Clinical trials involve the
administration of the product candidate to human subjects under the supervision of qualified medical investigators according to approved
protocols that detail the objectives of the study, dosing procedures, subject selection and exclusion criteria, and the parameters to
be used to monitor participant safety. Regulatory procedures differ in each country we will be working in. For example, in the US, each
protocol is submitted to the FDA as part of the IND for their review and consent before enrolling patients in the clinical trial. The
US is not the only place to perform clinical trials. Most countries have systems in place to allow academics and companies to sponsor
clinical trials of novel therapies in patients. For financial and technical reasons, the Company will perform the Phase I clinical trials
of our programs in the United Kingdom and Australia. The US will be included in the Phase II and//or Phase III programs. Other venues
such as Europe, Canada, Japan and other Pacific Rim countries may be included in the development program in the future.
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The INB03 Phase I trial has
been completed and provided evidence of safety and a pharmacodynamic drug affect, decrease of inflammatory biomarkers, needed to move
the program to a Phase II clinical trial in cancer. The Phase II clinical trial will combine INB03 with approved second line therapy in
patients with HER2+ breast cancer with or without brain metastasis that have progressed after treatment with TDxd. This is a combination
trial where the addition of INB03 to approved second line therapy may provide a therapeutic alternative in a disease without any drugs
approved. The Company has not lost interest in combining INB03 with immune checkpoint inhibitors (CPI), but competition for patients is
fierce in this arena. Our plan is to pursue treatment of tumors that express MUC4 as our lead indication. Tumors that express MUC4 are
resistant to all forms of immunotherapy due to a combination of increased MDSC in the tumor, decrease tumor macrophage (TAM) phagocytosis,
decreased inflammation in the tumor (a “cold” tumor) and direct effects of MUC4 and soluble TNF on HER2 function. If combination
therapy with INB03 decreases MUC4 expression and changes the TME to make the “cold” tumor “hot”, then addition
of a CPI will be warranted. At this time, the combination trial to treat MUC4+ TDxd resistant HER2+ expressing cancer is our most probable
registration strategy for INB03. This includes the combination of INB03 with trastuzumab antibody drug conjugate therapy TDxd in combination
with a TKI and/or CPI. Current therapies for TDxd resistant cancers are used on a trial by error approach. Using MUC4 expression as a
biomarker for to predict resistance may bring a precision medicine approach to this difficult clinical scenario. Addition of INB03 to
the treatment regimen for treating MUC4+ cancers may convert “cold” tumors to “hot” tumors making the eligible
for treatment with CPI. The design and successful completion of a Phase II trial is not guarantee of clinical relevance or commercial
viability. There are multiple therapies on the market or in development for the treatment of resistant breast cancer. The introduction
of TDxd to the clinician’s armamentarium is new and evolving. The future standard-of-care is not known. The registration and development
strategy for INB03 is multinational. The Phase II program may enroll patients in other countries, including the United States after submitting
an Investigational New Drug application, or IND, to the U.S. Food and Drug Administration, or FDA. If partnering is successful at any
stage of INB03 development, we expect the partner to influence the development and regulatory decisions needed with moving the drug to
commercialization. Finally, combination therapy to treat patients resistant to trastuzumab or CPI are not the only oncology application
for INB03. INB03 can be combined with other immune-oncology therapy to improve efficacy, safety or both. INB03 can be used as part of
combination therapy with immuno-oncology drugs, paired with tradition therapies such as cytotoxic chemotherapy, kinase inhibitors, cell
therapies or radiation therapy. The company is pursuing pre-clinical data in some of these areas. When and if positive developments occur,
we will communicate them to our shareholders. There are other regulatory venues that will be important for both our products – the
largest and most important is Europe. In Europe, the European Medicines Agencies (“EMA”) is responsible for authorization
of clinical trials in member states. In EU, there may be a requirement to get individual country authorization at the same time as EMA
authorization. The initial development of INB03 and XPro occurred in AUS followed by trials in other regulatory jurisdictions including
the US. The development of INKmune will start in the United Kingdom followed by trials in the US. XPro is being developed for the treatment
of Alzheimer’s disease under a Part-the-Cloud Award received Feb 2019. The biomarker directed Phase I trial was performed in AUS
using a regulatory strategy identical to that used for INB03 in cancer. Regulatory approval to initiate the trial was received on February
8, 2019. XPro treats microglial activation and innate immune dysregulation may be the cause with Alzheimer’s disease in some patients.
