UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 10-K
☒ ANNUAL REPORT UNDER SECTION 13 OR 15(d)
OF THE SECURITIES EXCHANGE ACT OF 1934
For the fiscal year ended: December 31 , 2021
☐ TRANSITION REPORT UNDER SECTION 13 OR 15(d)
OF THE SECURITIES EXCHANGE ACT OF 1934
For the transition period from ____________ to
____________
Commission file number: 001-38793
INMUNE BIO INC.
(Exact name of registrant as specified in its charter)
Nevada 47-5205835
(State or other jurisdiction of
incorporation or organization) (I.R.S. Employer
Identification No.)
INMUNE BIO INC.
David Moss
225 NE Mizner Blvd , Suite 640
Boca Raton , FL 33432
Phone: (858) 964 3720
(Address of principal executive offices)(Zip Code)
(858) 964 3720
(Registrant’s telephone number, including
area code)
Securities registered pursuant to Section 12(b)
of the Act:
Title of each class Trading Symbol Name of Market Where Traded
Common Stock ($.001 par value) INMB The Nasdaq Stock Market LLC
Securities
registered pursuant to Section 12(g) of the Act: None
Indicate by check mark if the registrant is a
well-known seasoned issuer, as defined in Rule 405 of the Securities Act. Yes ☐ No ☒
Indicate by check mark if the registrant is not
required to file reports pursuant to Section 13 or Section 15(d) of the Act. Yes ☐ No ☒
Indicate by checkmark whether the registrant (1)
has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months
(or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements
for the past 90 days. Yes ☒ No ☐
Indicate
by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule
405 of Regulation S-T (§ 232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant
was required to submit such files). Yes ☒ No ☐
Indicate by check mark whether the registrant
is a large accelerated filer, an accelerated filer, a non-accelerated filer, smaller reporting company, or an emerging growth company.
See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,”
and “emerging growth company” in Rule 12b-2 of the Exchange Act.
Large accelerated filer ☐ Accelerated filer ☐
Non-accelerated filer ☒ Smaller reporting company ☒
Emerging Growth Company ☒
If an emerging growth company, indicate by check
mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting
standards provided pursuant to Section 13(a) of the Exchange Act. ☐
Indicate by check mark whether the registrant
has filed a report on and attestation to its management’s assessment of the effectiveness of its internal control over financial
reporting under Section 404(b) of the Sarbanes-Oxley Act (15 U.S.C. 7262(b)) by the registered public accounting firm that prepared or
issued its audit report. ☐
Indicate by check mark whether the registrant
is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes ☐ No ☒
The aggregate market value of the registrant’s
common stock held by non-affiliates of the registrant was approximately $ 157 million as of the last business day of the registrant’s
most recently completed second fiscal quarter (June 30, 2021), based upon the closing sale price for the registrant’s common stock
on that day as reported by the NASDAQ Capital Market. Shares of common stock held by each officer and director of the registrant on
June 30, 2021 have been excluded in that such persons may be deemed to be affiliates.
As of March 3, 2022, there are 17,863,095 shares of common stock, $0.001
par value per share outstanding.
FORM 10-K
FOR THE YEAR ENDED DECEMBER 31, 2021
TABLE OF CONTENTS
Item Number and Caption
Page
Forward-Looking Statements
ii
PART I
1.
Business
1
1A.
Risk Factors
37
1B.
Unresolved Staff Comments
60
2.
Properties
60
3.
Legal Proceedings
60
4.
Mine Safety Disclosures
60
PART II
5.
Market for Registrant’s Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities
61
6.
[Reserved]
61
7.
Management’s Discussion and Analysis of Financial Condition and Results of Operations
62
7A.
Quantitative and Qualitative Disclosures About Market Risk
72
8.
Financial Statements and Supplementary Data
73
9.
Changes in and Disagreements with Accountants on Accounting, and Financial Disclosure
74
9A.
Controls and Procedures
74
9B.
Other Information
74
9C.
Disclosure Regarding Foreign Jurisdictions that Prevent Inspections
74
PART III
10.
Directors, Executive Officers, and Corporate Governance
75
11.
Executive Compensation
75
12.
Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters
75
13.
Certain Relationships and Related Transactions, and Director Independence
75
14.
Principal Accounting Fees and Services
75
PART IV
15.
Exhibits
76
16.
Form 10-K Summary
78
Signatures
79
i
PART I
All brand names or trademarks appearing in
this report are the property of their respective holders. Unless the context requires otherwise, references in this report to “INmune
Bio” the “Company,” “we,” “us,” and “our” refer to INmune Bio, Inc., a Nevada corporation.
FORWARD-LOOKING STATEMENTS
This Annual Report on Form
10-K (this “Annual Report”) contains “forward-looking statements” Forward-looking statements reflect our current
view about future events. When used in this Report, the words “anticipate,” “believe,” “estimate,”
“expect,” “future,” “intend,” “plan,” or the negative of these terms and similar expressions,
as they relate to us or our management, identify forward-looking statements. Such statements include, but are not limited to, statements
contained in this Report relating to our business strategy, our future operating results and liquidity and capital resources outlook.
Forward-looking statements are based on our current expectations and assumptions regarding our business, the economy and other future
conditions. Because forward–looking statements relate to the future, they are subject to inherent uncertainties, risks and changes
in circumstances that are difficult to predict. Our actual results may differ materially from those contemplated by the forward-looking
statements. They are neither statements of historical fact nor guarantees of assurance of future performance. We caution you therefore
against relying on any of these forward-looking statements. Important factors that could cause actual results to differ materially from
those in the forward-looking statements include, without limitation, our ability to raise capital to fund continuing operations; our ability
to protect our intellectual property rights; the impact of any infringement actions or other litigation brought against us; competition
from other providers and products; our ability to develop and commercialize products and services; changes in government regulation; our
ability to complete capital raising transactions; and other factors (including the risks contained in the section of this Annual Report
entitled “Risk Factors”) relating to our industry, our operations and results of operations. Actual results may differ significantly
from those anticipated, believed, estimated, expected, intended or planned.
Factors or events that could
cause our actual results to differ may emerge from time to time, and it is not possible for us to predict all of them. We cannot guarantee
future results, levels of activity, performance or achievements. Except as required by applicable law, including the securities laws of
the United States, we do not intend to update any of the forward-looking statements to conform these statements to actual results.
ii
PART I
Item 1. Business
Our Strategy
Our objective is to develop and commercialize our product candidates
to treat diseases where the innate immune system is not functioning normally and contributing to the patient’s disease. This can
be in cancer where Natural Killer (“NK”) cells are inactive and contribute to a tumor’s evasion of the immune system
and/or disease progression while expression of MUC4 and immunosuppressive cells of the tumor microenvironment proliferate to protect the
tumor from attack by the patient’s immune system or this can be other diseases such as neurologic and metabolic diseases where chronic
inflammation results in innate immune system dysfunction. Our initial focus will be the treatment of cancer, treatment of Alzheimer’s
Disease (“AD”), and the treatment of Treatment Resistant Depression (“TRD”). In cancer, we plan to pursue two
parallel development programs: (1) with INKmune we will initially focus on treating women with resistant disease relapse refractory ovarian
carcinoma and patients with high-risk myelodysplastic syndrome (high risk MDS); (2) with INB03, we will treat patients with cancers that
express MUC4, a mucinous polyglucan on the surface of some epithelial cancer cells, that appears to predict resistant to immunotherapy
including women with MUC4 expressing HER2+ breast cancer. Our third drug candidate XPro1595 (“XPro"), targets Alzheimer’s
Disease and TRD. XPro for AD has completed Phase I trials and is being prepared for Phase II trials. XPro for TRD is being prepared for
Phase II trials. During 2021, we closed our Phase II clinical trial for treatment of pulmonary complications due to COVID-19 infection
as the Company determined it was a high-risk, low reward program due to the development of vaccinations and therapies which were not available
when we started the clinical trial. The principal components of our strategy to achieve this objective are to:
●
pursue development strategies and regulatory approval pathways that allow the treatment of oncology patients with our lead product candidates, INKmune and INB03;
●
pursue development strategies
and regulatory approval pathways that allow the treatment of neurodegenerative diseases in patients with our lead product candidates,
XPro;
●
adopt a product development strategy that solidifies our existing intellectual property (“IP”) to prevent competition and expand our IP suite into related immunotherapeutic areas;
●
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
●
Collaborate
with other pharmaceutical companies with respect to, among other things, our INKmune and the DN-TNF platform that includes INB03 and
XPro product candidates and other products that will benefit from development or marketing beyond our current resources.
Pursue development and
regulatory approval pathways. We believe INKmune, INB03 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 “Government Regulation”).
We have not yet had a discussion with the 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 MDS cancer program may qualify for orphan status. We believe
that it would take a minimum of six months to receive Orphan Drug status once we submit an 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 as the FDA Accelerated Approval Program or have these applications approved if we do.
1
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 “Intellectual Property”)
will allow us both freedom-to-operate and provide robust protection from outside competition. We will continue to invest in expanding
our patent suite. We will also seek to further to strengthen our IP position by looking to in-license IP related to our focus on the innate
immune system.
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 and/or INB03 in patients with a high risk of tumor progression and death from tumor should prolong survival, improve
the patient’s quality of life and decrease the total cost of care for patients with these lethal malignancies. For example, ovarian
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 and INB03 therapy, once approved, should improve survival and quality of life. At the payor level, we believe INKmune,
once approved, should provide more predictable costs and outcomes. Therapies for Alzheimer’s disease are needed for medical, social
and economic reasons. The cost of Alzheimer’s disease to the government is large and growing. The cost to families and care givers
is real and burdensome. We believe treatment of patients with dementia, including Alzheimer’s disease, may provide a strategy to
alter the costly dynamic of this disease in society today.
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, INB03 and XPro 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 continue to look for ways to utilize our unique capabilities to
optimize clinical application of cell therapies. We believe that we have identified a way to manufacture human mesenchymal stem cells
for the medical research and biotech community that offers large volumes of high-quality, low passage human umbilical cord mesenchymal
stem cells with minimal batch-to-batch variability. We believe this may solve the problem associated with supplying an adequate supply
of human mesenchymal stem cells for clinical applications. 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. 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. The manufacturing
process can be performed at a contract manufacturing site under the direction of Mark Lowdell, the Company’s CSO. We will seek academic
laboratories and biopharma companies who need a reliable source of high quality pooled human umbilical cord mesenchymal stem cells for
research of and development of clinical products. Once identified, we plan to act as a cGMP for the development of therapeutic products
by utilizing contract manufacturers. Because the production of the product is not continuous, we do not expect to engage a contract manufacturer
until we have a customer identified. To date, we are supporting two academic clinical trials with CORDstrom. One program is a Phase 2
trial sponsored by the Great Ormond Street Children’s Hospital in the UK treating children with erythematous bullousa, a disfiguring
skin disease in children that is similar to a second degree burn and the second program is treatment of system lupus in adults. Both these
studies are ongoing. INmune Bio is supplying the clinical product for treatment of these patients. The Company does not know the results
of these trials until they are announced by the principle investigators at the clinical sites. We have identified contract manufacturers
in the UK that have the capability to produce cGMP stem cells. We expect the commercial arrangement with academic laboratories or biopharma
companies to be a combination of fee-for-service and licensing that does not require additional investment by us. We will be opportunistic
in pursuing therapeutic opportunities for our own portfolio with this platform in the future if resources become available. The regulatory
path for therapeutic applications of the mesenchymal stem cell products is well established and similar to the regulatory approval process
for other cell therapies. We will only be responsible for regulatory compliance related to manufacturing of the mesenchymal stem 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.
2
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. 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. Tumor Necrosis Factor alpha (“TNF”) is the focus of 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.
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.
3
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. The only FDA-approved dendritic cell therapy is 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 by 2027.
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.
4
Our Innate Immune Dominant-Negative
TNF product candidate
We renamed XPro, which
we license from Xencor, to INB03 when it is used for cancer related indications. We will continue to call the drug XPro when
used for treatment of neuropsychiatric diseases, including Alzheimer’s disease and TRD discussed below. INB03 and XPro are the
same drug with different names for marketing purposes. INB03 is a novel innate immune system check-point inhibitor that we believe
decreases expression of MUC4 by the tumor, an important resistance mechanism to immunotherapy, decreases proliferation of MDSC,
promotes recruitment of cytotoxic T cells to the TME and may convert immunosuppressive tumor macrophages into tumor phagocytic
macrophages. In murine models, these changes make the tumor reverse resistance to treatment with immunotherapy alone or in
combination with tyrosine kinase inhibitors (TKI) such a lapatinib. MUC4 expression is increased by sTNF. Resistance to trastuzumab
therapy by MUC4 expressing HER2+ breast and gastric cancer cells is driven by steric hinderance. By neutralizing sTNF with INB03,
MUC4 expression decreases allow trastuzumab to bind HER2/neu. The mechanism by which combination of INB03 with TKI improves efficacy
over TKI alone remains under investigation. By using INB03 as part of combination therapy for cancer, we believe the patient’s
dysregulated immune response, a hallmark of cancer progression and resistance to therapy, to be converted to a coordinated immune
response that can overcome resistance mechanisms to immunotherapy. These immune responses have been studied in at least two animal
models. In a murine model of an inflammatory cancer, where 3-methylcholanthrese is given to mice in a subcutaneous injection that
causes the development of multiple cutaneous fibrosarcoma. This model was developed by Y Akamatsu in 1967 while working at the
National Cancer Institute of the NIH. In research published by Professor Nikola Vujanovic in Cancer Immunology
Research in 2016, treatment with INB03 resulted in smaller and fewer cancers with increased survival. INB03 is an engineered
PEGylated protein that neutralizes human soluble TNF, a human inflammatory cytokine that is increased in patients with advanced
cancer. By specifically neutralizing the cytokine, there is decreased phosphorylation of STAT3, an essential step required for the
proliferation of the MDSC population, and secretion of the immunosuppressive cytokines. The combination of decreased MDSC
proliferation and decreased immunosuppressive cytokines allows the immune system to respond to the tumor. This data was published in
an article entitled Inhibition of Soluble Tumor Necrosis Factor Prevents Chemically Induced Carcinogenesis in Mice in Cancer
Immunology Research in Cancer Immunology Research 2016. In summary, INB03 functions as an innate immune system
checkpoint inhibitor by eliminating the population of MDSC that provides an immunosuppressive shield protecting the tumor, the
patient’s immune system is able to function normally to the benefit of the patient – it can attack the tumor. TNF plays
an important role in breast cancer (Schillaci R, Front. Oncol., 22 April 2020
| https://doi.org/10.3389/fonc.2020.00584 ). In a murine model of trastuzumab resistant breast cancer using JMIT-1 cells,
a human cell line of HER2 positive breast cancer resistant to trastuzumab placed into immunocompromised mice, INB03 downregulates
MUC4 from the surface of the JMIT-1 HER2+ breast cancer cells to allow the trastuzumab resistant cells to become trastuzumab
sensitive (Figure A from Bruni, NYAS 2020) to decrease tumor growth (from Schillaci SABCS 2018, Figure B). JMIT-1 cells are also
resistant to lapatinib, a TKI inhibitor used as a second line therapy in women with trastuzumab resistant HER2+ breast cancer. The
addition of INB03 to lapatinib in the animal model reverses lapatinib resistance in part by decreasing expression of MUC4 (from
Bruni NYAS 2020, Figure C). In addition to decreasing resistance to trastuzumab by decreasing MUC4 expression, INB03 decreases the
immunosuppressive tumor microenvironment (Schillaci SABCS 2018, Bruni NYAS 2020). Recently, Dr. Schillaci reported the MUC4
expressing triple negative breast (TNBC) cancer patients have a worse overall survival. (Schillaci SABCS 2021). These data may be
relevant to all tumors that express HER2 or MUC4 including upper gastrointestinal malignancies such as gastric and pancreatic
cancer. We believe MUC4 expression is a biomarker of resistance that may dictate changes therapeutic strategy by clinical teams
5
6
Because INB03 targets the
patient’s immune system and not the tumor, we believe INB03 is an immunotherapy that can be used to treat many types of hematologic
malignancies and solid tumors as part of combination therapy. The decision to use INB03 in a patient will be based on biomarkers that
should predict that a patient will benefit from treatment with the drug. We believe the ideal biomarker is easy to use and is determined
before treatment begins. MUC4 expression by epithelial tumors is an example of this type of biomarker. Our Phase I clinical trial preceded
the identification of MUC4 as a biomarker and focused on using INB03 as monotherapy. This is a typical Phase I clinical trial design for
first-in-man trials in cancer. We expect to use INB03 as part of combination therapy with approved cancer therapies as part of Phase II
development. We do not expect to need to modify INB03 therapy to treat each different type of cancer, because INB03 therapy targets the
immune system, not the cancer. We do expect to develop the INB03 beyond Phase II to target a specific type of cancer to meet the current
system of regulatory approval. For instance, INB03 may be approved to treat patients with HER2+/MUC4+ breast cancer. To get subsequent
approval for the treatment of patients with MUC4+ TNBC or MUC4+ pancreatic cancer, we will need to perform a pivotal trial in patients
with TNBC and pancreatic cancer respectively. After the first regulatory approval, if and when achieved, we believe the difficulty and
cost of achieving these labels extensions will decline with each successive approval. At this time, we cannot predict if patients without
biomarkers of inflammation, elevated MDSC or cytokines, or increased expression of MUC4 will benefit from treatment with INB03. Those
studies may be performed in the future, but they are not a priority.
XPro neutralizes soluble
TNF in the brain in exactly the same way INB03 neutralizes soluble TNF in the tumor microenvironment but the effects of soluble TNF neutralization
in the brain are different. The cause of the destructive neuroinflammation in the brain are microglial and astroglial cells. The glial
cell are two of four cells in the neural unit that also includes oligodentrocytes 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 dendritic pruning, 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.
7
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 is partially funded by a $1M USD Part-the-Cloud Award
from the Alzheimer’s Association. The clinical trial is 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. 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) and neuroimaging biomarkers using MRI. The primary
goal of this short, open label study is to demonstrate that treatment with XPro decreases neuroinflammation safely and to define the dose
of XPro to use in the Phase II trial. Studies of cognitive function are performed on the patients but are not expected to show significant
change because of the short duration of the trial and the wide range of disability in patients enrolled in the clinical trial (MMSE range:
24-12). The goal of the planned Phase II trial will be to demonstrate the prolonged control of neuroinflammation in patients with dementia
will help control cognitive decline. The Company plans two Phase II trials, one each in mild cognitive impairment (MCI) and mild AD.
The
trial enrolled 18 patients at doses of 0.3, 0.6 and 1.0mg/kg given once a week as subcutaneous injection for three months. Patients in
the 10mg/kg group were offered extended us 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. Neuroimaging data from six patients were presented in the figure below. In summary,
treatment with XPro at either 0.3 or 1.0mg/kg once-a-week as a subcutaneous injection (low and target dose respectively) decreased white
matter free water (WMFW) as measured by MRI. WMFW is a validated biomarker of neuroinflammation. Although the number of patients is low,
there was a dose response with a greater decrease in WMFW in the target dose compared to the low dose group. An analysis of inflammation
in white matter tracts demonstrated a significant decrease in WMFW (40%; range 20-52%) in the arcute fasciculus, a white matter tract
important in the control of language and short-term memory (Figure D). These data suggest XPro is decreasing neuroinflammation in patients
with Alzheimer’s disease who have biomarkers of peripheral inflammation.
8
Additional data was presented on January 21, 2021. The goal of the
January 21 data release was to show a correlation between the white matter free water, a novel biomarker of inflammation with cerebral
spinal fluid (“CSF”) cytokines and chemokine levels, a traditional measure neuroinflammation. CSF cytokine/chemokines were
measure in 9 patients before and after 12 weeks of weekly therapy with XPro using a panel from OLINK Target 48 Cytokine ( https://www.olink.com/products/olink-target-48-cytokine/ ),
that measures 45 (Figure AD1).
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%. Using data from
all patients treated for 12 weeks (3 low dose, 6 target dose), a high correlation (R 2 =.7561) between the white matter free
water safe mask and the inflammation composite score is shown in figure AD2. The data analyzed provides evidence that XPro decreases neuroinflammation
in patients with Alzheimer’s disease.
9
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 ( https://www.proteomics.com/services/tmtcalibrator-workflow ). 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 AD3). 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 AD4). The CSF proteome data is only partially analyzed. Additional data may result from these ongoing analytics.
10
The results of the Phase I study demonstrates that XPro safely decreases
neuroinflammation in patients with AD who have 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 biologic characteristics suggests 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 programs.
The Company plans two Phase
II trials in patients with AD with biomarkers of inflammation. A blinded randomized trial in patients with mild AD plans to enroll 201
patients in a 2:1 ratio (XPro:placebo) at 1mg/kg once a week. Patients will be treated for 6 months. A patient enrichment strategy will
be used to ensure patients have neuroinflammation – patients must have at least two of elevated CRP, hemoglobinA1c, ESR or have
an ApoE4 allele. 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 (ADAS-Cog13, CDR-SB and NPI) and functional (GAS, ADCS-ADL) end-points will be
measured. Biomarkers of inflammation using white and gray matter analytics measured by MRI DTI similar to those used in the Phase I trial
will also be used. All patients will be eligible to continue on XPro for at least 6 additional months. Clinical and MRI metrics will be
followed during the extension trial.
The second Phase II trial will be a blinded randomized trial in patients
with MCI in which the Company plans to enroll 60 patients in two arms in a 2:1 ratio (1mg/kg/week XPro, placebo). Patients will be treated
for 3 months. Patients must have at least one ApoE4 allele to qualify for the trial. The primary end-point is EMACC, a sensitive cognitive
end-point validated for use in patients with early AD. Secondary clinical endpoints include the CDR-SB, Cogstate Battery, E-Cog, NPI,
and ADCS-ADL. Imaging endpoints of neuroinflammation (White matter free water), white matter integrity (apparent fiber density, radial
diffusivity), and gray matter quality (cortical disarray measurement) will be assessed via MRI. Changes in brain metabolism will be assessed
via FDG-PET. Additional secondary measures of function include EEG, and speech and language. All patients will be eligible to continue
on XPro for at least 9 additional months. Clinical and MRI metrics will be followed during the extension trial. The Company may
amend the clinical trial design from time-to-time to improve the quality of the data or the probability of success.
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 Company received a $2.9M
USD award from the National Institute of Mental Health (“NIMH”) to treat TRD with XPro. The blinded, randomized Phase II trial
will use a biomarkers of peripheral inflammation to select patients with TRD for enrollment. Patients will be treated for 6 weeks. Primary
end-points include both clinical and neuroimaging measures. The final trial design is ongoing and discussions with the FDA are not complete.
The Company anticipates receiving authorization to initiate the clinical trial in the second half of 2022.
INB03 and XPro are delivered
as a subcutaneous injection, similar to an insulin treatment, given one to three times per week. 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 to themselves and not require expensive or logistically challenging clinic visits to receive the therapy.
Three step process to preparation
for INB03 and XPro for human clinical trials:
Release of INB03 and XPro drug supply
GMP DN-TNF product (INB03 and XPro) are available for clinical development
after completion of release testing. The annual process for release testing was completed in February 2018, January 2019, December 2019
and November 2020. The supply of 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 future trials, new batches of XPro have been produced. The Company engaged KBI Biopharma
to manufacture 6 lots of XPro/INB03 at the Boulder, Colorado facility using the original master cell bank and updated manufacturing process.
Two lots have been converted into drug product using the US fill/finish facility of Vetter Pharma. Two of the lots are frozen as drug
substance at -80C with a plan to convert to drug product the second half of 2023. The final two lots are frozen as a cell paste with a
plan to process to drug substance in during 2023 or 2024 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. We hope to improve the yield of the drug product using the existing E.coli
based system. Once the new 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.
11
Interaction with Regulatory Authorities Regarding
INB03 and XPro Development
We have completed a Phase I trial with INB03 in oncology and a Phase
I trial with XPro in patients with Alzheimer’s disease. The Phase II program with Alzheimer’s disease will start first half
2022. The Phase I trial with XPro in patients with Alzheimer’s disease is 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 with INB03 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 COVID19 infection. We plan to complete the regulatory process for the Phase II clinical trials in
patients with Alzheimer’s disease and Phase II TRD clinical trials with the FDA during the first half of 2022.
INB03 Product Development Path: Proposed Phase
II Studies in patients with cancer
Phase I open label study in
patients with advance solid tumors has been completed. All future studies cancer will use INB03 as part of combination therapy. Based
on the results of the Phase I study and work performed and reported by Prof. Roxana Schillaci, we are planning a study of INB03 in combination
with currently approved second line therapy for treatment of tumors that express MUC4. This may include a study in women with trastuzumab
resistant HER2+ metastatic breast cancer where primary or secondary resistance to trastuzumab is common and may include women with brain
metastasis. Alternatively, the Phase II trial may include women with MUC4+ TNBC or patients with MUC4+/HER2+ gastric cancer or MUC4+ pancreatic
cancer. These trials will not be initiated until the COVID-19 pandemic has run its course. We do not expect to treat patients in an oncology
INB03 Phase II trial with INB03 before 2023. Pre-clinical studies of INB03 in MUC4 expressing tumors continue.
INB03 Registration Studies and/or Partnering
We plan to pursue an efficient
registration strategy using INB03 to improve the lives of patients with cancer and biomarkers of inflammation such as MUC4. We believe
that this strategy has use across many types of solid tumors including patients who have failed CPI, tyrosine kinase inhibitors (“TKI”)
and anti-cancer antibody therapy such as trastuzumab monoclonal antibodies and trastuzumab based antibody drug conjugates. We have an
active partnering position as it relates to INB03 development in cancer, although no partnering discussion are underway at this time.
We do not expect partnering discussions to begin until Phase II data demonstrating efficacy of INB03 as part of combination therapy for
cancer are available.
Our INB03 platform can be
used in cancer patients in many ways. The Phase I trial suggests the drug should not be used alone to treat cancer but used in combination
with, but not limited to, other cancer therapies including cytotoxic chemotherapy, immunotherapy, radiation and surgery. We believe that
INB03 can also be used to treat many types of hematologic and epithelial cancers.
INB03 and 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 be blinded, randomized
clinical trials using validated end-points that have been authorized by a regulatory authority – the FDA, TGA, MHRA, EMA, etc. Currently,
all planned studies will be performed in North America, AUS and/or the UK. Studies will be expanded to Europe and beyond as resources
permit and development needs expand. Because there are no therapies similar to INB03 or XPro approved in any market and no therapies approved
for the treatment of the diseases we are pursuing, 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 “Government Regulation”),
and in the setting of COVID-19, Emergency Use Authorization. We cannot predict which, if any, of these programs we will benefit from without
further discussions with the FDA. Similar programs exist in the EU with the EMA. We will engage the EMA once we have initiated Phase II
trials in the United States and Australia.
12
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 is not an effective treatment strategy, but that 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 AUS 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 will be 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, MRI measures of white matter tract neuroinflammation, axonal
quality and axon myelin, and MRI measures of gray matter quality after XPro therapy. 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 allow the Company to choose a design the Phase II trials described above.
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 hopes to start patient enrollment
in the second half of 2022. We have an active partnering position as it relates to XPro development in neurodegenerative and neuropshyciatric
diseases, although no partnering discussion 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. We may to have biopharma partners participate in this decision making. We
may also seek to be acquired at this stage.
13
INKmune: Our NK cell Directed Product Candidate
INKmune is our lead 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 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 if these two strategies has yet to be worked out, they do not appear
to be identical. In summary, INKmune converts resting NK cells in to tumor killing memory like NK cells. (Figure 1 below).
14
The ability of NK cells to kill tumor cells depends on the strength
and duration of the cell-cell interaction. This is call 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).
15
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 UK
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.
Because INKmune primes NK cells to target naturally
occurring antigens, we believe INKmune can be used in 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 ovarian cancer and high-risk MDS, we will need to perform separate pivotal trials for
approval in lung, prostate or renal cancer.
16
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 both Phase I clinical trials in women with ovarian
cancer and in patients with high-risk MDS. 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 80 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.
INKmune Biomarker Development Program
We have discovered two biomarker
strategies that we believe can be used to demonstrate: i) who should receive INKmune therapy; ii) if the INKmune therapy is working; and
iii) when INKmune therapy should be repeated. For the initial Phase I/II trials in patients with ovarian cancer and high-risk MDS, we
expect the biomarker testing will be performed in a single laboratory under our direction. We may develop training programs for our standard
operating procedures to ensure uniform testing of the biomarkers to facilitate expansion of the clinical programs to multiple sites. We
anticipate that, in the future, the biomarker program may be a surrogate marker for both clinical effectiveness and marketing purposes.
Interaction with Regulatory Authorities Regarding
INKmune Development
The
INKmune Phase I studies in high-risk MDS and ovarian cancer will be performed in the UK and US. We met with the Medicines and Healthcare
Products Regulatory Agency (“MHRA”), the UK version of the FDA as part of a Scientific Advice Meetings in preparation for
submitting the CTA for our first planned program. The purpose of the meeting was to explain to the MHRA our manufacturing process and
clinical plan for the development of INKmune in a Phase I relapse/refractory ovarian cancer. We plan to expand the MDS program beyond
the UK. This may include sites in the EU and the US. We will need to work with the relevant regulatory authorities as we make those expansions.
We will seek regulatory approval to start the ovarian cancer program in the US after the first cohort of patients have been treated in
the UK.
INKmune Product Development Path Proposed Phase
I Study in patients with ovarian cancer
Pending the resolution of
the COVID-19 pandemic in 2022, we plan to initiate an open label Phase I cancer study in patients with ovarian carcinoma. Patients will
be enrolled who have a low burden of relapse refractory disease and have peripheral blood or ascites NK cells which can respond to INKmune
in a laboratory test on NK function. The study design agreed upon after discussion with the MHRA on September 12, 2017 was for a two-step
Phase I/II study but this has been modified to an classic Phase I study followed by a randomized phase II. At present we anticipate the
Phase I to be performed under the modified CTA at a single UK site, Sheffield University Hospital. We expect to initiate trial by the
third quarter of 2022. In the Phase I trial, women with relapse refractory ovarian cancer will be treated with INKmune, given as an intravenous
infusion in a traditional open label study to demonstrate safety and determine the dose of INKmune to be carried into the larger Phase
II portion of the study. Based on pre-clinical studies that indicate that women with relapsed/refractory ovarian cancer have NK cells
in their peritoneal cavity that response to INKmune to kill SKOV3, an NK-resistant ovarian cell line, we believe intravenous delivery
of INKmune will be therapeutically effective in treating intra-peritoneal disease. The key secondary efficacy end-points to be studied
are i) increased NK cell priming as determined by multicolor flow cytometry of NK cells from the patient; ii) increased NK cell killing
of SKOV3 tumor in a bioassay as shown in Figure 2 below; and iii) a decrease in tumor burden as measured by CA125 levels in the blood.
Once safety and the optimal INKmune dose have been determined, a randomized study of women treated with INKmune will be compared to a
group of control patients who receive only standard of care. We expect to treat six patients in the Phase I portion of the trial, but
this number can increase by as many as 18.
17
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”). Patients are being enrolled who have a low burden of disease after completion
of conventional therapy. At present we anticipate the Phase I to be performed at two sites UK site and will expand into additional sites
in EU and/or US during 2022. The first patients was enrolled in the first quarter of 2021. In the Phase I trial, patients with detectable
residual disease in bone marrow and/or peripheral blood (<15% blasts by conventional tests) will be treated 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
is now more than 6 months out from therapy with INKmune. 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 has had a significant
clinical improvement with a reduction of his ECOG score from 2 to 0 and a significant reduction in blood product support.
Two compassionate use cases
have also been treated. Both 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. She remains well and at home three months under the care of her clinical team. 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.
18
Because both INKmune programs
are being run in the UK, delays due to the COVID-19 pandemic continues to delay enrolment into the MDS clinical trial and is delaying
site initiation for the ovarian cancer trial.
INKmune Registration Studies and/or Partnering
After completion of proof-of-concept
Phase II studies with INKmune, we will decide whether to continue to develop INKmune as a treatment for ovarian carcinoma indication and/or
high risk MDS. 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 expect to have biopharma partners participate in this decision. We may also seek to be acquired at this stage or partner 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. Data to support this belief
should be presented in 2022.
19
INKmune Regulatory Strategy
INKmune is a new therapy for the treatment of cancer that will need
to be proven safe and effective by well-designed clinical trials that show a meaningful clinical benefit to patients. We believe that
registration trials will need to be designed as randomized trials in patients with cancer where one group of patients received INKmune
and another receive best available care. We received advice from the MHRA on September 12, 2017 on the design the Phase I clinical trial
for ovarian cancer. And have used that advice to plan both current phase I trials. We plan to initiate the Phase I trials with INKmune
in the United Kingdom under two clinical trials authorizations (“CTA”) – one for each indication. Both trials will be
expanded to sites in the US after opening of an IND. We expect those IND’s to be open by the end of 2022. If either phase I elicits
“positive” data we plan to open one or more Phase II programs to additional sites in the United Kingdom, EU and/or US. For
each regulatory jurisdiction outside of the UK, the competent regulatory authority will need to be engaged. In the US, that is the FDA.
In the EU, it will be the country specific regulatory authority. These follow-on regulatory submissions will include data from the patients
treated in the UK in the clinical trials or as part of compassionate use. Because there are no therapies similar to INKmune approved in
any market, we plan to take advantage of the regulatory opportunities afforded to therapies that treat small 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 “Government Regulation”). We cannot predict which of
these programs we will benefit from, if any at all, without further discussions with the FDA. Similar programs exist in the EU with the
European Medicines Agencies (“EMA”) and in the UK with the MHRA.
Emerging Market Opportunity
The cancer therapy market
is large, diverse and competitive. Although the concept of immunotherapy with monoclonal antibodies has been around for more than 20 years,
the concept that patient derived immunosuppressive factors was a barrier to effective cancer treatment was recently recognized and had
its first therapy approved just four years ago (ipilimumab, Yervoy, BMS, March 2011). Since then, more than five additional “check
point” inhibitors have been approved, but the market is in its infancy. Most of the focus on strategies for modulating tumor-based
immunosuppression focus is on the adaptive immune system (“T-cells”). The role of, and the importance of manipulating the
innate immune system has more recently become a target of therapeutic development. NK cells are part of the innate immune system and are
critical in both tumor surveillance (prevention) and treatment (killing). MDSCs and Tumor Associated Macrophages (TAM) are part of the
innate immune system that only appear in the TME of patients with cancer. The main role of the MDSC and TAM is to protect the tumor from
attack by the patient’s immune system. Because T-cell focused strategies do not have an effect on the innate immune system, patient’s
receiving such treatments may fail to recruit half of the patient’s immune system, the innate immune system, to attack the patient’s
cancer. Clinicians increasingly recognize that durable responses to cancer require a coordinated attack by the patient’s adaptive
and innate immune system. Normalizing the response of the innate immune system requires eliminating the dysregulated innate immune response
that decreases the patient’s ability to see and attack the cancer as well as mechanisms the protect the cancer from immunologic
attack (effector and protector function respectively). INKmune primes NK cells to enable them to attack the tumor. INB03, by decreasing
the immunosuppressive function of MDSC and TAM, will lessen the immunosuppressive shield that protects the tumor from immunologic attack
and, through NK/DC crosstalk, recruit the adaptive immune system to the fight and potentially increase local innate anti-tumor effects
such as improved NK cell function and anti-tumor macrophage phagocytic activity.
Challenges in the Market for Our Product Candidates
The market for new oncology
therapies is busy, 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.
20
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 promote INKmune and INB03 and to educate
the clinical, biopharma and investor community on the value of these novel therapeutic approaches.
DN-TNF Competition
To our knowledge, there are
no other innate immune system check-point inhibitors in development that combine the characteristics of neutralizing soluble TNF, decreasing
the population and function of MDSC while promoting NK/DC crosstalk that expands, decreases expression of MUC4 and recruits the adaptive
immune response to attack the patient’s tumor. Lilly is developing LY3022855, a human IgG1 monoclonal antibody designed to target
the CSF1R that should inhibit MDSC from receiving CSF1 signals, decreasing their survival and relieving the effect of MDSC in the tumor.
Daiichi Sankyo Inc., in collaboration with Bristol Myers Squibb, is testing DS-8273a, a TRIAL-R2 agonistic antibody in combination with
a PDL1 inhibitor to decrease the number of MDSC in patients with colorectal cancer. Rgenix Inc., is developing RGX-104, an orally bioavailable
small molecule immunotherapy that targets LXR (liver X Receptor). RGX-104 reportedly depletes MDSC. Syntrix Biosystems is developing SX-682.
SX-682 is a small-molecule dual-inhibitor of CXCR1 and CXCR2, the chemokine receptors pivotal to tumor metastasis, therapy-resistance,
and myeloid cell suppression of cancer surveillance by the adaptive immune system. By blocking the CXCR1/2 pathway, SX-682 may prevent
recruitment of MDSC to the tumor microenvironment. The University of Minnesota has a trivalent antibody program aimed at treating patients
with advanced hematologic malignancies. This CD16/IL-15/CD33 (161533) Tri-Specific Killer Engagers (TriKes) product may target CD33+ MDSC.
Siamab Therapeutics is developing an anti-sialyl-Tn monoclonal antibody that targets MDSC in some tumor types. Clathera Biosciences, in
collaboration with Incyte, a US based biotech, is developing CB-1158 (INCB01158), an arginase inhibitor to decreases MDSC. A Phase II
clinical trial is open that combines CB-1158 with nivolumab, an anti-PD1 CPI marketed by Bristol Myers Squib. Reata Pharmaceuticals is
testing omaveloxolone (RTA 408) in the phase Ib/II REVEAL trial in combination with either ipilimumab (Yervoy) or nivolumab (Opdivo) in
patients with advanced unresectable or metastatic melanoma. Currently approved non-selective TNF inhibitors, infliximab, etanercept, adalimumab
and others, are not considered direct competitors of INB03 in the treatment of cancer because of their mechanism of action and safety
side effects. Non- selective TNF inhibitors block the function of both sTNF and tmTNF. Blockade of tmTNF is immunosuppressive increasing
the risk of infection and cancer in patients. This is shown in Figure 3 below where maintaining function to tmTNF by genetic or pharmacologic
means results in an immunocompetent animal that can protect itself against infection. Blockade or knock-out of both sTNF and tmTNF results
in death from infection.
21
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.
22
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 product requires 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 to a single disease (for example: pediatric ALL). CAR-T therapy has become wildly popular
of late and includes many private companies, newer 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 just 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.
23
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 eleven (11) issued patents and forty-seven (47) 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, INB03, LIVNate. 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
4
global
2024-2041
Use of DNTNF for treating disease
31
3
global
2033-2041
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
2
0
global
2036-2040
Use of INKmune for treating disease
10
4
global
2036-2040
Use of INKmune for enhancing NK cell therapeutics
2
0
global
2036-2040
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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
of 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.
25
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 exists. 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 18, 2018, the parties
amended the agreement under which the Company was required to achieve milestones pursuant to the agreement. On October 30, 2020, the parties
executed an additional amendment to the agreement under which the Company is required to achieve the following milestones:
Initiation of Phase II clinical
trials or equivalent by October 29, 2023;
Initiation of Phase III
clinical trials or equivalent by October 29, 2025; and
Filing of NDA or equivalent by October 29, 2026 or equivalent.
If we don’t achieve
the above milestones, we are required to negotiate in good faith with Immune Ventures to determine how we can either remedy the failure
or achieve an alternate development. If we fail to make any required efforts or if the efforts do not remedy the situation within 60 days
of written notice by Immune Ventures then Immune Ventures may provide notice to terminate the license or convert it to a non-exclusive
license.
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 of 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.
In 2021, the company paid
$5,000 according to the PITT Agreement as an annual maintenance fee.
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.
26
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.
University College London License Agreement
– MSC
On July 19, 2019, the Company
entered into license agreement with UCL Business PLC (“UCLB”) with a ten (10) year term. Pursuant to the license agreement,
the Company acquired an exclusive license (and a right to sub-license) to the technology and know-how relating to an isolation and commercial
scale expansion methodology of GMP grade human umbilical cord mesenchymal stem/stromal cells (“MSC”).
On July 16, 2021, we provided
notice of intent to terminate the agreement with UCLB, which per the agreement became effective August 15, 2021.
27
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 in ovarian cancer. 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 of the high-risk MDS 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, 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 human umbilical cord derived mesenchymal stem cells (“HucMSC”). We believe the reproducible and reliable supply of
large quantities of high-quality a may solve one of the major problems associated with the development of mesenchymal stem cell therapies
for medicine. 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 two academic clinical trials with CORDstrom. One program is a in the UK treating children with
erythematous bullousa, a disfiguring skin disease in children that is similar to a second degree burn and treatment of system lupus in
adults. Both these studies are ongoing. INmune Bio is supplying the clinical product for treatment of these patients. The Company does
not know the results of these trials until they are announced by the principal investigators at the clinical sites. Currently, we plan
to supply HucMSC to third parties for their research use and in clinical trials as part of the development process for commercial pro/ducts.
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.
28
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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We plan to seek orphan drug
designation for INKmune for the treatment of high-risk MDS if the results of the clinical trials support this activity. 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 programs. Other venues such as Europe, Canada,
Japan and other Pacific Rim countries may be included in the development program in the future. The first clinical trial with INKmune
will be initiated in the United Kingdom. In the United Kingdom, the regulatory submission is made to the MHRA for a clinical trials authorization
(“CTA”). This is a multistep process. The Company had a Scientific Advice meeting with the MHRA in September 2017 to discuss
the INKmune Phase I/II trial in women with relapse/refractory ovarian cancer including trial design, manufacturing processes and clinical
trial execution. The MHRA gave recommendations on trial design, manufacturing controls and the regulatory procedures needed to initiate
the clinical trial. We received CTA approval from the MHRA for an INKmune trial in ovarian cancer on December 18, 2018. The approval allows
for the execution of the Phase I/II INKmune clinical trial in the United Kingdom. We plan to have two cancer clinics referring the 6 patients
needed for the Phase I portion of the trial. We expect the first Phase I sites to be in the United Kingdom. If the first cohort of the
Phase I trial proceeds as planned, we expect to expand the clinical trial in the United Kingdom and may include clinical sites in the
US. Any Phase II program will start as a multi-national trial because at least 30 patients will be required to complete the Phase II program.
The additional clinical sites in the United Kingdom or US have not been identified at this time. No additional regulatory procedures will
be needed to add sites in the United Kingdom. To add sites in the US, we will need to file an IND with the FDA. Once the FDA approves
the IND, clinical sites can be opened. We have chosen relapsed/refractory ovarian cancer as the anticipated Phase 1 study for INKmune
for a number of reasons. Relapsed refractory is a disease with poor treatment options. Our pre-clinical data suggests INKmune may have
advantages over other immunotherapies in the treatment of ovarian cancer. Ovarian cancer has a sensitive and validated biomarker to measure
disease burden – CA125. This allows the Company to accurately select patients for the clinical trial and determine if INKmune therapy
is effective. This provides regulatory advantages for registration of INKmune. INB03 will follow a similar development strategy, but used
Australia for the Phase I programs. In Australia, clinical trials for INB03 are performed under the clinical trials notification (“CTN”)
scheme authorized by the Therapeutic Good Administration (“TGA”). The TGA is the equivalent agency to the FDA in the US and
the MHRA in the United Kingdom. We filed an Australian Clinical Trial Notification, or CTN, for INB03 and XPro during the second quarter
of 2018 and 2019 respectively. Applications were accepted in May 2018 and 2019 to allow us to initiate the Phase I trials in cancer and
Alzheimer’s disease respectively. We have completed the oncology Phase 1 open label dose escalation trial in patients with advanced
solid tumors and biomarkers of inflammation in their blood.
30
The 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
MUC4+ breast cancer with or without brain metastasis that have a measurable pharmacodynamic biomarker. 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/neu 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+ trastuzumab resistant HER2+ expressing cancer is our most probable registration
strategy for INB03. This includes the combination of INB03 with trastuzumab antibody drug conjugate therapies such as ENHERTU (trastuzumab-deruxtecan;
(Daiichi-Sankyo). Current therapies for trastuzumab resistant cancers are used on a trial by error approach. Using MUC4 expression as
a biomarker for to predict trastuzumab resistance brings a precision medicine approach to this difficult clinical scenario. Addition of
INB03 to the treatment regimen for treating HER2+ cancers may convert “cold” tumors to “hot” tumors making the
eligible for treatment with CPI. Finally, the clinical development landscape for CPI combination therapies to treat CPI resistant therapies
is chaotic. 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 trastuzumab resistant breast cancer. The most prominent are
antibody conjugates including ado-trastuzumab emtansine (Kadycycla/T-DM1, Genentech/Roche) and trastuzumab deruxtecan (Enhertu, Daiichi
Sankyo). 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 is being 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.
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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.
32
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.
33
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
The United States and some
foreign jurisdictions are considering or have enacted a number of legislative and regulatory proposals to change the healthcare system
in ways that could affect our ability to sell our products profitably. Among policy makers and payors in the United States and elsewhere,
there is significant interest in promoting changes in healthcare systems with the stated goals of containing healthcare costs, improving
quality and/or expanding access. In the United States, the pharmaceutical industry has been a particular focus of these efforts and has
been significantly affected by major legislative initiatives.
By way of example, in March
2010, the Affordable Care Act was signed into law, intended to broaden access to health insurance, reduce or constrain the growth of healthcare
spending, enhance remedies against fraud and abuse, add new transparency requirements for the healthcare and health insurance industries,
impose new taxes and fees on the health industry and impose additional health policy reforms. Among the provisions of the Affordable Care
Act of importance to our potential drug candidates are:
●
an annual, nondeductible fee on any entity that manufactures or imports specified branded prescription drugs and biologic agents, apportioned among these entities according to their market share in certain government healthcare programs;
●
an increase in the statutory minimum rebates a manufacturer must pay under the Medicaid Drug Rebate Program to 23.1% and 13.0% of the average manufacturer price for branded and generic drugs, respectively;
●
a new methodology by which rebates owed by manufacturers under the Medicaid Drug Rebate Program are calculated for drugs that are inhaled, infused, instilled, implanted or injected;
●
a new Medicare Part D coverage gap discount program, in which manufacturers must agree to offer 50% point-of-sale discounts off negotiated prices of applicable brand drugs to eligible beneficiaries during their coverage gap period, as a condition for a manufacturer’s outpatient drugs to be covered under Medicare Part D;
●
extension of a manufacturer’s Medicaid rebate liability to covered drugs dispensed to individuals who are enrolled in Medicaid managed care organizations;
35
●
expansion of eligibility criteria for Medicaid programs by, among other things, allowing states to offer Medicaid coverage to additional individuals and by adding new mandatory eligibility categories for certain individuals with income at or below 133% of the federal poverty level, thereby potentially increasing a manufacturer’s Medicaid rebate liability;
●
expansion of the entities eligible for discounts under the Public Health Service pharmaceutical pricing program; and
●
a new Patient-Centered Outcomes Research Institute to oversee, identify priorities in, and conduct comparative clinical effectiveness research, along with funding for such research.
In addition, other legislative
changes have been proposed and adopted since the Affordable Care Act was enacted. These changes include, among others, the Budget Control
Act of 2011, which mandates aggregate reductions to Medicare payments to providers of up to 2% per fiscal year effective April 1, 2013,
and, due to subsequent legislative amendments, will remain in effect through 2024 unless additional Congressional action is taken. In
January 2013, President Obama signed into law the American Taxpayer Relief Act of 2012, which, among other things, further reduced Medicare
payments to several providers, including hospitals and cancer treatment centers, increased the statute of limitations period for the government
to recover overpayments to providers from three to five years. These new laws may result in additional reductions in Medicare and other
healthcare funding, which could have a material adverse effect on customers for our product candidates, if approved, and, accordingly,
our financial operations.
We expect that the Affordable
Care Act, as well as other healthcare reform measures that may be adopted in the future, may result in more rigorous coverage criteria
and lower reimbursement, and in additional downward pressure on the price that we receive for any approved product. Any reduction in reimbursement
from Medicare or other government-funded programs may result in a similar reduction in payments from private payors. The implementation
of cost containment measures or other healthcare reforms may prevent us from being able to generate revenue, attain profitability or commercialize
our drugs.
Human Capital Resources
As of December 31, 2021, we
had 10 full-time employees. 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.
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Item 1a. Risk Factors
Summary of Risk Factors
Below is a summary of the principal factors that
make an investment in our common stock speculative or risky. This summary does not address all of the risks that we face. Additional discussion
of the risks summarized in this risk factor summary, and other risks that we face, can be found below under the heading “Risk Factors”
and should be carefully considered, together with other information in this Form 10-K and our other filings with the SEC, before making
an investment decision regarding our common stock.
●
We have incurred significant losses since our inception and anticipate that we will continue to incur losses for the foreseeable future.
●
We will require additional capital to fund our operations and if we fail to obtain necessary financing we will not be able to complete the development and commercialization of our product candidates.
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We are significantly dependent on the success of our DN-TNF product platform and Natural Killer Cell Priming Platform (INKmune) and our product candidates based on these platforms.
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We need to attract and retain highly skilled personnel; we may be unable to effectively manage growth with our limited resources.
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We depend upon our senior management and key consultants and their loss or unavailability could put us at a competitive disadvantage.
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The biotechnology and immunotherapy industries are characterized by rapid technological developments and a high degree of competition. We may be unable to compete with more substantial enterprises.
●
We can provide no assurance that our clinical product candidates will obtain regulatory approval or that the results of clinical studies will be favorable.
●
Drug discovery and development is a complex, time-consuming and expensive process with a high rate of failure.
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We may face legal claims; legal disputes are expensive and we may not be able to afford the costs.
●
We can provide no assurance of the successful and timely development of new products.
●
We must comply with significant government regulations.
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We rely upon patents to protect our technology. We may be unable to protect our intellectual property rights.
●
The price of our common stock may be volatile.
●
The market prices for our common stock may be adversely impacted by future events.
●
A limited public trading market may cause volatility in the price of our common stock.
●
Our Rights Agreement contains anti-takeover provisions that could discourage, delay or prevent a change in control, which may cause our stock price to decline.