To our knowledge, there are few companies using an anti-inflammatory strategy for the treatment of Alzheimer’s disease. Those companies
include Denali Therapeutics (NASDAQ: DNLI); developing DNL747 that targets critical signaling proteins in the TNF pathway that regulate
inflammation and cell death. Alector (NASDAQ: ALEC) in partnership with Abbvie is developing AL002 that targets TREM2 on microglial cells.
Gliacure is targeting microglial cells in Alzheimer’s disease with a small molecule candidate GC021109.
Lecanemab (Leqembi™;
Eisai) was approved for the treatment of patients with Early AD in January 2023 This is this the second anti-amyloid drug for the treatment
of early AD to be approved. Donanemab (Lilly), a third drug anti-amyloid therapy for early AD is expected to be approved 2Q24. These two
drugs have similar efficacy and safety profiles. One of the common safety problems is the development of ARIA (Alzheimer’s Related
Imaging Abnormality) that causes a delay or discontinuation of therapy. ARIA is neuroinflammation related side-effect more common in patients
expressing ApoE4. The modest efficacy, sub-optimal safety and difficulty of use makes combination therapy for the treatment of early AD
an attractive development and therapeutic strategy. The Company is following the developments in this area closely. The Company believes
the anti-amyloid therapies will slowly develop market share, but due to their safety and efficacy profile, there will be demand for safer
and more efficacious therapies that do not target amyloid.
24
Clinical testing must satisfy
extensive FDA regulations. Reports detailing the results of the clinical trials must be submitted at least annually to the FDA and safety
reports must be submitted for serious and unexpected adverse events. Success in early-stage clinical trials does not assure success in
later stage clinical trials. The FDA, an IRB or we may suspend a clinical trial at any time on various grounds, including a finding that
the research subjects or patients are being exposed to an unacceptable health risk.
New Drug Applications
Assuming successful completion
of the required clinical trials, the results of product development, preclinical studies and clinical trials are submitted to the FDA
as part of an NDA. An NDA also must contain extensive manufacturing information, as well as proposed labeling for the finished product.
An NDA applicant must develop information about the chemistry and physical characteristics of the drug and finalize a process for manufacturing
the product in accordance with cGMP. The manufacturing process must be capable of consistently producing quality product within specifications
approved by the FDA. The manufacturer must develop methods for testing the quality, purity and potency of the final product. In addition,
appropriate packaging must be selected and tested, and stability studies must be conducted to demonstrate that the product does not undergo
unacceptable deterioration over its shelf life. Prior to approval, the FDA will conduct an inspection of the manufacturing facilities
to assess compliance with cGMP.
The FDA reviews all NDAs submitted
before it accepts them for filing. The FDA may request additional information rather than accept an NDA for filing. In this event, the
NDA must be resubmitted with the additional information and is subject to review before the FDA accepts it for filing. After an application
is filed, the FDA may refer the NDA to an advisory committee for review, evaluation and recommendation as to whether the application should
be approved and under what conditions. The FDA is not bound by the recommendation of an advisory committee, but it considers them carefully
when making decisions. The FDA may deny approval of an NDA if the applicable regulatory criteria are not satisfied. Data obtained from
clinical trials are not always conclusive and the FDA may interpret data differently than we interpret the same data. The FDA may issue
a complete response letter, which may require additional clinical or other data or impose other conditions that must be met in order to
secure final approval of the NDA. If a product receives regulatory approval, the approval may be significantly limited to specific diseases
and dosages or the indications for use may otherwise be limited, which could restrict the commercial value of the product. In addition,
the FDA may require us to conduct Phase 4 testing which involves clinical trials designed to further assess a drug’s safety and
effectiveness after NDA approval and may require surveillance programs to monitor the safety of approved products which have been commercialized.
Once issued, the FDA may withdraw product approval if ongoing regulatory requirements are not met or if safety or efficacy questions are
raised after the product reaches the market.
Post-Approval Requirements
Any products manufactured
or distributed by us pursuant to FDA approvals are subject to pervasive and continuing regulation by the FDA, including, among other things,
requirements relating to record-keeping, reporting of adverse experiences, periodic reporting, distribution, and advertising and promotion
of the product. After approval, most changes to the approved product, such as adding new indications or other labeling claims, are subject
to prior FDA review and approval. There also are continuing, annual user fee requirements for any marketed products and the establishments
at which such products are manufactured, as well as new application fees for supplemental applications with clinical data. Pharmaceutical
manufacturers and their subcontractors are required to register their establishments with the FDA and certain state agencies and are subject
to periodic unannounced inspections by the FDA and certain state agencies for compliance with GMP, which impose certain procedural and
documentation requirements upon us and our third-party manufacturers. Changes to the manufacturing process are strictly regulated, and,
depending on the significance of the change, may require prior FDA approval before being implemented. FDA regulations also require investigation
and correction of any deviations from cGMP and impose reporting requirements upon us and any third-party manufacturers that we may decide
to use. Accordingly, manufacturers must continue to expend time, money and effort in the area of production and quality control to maintain
compliance with cGMP and other aspects of regulatory compliance. If our future suppliers are not able to comply with these requirements,
the FDA may, among other things, halt our clinical trials, require us to recall a product from distribution, or withdraw approval of the
product.
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The FDA may withdraw approval
if compliance with regulatory requirements and standards is not maintained or if problems occur after the product reaches the market.
Later discovery of previously unknown problems with a product, including adverse events of unanticipated severity or frequency, or with
manufacturing processes, or failure to comply with regulatory requirements, may result in revisions to the approved labeling to add new
safety information; imposition of post-market studies or clinical studies to assess new safety risks; or imposition of distribution restrictions
or other restrictions under a REMS program.
The FDA closely regulates
the marketing, labeling, advertising and promotion of pharmaceutical products. A company can make only those claims relating to safety
and efficacy, purity and potency that are approved by the FDA and in accordance with the provisions of the approved label. The FDA and
other agencies actively enforce the laws and regulations prohibiting the promotion of off-label uses. Failure to comply with these requirements
can result in, among other things, adverse publicity, warning letters, corrective advertising and potential civil and criminal penalties.
Physicians may prescribe legally available products for uses that are not described in the product’s labeling and that differ from
those tested by us and approved by the FDA. Such off-label uses are common across medical specialties. Physicians may believe that such
off-label uses are the best treatment for many patients in varied circumstances. The FDA does not regulate the behavior of physicians
in their choice of treatments. The FDA does, however, restrict manufacturer’s communications on the subject of off-label use of
their products.
Other Healthcare Laws and Compliance Requirements
Our sales, promotion, medical
education, clinical research and other activities following product approval will be subject to regulation by numerous regulatory and
law enforcement authorities in the United States in addition to FDA, including potentially the Federal Trade Commission, the Department
of Justice, the Centers for Medicare and Medicaid Services, or CMS, other divisions of the U.S. Department of Health and Human Services
and state and local governments. Our promotional and scientific/educational programs must comply with the federal Anti-Kickback Statute,
the civil False Claims Act, physician payment transparency laws, privacy laws, security laws, and additional federal and state laws similar
to the foregoing.