You should carefully consider the risks described
below as well as other information provided to you in this document, including information in the section of this document entitled “Information
Regarding Forward Looking Statements.” If any of the following risks actually occur, the Company’s business, financial condition
or results of operations could be materially adversely affected, the value of the Company’s Common Stock could decline, and you
may lose all or part of your investment.
37
RISKS RELATED TO OUR BUSINESS
We will need additional capital. If additional
capital is not available or is available at unattractive terms, we may be forced to delay, reduce the scope of or eliminate our research
and development programs, reduce our commercialization efforts or curtail our operations.
In order to develop and bring our product candidates
to market, we must commit substantial resources to costly and time-consuming research, preclinical and clinical trials and marketing activities.
We anticipate that our existing cash and cash equivalents will enable us to maintain our current operations for at least the next twelve
months. We anticipate using our cash and cash equivalents to fund further research and development with respect to our lead product candidates.
We may, however, need to raise additional funding sooner if our business or operations change in a manner that consumes available resources
more rapidly than we anticipate. Our requirements for additional capital will depend on many factors, including:
●
successful commercialization of our product candidates;
●
the time and costs involved in obtaining regulatory approval for our product candidates;
●
costs associated with protecting our intellectual property rights;
●
development of marketing and sales capabilities;
●
payments received under future collaborative agreements, if any; and
●
market acceptance of our products, if any.
To the extent we raise additional capital through
the sale of equity securities, the issuance of those securities could result in dilution to our shareholders. In addition, if we obtain
debt financing, a substantial portion of our operating cash flow may be dedicated to the payment of principal and interest on such indebtedness,
thus limiting funds available for our business activities. If adequate funds are not available, we may be required to delay, reduce the
scope of or eliminate our research and development programs, reduce our commercialization efforts or curtail our operations. In addition,
we may be required to obtain funds through arrangements with collaborative partners or others that may require us to relinquish rights
to technologies, product candidates or products that we would otherwise seek to develop or commercialize ourselves or license rights to
technologies, product candidates or products on terms that are less favorable to us than might otherwise be available.
The Company will require substantial additional
funds to support its research and development activities, and the anticipated costs of preclinical studies and clinical trials, regulatory
approvals and eventual commercialization. Such additional sources of financing may not be available on favorable terms, if at all. If
we do not succeed in raising additional funds on acceptable terms, we may be unable to initiate clinical trials or obtain approval of
any product candidates from the FDA and other regulatory authorities. In addition, we could be forced to discontinue product development,
forego sales and marketing efforts and forego attractive business opportunities. Any additional sources of financing will likely involve
the issuance of our equity securities, which will have a dilutive effect on our stockholders.
We face intense competition in the markets
targeted by our lead product candidates. Many of our competitors have substantially greater resources than we do, and we expect that all
of our product candidates under development will face intense competition from existing or future drugs.
We expect that all of our product candidates under
development, if approved, will face intense competition from existing and future drugs marketed by large companies. These competitors
may successfully market products that compete with our products, successfully identify drug candidates or develop products earlier than
we do, or develop products that are more effective, have fewer side effects or cost less than our products, if any.
38
Additionally, if a competitor receives FDA approval
before we do for a drug that is similar to one of our product candidates, FDA approval for our product candidate may be precluded or delayed
due to periods of non-patent exclusivity and/or the listing with the FDA by the competitor of patents covering its newly-approved drug
product. Periods of non-patent exclusivity for new versions of existing drugs such as our current product candidates can extend up to
three and one-half years. See “Business — Government Regulation.”
These competitive factors could require us to
conduct substantial new research and development activities to establish new product targets, which would be costly and time consuming.
These activities would adversely affect our ability to commercialize products and achieve revenue and profits.
Competition and technological change may
make our product candidates and technologies less attractive or obsolete.
We compete with established pharmaceutical and
biotechnology companies that are pursuing other forms of treatment for the same indications we are pursuing and that have greater financial
and other resources. Other companies may succeed in developing products earlier than us, obtaining FDA approval for products more rapidly,
or developing products that are more effective than our product candidates. Research and development by others may render our technology
or product candidates obsolete or noncompetitive, or result in treatments or cures superior to any therapy we develop. We face competition
from companies that internally develop competing technology or acquire competing technology from universities and other research institutions.
As these companies develop their technologies, they may develop competitive positions that may prevent, make futile, or limit our product
commercialization efforts, which would result in a decrease in the revenue we would be able to derive from the sale of any products.
There can be no assurance that any of our product
candidates will be accepted by the marketplace as readily as these or other competing treatments. Furthermore, if our competitors’
products are approved before ours, it could be more difficult for us to obtain approval from the FDA. Even if our products are successfully
developed and approved for use by all governing regulatory bodies, there can be no assurance that physicians and patients will accept
our product(s) as a treatment of choice.
Furthermore, the pharmaceutical research industry
is diverse, complex, and rapidly changing. By its nature, the business risks associated therewith are numerous and significant. The effects
of competition, intellectual property disputes, market acceptance, and FDA regulations preclude us from forecasting revenues or income
with certainty or even confidence.
If we fail to protect our intellectual property
rights, our ability to pursue the development of our technologies and products would be negatively affected.
Our success will depend, in part, on our ability
to obtain patents and maintain adequate protection of our technologies and products. If we do not adequately protect our intellectual
property, competitors may be able to use our technologies to produce and market drugs in direct competition with us and erode our competitive
advantage. Some foreign countries lack rules and methods for defending intellectual property rights and do not protect proprietary rights
to the same extent as the United States. Many companies have had difficulty protecting their proprietary rights in these foreign countries.
We may not be able to prevent misappropriation of our proprietary rights.
We have received, and are currently seeking, patent
protection for numerous compounds and methods of treating diseases. However, the patent process is subject to numerous risks and uncertainties,
and there can be no assurance that we will be successful in protecting our products by obtaining and defending patents. These risks and
uncertainties include the following: patents that may be issued or licensed may be challenged, invalidated, or circumvented, or otherwise
may not provide any competitive advantage; our competitors, many of which have substantially greater resources than us and many of which
have made significant investments in competing technologies, may seek, or may already have obtained, patents that will limit, interfere
with, or eliminate our ability to make, use, and sell our potential products either in the United States or in international markets;
there may be significant pressure on the United States government and other international governmental bodies to limit the scope of patent
protection both inside and outside the United States for treatments that prove successful as a matter of public policy regarding worldwide
health concerns; countries other than the United States may have less restrictive patent laws than those upheld by United States courts,
allowing foreign competitors the ability to exploit these laws to create, develop, and market competing products.
39
Moreover, any patents issued to us may not provide
us with meaningful protection, or others may challenge, circumvent or narrow our patents. Third parties may also independently develop
products similar to our products, duplicate our unpatented products or design around any patents on products we develop. Additionally,
extensive time is required for development, testing and regulatory review of a potential product. While extensions of patent term due
to regulatory delays may be available, it is possible that, before any of our product candidates can be commercialized, any related patent,
even with an extension, may expire or remain in force for only a short period following commercialization, thereby reducing any advantages
of the patent.
In addition, the United States Patent and Trademark
Office (the “USPTO”) and patent offices in other jurisdictions have often required that patent applications concerning pharmaceutical
and/or biotechnology-related inventions be limited or narrowed substantially to cover only the specific innovations exemplified in the
patent application, thereby limiting the scope of protection against competitive challenges. Thus, even if we or our licensors are able
to obtain patents, the patents may be substantially narrower than anticipated.
Our success depends on patent applications that
are licensed exclusively to us and other patents to which we may obtain assignment or licenses. We may not be aware, however, of all patents,
published applications or published literature that may affect our business either by blocking our ability to commercialize our product
candidates, by preventing the patentability of our product candidates to us or our licensors, or by covering the same or similar technologies
that may invalidate our patents, limit the scope of our future patent claims or adversely affect our ability to market our product candidates.
In addition to patents, we rely on a combination
of trade secrets, confidentiality, nondisclosure and other contractual provisions, and security measures to protect our confidential and
proprietary information. These measures may not adequately protect our trade secrets or other proprietary information. If they do not
adequately protect our rights, third parties could use our technology, and we could lose any competitive advantage we may have. In addition,
others may independently develop similar proprietary information or techniques or otherwise gain access to our trade secrets, which could
impair any competitive advantage we may have.
Patent protection and other intellectual property
protection is crucial to the success of our business and prospects, and there is a substantial risk that such protections will prove inadequate.
We license our patents from third party
owners. If such owners do not properly maintain or enforce the intellectual property underlying such licenses, our competitive position
and business prospects could be harmed. Our licensors may also seek to terminate our license.
We are a party to a number of licenses that give
us rights to third-party intellectual property that is necessary or useful to our business. To this end, we are dependent on our licenses
with Xencor, Inc., Immune Ventures, LLC and the University of Pittsburgh. Our success will depend in part on the ability of our licensors
to obtain, maintain and enforce our licensed intellectual property. Our licensors may not successfully prosecute any applications for
or maintain intellectual property to which we have licenses, may determine not to pursue litigation against other companies that are infringing
such intellectual property, or may pursue such litigation less aggressively than we would. Without protection for the intellectual property
we license, other companies might be able to offer similar products for sale, which could adversely affect our competitive business position
and harm our business prospects. If we lose any of our right to use third-party intellectual property, it could adversely affect our ability
to commercialize our technologies, products or services, as well as harm our competitive business position and our business prospects.
40
We are dependent on our licensing agreement
with Xencor and the termination of this agreement could a have an adverse effect on our business.
On October 3, 2017, the Company entered into a license agreement with
Xencor, Inc., which has discovered and developed a proprietary biological molecule that inhibits soluble tumor necrosis factor. Pursuant
to the license agreement, Xencor granted the Company an exclusive worldwide, royalty-bearing license in licensed patent rights, licensed
know-how and licensed materials 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. If we breach this Agreement Xencor may be able to terminate it and as a result of this terminate our business
could be negatively impacted.
Our officers and Directors own the company
that we license our INKmune patent from.
On October 29, 2015, we entered into an exclusive
license agreement with Immune Ventures, LLC (Immune Ventures). The license agreement relates to our natural killer program, INKmune. Immune
Ventures is owned by our President and a member of our Board of Directors, David Moss, our Chief Financial Officer and Treasurer and Mark
Lowdell, our Chief Scientific Officer. Because our officers and directors also own Immune Ventures there may be an inherent conflict of
interest which could result in unanticipated actions that adversely affect us.
We have a limited operating history, and
expect to incur significant additional operating losses.
We are an early-stage company formed in September 2015 and have only a limited operating history. Therefore, there is limited historical
financial information upon which to base an evaluation of our performance. Our prospects must be considered in light of the uncertainties,
risks, expenses, and difficulties frequently encountered by companies in their early stages of operations. We expect to incur substantial
additional operating expenses over the next several years as our research, development, and commercial activities increase. The amount
of future losses and when, if ever, we will achieve profitability are uncertain. Our ability to generate material revenue and achieve
profitability will depend on, among other things, successful completion of the preclinical and clinical development of our product candidate;
obtaining necessary regulatory approvals from the FDA and international regulatory agencies; implementing successful manufacturing, sales,
and marketing arrangements; and raising sufficient funds to finance our activities. If we are unsuccessful at some or all of these undertakings,
our business, prospects, and results of operations may be materially adversely affected.
INKmune represents a novel approach to cancer
treatment that creates significant challenges for us.
We believe INKmune represents a novel approach
to cancer treatment. Advancing this novel therapy creates significant challenges for us, including:
●
Educating medical personnel regarding the potential side effect profile of INKmune;
●
Sourcing clinical and, if approved, commercial supplies for the materials used to manufacture and process our product candidates;
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Obtaining regulatory approval, as the FDA and other regulatory authorities have limited experience with commercial development of immunotherapies for cancer; and
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Establishing sales and marketing capabilities upon obtaining any regulatory approval to gain market acceptance of a novel therapy.
Even if we are able to commercialize any
product candidate that we develop, the product may become subject to unfavorable pricing regulations, third-party payor reimbursement
practices or healthcare reform initiatives that could harm our business.
The commercial success of our product candidates
will depend substantially, both domestically and abroad, on the extent to which the costs of our product candidates will be paid by health
maintenance, managed care, pharmacy benefit and similar healthcare management organizations, or reimbursed by government health administration
authorities (such as Medicare and Medicaid), private health coverage insurers and other third-party payors. If reimbursement is not available,
or is available only to limited levels, we may not be able to successfully commercialize our product candidates. Even if coverage is provided,
the approved reimbursement amount may not be high enough to allow us to establish and maintain pricing sufficient to realize a meaningful
return on our investment.
41
There is significant uncertainty related to third-party
payor coverage and reimbursement of newly approved drugs. Marketing approvals, pricing and reimbursement for new drug products vary widely
from country to country. Some countries require approval of the sale price of a drug before it can be marketed. In many countries, the
pricing review period begins after marketing or product licensing approval is granted. In some non-U.S. markets, prescription pharmaceutical
pricing remains subject to continuing governmental control even after initial approval is granted. As a result, we might obtain marketing
approval for a product in a particular country, but then be subject to price regulations that delay commercial launch of the product,
possibly for lengthy time periods, which may negatively impact the revenues we are able to generate from the sale of the product in that
country. Adverse pricing limitations may hinder our ability to recoup our investment in one or more product candidates, even if our product
candidates obtain marketing approval.
We depend on obtaining certain patents and
protecting our proprietary rights.
Our success will depend, in part, on our ability
to obtain patents, maintain trade secret protection and operate without infringing on the proprietary rights of third parties or having
third parties circumvent our rights. We have filed and are actively pursuing a patent application for our product candidates. The patent
positions of biotechnology, biopharmaceutical and pharmaceutical companies can be highly uncertain and involve complex legal and factual
questions. Thus, there can be no assurance that our patent application will result in the issuance of a patent, that we will develop additional
proprietary products that are patentable, that any patents issued to us will provide us with any competitive advantages or will not be
challenged by any third parties, that the patents of others will not impede our ability to do business or that third parties will not
be able to circumvent our patents. Furthermore, there can be no assurance that others will not independently develop similar products,
duplicate any of our products not under patent protection, or, if patents are issued to us, design around the patented products we developed
or will develop.
We may be required to obtain licenses from third
parties to avoid infringing patents or other proprietary rights. No assurance can be given that any licenses required under any such patents
or proprietary rights would be made available, if at all, on terms we find acceptable. If we do not obtain such licenses, we could encounter
delays in the introduction of products or could find that the development, manufacture or sale of products requiring such licenses could
be prohibited.
A number of pharmaceutical, biopharmaceutical
and biotechnology companies and research and academic institutions have developed technologies, filed patent applications or received
patents on various technologies that may be related to or affect our business. Some of these technologies, applications or patents may
conflict with our technologies or patent applications. Such conflict could limit the scope of the patents, if any, that we may be able
to obtain or result in the denial of our patent applications. In addition, if patents that cover our activities are issued to other companies,
there can be no assurance that we would be able to obtain licenses to these patents at a reasonable cost or be able to develop or obtain
alternative technology. If we do not obtain such licenses, we could encounter delays in the introduction of products, or could find that
the development, manufacture or sale of products requiring such licenses could be prohibited. In addition, we could incur substantial
costs in defending ourselves in suits brought against us on patents it might infringe or in filing suits against others to have such patents
declared invalid.
Much of our know-how and technology may not be
patentable. To protect our rights, we plan to require employees, consultants, advisors and collaborators to enter into confidentiality
agreements. There can be no assurance, however, that these agreements will provide meaningful protection for our trade secrets, know-how
or other proprietary information in the event of any unauthorized use or disclosure. Further, our business may be adversely affected by
competitors who independently develop competing technologies, especially if we obtain no, or only narrow, patent protection.
42
We are subject to various government regulations.
The manufacture and sale of human therapeutic
products in the U.S. and foreign jurisdictions are governed by a variety of statutes and regulations. These laws require approval of manufacturing
facilities, controlled research and testing of products and government review and approval of a submission containing manufacturing, preclinical
and clinical data in order to obtain marketing approval based on establishing the safety and efficacy of the product for each use sought,
including adherence to current cGMP during production and storage, and control of marketing activities, including advertising and labeling.
The products we are currently developing will
require significant development, preclinical and clinical testing and investment of substantial funds prior to its commercialization.
The process of obtaining required approvals can be costly and time-consuming, and there can be no assurance that we develop successfully
this product or any future products, or that this product or any future products we develop will prove to be safe and effective in clinical
trials or receive applicable regulatory approvals. Potential investors and shareholders should be aware of the risks, problems, delays,
expenses and difficulties which we may encounter in view of the extensive regulatory environment which controls our business.
If we are unable to keep up with rapid technological
changes in our field or compete effectively, we will be unable to operate profitably.
We are engaged in a rapidly changing field. Other
products and therapies that will compete directly with the product that we are seeking to develop and market currently exist or are being
developed. Competition from fully integrated pharmaceutical companies and more established biotechnology companies is intense and is expected
to increase. Most of these companies have significantly greater financial resources and expertise in discovery and development, manufacturing,
preclinical and clinical testing, obtaining regulatory approvals and marketing than us. Smaller companies may also prove to be significant
competitors, particularly through collaborative arrangements with large pharmaceutical and established biopharmaceutical or biotechnology
companies. Many of these competitors have significant products that have been approved or are in development and operate large, well-funded
discovery and development programs. Academic institutions, governmental agencies and other public and private research organizations also
conduct research, seek patent protection and establish collaborative arrangements for therapeutic products and clinical development and
marketing. These companies and institutions compete with us in recruiting and retaining highly qualified scientific and management personnel.
In addition to the above factors, we will face competition based on product efficacy and safety, the timing and scope of regulatory approvals,
availability of supply, marketing and sales capability, reimbursement coverage, price and patent position. There is no assurance that
our competitors will not develop more effective or more affordable products, or achieve earlier patent protection or product commercialization,
than our own.
Other companies may succeed in developing products
earlier than ourselves, obtaining FDA and European Medicines Agency (“EMA”) approvals for such products more rapidly than
we will, or in developing products that are more effective than products we propose to develop. While we will seek to expand our technological
capabilities in order to remain competitive, there can be no assurance that research and development by others will not render our technology
or products obsolete or non-competitive or result in treatments or cures superior to any therapy we develop, or that any therapy we develop
will be preferred to any existing or newly developed technologies.
We may request priority review for our product
candidate in the future. The FDA may not grant priority review for our product candidate. Moreover, even if the FDA designates such product
for priority review, that designation may not lead to a faster regulatory review or approval process and, in any event, would not assure
FDA approval.
We may be eligible for priority review designation
for our product candidate if the FDA determines such product candidate offers major advances in treatment or provides a treatment where
no adequate therapy exists. A priority review designation means that the goal for the FDA to review an application in six months, rather
than the standard review period of ten months. The FDA has broad discretion with respect to whether or not to grant priority review status
to a product candidate, so even if we believe a particular product candidate is eligible for such designation or status, the FDA may decide
not to grant it. Thus, while the FDA has granted priority review to other oncology disease products, our product candidate, should we
determine to seek priority review, may not receive similar designation. Moreover, even if our product candidate is designated for priority
review, such a designation does not necessarily mean a faster regulatory review process or necessarily confer any advantage with respect
to approval compared to conventional FDA procedures. Receiving priority review from the FDA does not guarantee approval within an accelerated
timeline or thereafter.
43
We believe we may in some instances be able to secure
approval from the FDA or comparable non-U.S. regulatory authorities to use accelerated development pathways. If we are unable to obtain
such approval, we may be required to conduct additional preclinical studies or clinical trials beyond those that we contemplate, which
could increase the expense of obtaining, and delay the receipt of, necessary marketing approvals.
We anticipate that we may seek an accelerated
approval pathway for our product candidates. Under the accelerated approval provisions in the Federal Food, Drug, and Cosmetic Act, or
FDCA, and the FDA’s implementing regulations, the FDA may grant accelerated approval to a product designed to treat a serious or
life-threatening condition that provides meaningful therapeutic benefit over available therapies upon a determination that the product
has an effect on a surrogate endpoint or intermediate clinical endpoint that is reasonably likely to predict clinical benefit. The FDA
considers a clinical benefit to be a positive therapeutic effect that is clinically meaningful in the context of a given disease, such
as irreversible morbidity or mortality. For the purposes of accelerated approval, a surrogate endpoint is a marker, such as a laboratory
measurement, radiographic image, physical sign, or other measure that is thought to predict clinical benefit, but is not itself a measure
of clinical benefit. An intermediate clinical endpoint is a clinical endpoint that can be measured earlier than an effect on irreversible
morbidity or mortality that is reasonably likely to predict an effect on irreversible morbidity or mortality or other clinical benefit.
The accelerated approval pathway may be used in cases in which the advantage of a new drug over available therapy may not be a direct
therapeutic advantage, but is a clinically important improvement from a patient and public health perspective. If granted, accelerated
approval is usually contingent on the sponsor’s agreement to conduct, in a diligent manner, additional post-approval confirmatory
studies to verify and describe the drug’s clinical benefit. If such post-approval studies fail to confirm the drug’s clinical
benefit, the FDA may withdraw its approval of the drug.
Prior to seeking such accelerated approval, we
will seek feedback from the FDA and will otherwise evaluate our ability to seek and receive such accelerated approval. There can be no
assurance that after our evaluation of the feedback and other factors we will decide to pursue or submit a New Drug Application, or NDA,
for accelerated approval or any other form of expedited development, review or approval. Similarly, there can be no assurance that after
subsequent FDA feedback we will continue to pursue or apply for accelerated approval or any other form of expedited development, review
or approval, even if we initially decide to do so. Furthermore, if we decide to submit an application for accelerated approval or under
another expedited regulatory designation (e.g., breakthrough therapy designation), there can be no assurance that such submission or application
will be accepted or that any expedited development, review or approval will be granted on a timely basis, or at all. The FDA or other
non-U.S. authorities could also require us to conduct further studies prior to considering our application or granting approval of any
type. A failure to obtain accelerated approval or any other form of expedited development, review or approval for our product candidate
would result in a longer time period to commercialization of such product candidate, could increase the cost of development of such product
candidate and could harm our competitive position in the marketplace.
Clinical drug development involves a lengthy
and expensive process with an uncertain outcome. We may incur additional costs or experience delays in completing, or ultimately be unable
to complete the development and commercialization of our product candidate.
Our product candidates are either in early clinical
development or have not entered into clinical trials and are in development stage. Therefore, the risk of failure of our product candidates
is high. It is impossible to predict when or if our product candidates will prove effective or safe in humans or will receive regulatory
approval. Before obtaining marketing approval from regulatory authorities for the sale of any product candidate, we must complete preclinical
development and then conduct extensive clinical trials to demonstrate the safety and efficacy of our product candidate in humans. Clinical
testing is expensive, difficult to design and implement, can take many years to complete and is uncertain as to outcome. A failure of
one or more clinical trials can occur at any stage of testing. The clinical development of our product candidates is susceptible to the
risk of failure inherent at any stage of drug development, including failure to demonstrate efficacy in a clinical trial or across a broad
population of patients, the occurrence of severe or medically or commercially unacceptable adverse events, failure to comply with protocols
or applicable regulatory requirements and determination by the FDA or any comparable non-U.S. regulatory authority that a drug product
is not safe or effective for its intended uses. It is possible that even if our product candidate has a beneficial effect, that effect
will not be detected during clinical evaluation as a result of one or more of a variety of factors, including the size, duration, design,
measurements, conduct or analysis of our clinical trials. Conversely, as a result of the same factors, our clinical trials may indicate
an apparent positive effect of a product candidate that is greater than the actual positive effect, if any. Similarly, in our clinical
trials we may fail to detect toxicity of or intolerability caused by our product candidates, or mistakenly believe that our product candidates
are toxic or not well tolerated when that is not in fact the case.
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The outcome of preclinical studies and early clinical trials
may not be predictive of the success of later clinical trials, and interim results of a clinical trial do not necessarily predict final
results. Many companies in the pharmaceutical and biotechnology industries have suffered significant setbacks in late-stage clinical
trials after achieving positive results in earlier development, and we cannot be certain that we will not face additional setbacks.
The design of a clinical trial can determine whether
its results will support approval of a product; however, flaws in the design of a clinical trial may not become apparent until the clinical
trial is well advanced or completed. In addition, preclinical and clinical data are often susceptible to varying interpretations and analyses.
Many companies that believed their product candidates performed satisfactorily in preclinical studies and clinical trials have nonetheless
failed to obtain marketing approval for the product candidates. Even if we believe that the results of clinical trials for our product
candidate warrant marketing approval, the FDA or comparable non-U.S. regulatory authorities may disagree and may not grant marketing approval
of our product candidate.
In some instances, there can be significant variability
in safety or efficacy results between different clinical trials of the same product candidate due to numerous factors, including changes
in trial procedures set forth in protocols, differences in the size and type of the patient populations, changes in and adherence to the
clinical trial protocols and the rate of dropout among clinical trial participants. Any clinical trials that we may conduct may not demonstrate
the efficacy and safety necessary to obtain regulatory approval to market our product candidate.
The results of preclinical studies and
early-stage clinical trials may not be predictive of future results. Initial success in clinical trials may not be indicative of results
obtained when these trials are completed or in later-stage trials.