The federal Anti-Kickback
Statute prohibits, among other things, the knowing and willing, direct or indirect offer, receipt, solicitation or payment of remuneration
in exchange for or to induce the referral of patients, including the purchase, order or lease of any good, facility, item or service that
would be paid for in whole or part by Medicare, Medicaid or other federal health care programs. Remuneration has been broadly defined
to include anything of value, including cash, improper discounts, and free or reduced-price items and services. The federal Anti-Kickback
Statute has been interpreted to apply to arrangements between pharmaceutical manufacturers on one hand and prescribers, purchasers, formulary
managers, and beneficiaries on the other. Although there are a number of statutory exceptions and regulatory safe harbors protecting some
common activities from prosecution, the exceptions and safe harbors are drawn narrowly. Practices that involve remuneration that may be
alleged to be intended to induce prescribing, purchases or recommendations may be subject to scrutiny if they do not qualify for an exception
or safe harbor. Failure to meet all of the requirements of a particular applicable statutory exception or regulatory safe harbor does
not make the conduct per se illegal under the federal Anti-Kickback Statute. Instead, the legality of the arrangement will be evaluated
on a case-by-case basis based on a cumulative review of all its facts and circumstances. Several courts have interpreted the statute’s
intent requirement to mean that if any one purpose of an arrangement involving remuneration is to induce referrals of federal healthcare
covered business, the federal Anti-Kickback Statute has been violated. The government has enforced the federal Anti-Kickback Statute to
reach large settlements with healthcare companies based on sham research or consulting and other financial arrangements with physicians.
Further, a person or entity does not need to have actual knowledge of the statute or specific intent to violate it to have committed a
violation. In addition, the government may assert that a claim including items or services resulting from a violation of the federal Anti-Kickback
Statute constitutes a false or fraudulent claim for purposes of the False Claims Act. Many states have similar laws that apply to their
state health care programs as well as private payors.
26
Federal false claims and false
statement laws, including the federal civil False Claims Act, or FCA, imposes liability on persons or entities that, among other things,
knowingly present or cause to be presented claims that are false or fraudulent or not provided as claimed for payment or approval by a
federal health care program. The FCA has been used to prosecute persons or entities that “cause” the submission of claims
for payment that are inaccurate or fraudulent, by, for example, providing inaccurate billing or coding information to customers, promoting
a product off-label, submitting claims for services not provided as claimed, or submitting claims for services that were provided but
not medically necessary. Actions under the FCA may be brought by the Attorney General or as a qui tam action by a private individual in
the name of the government. Violations of the FCA can result in significant monetary penalties and treble damages. The federal government
is using the FCA, and the accompanying threat of significant liability, in its investigation and prosecution of pharmaceutical and biotechnology
companies throughout the country, for example, in connection with the promotion of products for unapproved uses and other illegal sales
and marketing practices. The government has obtained multi-million and multibillion dollar settlements under the FCA in addition to individual
criminal convictions under applicable criminal statutes. In addition, certain companies that were found to be in violation of the FCA
have been forced to implement extensive corrective action plans, and have often become subject to consent decrees or corporate integrity
agreements, restricting the manner in which they conduct their business.
The federal Health Insurance
Portability and Accountability Act of 1996, or HIPAA, created additional federal criminal statutes that prohibit, among other things,
knowingly and willfully executing, or attempting to execute, a scheme to defraud any healthcare benefit program, including private third-party
payors; knowingly and willfully falsifying, concealing or covering up a material fact or making any materially false, fictitious or fraudulent
statement in connection with the delivery of or payment for healthcare benefits, items or services; and willfully obstructing a criminal
investigation of a healthcare offense. Like the federal Anti-Kickback Statute, the Affordable Care Act amended the intent standard for
certain healthcare fraud statutes under HIPAA such that a person or entity no longer needs to have actual knowledge of the statute or
specific intent to violate it in order to have committed a violation.
Given the significant size
of actual and potential settlements, we expect that the government will continue to devote substantial resources to investigating healthcare
providers’ and manufacturers’ compliance with applicable fraud and abuse laws. Also, many states have similar fraud and abuse
statutes or regulations that may be broader in scope and may apply regardless of payor, in addition to items and services reimbursed under
Medicaid and other state programs. Additionally, to the extent that our products, once commercialized, are sold in a foreign country,
we may be subject to similar foreign laws.
In addition, there has been
a recent trend of increased federal and state regulation of payments made to physicians and other healthcare providers. The Patient Protection
and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act, or collectively, the Affordable Care Act, among
other things, imposed new reporting requirements on certain manufacturers of drugs, devices, biologics and medical supplies for which
payment is available under Medicare, Medicaid or the Children’s Health Insurance Program, with specific exceptions, for payments
or other transfers of value made by them to physicians and teaching hospitals, as well as ownership and investment interests held by physicians
and their immediate family members. Covered manufacturers are required to collect and report detailed payment data and submit legal attestation
to the accuracy of such data to the government each year. Failure to submit required information may result in civil monetary penalties
of up to an aggregate of $150,000 per year (or up to an aggregate of $1 million per year for “knowing failures”), for all
payments, transfers of value or ownership or investment interests that are not timely, accurately, and completely reported in an annual
submission. Additionally, entities that do not comply with mandatory reporting requirements may be subject to a corporate integrity agreement.
Certain states also mandate implementation of commercial compliance programs, impose restrictions on covered manufacturers’ marketing
practices and/or require the tracking and reporting of gifts, compensation and other remuneration to physicians and other healthcare professionals.
We may also be subject to
data privacy and security regulation by both the federal government and the states in which we conduct our business. HIPAA, as amended
by the Health Information Technology and Clinical Health Act, or HITECH, and their respective implementing regulations, imposes specified
requirements on certain health care providers, plans and clearinghouses (collectively, “covered entities”) and their “business
associates,” relating to the privacy, security and transmission of individually identifiable health information. Among other things,
HITECH makes HIPAA’s security standards directly applicable to “business associates,” defined as independent contractors
or agents of covered entities that create, receive, maintain or transmit protected health information in connection with providing a service
for or on behalf of a covered entity. HITECH also increased the civil and criminal penalties that may be imposed against covered entities,
business associates and possibly other persons, and gave state attorneys general new authority to file civil actions for damages or injunctions
in federal courts to enforce HIPAA and seek attorney’s fees and costs associated with pursuing federal civil actions. In addition,
certain states have their own laws that govern the privacy and security of health information in certain circumstances, many of which
differ from each other and/or HIPAA in significant ways and may not have the same effect, thus complicating compliance efforts.
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Coverage and Reimbursement
Sales of pharmaceutical products
depend significantly on the extent to which coverage and adequate reimbursement are provided by third-party payors. Third-party payors
include state and federal government health care programs, managed care providers, private health insurers and other organizations. Although
we currently believe that third-party payors will provide coverage and reimbursement for our product candidates, if approved, we cannot
be certain of this. Third-party payors are increasingly challenging the price, examining the cost-effectiveness, and reducing reimbursement
for medical products and services. In addition, significant uncertainty exists as to the reimbursement status of newly approved healthcare
products. The U.S. government, state legislatures and foreign governments have continued implementing cost containment programs, including
price controls, restrictions on coverage and reimbursement and requirements for substitution of generic products. Adoption of price controls
and cost containment measures, and adoption of more restrictive policies in jurisdictions with existing controls and measures, could
further limit our net revenue and results. We may need to conduct expensive clinical studies to demonstrate the comparative cost-effectiveness
of our products. The product candidates that we develop may not be considered cost-effective and thus may not be covered or sufficiently
reimbursed. It is time consuming and expensive for us to seek coverage and reimbursement from third-party payors, as each payor will
make its own determination as to whether to cover a product and at what level of reimbursement. Thus, one payor’s decision to provide
coverage and adequate reimbursement for a product does not assure that another payor will provide coverage or that the reimbursement
levels will be adequate. Moreover, a payor’s decision to provide coverage for a drug product does not imply that an adequate reimbursement
rate will be approved. Reimbursement may not be available or sufficient to allow us to sell our products on a competitive and profitable
basis.