The results of preclinical studies may not be predictive of the results
of clinical trials, and the results of any early-stage clinical trials we commence may not be predictive of the results of the later-stage
clinical trials. In addition, initial success in clinical trials may not be indicative of results obtained when such trials are completed.
In particular, the small number of patients in our planned early clinical trials may make the results of these trials less predictive
of the outcome of later clinical trials. For example, even if successful, the results of our initial clinical trials for XPro may not
be predictive of the results of further clinical trials of this drug candidate or any of our other drug candidates. Moreover, preclinical
and clinical data often are susceptible to varying interpretations and analyses, and many companies that have believed their drug candidates
performed satisfactorily in preclinical studies and clinical trials nonetheless have failed to obtain marketing approval of their products.
Our future clinical trials may not ultimately be successful or support further clinical development of any of our drug candidates. There
is a high failure rate for drug candidates proceeding through clinical trials. A number of companies in the pharmaceutical and biotechnology
industries have suffered significant setbacks in clinical development even after achieving encouraging results in earlier studies. Any
such setbacks in our clinical development could materially harm our business, results of operations, financial condition and prospects.
Interim top-line and preliminary data
from our planned clinical trials that we announce or publish from time to time may change as more patient data become available and are
subject to audit and verification procedures that could result in material changes in the final data.
From time to time, we
may publish interim top-line or preliminary data from our planned clinical trials. Interim data from clinical trials that we may complete
are subject to the risk that one or more of the clinical outcomes may materially change as patient enrollment continues and more patient
data become available. Preliminary or top-line data also remain subject to audit and verification procedures that may result in the final
data being materially different from the preliminary data we previously published. As a result, interim and preliminary data should be
viewed with caution until the final data are available. Adverse differences between preliminary or interim data and final data could significantly
harm our reputation and business prospects.
If clinical trials of our product candidates
fail to demonstrate safety and efficacy to the satisfaction of the FDA and comparable non-U.S. regulators, we may incur additional costs
or experience delays in completing, or ultimately be unable to complete, the development and commercialization of our product candidates.
We are not permitted to commercialize, market,
promote or sell any product candidate in the United States without obtaining marketing approval from the FDA. Comparable non-U.S. regulatory
authorities, such as the EMA, impose similar restrictions. We may never receive such approvals. We must complete extensive preclinical
development and clinical trials to demonstrate the safety and efficacy of our product candidate in humans before we will be able to obtain
these approvals.
Clinical testing is expensive, difficult to design
and implement, can take many years to complete and is inherently uncertain as to outcome. We have not previously submitted an NDA to the
FDA or similar drug approval filings to comparable non-U.S. regulatory authorities for any product candidate.
Any inability to successfully complete preclinical
and clinical development could result in additional costs to us and impair our ability to generate revenues from product sales, regulatory
and commercialization milestones and royalties. In addition, if (1) we are required to conduct additional clinical trials or other testing
of our product candidate beyond the trials and testing than we contemplate, (2) we are unable to successfully complete clinical trials
of our product candidate or other testing, (3) the results of these trials or tests are unfavorable, uncertain or are only modestly favorable,
or (4) there are unacceptable safety concerns associated with our product candidate, we, in addition to incurring additional costs, may:
●
be delayed in obtaining marketing approval for our product candidate;
●
not obtain marketing approval at all;
●
obtain approval for indications or patient populations that are not as broad as we intended or desired;
●
obtain approval with labeling that includes significant use or distribution restrictions or significant safety warnings, including boxed warnings;
45
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be subject to additional post-marketing testing or other requirements; or
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be required to remove the product from the market after obtaining marketing approval.
If we experience any of a number of possible
unforeseen events in connection with clinical trials of any of our product candidates, potential marketing approval or commercialization
of that product candidate could be delayed or prevented.
We may experience numerous unforeseen events during,
or as a result of, clinical trials that could delay or prevent marketing approval of any of our product candidates, including:
●
clinical trials of our product candidate may produce unfavorable or inconclusive results;
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we may decide, or regulators may require us, to conduct additional clinical trials or abandon product development programs;
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the number of patients required for clinical trials of our product candidate may be larger than we anticipate, patient enrollment in these clinical trials may be slower than we anticipate or participants may drop out of these clinical trials at a higher rate than we anticipate;
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data safety monitoring committees may recommend suspension, termination or a clinical hold for various reasons, including concerns about patient safety;
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regulators or institutional review boards, or IRBs, may suspend or terminate the trial or impose a clinical hold for various reasons, including noncompliance with regulatory requirements or concerns about patient safety;
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patients with serious, life-threatening diseases included in our clinical trials may die or suffer other adverse medical events for reasons that may not be related to our product candidate;
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participating patients may be subject to unacceptable health risks;
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patients may not complete clinical trials due to safety issues, side effects, or other reasons;
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changes in regulatory requirements and guidance may occur, which require us to amend clinical trial protocols to reflect these changes;
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our third-party contractors, including those manufacturing our product candidate or components or ingredients thereof or conducting clinical trials on our behalf, may fail to comply with regulatory requirements or meet their contractual obligations to us in a timely manner or at all;
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regulators or IRBs may not authorize us or our investigators to commence a clinical trial or conduct a clinical trial at a prospective trial site;
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we may experience delays in reaching or fail to reach agreement on acceptable clinical trial contracts or clinical trial protocols with prospective trial sites;
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patients who enroll in a clinical trial may misrepresent their eligibility to do so or may otherwise not comply with the clinical trial protocol, resulting in the need to drop the patients from the clinical trial, increase the needed enrollment size for the clinical trial or extend the clinical trial’s duration;
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we may have to suspend or terminate clinical trials of our product candidate for various reasons, including a finding that the participants are being exposed to unacceptable health risks, undesirable side effects or other unexpected characteristics of a product candidate;
46
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the FDA or comparable non-U.S. regulatory authorities may disagree with our clinical trial design or our interpretation of data from preclinical studies and clinical trials;
●
the FDA or comparable non-U.S. regulatory authorities may fail to approve or subsequently find fault with the manufacturing processes or facilities of third-party manufacturers with which we enter into agreements for clinical and commercial supplies;
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the supply or quality of raw materials or manufactured product candidate or other materials necessary to conduct clinical trials of our product candidate may be insufficient, inadequate, delayed, or not available at an acceptable cost, or we may experience interruptions in supply; and
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the approval policies or regulations of the FDA or comparable non-U.S. regulatory authorities may significantly change in a manner rendering our clinical data insufficient to obtain marketing approval.
Product development costs for us will increase
if we experience delays in testing or pursuing marketing approvals and we may be required to obtain additional funds to complete clinical
trials and prepare for possible commercialization of our product candidates. We do not know whether any preclinical tests or clinical
trials will begin as planned, will need to be restructured or will be completed on schedule, or at all. Significant preclinical or clinical
trial delays also could shorten any periods during which we may have the exclusive right to commercialize our product candidates or allow
our competitors to bring products to market before we do and impair our ability to successfully commercialize our product candidates and
may harm our business and results of operations. In addition, many of the factors that cause, or lead to, clinical trial delays may ultimately
lead to the denial of marketing approval of our product candidates.
If we experience delays or difficulties
in the enrollment of patients in clinical trials, we may not achieve our clinical development on our anticipated timeline, or at all,
and our receipt of necessary regulatory approvals could be delayed or prevented.
We may not be able to initiate or continue clinical
trials for INKmune our DN-TNF product platform or any other product candidate if we are unable to locate and enroll a sufficient number
of eligible patients to participate in clinical trials. Patient enrollment is a significant factor in the timing of clinical trials, and
is affected by many factors, including:
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the size and nature of the patient population;
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the severity of the disease under investigation;
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the proximity of patients to clinical sites;
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the eligibility criteria for the trial;
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the design of the clinical trial;
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efforts to facilitate timely enrollment;
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competing clinical trials; and
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clinicians’ and patients’ perceptions as to the potential advantages and risks of the drug being studied in relation to other available therapies, including any new drugs that may be approved for the indications we are investigating.
47
Our inability to enroll a sufficient number of
patients for our clinical trials could result in significant delays or may require us to abandon one or more clinical trials altogether.
Enrollment delays in our clinical trials may result in increased development costs for our product candidates, delay or halt the development
of and approval processes for our product candidates and jeopardize our ability to achieve our clinical development timeline and goals,
including the dates by which we will commence, complete and receive results from clinical trials. Enrollment delays may also delay or
jeopardize our ability to commence sales and generate revenues from our product candidates. Any of the foregoing could cause the value
of the Company to decline and limit our ability to obtain additional financing, if needed.
We will need to obtain FDA approval of any
proposed product brand names, and any failure or delay associated with such approval may adversely impact our business.
A pharmaceutical product cannot be marketed in
the U.S. or other countries until we have completed rigorous and extensive regulatory review processes, including approval of a brand
name. Any brand names we intend to use for our product candidates will require approval from the FDA regardless of whether we have secured
a formal trademark registration from the U.S. Patent and Trademark Office, or the USPTO. The FDA typically conducts a review of proposed
product brand names, including an evaluation of potential for confusion with other product names. The FDA may also object to a product
brand name if it believes the name inappropriately implies medical claims. If the FDA objects to any of our proposed product brand names,
we may be required to adopt an alternative brand name for our product candidates. If we adopt an alternative brand name, we would lose
the benefit of our existing trademark applications for such product candidate and may be required to expend significant additional resources
in an effort to identify a suitable product brand name that would qualify under applicable trademark laws, not infringe the existing rights
of third parties and be acceptable to the FDA. We may be unable to build a successful brand identity for a new trademark in a timely manner
or at all, which would limit our ability to commercialize our product candidates.
We may rely on orphan drug status to develop
and commercialize our product candidates, but orphan drug designation, if obtained, may not confer marketing exclusivity or other expected
commercial benefits as anticipated.
Market exclusivity afforded by orphan drug designation
is generally offered as an incentive to drug developers to invest in developing and commercializing products for unique diseases that
impact a limited number of patients. The FDA may grant orphan drug designation to drugs intended to treat a rare disease or condition,
which is generally a disease or condition that affects fewer than 200,000 individuals in the United States. Qualification to maintain
orphan drug status is generally monitored by the regulatory authorities during the orphan drug exclusivity period, currently seven years
from the date of approval in the United States.
We intend to seek orphan drug designation in the
United States for our product candidate for the treatment of AML and ovarian cancer and we expect to rely on orphan drug exclusivity for
our product candidate. Even if granted, orphan drug designation, and related market exclusivity, in the United States could be lost. Further,
even if we are granted orphan drug status, the FDA can still approve different drugs for use in treating the same indication or disease,
which would create a more competitive market for us and our revenues will be diminished.
Further, for our product candidate, it is possible
that another company also holding orphan drug designation for the same product candidate will receive marketing approval for the same
indication before we do. If that were to happen, our applications for that indication may not be approved until the competing company’s
period of exclusivity expires. Even if we are the first to obtain marketing authorization for an orphan drug indication, there are circumstances
under which a competing product may be approved for the same indication during the seven-year period of marketing exclusivity, such as
if the later product is shown to be clinically superior to the orphan product, or if the later product is deemed a different product than
ours. Further, the seven-year marketing exclusivity would not prevent competitors from obtaining approval of the same product candidate
as ours for indications other than those in which we have been granted orphan drug designation, or for the use of other types of products
in the same indications as our orphan product.
48
If the market opportunities for our product
candidates are smaller than we believe they are, our revenues may be adversely affected and our business may suffer. Because the target
patient populations of our product candidates are small, we must be able to successfully identify patients and capture a significant market
share to achieve and maintain profitability.
We focus our research and product development
on treatments for certain cancer indications. Our projections of both the number of people who have failed other therapies or have limited
medical options for such indications, are based on estimates. These estimates may prove to be incorrect and new studies may change the
estimated incidence or prevalence. The number of patients with such diseases in the United States, Europe and elsewhere may turn out to
be lower than expected or may not be otherwise amenable to treatment with our products, or new patients may become increasingly difficult
to identify or gain access to, all of which would adversely affect our results of operations and our business. Additionally, because our
target patient populations are small, we will be required to capture a significant market share to achieve and maintain profitability.
We may fail to comply with regulatory requirements .
Our success will be dependent upon our ability,
and our collaborative partners’ abilities, to maintain compliance with regulatory requirements, including cGMP, and safety reporting
obligations. The failure to comply with applicable regulatory requirements can result in, among other things, fines, injunctions, civil
penalties, total or partial suspension of regulatory approvals, refusal to approve pending applications, recalls or seizures of products,
operating and production restrictions and criminal prosecutions.
Even if our product candidates receive marketing
approval, they may fail to achieve the degree of market acceptance by physicians, patients, third-party payors and others in the medical
community necessary for commercial success and the market opportunity for the product candidates may be smaller than we estimate.
We have never commercialized a product. Even if
INKmune, our DN-TNF product platform (INB03 or XPro), or any other product candidate we develop is approved by the appropriate regulatory
authorities for marketing and sale, it may nonetheless fail to gain sufficient market acceptance by physicians, patients, third-party
payors and others in the medical community. For example, physicians are often reluctant to switch their patients from existing therapies
even when new and potentially more effective or convenient treatments enter the market. Further, patients often acclimate to the therapy
that they are currently taking and do not want to switch unless their physicians recommend switching products or they are required to
switch therapies due to lack of reimbursement for existing therapies.
Efforts to educate the medical community and third-party
payors on the benefits of our product candidate may require significant resources and may not be successful. If our product candidate
is approved but does not achieve an adequate level of market acceptance, we may not generate significant revenues and we may not become
profitable. The degree of market acceptance of INmune or any other product candidate we develop, if approved for commercial sale, will
depend on a number of factors, including:
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the efficacy and safety of the product;
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the potential advantages of the product compared to alternative treatments;
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the prevalence and severity of any side effects;
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the clinical indications for which the product is approved;
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whether the product is designated under physician treatment guidelines as a first-line therapy or as a second- or third-line therapy;
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limitations or warnings, including distribution or use restrictions, contained in the product’s approved labeling;
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our ability to offer the product for sale at competitive prices;
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our ability to establish and maintain pricing sufficient to realize a meaningful return on our investment;
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the product’s convenience and ease of administration compared to alternative treatments;
49
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the willingness of the target patient population to try, and of physicians to prescribe, the product;
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the strength of sales, marketing and distribution support;
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the approval of other new products for the same indications;
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changes in the standard of care for the targeted indications for the product;
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the timing of market introduction of our approved products as well as competitive products and other therapies;
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availability and amount of reimbursement from government payors, managed care plans and other third-party payors;
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adverse publicity about the product or favorable publicity about competitive products; and
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potential product liability claims.
The potential market opportunities for our product
candidate are difficult to estimate precisely. Our estimates of the potential market opportunities are predicated on many assumptions,
including industry knowledge and publications, third-party research reports and other surveys. While we believe that our internal assumptions
are reasonable, these assumptions involve the exercise of significant judgment on the part of our management, are inherently uncertain
and the reasonableness of these assumptions has not been assessed by an independent source. If any of the assumptions proves to be inaccurate,
the actual markets for our product candidate could be smaller than our estimates of the potential market opportunities.
Even if we obtain regulatory approvals for
INKmune and/or any product from our DN-TNF platform (INB03, XPro) those approvals and ongoing regulation of our products may limit how
we manufacture and market our products, which could prevent us from realizing the full benefit of our efforts.
If we obtain regulatory approvals, INKmune and/or
the DN-TNF product platform, and the manufacturing facilities used for its production will be subject to continual review, including periodic
inspections, by the FDA and other United States and foreign regulatory authorities. In addition, regulatory authorities may impose significant
restrictions on the indicated uses or marketing of INKmune or other products that we may develop. These and other factors may significantly
restrict our ability to successfully commercialize INKmune.
We and many of our vendors and suppliers will
be required to comply with current Good Manufacturing Practices, or GMP, which include requirements relating to quality control and quality
assurance as well as to the corresponding maintenance of records and documentation. Furthermore, any manufacturing facilities will need
to be approved by regulatory agencies before these facilities can be used to manufacture, and they will also be subject to additional
regulatory inspections. Any material changes we may make to our manufacturing process may require approval by the FDA and state or foreign
regulatory authorities. Failure to comply with FDA or other applicable regulatory requirements may result in criminal prosecution, civil
penalties, recall or seizure of products, partial or total suspension of production or withdrawal of a product from the market.
We must also report adverse events that occur
when our products are used. The discovery of previously unknown problems with INKmune, the DN-TNF product platform or manufacturing facilities
used to manufacture INKmune or the DN-TNF product platform may result in restrictions or sanctions on our products or manufacturing facilities,
including withdrawal of our products from the market. Regulatory agencies may also require us to reformulate our products, conduct additional
clinical trials, make changes in the labeling of our product or obtain re-approvals. This may cause our reputation in the market place
to suffer or subject us to lawsuits, including class action suits.
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If our product candidates receive marketing approval and
we, or others, later discover that the drug is less effective than previously believed or causes undesirable side effects that were not
previously identified, our ability to market the drugs could be compromised.
Clinical trials of our product candidates will
be conducted in carefully defined subsets of patients who have agreed to enter into clinical trials. Consequently, it is possible that
our clinical trials may indicate an apparent positive effect of a product candidate that is greater than the actual positive effect, if
any, or alternatively fail to identify undesirable side effects. If, following approval of our product candidate, we, or others, discover
that the drug is less effective than previously believed or causes undesirable side effects that were not previously identified, any of
the following adverse events could occur:
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regulatory authorities may withdraw their approval of the drug or seize the drug;
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we may be required to recall the drug or change the way the drug is administered;
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additional restrictions may be imposed on the marketing of, or the manufacturing processes for, the particular drug;
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we may be subject to fines, injunctions or the imposition of civil or criminal penalties;
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regulatory authorities may require the addition of labeling statements, such as a “black box” warning or a contraindication;
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we may be required to create a Medication Guide outlining the risks of the previously unidentified side effects for distribution to patients;
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we could be sued and held liable for harm caused to patients;
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the drug may become less competitive; and
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our reputation may suffer.
Any of these events could have a material and
adverse effect on our operations and business.
Any product candidate for which we obtain
marketing approval, along with the manufacturing processes, qualification testing, post-approval clinical data, labeling and promotional
activities for such product, will be subject to continual and additional requirements of the FDA and other regulatory authorities.
These requirements include submissions of safety
and other post-marketing information, reports, registration and listing requirements, good manufacturing practices, or GMP requirements
relating to quality control, quality assurance and corresponding maintenance of records and documents, and recordkeeping. Even if marketing
approval of our product candidate is granted, the approval may be subject to limitations on the indicated uses for which the product may
be marketed or to conditions of approval, or contain requirements for costly post-marketing testing and surveillance to monitor the safety
or efficacy of the product. The FDA closely regulates the post-approval marketing and promotion of pharmaceutical products to ensure such
products are marketed only for the approved indications and in accordance with the provisions of the approved labeling.
In addition, later discovery of previously unknown
problems with our products, manufacturing processes, or failure to comply with regulatory requirements, may lead to various adverse results,
including:
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restrictions on such products, manufacturers or manufacturing processes;
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restrictions on the labeling or marketing of a product;
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restrictions on product distribution or use;
51
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requirements to conduct post-marketing clinical trials;
●
requirements to institute a risk evaluation mitigation strategy, or REMS, to monitor safety of the product post-approval;
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warning letters issued by the FDA or other regulatory authorities;
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withdrawal of the products from the market;
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refusal to approve pending applications or supplements to approved applications that we submit;
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recall of products, fines, restitution or disgorgement of profits or revenue;
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suspension, revocation or withdrawal of marketing approvals;
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refusal to permit the import or export of our products; and
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injunctions or the imposition of civil or criminal penalties.
We currently have no marketing and sales
organization and have no experience in marketing products. If we are unable to establish marketing and sales capabilities or enter into
agreements with third parties to market and sell our product candidates, we may not be able to generate product revenue.
We currently have no sales, marketing or distribution
capabilities and have no experience as a company in marketing products. If we develop internal sales, marketing and distribution organization,
this would require significant capital expenditures, management resources and time, and we would have to compete with other pharmaceutical
and biotechnology companies to recruit, hire, train and retain marketing and sales personnel.
If we are unable or decide not to establish internal
sales, marketing and distribution capabilities, we expect to pursue collaborative arrangements regarding the sales, marketing and distribution
of our products. However, we may not be able to establish or maintain such collaborative arrangements, or if we are able to do so, their
sales forces may not be successful in marketing our products. Any revenue we receive would depend upon the efforts of such third parties,
which may not be successful. We may have little or no control over the sales, marketing and distribution efforts of such third parties
and our revenue from product sales may be lower than if we had commercialized our product candidates ourselves. We also face competition
in our search for third parties to assist us with the sales, marketing and distribution efforts of our product candidates. There can be
no assurance that we will be able to develop internal sales, marketing distribution capabilities or establish or maintain relationships
with third-party collaborators to commercialize any product in the United States or overseas.
We face substantial competition from other
pharmaceutical and biotechnology companies and our operating results may suffer if we fail to compete effectively.
The development and commercialization of new drug
products is highly competitive. We expect that we will face significant competition from major pharmaceutical companies, specialty pharmaceutical
companies and biotechnology companies worldwide with respect to INKmune, our DN-TNF product platform, and any other of our product candidates
that we may seek to develop or commercialize in the future. Specifically, due to the large unmet medical need, global demographics and
relatively attractive reimbursement dynamics, the oncology market is fiercely competitive and there are a number of large pharmaceutical
and biotechnology companies that currently market and sell products or are pursuing the development of product candidates for the treatment
of cancer. Our competitors may succeed in developing, acquiring or licensing technologies and drug products that are more effective, have
fewer or more tolerable side effects or are less costly than any product candidates that we are currently developing or that we may develop,
which could render our product candidates obsolete and noncompetitive.
52
We rely on key personnel and, if we are
unable to retain or motivate key personnel or hire qualified personnel, we may not be able to grow effectively.
We are dependent on certain members of our management,
the loss of services of one or more of whom could materially adversely affect us. In particular, our success depends to a significant
extent upon the continued services of Dr. Raymond J. Tesi, our President and CEO. Dr. Tesi has overseen INmune Bio since inception and
provides leadership for our growth and operations strategy as well as being an inventor of our patents. Although we have entered into
an employment agreement with Dr. Tesi, if he were to nevertheless terminate his employment with us, the loss of the services of Dr. Tesi,
would have a material adverse effect on our growth, revenues, and prospective business. We are also highly dependent on the other principal
members of our management and scientific team. We are not aware of any present intention of any of our key personnel to leave our company
or to retire. The loss of any of our key personnel, or the inability to attract and retain qualified personnel, may significantly delay
or prevent the achievement of our research, development or business objectives and could materially adversely affect our business, financial
condition and results of operations.
Our ability to manage growth effectively will
require us to continue to implement and improve our management systems and to recruit and train new employees. There can be no assurance
that we will be able to successfully attract and retain skilled and experienced personnel.
Product liability lawsuits against us could
divert our resources, cause us to incur substantial liabilities and limit commercialization of any products that we may develop.
We face an inherent risk of product liability
claims as a result of the clinical testing of our product candidate despite obtaining appropriate informed consents from our clinical
trial participants. We will face an even greater risk if we commercially sell any product that we may develop. For example, we may be
sued if any product we develop allegedly causes injury or is found to be otherwise unsuitable during clinical testing, manufacturing,
marketing or sale. Any such product liability claims may include allegations of defects in manufacturing, defects in design, a failure
to warn of dangers inherent in the product, negligence, strict liability or a breach of warranties. Claims could also be asserted under
state consumer protection acts. If we cannot successfully defend ourselves against product liability claims, we may incur substantial
liabilities or be required to limit commercialization of our product candidate. Regardless of the merits or eventual outcome, liability
claims may result in:
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decreased demand for our product candidate or products that we may develop;
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injury to our reputation and significant negative media attention;
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withdrawal of clinical trial participants;
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significant costs to defend resulting litigation;
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substantial monetary awards to trial participants or patients;
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loss of revenue;
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reduced resources of our management to pursue our business strategy; and
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the inability to commercialize any products that we may develop.
Although we plan to maintain general liability
insurance, this insurance may not fully cover potential liabilities that we may incur. The cost of any product liability litigation or
other proceeding, even if resolved in our favor, could be substantial. In addition, insurance coverage is becoming increasingly expensive.
If we are unable to obtain or maintain sufficient insurance coverage at an acceptable cost or to otherwise protect against potential product
liability claims, it could prevent or inhibit the development and commercial production and sale of our product candidate, which could
adversely affect our business, financial condition, results of operations and prospects.
53
We will need to grow the size and capabilities
of our organization, and we may experience difficulties in managing this growth.
To execute our business plan, we will need to
rapidly add other management, accounting, regulatory, manufacturing and scientific staff. We currently have 11 full time employees and
retain the services of additional personnel on an independent contractor basis. We will need to attract, retain and motivate a significant
number of new additional managerial, operational, sales, marketing, financial, and other personnel, as well as highly skilled scientific
and medical personnel, and to expand our capabilities to successfully pursue our research, development, manufacturing and commercialization
efforts and secure collaborations to market and distribute our products. This growth may strain our existing managerial, operational,
financial and other resources. We also intend to add personnel in our research and development and manufacturing departments as we expand
our clinical trial and research capabilities. Any inability to attract and retain qualified employees to enable our planned growth and
establish additional capabilities or our failure to manage our growth effectively could delay or curtail our product development and commercialization
efforts and harm our business.