Healthcare
Reform
In
the United States and foreign jurisdictions, there have been a number of legislative and regulatory changes and proposed changes regarding
the healthcare system that could prevent or delay marketing approval of our investigational medicines, restrict or regulate post-approval
activities and affect our ability to profitably sell any approved products. The ACA, for example, contains provisions that subject biological
products to potential competition by lower-cost biosimilars and may reduce the profitability of drug products through increased rebates
for drugs reimbursed by Medicaid programs, extension of Medicaid rebates to Medicaid managed care plans, mandatory discounts for certain
Medicare Part D beneficiaries and, annual fees based on pharmaceutical companies’ share of sales to federal health care programs.
Current laws, as well as other healthcare reform measures that may be adopted in the future, may result in more rigorous coverage criteria
and in additional downward pressure on the price for any approved products.
In
the United States, it is unclear whether the ACA will be overturned or further amended. We cannot predict what effect further changes
to the ACA would have on our business. Additionally, other federal health reform measures have been proposed and adopted in the United
States since the ACA was enacted, including the Budget Control Act of 2011, which includes provisions to reduce the federal deficit. The
Budget Control Act, as amended, resulted in the imposition of 2% reductions in Medicare payments to providers, which began in April 2013
and will remain in effect through 2031 unless additional Congressional action is taken. In 2021, President Biden signed the American Rescue
Plan Act of 2021 into law, which eliminated the statutory Medicaid drug rebate cap, previously set at 100% of a drug’s average manufacturer
price, for single source and innovator multiple source drugs, beginning in 2024. These laws and regulations may result in additional reductions
in Medicare and other healthcare funding and otherwise affect the prices we may obtain for any of our product candidates for which we
may obtain regulatory approval or the frequency with which any such product candidate is prescribed or used.
In
August 2022, the Inflation Reduction Act of 2022 (IRA) was signed into law. The IRA includes several provisions including provisions that
create a $2,000 out-of-pocket cap for Medicare Part D beneficiaries, impose new manufacturer financial liability on all drugs in Medicare
Part D, allow the U.S. government to negotiate Medicare Part B and Part D pricing for certain high-cost drugs and biologics without generic
or biosimilar competition, require companies to pay rebates to Medicare for drug prices that increase faster than inflation and delay
the rebate rule that would require pass through of pharmacy benefit manager rebates to beneficiaries. The effect of IRA on our business
and the healthcare industry in general is not yet known.
Further,
there has been heightened governmental scrutiny over the manner in which manufacturers set prices for their marketed products, which
have resulted in several Congressional inquiries and proposed bills designed to, among other things, bring more transparency to product
pricing, review the relationship between pricing and manufacturer patient programs and reform government program reimbursement methodologies
for products. In addition, the federal government, state legislatures, and foreign governments have shown significant interest in implementing
cost containment programs, including price-controls and price transparency, restrictions on reimbursement, and requirements for substitution
of generic products for branded prescription drugs to limit the growth of government paid health care costs. For example, the federal
government has passed legislation requiring pharmaceutical manufacturers to provide rebates and discounts to certain entities and governmental
payors to participate in federal healthcare programs.
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Human Capital Resources
As of December 31, 2024, we
had 13 full-time employees in the United States and 9 full-time employees in the United Kingdom. We consider the intellectual capital
of our employees to be an important driver of our business and key to our future prospects. We monitor our compensation programs closely
and provide what we consider to be a very competitive mix of compensation and insurance benefits for all our employees, as well as participation
in our equity programs. None of our employees is subject to a collective bargaining agreement or represented by a trade or labor union.
We consider our relations with our employees to be good.
Corporate Information
We were incorporated under
the laws of the State of Nevada on September 25, 2015. Our principal executive office is located at 225 NE Mizner Blvd, Suite 640, Boca
Raton FL 33432 and our telephone number is (858) 964-3720.