If we or any of our third-party manufacturers
do not maintain high standards of manufacturing, our ability to develop and commercialize our product candidate could be delayed or curtailed.
We and any third parties that we may use in the
future to manufacture our products must continuously adhere to cGMP regulations rigorously enforced by the FDA through its facilities
inspection program. If our facilities or the facilities of third parties who produce our products do not pass a pre-approval inspection,
the FDA will not grant market approval for our product candidates. In complying with cGMP, we and any third-party manufacturers will need
to expend significant time, money and effort in production, record-keeping and quality control to assure that each component of our product
candidates meets applicable specifications and other requirements. We or any of these third-party manufacturers may also be subject to
comparable or more stringent regulations of foreign regulatory authorities. If we or any of our third-party manufacturers fail to comply
with these requirements, we may be subject to regulatory action, which could delay or curtail our ability to develop, obtain regulatory
approval of, and commercialize our product candidates. If our component part manufacturers and suppliers fail to provide components of
sufficient quality, and that meet our required specifications, our clinical trials or commercialization of our product candidates could
be delayed or halted, and we could face product liability claims. There can be no assurance we can manufacture a scalable quantity of
our product for clinical trials or commercialization.
If we or our third-party manufacturers use
hazardous and biological materials in a manner that causes injury or violates applicable law, we may be liable for damages.
Our research and development activities involve
the controlled use of potentially hazardous substances, including chemical and biological materials, by us and any third-party manufacturers.
We and such manufacturers will be subject to federal, state and local laws and regulations in the United States governing the use, manufacture,
storage, handling and disposal of medical and hazardous materials. Although we will seek to ensure that our procedures for using, storing
and disposing of these materials comply with legally prescribed standards, we cannot completely eliminate the risk of contamination or
injury resulting from medical or hazardous materials. As a result of any such contamination or injury, we may incur liability or local,
city, state or federal authorities may curtail the use of these materials and interrupt our business operations. In the event of an accident,
we could be held liable for damages or penalized with fines, and the liability could exceed our resources. We do not have any insurance
for liabilities arising from medical or hazardous materials. Compliance with applicable environmental laws and regulations is expensive,
and current or future environmental regulations may impair our research, development and production efforts, which could harm our business,
prospects, financial condition or results of operations.
We plan to rely on third parties to conduct
clinical trials for our product candidates. Any failure by a third party to meet its obligations with respect to the clinical development
of our product candidate may delay or impair our ability to obtain regulatory approval for our product candidates.
We plan to rely on academic institutions and private
oncology centers to conduct clinical trials relating to our product candidates. Our reliance on third parties to conduct clinical trials
could, depending on the actions of such third parties, jeopardize the validity of the clinical data generated and adversely affect our
ability to obtain marketing approval from the FDA or other applicable regulatory authorities.
Such clinical trial arrangements will provide
us with information rights with respect to the clinical data, including access to and the ability to use and reference the data, including
for our own regulatory filings, resulting from the clinical trials. If investigators or institutions breach their obligations with respect
to the clinical trials of our product candidate, or if the data proves to be inadequate, then our ability to design and conduct any future
clinical trials may be adversely affected.
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Our reliance on these third parties for research
and development activities will reduce our control over these activities but will not relieve us of our responsibilities. For example,
we will design our clinical trials and will remain responsible for ensuring that each of our clinical trials is conducted in accordance
with the general investigational plan and protocols for the trial. Moreover, the FDA requires us to comply with standards, commonly referred
to as good clinical practices, or GCPs, for conducting, recording and reporting the results of clinical trials to assure that data and
reported results are credible and accurate and that the rights, integrity and confidentiality of trial participants are protected. Our
reliance on third parties that we do not control will not relieve us of these responsibilities and requirements. We also are required
to register ongoing clinical trials and post the results of completed clinical trials on a government-sponsored database, ClinicalTrials.gov,
within specified timeframes. Failure to do so can result in fines, adverse publicity and civil and criminal sanctions.
Furthermore, these third parties may also have
relationships with other entities, some of which may be our competitors. If these third parties do not successfully carry out their contractual
duties, meet expected deadlines or conduct our clinical trials in accordance with regulatory requirements or our stated protocols, we
will not be able to obtain, or may be delayed in obtaining, marketing approvals for our product candidate and will not be able to, or
may be delayed in our efforts to, successfully commercialize our product candidate.
We also expect to rely on other third parties
to store and distribute drug supplies for our clinical trials. Any performance failure on the part of our distributors could delay clinical
development or marketing approval of our product candidate or commercialization of our products, producing additional losses and depriving
us of potential product revenue.
Recent legislative and regulatory activity
may exert downward pressure on potential pricing and reimbursement for our products, if approved, could materially affect our opportunity
to commercialize such products.
The United States and several other jurisdictions
are considering, or have already enacted, a number of legislative and regulatory proposals to change the healthcare system in ways that
could affect our ability to sell any of our products profitably, if approved. Among policy-makers and payors in the United States and
elsewhere, there is significant interest in promoting changes in healthcare systems with the stated goals of containing healthcare costs,
improving quality and/or expanding access to healthcare. In the United States, the pharmaceutical industry has been a particular focus
of these efforts and has been significantly affected by major legislative initiatives. There have been, and likely will continue to be,
legislative and regulatory proposals at the federal and state levels directed at broadening the availability of healthcare and containing
or lowering the cost of healthcare. We cannot predict the initiatives that may be adopted in the future. The continuing efforts of the
government, insurance companies, managed care organizations and other payors of healthcare services to contain or reduce costs of healthcare
may adversely affect:
●
the demand for any of our products, if approved;
●
our ability to set a price that we believe is fair for any of our products, if approved;
●
our ability to generate revenues and achieve or maintain profitability;
●
the level of taxes that we are required to pay; and
●
the availability of capital.
In March 2010, the Affordable Care Act, or the
ACA, became law in the United States (see “Business — Government Regulation”). The goal of ACA is to reduce the cost
of healthcare, broaden access to health insurance, constrain healthcare spending, enhance remedies against fraud and abuse, add transparency
requirements for the healthcare and health insurance industries, impose taxes and fees on the health industry, impose additional health
policy reforms, and substantially change the way healthcare is financed by both governmental and private insurers. While we cannot predict
what impact on federal reimbursement policies this legislation will have in general or on our business specifically, ACA may result in
downward pressure on pharmaceutical reimbursement, which could negatively affect market acceptance of any of our products, if they are
approved.
55
We cannot predict what healthcare reform initiatives
may be adopted in the future. Further federal, state and foreign legislative and regulatory developments are likely, and we expect ongoing
initiatives to increase pressure on drug pricing. Such reforms could have an adverse effect on anticipated revenues from product candidates
that we may successfully develop and for which we may obtain regulatory approval and may affect our overall financial condition and ability
to develop product candidates.
Changes in U.S. patent law could diminish
the value of patents in general, thereby impairing our ability to protect our products.
As is the case with other pharmaceutical companies,
our success is heavily dependent on intellectual property, particularly on obtaining and enforcing patents. Obtaining and enforcing patents
in the pharmaceutical industry involves both technological and legal complexity, and therefore, is costly, time-consuming and inherently
uncertain. In addition, the United States has recently enacted and is currently implementing wide-ranging patent reform legislation. Further,
recent U.S. Supreme Court rulings have either narrowed the scope of patent protection available in certain circumstances or weakened the
rights of patent owners in certain situations. In addition to increasing uncertainty with regard to our ability to obtain patents in the
future, this combination of events has created uncertainty with respect to the value of patents, once obtained.
In September 2011, the Leahy-Smith America Invents
Act, or the American Invents Act, or AIA, was signed into law. The AIA includes a number of significant changes to U.S. patent law, including
provisions that affect the way patent applications will be prosecuted and may also affect patent litigation. The USPTO is currently developing
regulations and procedures to govern administration of the AIA, and many of the substantive changes to patent law associated with the
AIA. It is not clear what other, if any, impact the AIA will have on the operation of our business. Moreover, the AIA and its implementation
could increase the uncertainties and costs surrounding the prosecution of our patent application, which could have a material adverse
effect on our business and financial condition.
An important change introduced by the AIA is that,
as of March 16, 2013, the United States transitioned to a “first-to-file” system for deciding which party should be granted
a patent when two or more patent applications are filed by different parties claiming the same invention. A third party that files a patent
application in the USPTO after that date but before us could therefore be awarded a patent covering an invention of ours even if we had
made the invention before it was made by the third party. This will require us to be cognizant going forward of the time from invention
to filing of a patent application. Furthermore, our ability to obtain and maintain valid and enforceable patents depends on whether the
differences between our technology and the prior art allow our technology to be patentable over the prior art. Since patent applications
in the United States and most other countries are confidential for a period of time after filing, we cannot be certain that we were the
first to either (1) file any patent application related to our product candidates or (2) invent any of the inventions claimed in our patents
or patent applications.
Among some of the other changes introduced by
the AIA are changes that limit where a patentee may file a patent infringement suit and providing opportunities for third parties to challenge
any issued patent in the USPTO. This applies to all of our U.S. patents, even those issued before March 16, 2013. Because of a lower evidentiary
standard in USPTO proceedings compared to the evidentiary standard in United States federal court necessary to invalidate a patent claim,
a third party could potentially provide evidence in a USPTO proceeding sufficient for the USPTO to hold a claim invalid even though the
same evidence would be insufficient to invalidate the claim if first presented in a district court action. Accordingly, a third party
may attempt to use the USPTO procedures to invalidate our patent claims that would not have been invalidated if first challenged by the
third party as a defendant in a district court action.
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The outbreak of
COVID-19 may adversely affect our business and the market price of our common stock.
The ongoing COVID-19
pandemic has broadly affected the global economy, resulted in significant travel and work restrictions in many regions and put a significant
strain on healthcare resources. The pandemic has had, and we expect it will continue to have, an impact on our operations and on the operations
of our collaborators, third-party contractors and other entities, including governmental agencies with which we interact. We have experienced
delays in obtaining materials and supplies needed to manufacture our product candidates as a result of production shortages experienced
by our suppliers. Additionally, at times we have been subject to temporary pauses in enrollment and dosing implemented by some clinical
trial sites due to COVID-19, and some clinical trial sites have also restricted initiation of new trials at times as well as visits by
sponsors and clinical research organizations (CROs) for ongoing trials to protect both site staff and patients from possible COVID-19
exposure.
The COVID-19 pandemic,
including the emergence of new variants, has impacted, and may in the future impact, the clinical development of our product candidates
if we are subject to restrictions or limitations on, or delays in, the performance of study procedures (particularly any procedures that
may be deemed non-essential), participant dosing, distribution of our product candidates or clinical trial materials, study monitoring,
or site inspections and data analysis, including as a result of changes in hospital or research institution policies, federal, state or
local regulations, prioritization of hospital and other medical resources toward pandemic efforts, reduced availability of site staff
supporting the conduct of clinical trials, heightened risks of exposure of study participants, principal investigators or site staff to
COVID-19 if an outbreak occurs in their geographic region, or other reasons related to the pandemic. Quarantine or other travel limitations
(whether voluntary or required) also may impede participant movement, affect access to study sites, or interrupt healthcare services.
Furthermore, the pandemic
could cause delays in review and response times by the FDA and other regulatory agencies, or such health regulatory agencies may refuse
to accept data from our clinical trials due to mitigation strategies we implement in response to the COVID-19 pandemic and current regulatory
guidance. In addition, our ability to manufacture and ship our product candidates for our clinical trials may be impacted if we, or any
third parties which manufacture and supply materials used in either the manufacture of our product candidates or the conduct of our research
and development activities, or which perform certain testing relating to our product candidates, are adversely impacted by restrictions
resulting from the coronavirus outbreak. There is also the potential that manufacturing facilities, equipment, and materials required
for manufacture or administration of our product candidates could be commandeered under the Defense Production Act of 1950, or equivalent
foreign legislation, which may make it more difficult to obtain materials, equipment, or manufacturing slots necessary for the clinical
supply of our product candidates.
The extent to which the pandemic affects our operations and the research
and development of our product candidates will depend on continuously changing circumstances, which are highly uncertain and cannot be
predicted with confidence, such as the duration of the pandemic, including the emergence of new variants of the virus, such as the Delta
and Omicron variants, which may impact rates of infection and vaccination efforts, developments or perceptions regarding the safety of
vaccines, future waves of infection, and the effectiveness of actions taken to contain the pandemic or mitigate its impact, including
vaccination campaigns. While the ultimate impact of the COVID-19 pandemic on our business is highly uncertain, any negative impacts that
materialize could materially adversely affect our clinical development and operations, financial performance and stock price.
A cybersecurity incident and other technology
disruptions could negatively affect our business and our relationships with customers.
We use technology in substantially all aspects
of our business operations. The widespread use of technology, including mobile devices, cloud computing, and the internet, give rise to
cybersecurity risks, including security breach, espionage, system disruption, theft and inadvertent release of information. Our business
involves the storage and transmission of numerous classes of sensitive and/or confidential information and intellectual property, including
information relating to suppliers, private information about employees, and financial and strategic information about us and our business
partners. If we fail to effectively assess and identify cybersecurity risks associated with the use of technology in our business operations,
we may become increasingly vulnerable to such risks. Additionally, while we have implemented measures to prevent security breaches and
cyber incidents, our preventative measures and incident response efforts may not be entirely effective. The theft, destruction, loss,
misappropriation, or release of sensitive and/or confidential information or intellectual property, or interference with our information
technology systems or the technology systems of third parties on which we rely, could result in business disruption, negative publicity,
brand damage, violation of privacy laws, loss of customers, potential liability and competitive disadvantage.
57
Risks Related to our Common Stock
We do not intend to pay dividends for the
foreseeable future.
We have paid no dividends on our common stock
to date, and we do not anticipate paying any dividends to holders of our common stock in the foreseeable future. While our future dividend
policy will be based on the operating results and capital needs of the business, we anticipate that we will retain any earnings to finance
our future expansion and for the implementation of our business plan. As an investor, you should take note of the fact that a lack of
a dividend can further affect the market value of our common stock, and could significantly affect the value of any investment in our
Company.
We are subject to the reporting requirements
of federal securities laws, which can be expensive and may divert resources from other projects, thus impairing our ability grow.
We are a public reporting company and, accordingly,
subject to the information and reporting requirements of the Exchange Act and other federal securities laws, including compliance with
the Sarbanes-Oxley Act of 2002 (the “Sarbanes-Oxley Act”). The costs of preparing and filing annual and quarterly reports,
proxy statements and other information with the SEC and furnishing audited reports to stockholders would cause our expenses to be higher
than they would be if we remained privately held.
It may be time consuming, difficult and costly
for us to develop and implement the internal controls and reporting procedures required by the Sarbanes-Oxley Act. We may need to hire
additional financial reporting, internal controls and other finance personnel in order to develop and implement appropriate internal controls
and reporting procedures.
We are an “emerging growth company”
within the meaning of the Securities Act of 1933, as amended, or the Securities Act, and if we decide to take advantage of certain exemptions
from various reporting requirements applicable to emerging growth companies, our common stock could be less attractive to investors.
We will remain an emerging growth company until
the earliest of (1) the last day of the fiscal year during which we have total annual gross revenues of $1.07 billion or more, (2) December
31, 2024 (the last day of the fiscal year following the fifth anniversary of the completion of our initial public offering), (3) the date
on which we have, during the previous three-year period, issued more than $1.0 billion in non-convertible debt, and (4) the date on which
we are deemed to be a “large accelerated filer” under the Securities Exchange Act of 1934, as amended, or the Exchange Act
(i.e., the first day of the fiscal year after we have (a) more than $700.0 million in outstanding common equity held by our non-affiliates,
measured each year on the last day of our second fiscal quarter, and (b) been public for at least 12 months).
Even after we no longer qualify as an emerging
growth company, we may still qualify as a “smaller reporting company,” which would allow us to take advantage of many of the
same exemptions from disclosure requirements including exemption from compliance with the auditor attestation requirements of Section
404 of the Sarbanes-Oxley Act and reduced disclosure obligations regarding executive compensation in our periodic reports and proxy statements.
We cannot predict if investors will find our common stock less attractive because we may rely on these exemptions. If some investors find
our common stock less attractive as a result, there may be a less active trading market for our common stock and our stock price may be
more volatile.
Our stock price may be volatile.
The market price of our common stock is likely
to be highly volatile and could fluctuate widely in price in response to various factors, many of which are beyond our control, including
the following:
●
changes in our industry;
●
competitive pricing pressures;
58
●
our ability to obtain working capital financing;
●
additions or departures of key personnel;
●
limited “public float” in the hands of a small number of persons whose sales or lack of sales could result in positive or negative pricing pressure on the market price for our common stock;
●
sales of our common stock;
●
our ability to execute our business plan;
●
operating results that fall below expectations;
●
loss of any strategic relationship;
●
regulatory developments;
●
economic and other external factors;
●
period-to-period fluctuations in our financial results; and
●
inability to develop or acquire new or needed technology or products.
In addition, the securities markets have from
time to time experienced significant price and volume fluctuations that are unrelated to the operating performance of particular companies.
These market fluctuations may also materially and adversely affect the market price of our Common Stock.
You may have difficulty trading and obtaining
quotations for our common stock.
Our securities are not actively traded, and the
bid and asked prices for our common stock may fluctuate widely. As a result, investors may find it difficult to dispose of, or to obtain
accurate quotations of the price of, our securities. This severely limits the liquidity of the common stock and would likely reduce the
market price of our common stock and hamper our ability to raise additional capital. There is a limited market for our securities. Accordingly,
investors may therefore bear the economic risk of an investment in the Securities thereof, for an indefinite period of time.
Additional stock offerings in the future
may dilute your percentage ownership of our company.
Given our plans and expectations that we may need
additional capital and personnel, we may need to issue additional shares of common stock or securities convertible or exercisable for
shares of common stock, including convertible preferred stock, convertible notes, stock options or warrants. The issuance of additional
securities in the future will dilute the percentage ownership of then current stockholders.
Anti-takeover provisions in our stockholder
rights plan could make a third-party acquisition of us difficult.
We have a stockholder rights plan that may have
the effect of discouraging unsolicited takeover proposals. Specifically, the rights issued under the stockholder rights plan could cause
significant dilution to a person or group that attempts to acquire us on terms not approved in advance by our board of directors. The
rights plan is not intended to prevent a takeover, and we believe it will enable all our stockholders to realize the full potential value
of their investment in the Company and protect the Company and its stockholders from efforts to obtain control of the Company that are
inconsistent with the best interests of the Company and its stockholders. The rights under the plan will expire on December 30, 2022,
subject to a possible earlier expiration to the extent provided in the stockholder rights plan, unless extended.
59
ITEM 1B. UNRESOLVED STAFF COMMENTS
Not applicable.
ITEM 2. PROPERTIES
The Company leases approximately 5,000 square
feet of office space in Boca Raton, Florida from a third-party, which serves as the headquarters of the Company. We currently pay approximately
$10,000 per month for this sublease which expires in January 2027.
The Company subleases approximately 1,000 square
feet of office space in La Jolla, California from a related party, which served as the former headquarters of the Company. We pay approximately
$4,000 per month for this sublease which expires in July 2024.
We believe our current facilities are suitable
and adequate to meet our current needs.
ITEM 3. LEGAL PROCEEDINGS
We currently are not a party to any material litigation
or other material legal proceedings. We may, from time to time, be subject to legal proceedings and claims arising in the normal course
of business.
ITEM 4. MINE SAFETY DISCLOSURES
Not applicable.
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PART II
ITEM 5. MARKET FOR REGISTRANT’S COMMON
EQUITY, RELATED STOCKHOLDER MATTERS AND ISSUER PURCHASES OF EQUITY SECURITIES
Common Stock
Our common stock trades under the symbol “INMB”
on the Nasdaq and has been publicly traded since February 4, 2019. Prior to this time, there was no public market for our common stock.
As of December 31, 2021, there were 26 holders
of record of our common stock. Because shares of our common stock are held by depositories, brokers and other nominees, the number of
beneficial holders of our shares is substantially larger than the number of record holders.
Dividend Policy
We have not declared any cash dividends on our
common stock since inception and do not anticipate paying such dividends in the foreseeable future. We plan to retain any future earnings
for use in our business operations. Any decisions as to future payment of cash dividends will depend on our earnings and financial position
and such other factors as the Board of Directors deems relevant.
ITEM 6. [RESERVED]
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PART II
ITEM 7. MANAGEMENT’S DISCUSSION AND ANALYSIS
OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS
You should read the following
discussion and analysis of our financial condition and results of operations in conjunction with our financial statements and notes thereto
appearing elsewhere in this Annual Report. In addition to historical financial information, the following discussion and analysis contains
forward-looking statements that involve risks, uncertainties, and assumptions. Our actual results could differ materially from those anticipated
by these forward-looking statements as a result of many factors. We discuss factors that we believe could cause or contribute to these
differences below and elsewhere in this Form 10-K, including those set forth under “Risk Factors” and “Forward-Looking
Statements.”
Overview
We are a clinical-stage immunotherapy
company focused on developing drugs that may reprogram the patient’s innate immune system to treat disease. We believe this may
be done by targeting cells of the innate immune system that cause acute and chronic inflammation and are involved in the immune dysfunction
associated with chronic diseases such as cancer and neurodegenerative diseases. The Company has two therapeutic platforms – dominant-negative
TNF platform (“DN-TNF”) and the Natural Killer (“NK”) platform. The DN-TNF platform neutralizes soluble TNF (“sTNF”)
without affecting trans-membrane TNF (“tmTNF”) or TNF receptors -TNFR1 and TNFR2. This unique biologic mechanism differentiates
the DN-TNF drugs from currently approved non-selective TNF inhibitors that inhibit both sTNF and tmTNF. Protecting the function of tmTNF
while neutralizing the function of sTNF is a potent anti-inflammatory strategy that does not cause immunosuppression or demyelination
which occur in the currently approved non-selective TNF inhibitors. Currently approved non-selective TNF inhibitors are approved to treat
autoimmune disease, but are contraindicated in patients with infection, cancer and neurologic diseases because they increase the risk
of infection, cancer and demyelinating neurologic diseases, respectively; all the safety problems are due to off-target effects on inhibiting
tmTNF. The NK platform targets the dysfunctional natural killer cells (“NK cells”) in patients with cancer. NK cells are part
of the normal immunologic response to cancer with important roles in immunosurveillance to prevent cancer and in preventing relapse by
eliminating residual disease. Residual disease is the cancer left behind after therapy is finished. Residual disease, can grow to cause
relapse. The NK cells of cancer patients loses the ability to bind and kill cancer cells. The strength of the bond of binding to cancer
cells, called avidity, is a necessary step NK killing of cancer cells. INKmune improves avidity of the patients NK cells to overcome the
immune evasion of the patient’s cancer cells. We believe INKmune is best used to eliminate residual disease after the patient has
completed other cancer therapies. Both the DN-TNF platform and the INKmune platform can be used to treat multiple diseases. The DN-TNF
platform will be used as an immunotherapy for the treatment of cancer and neurodegenerative disease. INKmune is being developed to treat
NK sensitive hematologic malignancies and solid tumors.
We believe our DN-TNF
platform can be used as a cancer therapy to reverse resistance in immunotherapy and as a CNS therapy to target glial activation to prevent
progression of Alzheimer’s disease (“AD”), and to target neuroinflammation in treatment resistant depression (“TRD”).
The drug is named differently for the oncology and CNS indications; INB03 or XPro, respectively, but it is the same drug product. In each
case, we believe neutralizing sTNF is a cornerstone to the treatment of these diseases. As an immunotherapy for cancer, we are using INB03
to neutralize sTNF produced by HER2+ trastuzumab resistant breast cancers to reverse resistance to therapy. sTNF causes an up-regulation
of MUC4 expression that causes steric hindrance of trastuzumab binding to the HER2/Neu receptor on HER2+ breast cancer cells. Without
binding, trastuzumab is not effective. In addition, INB03 changes the immunobiology of the tumor microenvironment by decreasing the number
of immunosuppressive myeloid cells, both myeloid derived suppressor cells and tumor active macrophages, and increasing the number of cytotoxic
lymphocytes in the TME. The Company has completed an open label dose escalation trial in cancer patients with metastatic solid tumors
that have failed multiple lines of therapy. The trial informs the design of the Phase II trial by demonstrating that INB03 was safe and
well tolerated, defined the dose of INB03 to carry into Phase II trials, and demonstrated a pharmacodynamic end-point. A Phase II trial
is planned in women with advanced MUC4+ breast cancer with advanced disease.
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Likewise, we believe
the DN-TNF platform can be used to treat selected neurodegenerative diseases by modifying the brain microenvironment (BME). The Company
believes the core pathology of cognitive decline is a combination of neurodegeneration and synaptic dysfunction. XPro completed a Phase
I trial treating patients with Alzheimer’s disease that was partially funded by a Part-the-Clouds Award from the Alzheimer’s
Association. We believe XPro targets activated microglia and astrocytes of the brain that produce sTNF that promotes nerve cell loss and
synaptic dysfunction, key elements in the development of dementia. In animal models, elimination of sTNF prevents nerve cell dysfunction
and reverses synaptic pruning. The Phase I trial in patients with biomarkers of inflammation with AD has been completed. The open label,
dose escalation trial is designed to demonstrate that XPro can safely decrease neuroinflammation in patients with AD. The endpoints of
the trial are measures of neuroinflammation and neurodegeneration in blood and cerebral spinal fluid, measures of neuroinflammation by
measuring cytokines in the CSF and MRI by measuring white matter free water. XPro, at the 1mg/kg/week dose decreased inflammatory cytokines
in the CSF and white matter free water in the brain demonstrating that XPro can decrease neuroinflammation in patients with AD. We also
studied downstream benefits of decreasing neuroinflammation by measuring changes in the CSF proteome and quantifying changes in novel
white matter MRI biomarkers. XPro significantly decreases biomarkers of neurodegeneration as measured by changes in the CSF proteome
including neurofilament light chain, phospho Tau 217 and VILIP-1; decreases of 84%, 46% and 91% respectively after 3 months of therapy.
Three months of XPro therapy improved measures of synaptic function, as measured in the CSF proteome including a 222% increase in Contactin
2 and a 56% decrease neurogranin, proteins that contribute to improved synaptic function.
The successful completion
of the Phase I trial in AD has informed the design of two Phase II trials in patients with AD; one in mild AD and the other in MCI. The
mild AD trial will be a blinded randomized trial to test if treatment of mild AD patients with neuroinflammation will affect cognitive
decline. The Phase II trial has six important elements. Two hundred patients will be enrolled in a 2:1 ratio (XPro vs placebo). The patients
will receive 1mg/kg/week as a subcutaneous injection for six months. An enrichment strategy identical to the successful strategy used
in the Phase I trial will be used to ensure patients have neuroinflammation. Patients will need to have some combination of elevated C-reactive
protein, hemoglobin A1c, erythrocyte sedimentation rated in the blood and at least one allele of ApoE4. The primary end-point will be
Early/mild Alzheimer’s Cognitive Composite (“EMACC”), a validated cognitive measure that is more sensitive than traditional
end-points used in many studies of patients with early AD. The trial will be performed in North America and Australia, is expected to
start enrolling patients in early 2022. We expect top-line clinical data to be available late-2023. All patients will be offered to stay
on therapy for at least 12 months in an extension trial. Clinical and biomarker data will be collected during the extension trial.
The second Phase II trial will be a blinded randomized
trial in patients with MCI in which the Company plans to enroll 60 patients in two arms in a 2:1 ratio (1mg/kg/week XPro, placebo). Patients
will be treated for 3 months. Patients must have at least one ApoE4 allele to qualify for the trial. The primary end-point is EMACC, a
sensitive cognitive end-point validated for use in patients with early AD. Secondary clinical endpoints include the CDR-SB, Cogstate Battery,
E-Cog, NPI, and ADCS-ADL. Imaging endpoints of neuroinflammation (White matter free water), white matter integrity (apparent fiber density,
radial diffusivity), and gray matter quality (cortical disarray measurement) will be assessed via MRI. Changes in brain metabolism will
be assessed via FDG-PET. Additional secondary measures of function include EEG, and speech and language. All patients will be eligible
to continue on XPro for at least 9 additional months. Clinical and MRI metrics will be followed during the extension trial. The
Company may amend the clinical trial design from time-to-time to improve the quality of the data or the probability of success.
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 demonstrated the patients have elevated TNF levels
and treatment with infliximab treated their depression (Miller, 2011). The Company received a $2.9M USD award from the National Institute
of Mental Health (“NIMH”) to treat TRD with XPro. The blinded, randomized Phase II trial will use a biomarkers of peripheral
inflammation to select patients with TRD for enrollment. Patients will be treated for 6 weeks. Primary end-points include both clinical
and neuroimaging measures. The final trial design has is ongoing and discussions with the FDA are not complete. The Company anticipates
receiving authorization to initiate the clinical trial in the second half of 2022.
63
We believe that INKmune
improves the ability of the patient’s own NK cells to attack their tumor. INKmune interacts with the patient’s NK cells to
convert them from inert resting NK cells into memory-like NK cells that kill the patient’s cancer cells. INKmune is a replication
incompetent proprietary cell line that is given to the patient after determining that i) the patient has adequate NK cells in their circulation
and ii) those NK cells are functional when exposed to INKmune in vitro. INKmune is designed to be given to patients after their immune
system has recovered after cytotoxic chemotherapy to target the residual disease the remains after treatment with cytotoxic therapy.
We believe INKmune can be used to treat numerous hematologic malignancies and solid tumors including leukemia, multiple myeloma, lymphoma,
lung, ovary, breast, renal and prostate cancer. The Company has initiated a Phase I trial using INKmune to treat patients with high risk
MDS, a form of leukemia. One patient has been treated in the Phase I trial. In the single patient, INKmune therapy is safe, produces
memory-like NK cells that kill cancer in vitro, promotes development of cancer killing memory-like NK cells that can be found in the
patient’s circulation of 4 months. The Company will continue to enroll patients in the Phase I trial with a goal of completing
patient enrollment in 2022. The Company intends to treat women with relapsed refractory ovarian in separate Phase I trial beginning during
2022.
The Company has presented pre-clinical data on the use of DN-TNF to
treat non-alcoholic steatohepatitis (“NASH”). The Company has decided to defer the NASH program for the near future due to
the complex and evolving clinical and regulatory environment. The Company may choose to reactivate the program or abandon the program
in the future.
Since our inception in 2015, we have devoted substantially all of our
resources to the discovery and development of our product candidates, including clinical trials and preclinical studies as well as general
and administrative support for these operations. To date, we have generated no significant revenue. We have incurred net losses in each
year since our inception and, as of December 31, 2021, we had an accumulated deficit of approximately $63.7 million. Our net losses were
$30,340,000 and $12,099,000 for the year ended December 31, 2021 and 2020, respectively. Substantially all of our net losses resulted
from costs incurred in connection with our research and development programs and from general and administrative costs associated with
our operations, including stock-based compensation.
The
Company is subject to risks and uncertainties as a result of the COVID-19 pandemic. The extent of the impact of the COVID-19 pandemic
on the Company’s business is highly uncertain and difficult to predict. Also, economies worldwide have also been negatively impacted
by the COVID-19 pandemic, however policymakers around the globe have responded with fiscal policy actions to support the healthcare industry
and economy as a whole. The magnitude and overall effectiveness of these actions remain uncertain.
In
addition, the Company’s clinical trials have been affected by and may continue to be affected by the COVID-19 pandemic. Clinical
site initiation and patient enrollment have and may continue to be delayed due to prioritization of hospital resources toward the COVID-19
pandemic. Some patients have not and others may not be able to comply with clinical trial protocols if quarantines impede patient movement
or interrupt healthcare services. Similarly, the ability to recruit and retain patients and principal investigators and site staff who,
as healthcare providers, may have heightened exposure to COVID-19, may adversely impact the Company’s clinical trial operations.
The
severity of the impact of the COVID-19 pandemic on the Company’s business will depend on a number of factors, including, but not
limited to, the duration and severity of the pandemic and the extent and severity of the impact on the Company’s service providers,
suppliers, contract research organizations (“CROs”) and the Company’s clinical trials, all of which are uncertain and
cannot be predicted. As of the date of issuance of Company’s financial statements, the extent to which the COVID-19 pandemic may
materially impact the Company’s financial condition, liquidity or results of operations is uncertain.
64
As a company with less than $1.07 billion in revenue
during our last fiscal year, we qualify as an “emerging growth company” under the JOBS Act. As an emerging growth company,
we may take advantage of specified reduced disclosure and other requirements that are otherwise applicable generally to public companies.
These provisions include:
● only
two years of audited financial statements in addition to any required unaudited interim financial statements with correspondingly reduced
“Management’s Discussion and Analysis of Financial Condition and Results of Operations” disclosure;
● reduced
disclosure about our executive compensation arrangements;
● no
non-binding advisory votes on executive compensation or golden parachute arrangements;
● exemption
from the auditor attestation requirement in the assessment of our internal control over financial reporting; and
● delaying
the adoption of new or revised accounting standards that have different effective dates for public and private companies until those
standards apply to private companies.
We have elected to take advantage of the above-referenced
exemptions and we may take advantage of these exemptions for up to five years or such earlier time that we are no longer an emerging growth
company. We would cease to be an emerging growth company if we have more than $1.07 billion in annual revenues, we have more than $700
million in market value of our stock held by non-affiliates, or we issue more than $1 billion of non-convertible debt over a three-year
period. We may choose to take advantage of some but not all of these reduced burdens.
Components of Operating Results
Operating Expenses
Research and Development
Research and development expense consists of expenses
incurred while performing research and development activities to discover and develop our product candidates. This includes conducting
preclinical studies and clinical trials, manufacturing development efforts and activities related to regulatory filings for product candidates.
We recognize research and development expenses as they are incurred. Our research and development expense primarily consist of:
●
clinical trial and regulatory-related costs;
●
expenses incurred under agreements with investigative sites and consultants that conduct our clinical trials;
●
manufacturing and testing costs and related supplies and materials; and
●
employee-related expenses, including salaries, benefits, travel and stock-based compensation
We typically use our employee, consultant and
infrastructure resources across our development programs. We track outsourced development costs by product candidate or development program,
but we do not allocate personnel costs, other internal costs or external consultant costs to specific product candidates or development
programs.
We participate, through our wholly-owned subsidiary
in Australia, in the Australian research and development tax incentive program, such that a percentage of our qualifying research and
development expenditures are reimbursed by the Australian government, and such incentives are reflected as a reduction of research and
development expense. The Australian research and development tax incentive is recognized when there is reasonable assurance that the incentive
will be received, the relevant expenditure has been incurred and the amount of the consideration can be reliably measured.
65
We participate, through our wholly-owned subsidiary
in the United Kingdom, in the research and development program provided by the United Kingdom tax relief program, such that a percentage
of our qualifying research and development expenditures are reimbursed by the United Kingdom government, and such incentives are reflected
as a reduction of research and development expense. The United Kingdom research and development tax incentive is recognized when there
is reasonable assurance that the incentive will be received, the relevant expenditure has been incurred and the amount of the consideration
can be reliably measured. During 2022, the Company expects to receive a research and development tax rebate for eligible expenditures
incurred in 2021, however the Company will be ineligible for research and development tax incentives for expenditures incurred after 2021
as a result of changes in the United Kingdom tax relief program.
Substantially all of our research and development
expenses to date have been incurred in connection with our current and future product candidates. We expect our research and development
expenses to increase significantly for the foreseeable future as we advance an increased number of our product candidates through clinical
development, including the conduct of our planned clinical trials and manufacturing drug to be used in those clinical trials. The process
of conducting clinical trials necessary to obtain regulatory approval is costly and time consuming. The successful development of product
candidates is highly uncertain. At this time, we cannot reasonably estimate the nature, timing or costs required to complete the remaining
development of any product candidates. This is due to the numerous risks and uncertainties associated with the development of product
candidates.
The costs of clinical trials may vary significantly
over the life of a project owing to, but not limited to, the following:
●
per patient trial costs;
●
the number of sites included in the clinical trials;
●
the countries in which the clinical trials are conducted;
●
the length of time required to enroll eligible patients;
●
the number of patients that participate in the clinical trials;
●
the number of doses that patients receive;
●
the cost of comparative agents used in clinical trials;
●
the drop-out or discontinuation rates of patients;
●
potential additional safety monitoring or other studies requested by regulatory agencies;
●
the duration of patient follow-up;
●
the efficacy and safety profile of the product candidate; and
●
the cost of manufacturing, finishing, labeling and storage drug used in the clinical trial
We do not expect any of our product candidates
to be commercially available for at least the next several years, if ever. We expect to continue to incur significant expenses and increasing
operating losses for the foreseeable future, which may fluctuate significantly from quarter-to-quarter and year-to-year. We anticipate
that our expenses will increase substantially as we:
●
continue research and development, including preclinical and clinical development of our existing product candidates;
●
potentially seek regulatory approval for our product candidates;
66
●
seek to discover and develop additional product candidates;
●
establish a commercialization infrastructure and scale up our manufacturing and distribution capabilities to commercialize any of our product candidates for which we may obtain regulatory approval;
●
seek to comply with regulatory standards and laws;
●
maintain, leverage and expand our intellectual property portfolio;
●
hire clinical, manufacturing, scientific and other personnel to support our product candidates development and future commercialization efforts;
●
add operational, financial and management information systems and personnel; and
●
incur additional legal, accounting and other expenses in operating as a public company.
General and Administrative Expenses
General and administrative expenses consist principally
of payroll and personnel expenses, including stock-based compensation; professional fees for legal, consulting, accounting and tax services;
insurance, overhead, including rent and utilities; and other general operating expenses not otherwise classified as research and development
expenses.
Other income (expense)
Other expense consists primarily of interest expense
incurred on debt in 2021. Other income primarily consists of income from a settlement in 2020.
Critical Accounting Policies and Significant
Judgments and Estimates
This management’s discussion and analysis
of our financial condition and results of operations is based on our financial statements, which we have prepared in accordance with accounting
principles generally accepted in the United States. The preparation of our financial statements requires us to make estimates and assumptions
that affect the reported amounts of assets and liabilities and the disclosure of contingent assets and liabilities at the date of our
financial statements, as well as the reported revenues and expenses during the reported periods. We evaluate these estimates and judgments
on an ongoing basis. We base our estimates on historical experience and on various other factors that we believe are reasonable under
the circumstances, the results of which form the basis for making judgments about the carrying value of assets and liabilities that are
not readily apparent from other sources. Actual results may differ from these estimates under different assumptions or conditions.
In-Process Research and Development
The Company evaluates the carrying value of indefinite-lived
intangible assets, which consists of in-process research and development (“IPR&D”), on an annual basis or more frequently
when indicators of impairment exist. An impairment of indefinite-lived intangible assets would occur if the fair value of the intangible
asset is less than the carrying value. Intangible assets with finite lives are tested for impairment when events or changes in circumstances
indicate that the carrying amount of such assets may not be recoverable. If these facts and circumstances exist, the Company assesses
for recovery by comparing the carrying values of the assets with their future undiscounted net cash flows. Significant management judgment
is required in the forecast of future operating results that are used in the preparation of expected undiscounted cash flows.
67
IPR&D assets are considered to be indefinite-lived
until the completion or abandonment of the associated research and development projects. During the period the assets are considered indefinite-lived,
they are tested for impairment. If the related project is terminated or abandoned, the Company may have a full or partial impairment related
to the IPR&D assets, calculated as the excess of their carrying value over fair value. The valuation process is very complex and requires
significant input and judgment using internal and external sources with respect to the Company’s future revenue and expense growth
rates, changes in working capital use, the selection of an appropriate discount rate, and other assumptions and estimates.
Research and Development (“R&D”)
R&D expenses consist primarily of costs related
to clinical studies and outside services, personnel expenses, and other R&D expenses. Clinical studies and outside services costs
relate primarily to services performed by clinical research organizations and related clinical or development manufacturing costs, materials
and supplies, filing fees, regulatory support, and other third-party fees. Personnel expenses relate primarily to salaries, benefits and
share-based compensation. R&D expenditures are charged to operations as incurred.
We recognize R&D tax credits receivable from
the United Kingdom and Australian government for spending on R&D as an offset of R&D expenses.
Stock-Based Compensation
We measure and recognize compensation
expense for all stock-based awards granted to service providers, employees, and directors based on the estimated fair value of the
award on the grant date. We calculate the estimated fair value of stock options on the date of grant using the Black-Scholes
option-pricing model, which is impacted by the fair value of our common stock, as well as changes in assumptions regarding a number
of highly complex and subjective variables. These variables include, but are not limited to, the market value of common stock on the
grant date, the expected dividend yield, the expected term of the awards, the risk-free interest rates and the expected common stock
price volatility over the term of the option awards. The expected volatility is based on the historical volatility of a few
unrelated public companies within our industry over the most recent period commensurate with the estimated expected term of our
stock options as we have insufficient historical information regarding the volatility of the share price of our common stock. The
risk-free interest rate for periods within the contractual life of the option is based on the U.S. Treasury yield in effect at
the time of grant. We have never declared or paid dividends and have no plans to do so in the foreseeable future.
We recognize the fair value of stock options on
a straight-line basis over the period during which a service provider is required to provide services in exchange for the award (generally
the vesting period). We account for forfeitures as they occur.
Off-Balance Sheet Arrangements
During the periods presented, we did not have
any off-balance sheet arrangements as defined under SEC rules.
Licensing and Collaboration Agreements
We anticipate that in-licensing, out-licensing
and strategic collaborations will become an integral part of our operations, providing the company with opportunities to leverage our
partners’ expertise and capabilities to further expand the potential of our technologies, product candidates and revenue streams.
Xencor
In October 2017, we licensed INB03 (also known
as XPro) from Xencor. This exclusive, global, unrestricted license came with considerable know-how, intellectual property, pre-clinical
data, regulatory documentation and product stocks. Currently, we are focused on the immune-oncology uses of this unique asset. In the
future, we may develop the asset in a wide variety of therapeutic areas, with a variety of delivery techniques by ourselves or in conjunction
with partners.
68
Results of Operations
Comparison of the Years Ended December 31,
2021 and December 31, 2020
Year Ended
(in thousands)
December 31,
2021
December 31,
2020
Change
Revenues
$ (181 )
$ (11 )
$ (170 )
General and Administrative
8,791
6,321
2,470
Research and Development
20,543
5,918
14,625
Other Expense (Income)
1,187
(129 )
1,316
Net loss
$ (30,340 )
$ (12,099 )
$ 18,241
Revenues
During 2021, the Company sold MSC’s to three
customers and recognized $181,000 of revenues. We recorded $11,000 of revenues in 2020 as a result of selling MSC’s to one customer.
General and Administrative
General and administrative expenses were $8.8 million for the year
ended December 31, 2021, compared to $6.3 million for the year ended December 31, 2020. The increase was primarily attributable to higher
professional fees ($1.0 million higher in 2021), higher stock-based compensation expense ($0.6 million higher in 2021), and higher salary
expense ($0.5 million higher in 2021).
Research and Development
Research and development expenses increased to $20.5 million for the
year ended December 31, 2021 from $5.9 million for the year ended December 31, 2020. The increase in research and development expenses
during the year ended December 31, 2021 compared to 2020 is due to $5.4 million of higher expenses for the Alzheimer’s clinical
program, $1.9 million of higher expenses on the COVID-19 clinical trial, and due to the Company incurring $5.5 million of higher manufacturing
costs in connection with producing its DN-TNF product. In addition, the Company’s stock-based compensation was $1.1 million higher
in 2021 compared to 2020.
Other Expense (Income)
Other expense increased during the year ended
December 31, 2021 compared to 2020 as a result of the incurring $1.0 million of interest expense
from a loan the Company obtained in June 2021. During 2020, the Company received a refund from a third-party vendor pursuant to
a release and settlement agreement of approximately $0.1 million for services provided in a previous year.
69
Liquidity and Capital Resources
Liquidity is the ability of a company to generate
funds to support its current and future operations, satisfy its obligations and otherwise operate on an ongoing basis.
We incurred a net loss of $30,340,000 and $12,099,000 for the years
ended December 31, 2021 and 2020, respectively. Net cash used in operating activities was $28,504,000 and $8,943,000 for the years ended
December 31, 2021 and 2020, respectively. Since inception, we have funded our operations primarily with proceeds from the sales of our
common stock and from the receipts of grants. As of December 31, 2021, we had cash and cash equivalents of $74.8 million. We anticipate
that operating losses and net cash used in operating activities will increase over the next few years as we advance our products under
development.
Our primary uses of capital are, and we expect
will continue to be, third-party clinical and preclinical research and development services, costs incurred to manufacture our drugs under
development, compensation and related expenses, legal, patent and other regulatory expenses and general overhead costs. We believe our
use of CROs provides us with flexibility in managing our spending.
The Company incurs the majority of its research
and development expenses in Australia and the United Kingdom. Fluctuations in the rate of exchange between the United States dollar and
the pound sterling as well as the Australian dollar could adversely affect our financial results, including our expenses as well
as assets and liabilities. We currently do not hedge foreign currencies but will continue to assess whether that strategy is appropriate.
As of December 31, 2021, the cash balance held by our foreign subsidiaries with currencies other than the United States dollar was approximately
$0.2 million. We do not have any material financial exposure to one customer or one country that would significantly hinder our liquidity.
As of December 31, 2021, the Company had an accumulated deficit of
$63.7 million and working capital of $78.2 million. Losses have principally occurred as a result of the substantial resources required
for research and development of the Company’s products which included the general and administrative expenses associated with its
organization and product development, as well as the lack of sources of material revenues until such time as the Company’s products
are commercialized. As of December 31, 2021, we had cash and cash equivalents of $74.8 million. We believe our cash and cash equivalents
will be sufficient to fund our operations for at least the next 12 months following the filing date of this Annual Report on Form 10-K.
Registered Direct
Offering
During
July 2021, the Company completed a registered direct offering whereby the Company sold 1,818,182 shares of its common stock to investors
for net proceeds of $36.9 million.
ATM Sales Agreements
During the year ended
December 31, 2020, we issued and sold 178,600 shares of common stock at an average price of $5.45 per share under the 2020 ATM agreement.
The aggregate net proceeds were approximately $0.8 million after BTIG’s commission and other offering expenses.
During the year ended
December 31, 2021, we issued and sold 1,439,480 shares of common stock at an average price of $20.17 per share under the 2020 ATM agreement.
The aggregate net proceeds were approximately $28.4 million after BTIG’s commission and other offering expenses. As of December
31, 2021, sales of our common stock pursuant to the 2020 ATM have been completed.
During March 2021, the Company entered into the 2021 ATM agreement
with BTIG, as sales agent, to establish an ATM offering of up to $45 million of common stock. During the year ended December 31, 2021,
the Company sold 713,192 shares at an average price per share of $21.73 for net proceeds of approximately $14.9 million under the 2021
ATM agreement.
Term Loan
On
June 10, 2021, we entered into a Loan and Security Agreement with SVB and an affiliate of SVB, providing for a $15.0 million term loan.
The Term Loan also provides for us to request an additional $5.0 million term loan from the Lenders, which may be granted or denied at
the sole discretion of the Lenders. The Term Loan provides for an annual interest rate equal to the greater of (i) the prime rate then
in effect as reported in The Wall Street Journal plus 4.50% and (ii) 7.75% and also includes a final payment fee equal to 6.5%
of the original principal amount borrowed payable on the earlier of the repayment of the loan in full and the maturity date. The Company
used the proceeds of the term loan to fund the cash consideration for the Option Cancellation Agreement with Xencor.
The Lincoln Park Transaction
On May 15, 2019, the Company and Lincoln Park entered into a purchase
agreement (the “Purchase Agreement”) pursuant to which the Company had the right to sell to Lincoln Park up to $20.0 million
in shares of the Company’s common stock, subject to certain limitations and conditions set forth in the Purchase Agreement. During
the year ended December 31, 2020, the Company issued 196,000 shares of the Company’s common stock to Lincoln Park for gross proceeds
of $1,003,000. During April 2021, the Company terminated the Purchase Agreement.
70
Cash Flows
The following table provides information regarding
our cash flows for the years ended December 31, 2021 and 2020:
Year Ended
December 31,
2021
2020
Net cash used in operating activities
$ (28,504 )
$ (8,943 )
Net cash used in investing activities
(15,000 )
-
Net cash provided by financing activities
96,357
23,895
Impact on cash from foreign currency translation
(10 )
19
Net increase in cash and cash equivalents
$ 52,843
$ 14,971
Net Cash Used in Operating Activities
Our cash used in operating activities was primarily
driven by our net loss.
Operating activities used $28.5 million of cash for the year ended
December 31, 2021, primarily resulting from our net loss of $30.3 million, a net cash outflow of $3.1 million for changes in our net operating
assets and liabilities, and non-cash stock-based compensation charges of $4.8 million. The change in our net operating assets and liabilities
was primarily due to an increase in research and development tax credit receivable of $3.2 million and an increase in prepaid expenses
of $2.1 million, partially offset by an increase in accounts payable and accrued liabilities of $2.2 million.
Operating activities used $8.9 million of cash
for the year ended December 31, 2020, primarily resulting from our net loss of $12.1 million, partially offset by non-cash stock-based
compensation charges of $3.1 million.
71
Investing
Activities
Investing activities used $15.0 million of cash for the year ended
December 31, 2021 compared to $0 for the year ended December 31, 2020. During the year ended December 31, 2021, the Company paid Xencor
$15.0 million to settle an option to acquire 10% of the Company’s common stock on a fully diluted basis which was issued to acquire
the Company’s acquired in-process research and development intangible asset.
Net Cash Provided by Financing Activities
During the year ended
December 31, 2021, the Company sold 1,439,480 shares of its common stock under its 2020 ATM agreement for net proceeds of approximately
$28.4 million.
During the year ended
December 31, 2021, the Company sold 713,192 shares of its common stock under the 2021 ATM agreement for net proceeds of approximately
$14.9 million.
During July 2021, the
Company completed a registered direct offering whereby the Company sold 1,818,182 shares of its common stock to investors for net proceeds
of $36.9 million.
During June 2021, we
entered into a Loan and Security Agreement with SVB and an affiliate of SVB, providing for a $15.0 million term loan.
During the year ended December 31, 2021, the Company received approximately
1.2 million in connection with the exercise of stock options and warrants.
During July 2020, the Company completed an underwritten
public offering in which it sold 2,500,000 shares of common stock at a public offering price of $10.00 per share. Aggregate net proceeds
from the underwritten public offering were approximately $23.1 million, net of approximately $1.9 million in underwriting discounts and
commissions and offering expenses.
During the year ended December 31, 2020, the Company
purchased 220,000 shares from an investor for approximately $1.0 million. In addition, the Company sold 196,000 shares of its common stock
to Lincoln Park for cash proceeds of approximately $1.0 million.
During the year ended December 31, 2020, the Company issued and sold
178,600 shares of common stock at an average price of $5.45 per share under the ATM agreement for net cash proceeds of approximately $0.8
million.
Item 7A. Quantitative and Qualitative Disclosures
about Market Risk
We are exposed to market risk from changes in
foreign currency rates.
72
Item 8. Financial Statements and Supplementary
Data
INDEX TO CONSOLIDATED FINANCIAL STATEMENTS
Page
AUDITED FINANCIAL STATEMENTS:
REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM (PCAOB ID Number 688 )
F-1
CONSOLIDATED BALANCE SHEETS AS OF DECEMBER 31, 2021 AND 2020 F-2
CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE LOSS FOR THE YEARS ENDED DECEMBER 31, 2021 AND 2020 F-3
CONSOLIDATED STATEMENT OF CHANGES IN STOCKHOLDERS’ EQUITY FOR THE YEARS ENDED DECEMBER 31, 2021 AND 2020 F-4
CONSOLIDATED STATEMENTS OF CASH FLOWS FOR THE YEARS ENDED DECEMBER 31, 2021 AND 2020 F-5
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS F-6
73
REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING
FIRM
To the Stockholders and the Board of Directors
of
INmune Bio, Inc.
Boca Raton, Florida
Opinion on the Financial Statements
We have audited the accompanying consolidated
balance sheets of INmune Bio, Inc. (the “Company”) as of December 31, 2021 and 2020, the related consolidated statements
of operations and comprehensive loss, changes in stockholders’ equity and cash flows for each of the two years in the period ended
December 31, 2021, and the related notes (collectively referred to as the “financial statements”). In our opinion, the financial
statements present fairly, in all material respects, the financial position of the Company as of December 31, 2021 and 2020, and the results
of its operations and its cash flows for each of the two years in the period ended December 31, 2021, in conformity with accounting principles
generally accepted in the United States of America.
Basis for Opinion
These financial statements are the responsibility
of the Company's management. Our responsibility is to express an opinion on the Company's financial statements based on our audits. We
are a public accounting firm registered with the Public Company Accounting Oversight Board (United States) (“PCAOB”) and are
required to be independent with respect to the Company in accordance with the U.S. federal securities laws and the applicable rules and
regulations of the Securities and Exchange Commission and the PCAOB.
We conducted our audits in accordance with the
standards of the PCAOB. Those standards require that we plan and perform the audits to obtain reasonable assurance about whether the financial
statements are free of material misstatement, whether due to error or fraud. The Company is not required to have, nor were we engaged
to perform, an audit of its internal control over financial reporting. As part of our audits, we are required to obtain an understanding
of internal control over financial reporting but not for the purpose of expressing an opinion on the effectiveness of the Company's internal
control over financial reporting. Accordingly, we express no such opinion.
Our audits included performing procedures to assess
the risks of material misstatement of the financial statements, whether due to error or fraud, and performing procedures that respond
to those risks. Such procedures included examining, on a test basis, evidence regarding the amounts and disclosures in the financial statements.
Our audits also included evaluating the accounting principles used and significant estimates made by management, as well as evaluating
the overall presentation of the financial statements. We believe that our audits provide a reasonable basis for our opinion.
/s/ Marcum llp
Marcum llp
We have served as the Company’s auditor since 2017.
Houston, Texas
March 3, 2022
F- 1
INMUNE BIO, INC.
CONSOLIDATED BALANCE SHEETS
(In thousands, except share and per share amounts)
December 31,
2021
December 31,
2020
ASSETS
CURRENT ASSETS
Cash
$ 74,810
$ 21,967
Research and development tax credit receivable
4,913
1,686
Other tax receivable
591
113
Prepaid expenses
2,278
220
Prepaid expenses – related party
14
-
TOTAL CURRENT ASSETS
82,606
23,986
Operating lease – right of use assets
726
156
Other assets
99
-
Acquired in-process research and development intangible assets
16,514
16,514
TOTAL ASSETS
$ 99,945
$ 40,656
LIABILITIES AND STOCKHOLDERS’ EQUITY
CURRENT LIABILITIES
Accounts payable and accrued liabilities
$ 3,733
$ 1,518
Accounts payable and accrued liabilities – related parties
80
34
Deferred liabilities
474
190
Operating lease, current liabilities
72
34
TOTAL CURRENT LIABILITIES
4,359
1,776
Long-term debt, less debt discount
14,458
-
Long-term operating lease liabilities
704
126
Accrued liability – long-term
199
-
TOTAL LIABILITIES
19,720
1,902
COMMITMENTS AND CONTINGENCIES
STOCKHOLDERS’ EQUITY
Preferred stock, $ 0.001 par value, 10,000,000 shares authorized, 0 shares issued and outstanding
-
-
Common stock, $ 0.001 par value, 200,000,000 shares authorized, 17,843,303 and 13,481,283 shares issued and outstanding, respectively
18
13
Additional paid-in capital
143,921
72,105
Accumulated other comprehensive income
1
11
Accumulated deficit
( 63,715 )
( 33,375 )
TOTAL STOCKHOLDERS’ EQUITY
80,225
38,754
TOTAL LIABILITIES AND STOCKHOLDERS’ EQUITY
$ 99,945
$ 40,656
See accompanying notes to these consolidated financial
statements.
F- 2
INMUNE BIO, INC.
CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE
LOSS
FOR THE YEARS ENDED DECEMBER 31, 2021 AND 2020
( In
thousands, except share and per share amounts)
2021
2020
REVENUE
$
181
$
11
OPERATING EXPENSES
General and administrative
8,791
6,321
Research and development
20,543
5,918
Total operating expenses
29,334
12,239
LOSS FROM OPERATIONS
( 29,153 )
( 12,228 )
OTHER (EXPENSE) INCOME
Other (expense) income
( 1,187 )
129
Total other (expense) income
( 1,187 )
129
NET LOSS
$ ( 30,340 )
$ ( 12,099 )
Net loss per common share – basic and diluted
$ ( 1.88 )
$ ( 1.01 )
Weighted average number of common shares outstanding – basic and diluted
16,130,539
11,988,492
COMPREHENSIVE LOSS
Net loss
$ ( 30,340 )
$ ( 12,099 )
Other comprehensive (loss) income – foreign currency translation
( 10 )
20
Total comprehensive loss
$ ( 30,350 )
$ ( 12,079 )
See accompanying notes to these consolidated financial
statements.
F- 3
INMUNE BIO, INC.
CONSOLIDATED STATEMENT OF CHANGES IN STOCKHOLDERS’
EQUITY
FOR THE YEARS ENDED DECEMBER 31, 2021 AND 2020
(In thousands, except share amounts)
Accumulated
Additional
Common
Other
Total
Common Stock
Paid-In
Stock
Comprehensive
Accumulated
Stockholders’
Shares
Amount
Capital
Issuable
Income (loss)
Deficit
Equity
Balance as of January 1, 2020
10,770,948
$ 11
$ 44,834
$ 50
$ ( 9 )
$ ( 21,276 )
$ 23,610
Issuance of common stock for cash, net
2,874,600
2
24,905
-
-
-
24,907
Acquisition and retirement of common stock
( 220,000 )
-
( 1,012 )
-
-
-
( 1,012 )
Capital contribution
-
-
216
-
-
-
216
Cashless exercise of warrants
2,400
-
-
-
-
-
-
Issuance of common stock issuable
33,335
-
50
( 50 )
-
-
-
Stock-based compensation
20,000
-
3,112
-
-
-
3,112
Gain on foreign currency translation
-
-
-
-
20
-
20
Net loss
-
-
-
-
-
( 12,099 )
( 12,099 )
Balance as of December 31, 2020
13,481,283
13
72,105
-
11
( 33,375 )
38,754
Issuance of common stock for cash, net
3,970,854
5
80,248
-
-
-
80,253
Settlement of Xencor warrant for cash and common stock
192,533
-
( 15,000 )
-
-
-
( 15,000 )
Warrants issued to lenders as debt inducement
-
-
619
-
-
-
619
Exercise of warrants
15,633
-
18
-
-
-
18
Exercise of stock options
183,000
-
1,135
-
-
-
1,135
Stock-based compensation
-
-
4,796
-
-
-
4,796
Loss on foreign currency translation
-
-
-
-
( 10 )
-
( 10 )
Net loss
-
-
-
-
-
( 30,340 )
( 30,340 )
Balance as of December 31, 2021
17,843,303
$ 18
$ 143,921
$ -
$ 1
$ ( 63,715 )
$ 80,225
See accompanying notes to these consolidated financial
statements.
F- 4
INMUNE BIO, INC.
CONSOLIDATED STATEMENTS OF CASH FLOWS
FOR THE YEARS ENDED DECEMBER 31, 2021 AND 2020
(In thousands)
2021
2020
CASH FLOWS FROM OPERATING ACTIVITIES:
Net loss
$ ( 30,340 )
$ ( 12,099 )
Adjustments to reconcile net loss to net cash used in operating activities:
Stock-based compensation
4,796
3,112
Accretion of debt discount
126
-
Changes in operating assets and liabilities:
Research and development tax credit receivable
( 3,227 )
( 1,118 )
Other tax receivable
( 478 )
( 36 )
Prepaid expenses
( 2,058 )
( 122 )
Prepaid expenses – related party
( 14 )
26
Other assets
( 99 )
-
Accounts payable and accrued liabilities
2,215
1,116
Accounts payable and accrued liabilities – related parties
46
( 40 )
Deferred liabilities
284
191
Accrued liability – long-term
199
-
Operating lease liabilities
46
27
Net cash used in operating activities
( 28,504 )
( 8,943 )
CASH FROM INVESTING ACTIVITIES
Cash paid to Xencor to settle warrant for acquired research and development intangible assets
( 15,000 )
-
Net cash used in investing activities
( 15,000 )
-
CASH FLOWS FROM FINANCING ACTIVITIES:
Net proceeds from the issuance of debt
14,951
-
Net proceeds from sale of common stock
80,253
24,907
Net proceeds from the exercise of stock options
1,135
-
Net proceeds from the exercise of warrants
18
-
Purchase of common stock
-
( 1,012 )
Net cash provided by financing activities
96,357
23,895
Impact on cash from foreign currency translation
( 10 )
19
NET INCREASE IN CASH
52,843
14,971
CASH AT BEGINNING OF YEAR
21,967
6,996
CASH AT END OF YEAR
$ 74,810
$ 21,967
SUPPLEMENTAL DISCLOSURE OF CASH FLOWS INFORMATION:
Cash paid for income taxes
$ -
$ -
Cash paid for interest expense
$ 559
$ -
NONCASH INVESTING AND FINANCING ACTIVITIES:
Common stock issued to Xencor to settle warrant issued for acquired research and development intangible assets
$ 3,300
$ -
Warrants issued to lenders as debt inducement
$ 619
$ -
Capital contribution
$ -
$ 216
Issuance of common stock issuable
$ -
$ 50
See accompanying notes to these consolidated financial
statements.
F- 5
INMUNE BIO, INC.
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
NOTE 1 – ORGANIZATION AND BASIS
OF PRESENTATION
Organization and Business Overview
INmune Bio, Inc. (the “Company” or
“INmune Bio”) was organized in the State of Nevada on September 25, 2015, and is a clinical stage biotechnology pharmaceutical
company focused on developing and commercializing its product candidates to treat diseases where the innate immune system is not functioning
normally and contributing to the patient’s disease. INmune Bio has two product platforms. The DN-TNF product platform utilizes
dominant-negative technology to selectively neutralize soluble TNF, a key driver of innate immune dysfunction and mechanistic target of
many diseases. DN-TNF is currently being developed for Alzheimer’s and treatment resistant depression (XPro) and cancer (INB03).
The Natural Killer Cell Priming Platform includes INKmune aimed at priming the patient’s NK cells to eliminate minimal residual
disease in patients with cancer. INmune Bio’s product platforms utilize a precision medicine approach for the treatment of a wide
variety of hematologic malignancies, solid tumors and chronic inflammation.
Basis of Presentation and Principles of
Consolidation
The accompanying consolidated financial statements
of the Company have been prepared in accordance with Generally Accepted Accounting Principles (“US GAAP”) in the United States
of America and the rules of the Securities and Exchange Commission (“SEC”).
The consolidated financial statements herein have
been prepared in accordance with US GAAP and include the accounts of INmune Bio, its wholly-owned UK subsidiary, and its wholly-owned
Australia subsidiary (collectively, the “Company”). All significant intercompany accounts and transactions have been eliminated.
NOTE 2 – LIQUIDITY
As of December 31, 2021, the Company had an accumulated
deficit of $ 63,715,000 and experienced losses since its inception. Losses have principally occurred as a result of the substantial resources
required for research and development of the Company’s products, which included the general and administrative expenses associated
with its organization and product development as well as the lack of sources of revenues until such time as the Company’s products
are commercialized.
F- 6
To meet its current and future obligations the
Company has taken the following steps to capitalize the business and achieve its business plan:
● During July 2021, the Company completed a registered direct
public offering in which it sold 1,818,182 shares of common stock to investors for estimated net proceeds of $ 36.9 million.
● During June 2021, the Company entered into a loan and security agreement and drew down a $ 15.0 million
term loan.
● During March 2021, the Company entered into a sales agreement with
BTIG, LLC (“BTIG”), as agent, to establish an At-The-Market (“ATM”) offering of up to $ 45 million of common stock
(the “2021 ATM”), subject to certain limitations on the amount of common stock that may be offered and sold by the Company
set forth in the sales agreement. The Company is required to pay BTIG a commission of 3 % of the gross proceeds from the sale of shares.
The Company has sold 713,192 shares of its common stock at an average price of $ 21.73 through the 2021 ATM for net proceeds of $ 14.9 million.
● During April 2020, the Company entered into a sales agreement with
BTIG, as sales agent, to establish an ATM offering to sell up to $ 10.0 million of the Company’s common stock (the “2020 ATM”).
In August 2020, the sales agreement was amended whereby the aggregate offering was increased from $ 10.0 million to $ 30.0 million. From
April 2020 through December 2020, the Company sold 178,600 shares of common stock at an average price of $ 5.45 per share for net proceeds
of approximately $ 0.8 million. During the year ended December 31, 2021, the Company sold in aggregate 1,439,480 shares on common stock
at an average price of $ 20.17 per share for net proceeds of $ 28.4 million. As of December 31, 2021, sales of our common stock pursuant
to the 2020 ATM have been completed.
Although it is difficult to predict the Company’s
liquidity requirements, as of December 31, 2021, and based upon the Company’s current operating plan, the Company believes that
it will have sufficient cash to meet its projected operating requirements for at least the next 12 months following the filing date of
this Annual Report on Form 10-K based on the balance of cash available as of December 31, 2021. The Company anticipates that it will continue
to incur net losses for the foreseeable future as it continues the development of its clinical drug candidates and preclinical programs
and incurs additional costs associated with being a public company.
NOTE 3 – SUMMARY OF SIGNIFICANT
ACCOUNTING POLICIES
Use of Estimates
Preparing financial statements in conformity with
US GAAP requires management to make estimates and assumptions that affect the reported amounts of assets, liabilities, revenue, and expenses.
Actual results and outcomes may differ from management’s estimates and assumptions.
Risks and Uncertainties
The Company is subject to risks and uncertainties
as a result of the COVID-19 pandemic. The extent of the impact of the COVID-19 pandemic on the Company’s business is highly uncertain
and difficult to predict. Also, economies worldwide have also been negatively impacted by the COVID-19 pandemic, however policymakers
around the globe have responded with fiscal policy actions to support the healthcare industry and economy as a whole. The magnitude and
overall effectiveness of these actions remain uncertain.
In addition, the Company’s clinical trials
have been affected by and may continue to be affected by the COVID-19 pandemic. Clinical site initiation and patient enrollment have and
may continue to be delayed due to prioritization of hospital resources toward the COVID-19 pandemic. Some patients have not and others
may not be able to comply with clinical trial protocols if quarantines impede patient movement or interrupt healthcare services. Similarly,
the ability to recruit and retain patients and principal investigators and site staff who, as healthcare providers, may have heightened
exposure to COVID-19, may adversely impact the Company’s clinical trial operations.
The severity of the impact of the COVID-19 pandemic
on the Company’s business will depend on a number of factors, including, but not limited to, the duration and severity of the pandemic
and the extent and severity of the impact on the Company’s service providers, suppliers, contract research organizations (“CROs”)
and the Company’s clinical trials, all of which are uncertain and cannot be predicted. As of the date of issuance of Company’s
financial statements, the extent to which the COVID-19 pandemic may materially impact the Company’s financial condition, liquidity
or results of operations is uncertain.
Cash and Cash Equivalents
The Company considers all highly liquid instruments purchased with
an original maturity of three months or less to be cash equivalents. The Company holds cash in banks in excess of Federal Deposit Insurance
Corporation insurance limits. However, the Company believes risk of loss is minimal as the cash is held by large, highly-rated financial
institutions.
F- 7
Research and Development Tax Incentive Receivable
The Company, through its wholly-owned subsidiary
in Australia, participates in the Australian research and development tax incentive program, such that a percentage of our qualifying
research and development expenditures are reimbursed by the Australian government, and such incentives are reflected as a reduction of
research and development expense. The Australian research and development tax incentive is recognized when there is reasonable assurance
that the incentive will be received, the relevant expenditure has been incurred and the amount of the consideration can be reliably measured.
At each period end, management estimates the reimbursement available to the Company based on available information at the time.
The Company, through its wholly-owned subsidiary
in the United Kingdom, participates in the research and development program provided by the United Kingdom tax relief program, such that
a percentage of our qualifying research and development expenditures are reimbursed by the United Kingdom government, and such incentives
are reflected as a reduction of research and development expense. The United Kingdom research and development tax incentive is recognized
when there is reasonable assurance that the incentive will be received, the relevant expenditure has been incurred and the amount of the
consideration can be reliably measured. At each period end, management estimates the reimbursement available to the Company based on available
information at the time.
Intangible Assets
The Company capitalizes costs incurred in connection
with in-process research and development purchased from others if the asset has alternative uses and such uses are not restricted under
applicable license agreements; patent applications (principally legal fees), patent purchases, and trademarks related to its cell line
as intangible assets. Acquired in-process research and development costs that do not have alternative uses are expensed as incurred. When
the assets are determined to have a finite life (upon completion of the development of the in-process research and development for its
DN-TNF platform), the useful life will be determined and the in-process research and development intangible assets will be amortized.
During the fourth quarter and if business factors
indicate more frequently, the Company performs an assessment of the qualitative factors affecting the fair value of our in-process research
and development. If the qualitative assessment suggests that impairment is more likely than not, a quantitative analysis is performed.
The quantitative analysis involves a comparison of the fair value of the in-process research and development with the carrying amount.
If the carrying amount of the in-process research and development exceeds its fair value, an impairment loss is recognized in an amount
equal to that excess. During the years ended December 31, 2020 and 2021, the Company performed a qualitative assessment of its in-process
research and development and determined that there was no impairment.
Basic and Diluted Loss per Share
Basic loss per share is computed by dividing net
loss available to common shareholders by the weighted average number of outstanding common shares during the period. Diluted loss per
share gives effect to all dilutive potential common shares outstanding during the period. Dilutive loss per share excludes all potential
common shares if their effect is anti-dilutive. For all periods presented, there is no difference in the number of shares used to calculate
basic and diluted shares outstanding due to the Company’s net loss position.
At December 31, 2021, the Company had 4,097,000
potentially issuable shares of common stock upon the exercise of stock options and 93,866 potentially issuable shares of common stock
upon the exercise of warrants.
At December 31, 2020, the Company had 3,457,000
potentially issuable shares of common stock upon the exercise of stock options and 1,955,922 potentially issuable shares of common stock
upon the exercise of warrants.
Revenue Recognition
The Company recognizes revenue when the customer
obtains control of promised goods or services, in an amount that reflects the consideration the Company expects to receive in exchange
for those goods or services. The Company recognizes revenue following the five-step model prescribed under ASC Topic 606: (1) identify
contract(s) with a customer; (2) identify the performance obligations in the contract; (3) determine the transaction price; (4) allocate
the transaction price to the performance obligations in the contract; and (5) recognize revenues when (or as) the Company satisfies the
performance obligations. The Company records the expenses related to revenue in research and development expense, in the periods such
expenses were incurred.
F- 8
The Company records deferred revenues when cash
payments are received or due in advance of performance, including amounts which are refundable.
The Company’s 2021 revenues were from the
sale of MSC’s to three customers. The sales were recognized when the MSC’s were delivered to the customers.
The Company’s 2020 revenue was from the
sale of MSC’s to one customer. The revenue was recognized when the MSC’s were delivered to the customer.
Stock-Based Compensation
The Company utilizes the Black-Scholes option
pricing model to estimate the fair value of stock option awards at the date of grant, which requires the input of highly subjective assumptions,
including expected volatility and expected life. Changes in these inputs and assumptions can materially affect the measure of estimated
fair value of our share-based compensation. These assumptions are subjective and generally require significant analysis and judgment to
develop. When estimating fair value, some of the assumptions will be based on, or determined from, external data and other assumptions
may be derived from our historical experience with stock-based payment arrangements. The appropriate weight to place on historical experience
is a matter of judgment, based on relevant facts and circumstances. The Company accounts for forfeitures of stock options as they occur.
Research and Development
Research and development (“R&D”)
costs are expensed as incurred. Research and development credits are recorded by the Company as a reduction of research and development
costs. Major components of research and development costs include cash compensation, stock-based compensation, costs of preclinical studies,
clinical trials and related clinical manufacturing, costs of drug development, costs of materials and supplies, facilities cost, overhead
costs, regulatory and compliance costs, and fees paid to consultants and other entities that conduct certain research and development
activities on the Company’s behalf.
The Company recognizes grants as contra research
and development expense in the consolidated statement of operations on a systematic basis over the periods in which the entity recognizes
as expenses the related costs for which the grants are intended to compensate.
Income Taxes
The Company follows the liability method of accounting
for income taxes. Under this method, deferred income tax assets and liabilities are recognized for the estimated tax consequences attributable
to differences between the financial statement carrying values and their respective income tax basis (temporary differences). The effect
on deferred income tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment
date.
Foreign Currency Translation
The Company’s financial statements are presented
in the U.S. dollar (“$”), which is the Company’s reporting currency, while its functional currencies are the U.S. Dollar
for its U.S. based operations, British Pound (“GBP”) for its United Kingdom-based operations and Australian Dollars (“AUD”)
for its Australian-based operations. All assets and liabilities are translated at the exchange rate on the balance sheet date, stockholders’
equity is translated at historical rates and statement of operations items are translated at the weighted average exchange rate for the
period. The resulting translation adjustments are reported under other comprehensive income. Gains and losses resulting from the translations
of foreign currency transactions and balances are reflected in the statement of operations and comprehensive loss.
Recently Adopted Accounting Pronouncements
There were various accounting standards and interpretations
issued recently, none of which are expected to a have a material impact on the Company´s consolidated financial position, operations,
or cash flows.
F- 9
Reclassifications
Certain amounts from the prior period have been
adjusted to conform to the current period presentation.
Subsequent Events
The Company has evaluated all transactions through
the financial statement issuance date for subsequent disclosure consideration.
NOTE 4 – RESEARCH AND DEVELOPMENT
ACTIVITY
According to UK tax law, the Company is allowed
an R&D tax credit that reduces a company’s tax bill in the UK for expenses incurred in R&D subject to certain requirements.
The Company’s UK subsidiary submits R&D tax credit requests annually for research and development expenses incurred. At December
31, 2021 and 2020, the Company recorded a research and development tax credit receivable of $ 3,319,000 and $ 833,000 , respectively for
R&D expenses incurred in the UK. During the years ended December 31, 2021 and 2020, the Company received $ 814,000 and $ 306,000 of
R&D tax credit reimbursements, respectively from the UK.
According to AUS tax law, the Company is allowed
an R&D tax credit that reduces a company’s tax bill in AUS for expenses incurred in R&D subject to certain requirements.
The Company’s Australian subsidiary submits R&D tax credit requests annually for research and development expenses incurred.
At December 31, 2021 and 2020, the Company recorded a research and development tax credit receivable of $ 1,594,000 and $ 853,000 , respectively,
for R&D expenses incurred in Australia. During the years ended December 31, 2021 and 2020, the Company received $ 1,296,000 and $ 178,000
of R&D tax credit reimbursements, respectively from Australia.
Xencor, Inc. License Agreement
On October 3, 2017, the Company entered into a
license agreement (“Xencor License Agreement”) with Xencor, Inc. (“Xencor”), which has discovered and developed
a proprietary biological molecule that inhibits soluble tumor necrosis factor. During June 2021, the Company entered into the First Amendment
to License Agreement. Pursuant to the license 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 license 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 (“Licensed
Products”). The Company believes the protein has numerous medical applications. Such additional alternative applications of the
technology are available under the Xencor License Agreement. In connection with the Xencor License Agreement, the Company paid Xencor
a one-time non-creditable and non-refundable fee of $ 100,000 and issued Xencor 1,585,000 shares of the Company’s common stock with
a fair value of $ 12,221,000 . In addition, the Company issued Xencor fully vested warrants with a fair value of $ 4,193,000 to purchase
an additional number of shares of common stock equal to 10 % of the fully diluted company shares immediately following such purchase, which
warrant has since been cancelled (see the description below). The aggregate purchase price for the full exercise of the option was $ 10,000,000 .
The Company recorded $ 16,514,000 for the acquisition
of intangible assets for the in-process research and development as the fair value of the cash, stock and warrants on the date of the
License Agreement acquisition in accordance with Accounting Standards Codification 730 – Research and Development . The Company
has the license rights to pursue alternative applications of the technology as part of its future development plans.
The Company also agreed to pay Xencor a royalty
on Net Sales of all Licensed Products in a given calendar year, which are payable on a country-by- country and licensed product by licensed
product basis until the date that is the later of (a) the expiration of the last to expire valid claim covering such Licensed Product
in such country or (b) ten years following the first sale to a third party of the licensed product in such country.
F- 10
Under the Xencor License Agreement, the Company
also agreed to pay Xencor a percentage of any sublicensing revenue that it receives.
On June 10, 2021, the Company and Xencor entered
into an Option Cancellation Agreement whereby Xencor terminated its warrant to purchase 10 % of the fully diluted shares of the Company
in exchange for a cash payment of $ 15,000,000 and 192,533 shares of the Company’s common stock with a fair value of $ 3,300,000 based
on the market price of the common stock as of June 10, 2021, which the Company issued in June 2021. The Company filed a registration statement
covering the resale of these shares during September 2021 and agreed to keep the registration statement continuously effective until all
such shares cease to be outstanding or otherwise cease to be registrable securities as defined in the Option Cancellation Agreement. The
Company charged the cash consideration paid to Xencor to enter into the Option Cancellation Agreement to equity as the fair value of the
warrant immediately prior to the Option Cancellation Agreement was greater than the consideration paid to Xencor.
INKmune 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, the Company was granted exclusive worldwide rights to the patents, including rights to incorporate
any improvements or additions to the patents that may be developed in the future. In consideration for the patent rights, the Company
agreed to the following milestone payments:
(in thousands)
Each Phase I initiation
$ 25
Each Phase II initiation
$ 250
Each Phase III initiation
$ 350
Each NDA/EMA filing
$ 1,000
Each NDA/EMA awarded
$ 9,000
During July 2021, the Company initiated a Phase
I clinical trial using INKmune and the Company paid Immune Ventures a $ 25,000 milestone payment.
In addition, the Company agreed to pay the licensor
a royalty of 1 % of net sales during the life of each patent granted to the Company. The License is owned by Immune Ventures. RJ Tesi,
the Company’s President and a member of our Board of Directors, David Moss, its Chief Financial Officer and Treasurer and Mark Lowdell,
its Chief Scientific Officer, are the owners of Immune Ventures. As of December 31, 2021 and December 31, 2020, no sales had occurred
under this license.
The term of the 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 exists. Upon the termination of the agreement we shall have a fully paid up, perpetual,
royalty-free license without further obligation to Immune Ventures. The agreement can be terminated by Immune Ventures if, after 60 days
from the Company’s receipt of notice that the Company has not made a payment under the agreement, and the Company still does not
make this payment. On July 20, 2018, the parties amended the agreement under which the Company was required achieve milestones pursuant
to the agreement. On October 30, 2020, the parties executed an additional amendment to the agreement under which the Company is required
to achieve the following milestones:
Initiation of Phase II clinical trials or equivalent
by October 29, 2023
Initiation of Phase III clinical trials or equivalent
by October 29, 2025
Filing of NDA or equivalent by October 29, 2026
or equivalent
If the Company doesn’t achieve the above
milestones, it is required to negotiate in good faith with Immune Ventures to determine how it can either remedy the failure or achieve
an alternate development. If the Company fails to make any required efforts, or if the efforts do not remedy the situation within 60 days
of written notice by Immune Ventures, then Immune Ventures may provide notice to terminate the license or convert it to a non-exclusive
license.
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 (“Assignment Agreement”), Immune Ventures assigned all of 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”).
F- 11
Consideration under the PITT Agreement includes:
(i) annual maintenance fees, (ii) royalty payments based on the sale of products making use of the licensed technology, and (iii) milestone
payments.
Annual maintenance fees under the PITT Agreement
include: $5,000 due June 26 of each year 2020-2022; $10,000 due on June 26 of each year 2023-2024; and $25,000 due on June 26 of each
year 2025 and annually thereafter until first commercial sale. The Company had no amounts owed pursuant to the PITT Agreement as of December
31, 2021.
(in thousands)
June 26 of each year 2020-2022
$ 5
June 26 of each year 2023-2024
$ 10
June 26 of each year 2025 until first commercial sale
$ 25
Upon first commercial sale of a product making
use of the licensed technology under the PITT Agreement, the Licensee is required to pay royalties equal to 2.5 % of Net Sales each calendar
quarter. There were no commercial sales of product making use of the licensed
technology under the PITT Agreement in 2021.
Moreover, under the PITT Agreement the Licensee
is required to make milestone payments as follows:
(in thousands)
Each Phase I initiation
$ 50
Each Phase III initiation
$ 500
First commercial sale of product making use of licensed technology
$ 1,250
The Company made a $ 50,000 milestone payment in
March 2019 pursuant to the PITT Agreement as a result of a Phase I initiation. 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 Licensee may terminate the PITT Agreement
upon 3 months prior written notice provided all payments under the license are current. The Licensor may terminate the PITT Agreement
upon written notice if: (i) Licensee defaults as to performance of material obligations which have not been cured within 60 days after
receiving written notice; or (ii) Licensee 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.
NOTE 5 – LEASE
In May 2019, the Company signed a sublease agreement
with a related party for office space in La Jolla, California, which served as the former headquarters of the Company. The lease has a
61 -month term, which corresponds to the lease term of the lessor. The lessor is CTI Clinical Trial & Consulting Services (“CTI”).
CTI is majority-owned by a member of the Company’s Board of Directors. During 2021, the Company moved its corporate headquarters
to Boca Raton, Florida. The Company intends to sublease its office space in La Jolla.
In September 2021, the Company signed a lease
with a third party for office space in Boca Raton, Florida. The lease agreement has a 64 -month term and commenced during the fourth
quarter of 2021.
F- 12
Below is a summary of the Company’s right-of-use
assets and liabilities:
(in thousands, except years and rate)
December 31,
2021
December 31,
2020
Right-of-use asset (La Jolla lease)
$
118
$
156
Right-of-use asset (Boca Raton lease)
608
-
Total
$
726
$
156
Operating lease, current liability (La Jolla lease)
$
52
$
8
Operating lease, current liability (Boca Raton lease)
20
-
Total
72
8
Long-term operating lease liability (La Jolla lease)
84
160
Long-term operating lease liability (Boca Raton lease)
620
-
704
160
Total lease liability
$
776
$
168
Weighted-average remaining lease term
4.6 years
4.5 years
Weighted-average discount rate
11.70
%
10.00
%
NOTE 6 – RELATED PARTY TRANSACTIONS
UCL
At December 31, 2021 and 2020, the Company owed
UCL Consultants Limited (“UCL”) $ 10,000 and $ 34,000 , respectively, in connection with medical research performed on behalf
of the Company. During the years ended December 31, 2021 and 2020, the Company paid UCL $ 218,000 and $ 335,000 , respectively, for medical
research performed on behalf of the Company. UCL is a wholly owned subsidiary of the University of London. The Company’s Chief Scientific
and Manufacturing Officer is a professor at the University of London.
CTI
During the
year ended December 31, 2021 and 2020, the Company paid CTI $ 0 and $ 127,000 , respectively, for medical research performed on behalf
of the Company. During the year ended December 31, 2020, the Company recorded a capital contribution of $ 216,000 for the forgiveness
of certain accounts payable due to CTI. During the years ended December 31, 2021 and 2020, the Company paid CTI $ 38,000 and $ 25,000 , respectively,
pursuant to its sublease agreement with CTI. See Note 5.
AmplifyBio
During the
year ended December 31, 2021, the Company engaged AmplifyBio to perform certain medical research on behalf of the Company. The CEO of
AmplifyBio is on the Board of Directors of the Company. At December 31, 2021, the Company owed AmplifyBio $ 70,000 . No amounts were paid
to AmplifyBio during 2021. The Company had no transactions with AmplifyBio during 2020.
NOTE
7 – DEBT
On June
10, 2021, the Company entered into a Loan and Security Agreement (the “Term Loan”) with Silicon Valley Bank and SVB Innovation
Credit Fund VIII, L.P., together (the “Lenders”). The Term Loan provides for a $ 15.0 million term loan, of which
the Company borrowed the entire amount on June 10, 2021, and is secured by the Company’s assets. The Term Loan also provides
for the Company to request an additional $ 5.0 million term loan from the Lenders, which may be granted or denied at the sole discretion
of the Lenders.
F- 13
The Company
paid the Lenders $ 47,000 to access the term loan, which has been included as a component of the debt discount and is amortized to
interest expense over the term of the loan. The term loan and debt discount are as follows as of December 31, 2021:
(in thousands)
Term Loan
$ 15,000
Less: debt discount and financing costs, net
( 542 )
Less: current portion
-
Long-term debt
$ 14,458
For the year ended December 31,
2021, the Company recognized interest expense of $ 985,000 related to the Term Loan.
The term
loan repayment schedule provided for interest only payments beginning on July 1, 2021, and continuing for 12 months, followed by monthly
principal and interest payments, starting on July 1, 2022 and continuing through the maturity date of January 1, 2025. During August
2021, the Lenders extended the interest-only period for one year due to the Company achieving an equity milestone as fully defined
in the Term Loan. As a result of achieving the equity milestone, monthly principal and interest payments begin on July 1, 2023. All outstanding
principal and accrued and unpaid interest will be due and payable on the maturity date. The Term Loan provides for an annual interest
rate equal to the greater of (i) the prime rate then in effect as reported in The Wall Street Journal plus 4.50 % and (ii) 7.75 %.
At December 31, 2021, the interest rate was 7.75 %.
The Term
Loan includes a final payment fee equal to 6.5 % of the original principal amount borrowed payable on the earlier of the repayment
of the loan in full and the maturity date. The Company has the option to prepay the outstanding balance of the term loans in full,
subject to a prepayment premium of (i) 3 % of the original principal amount borrowed for any prepayment on or prior to the first anniversary
of the loan, (ii) 2 % of the original principal amount borrowed for any prepayment after the first anniversary and on or before the
second anniversary of the loan or (iii) 1 % of the original principal amount borrowed for any prepayment after the second anniversary
of the loan but before the maturity date.
The expected
repayment of the $ 15.0 million Term loan principal is as follows as of December 31, 2021:
(in thousands,
except years)
2022
$ -
2023
5,833
2024
9,167
Total debt
15,000
Upon the
occurrence of certain events, including but not limited to the Company’s failure to satisfy its payment obligations under the Term
Loan, the breach of certain of its other covenants under the Term Loan, or the occurrence of a material adverse change, the Lenders will
have the right, among other remedies, to declare all principal and interest immediately due and payable, and will have the right to receive
the final payment fee and, if the payment of principal and interest is due prior to maturity, the applicable prepayment fee. The Company
was in compliance with its debt covenants at December 31, 2021.
F- 14
NOTE 8 – STOCKHOLDERS’ EQUITY
Common Stock – At the Market Offerings
During the year ended December 31, 2020, the Company
issued and sold 178,600 shares of common stock at an average price of $ 5.45 per share under the 2020 ATM agreement. The aggregate net
proceeds were approximately $ 0.8 million after BTIG’s commission and other offering expenses.
During the year ended December 31, 2021, the Company
sold 1,439,480 shares of its common stock at an average price of $ 20.17 per share under the 2020 ATM agreement. The aggregate net proceeds
were approximately $ 28.4 million after BTIG’s commission and other offering expenses.
During the year ended December 31, 2021, the Company
sold 713,192 shares of its common stock at an average price of $ 21.73 per share under the 2021 ATM agreement. The aggregate net proceeds
were approximately $ 14.9 million after BTIG’s commission and other offering expenses.
Registered
Direct Offering
During July
2021, the Company completed a registered direct offering whereby the Company sold 1,818,182 shares of its common stock to investors
for gross proceeds of $ 38.0 million (net proceeds of $ 36.9 million).
Underwritten Stock Offering
During July 2020, the Company completed an underwritten
public offering in which it sold 2,500,000 shares of common stock at a public offering price of $ 10.00 per share. The 2,500,000 shares
sold included the full exercise of the underwriters’ option to purchase 326,086 shares at a price of $ 10.00 per share. Aggregate
net proceeds from the underwritten public offering were $ 23.1 million, net of approximately $ 1.9 million in underwriting discounts and
commissions and offering expenses.
Issuance
of shares to Xencor
On June
10, 2021, the Company and Xencor entered into an Option Cancellation Agreement whereby the Company issued 192,533 shares of
its common stock to Xencor (See Note 4).
Lincoln Park
On May 15, 2019, the Company entered into both
a securities purchase agreement and registration rights agreement with Lincoln Park Capital Fund, LLC (“Lincoln Park”). Under
the terms and subject to the conditions of the securities purchase agreement, the Company had the right to sell to Lincoln Park, and Lincoln
Park was obligated to purchase, up to $20.0 million in shares of the Company’s common stock, subject to certain limitations, over
the 24-month period that commenced on May 15, 2019. During the year ended December 31, 2020, the Company issued 196,000 shares of its
common stock to Lincoln Park for approximately $1.0 million of cash.
During April 2021, the Company terminated the
securities purchase agreement with Lincoln Park.
Purchase and retirement of common stock
During January 2020, the Company purchased and
cancelled 220,000 shares of its common stock from a shareholder in exchange for $ 1,012,000 of cash. Immediately following the purchase,
the investor owned less than 10 % of the outstanding common stock of the Company.
F- 15
Common Stock Issued for Services
During July 2020, the Company granted a consultant
50,000 fully vested warrants with a 5 -year term, of which 25,000 warrants had an exercise price of $ 5.50 per share and 25,000 warrants
had an exercise price of $ 10.00 per share. The fair value of these warrants was $ 356,874 based on the Black-Scholes Option Pricing Model
and was recorded within general and administrative expense. The assumptions used for these warrants consist of the exercise prices, expected
dividends of 0 %, expected volatility of 111.67 % based on the trading history of similar companies, risk-free rate of 0.30 % based on the
applicable US Treasury bill rate and an expected life of 5.0 years. During July 2020, the Company issued the consultant 20,000 shares
of common stock and cancelled the 50,000 warrants. The 20,000 shares were issued from the Company’s 2019 Incentive Stock Plan and
had a fair value of approximately $ 230,000 based on the market value of the Company’s common stock on the grant date. The Company
accounted for the exchange of the warrants for shares of common stock as a modification and recorded no additional expense in connection
with the exchange as the fair value of warrants exceeded the fair value of the shares issued.
Settlement
In 2016, the Company entered into a settlement
agreement whereby the Company agreed to issue 33,335 shares of the Company’s common stock to an individual to settle a claim in
full. During 2020, the Company issued the 33,335 shares.
Stock options
During September 2020, the Company granted an
employee an option to purchase 40,000 shares of its common stock pursuant to the 2019 Incentive Stock Plan. The stock options vest over
four years and had a fair value of $ 339,731 that was calculated using the Black-Scholes option-pricing model. Variables used in the Black-Scholes
option-pricing model include: (1) discount rate of 0.46 % based on the applicable US Treasury bill rate (2) expected life of 6.25 years,
(3) expected volatility of approximately 106 % based on the trading history of similar companies, and (4) zero expected dividends.
During 2021, the Company granted various employees,
consultants and directors options to purchase 823,000 shares of common stock pursuant to the 2021, 2019 and 2017 Incentive Stock Plans.
The stock options vest over zero to four years and had a fair value of $ 14,027,000 that was calculated using the Black-Scholes option-pricing
model. Variables used in the Black-Scholes option-pricing model include: (1) discount rate of 0.78 -1. 49 %% based on the applicable US Treasury
bill rate (2) expected life of 6.00 - 10.00 years, (3) expected volatility of approximately 105 %- 114 % based on the trading history of similar
companies, and (4) zero expected dividends.
F- 16
The following table summarizes stock option activity:
(in thousands, except share and per share amounts)
Number
of
Shares
Weighted-
average
Exercise
Price
Weighted-
average
Remaining
Contractual
Term
(years)
Aggregate
Intrinsic
Value
Outstanding at January 1, 2020
3,417,000
$ 5.77
9.03
-
Options granted
40,000
$ 10.38
-
-
Options exercised
-
$ -
-
-
Options cancelled
-
$ -
-
-
Outstanding at January 1, 2021
3,457,000
$ 5.82
8.05
-
Options granted
823,000
$ 20.63
10.0
-
Options exercised
( 183,000 )
$ 6.21
-
-
Options cancelled
-
$ -
-
-
Outstanding at December 31, 2021
4,097,000
$ 8.67
7.21
$ 14,414
Exercisable at December 31, 2021
2,743,760
$ 6.45
6.91
$ 10,890
The Company
received $ 1,135,000 in cash proceeds from exercises of stock options during the year ended December 31, 2021.
During the years ended December 31, 2021 and 2020,
the Company recognized stock-based compensation expense of $ 4,796,000 and $ 2,755,000 , respectively, related to stock options. As of December
31, 2021, there was $ 13,308,000 of total unrecognized compensation cost related to non-vested stock options which is expected to be recognized
over a weighted-average period of 2.52 years.
Warrants
The Company
issued 45,386 warrants to the Company’s lenders upon obtaining its loan in June 2021. The warrants have a 10-year term
and an exercise price of $ 14.05 . The warrants have a fair value of approximately $ 0.6 million that was calculated using the Black-Scholes
option-pricing model. Variables used in the Black-Scholes option-pricing model include: (1) discount rate of 1.45 % based on the applicable
US Treasury bill rate (2) expected life of 10.0 years, (3) expected volatility of approximately 103 % based on the trading
history of similar companies, and (4) zero expected dividends. At December 31, 2021, the intrinsic value of these warrants is
$ 0 .
In connection
with the Company’s initial public offering in February 2019, the Company issued warrants to the placement agents to purchase the
Company’s common stock at an exercise price of $ 9.60 per common share, which warrants are exercisable until December 19, 2023. During
the year ended December 31, 2021, 6,147 of these warrants were exercised on a cashless basis in exchange for 3,758 shares
of common stock. At December 31, 2021, 28,688 of these warrants are outstanding and the intrinsic value is $ 17,000 .
On June
30, 2017, the Company issued fully vested warrants to purchase 31,667 shares of the Company’s common stock to a third
party in conjunction with the common stock sold for cash. The warrants have a $ 1.50 exercise price and expire on June 30, 2022 .
During the year ended December 31, 2021, 11,875 of these warrants were exercised for cash proceeds of $ 18,000 . At December 31,
2021, 19,792 of these warrants are outstanding, with an intrinsic value of $ 172,000 .
Stock-based Compensation by Class of Expense
The following summarizes the components of stock-based
compensation expense in the consolidated statements of operations for the years ended December 31, 2021 and 2020 respectively:
Year Ended
December 31,
2021
Year Ended
December 31,
2020
Research and development
$ 1,651,000
$ 583,000
General and administrative
3,145,000
2,529,000
Total
$ 4,796,000
$ 3,112,000
F- 17
Shareholder Rights Agreement
On December 30, 2020, the Board of Directors (the
“Board”) of the Company approved and adopted a Rights Agreement, dated as of December 30, 2020, by and between the Company
and VStock Transfer, LLC, as rights agent, pursuant to which the Board declared a dividend of one preferred share purchase right (each,
a “Right”) for each outstanding share of the Company’s common stock held by stockholders as of the close of business
on January 11, 2021. When exercisable, each right initially would represent the right to purchase from the Company one one-thousandth
of a share of a newly designated series of preferred stock, Series A Junior Participating Preferred Stock, par value $0.001 per share,
of the Company, at an exercise price of $300.00 per one one-thousandth of a Series A Junior Participating Preferred Share, subject to
adjustment. Subject to various exceptions, the Rights become exercisable in the event any person (excluding certain exempted or grandfathered
persons) becomes the beneficial owner of twenty percent or more of the Company’s common stock without the approval of the Board.
The Rights Agreement was scheduled to expire on December 30, 2021 but was extended until December 30, 2022 by the Board.
Preferred Stock
In 2020, the Company designated 45,000 shares
of its preferred stock with par value of $ 0.001 per share as Series A Junior Participating Preferred Stock. The remaining 9,955,000 shares
of preferred stock with par value of $ 0.001 remain undesignated. None of the preferred shares were issued and outstanding at December 31,
2021 and 2020.
NOTE 9– INCOME TAXES
The provision for income taxes consists of the
following components:
December 31,
2021
December 31,
2020
Current expense (benefit)
$ -
$ -
Federal
-
-
Foreign
-
-
Current income tax expense
-
-
Deferred expense (benefit)
-
-
Federal
-
-
Foreign
-
-
Deferred income tax
-
-
Net deferred taxes
$ -
$ -
A reconciliation of income tax benefit computed
using the federal statutory income tax rate to the Company’s tax expense is as follows:
(in thousands, except percentage)
December 31,
2021
December 31,
2020
Federal tax benefit at statutory rate (21%)
$ ( 6,381 )
$ ( 2,541 )
Stock-based compensation
1,156
599
State income tax benefit, net of federal tax effect
( 519 )
( 411 )
Foreign tax differential
( 41 )
( 61 )
Research credits
2,372
742
Other
2
1
Return to provision adjustment
166
33
Change in valuation allowance
3,245
1,638
Income tax benefit
$ -
$ -
F- 18
The principal components of deferred tax assets
and liabilities consist of the following at December 31, 2021 and 2020, respectively:
(in thousands)
December 31,
2021
December 31,
2020
Deferred tax assets
Stock-based compensation
$ 934
$ 563
Federal NOL carryforwards
3,702
2,202
Foreign NOL carryforwards
2,156
782
Total deferred tax assets
6,792
3,547
Less valuation allowance
( 6,792 )
( 3,547 )
Net deferred tax assets
$ -
$ -
At December 31, 2021, the Company had a federal
net operating loss carryforward of approximately $ 15.7 million. The net operating loss carryforwards for 2017 will begin to expire in
the year ending December 31, 2037 . The net operating loss carryforwards starting in 2018 have no expiration.
The Company’s gross deferred tax assets
of $ 6.8 million and $ 3.5 million at December 31, 2021 and 2020, respectively, primarily consist of net operating loss carryforwards for
income tax purposes. A valuation allowance is required to be recorded when it is not more likely than not that some portion or all of
the net deferred tax assets will be realized. Since the Company cannot be assured of generating taxable income and thereby realizing the
net deferred tax assets, a full valuation allowance has been recorded. The change in the valuation allowance was $ 3,245,000 during
the year ended December 31, 2021.
The Company recognizes uncertain tax positions
in accordance with ASC 740 on the basis of evaluating whether it is more likely than not that the tax positions will be sustained upon
examination by tax authorities. For those tax positions that meet the more-likely-than not recognition threshold, we recognize the largest
amount of tax benefit that is more than 50 percent likely to be realized upon ultimate settlement. As of December 31, 2021, and 2020,
the Company has no significant uncertain tax positions. There are no unrecognized tax benefits included on the balance sheet that would,
if recognized, impact the effective tax rate. The Company does not anticipate there will be a significant change in unrecognized tax benefits
within the next 12 months.
NOTE 10 – COLLABORATIVE AGREEMENTS
During the year ended December 31, 2020, the Company
was awarded a $500,000 grant from the Amyotrophic Lateral Sclerosis (“ALS”) Association to fund a study of the efficacy of
XPro to reverse ALS in vitro and to fund a study of the efficacy of XPro to protect against ALS model phenotypes in vivo. During the years
ended December 31, 2021 and 2020, the Company received $ 200,000 , and $ 300,000 , respectively of cash proceeds pursuant to this grant which
the Company recorded as deferred liabilities. The Company records costs incurred related to the ALS study as a reduction of the deferred
liabilities. As of December 31, 2021, the Company has $ 257,000 recorded as deferred liabilities related to the ALS grant.
During September 2020, the Company was awarded
a grant of up to $2.9 million from the National Institutes of Health (“NIH”). The grant will support a Phase 2 study of XPro
in patients with treatment resistant depression. As of December 31, 2021, the Company has not received any proceeds pursuant to this grant.
NOTE
11 – COMMITMENTS AND CONTINGENCIES
Lease
In May 2019,
the Company signed a sublease agreement with a related party for office space in La Jolla, California. The lease has a 61-month term,
which corresponds to the lease term of the lessor. The lessor is CTI.
During September
2021, the Company signed a lease agreement with a third party for office space in Boca Raton, Florida. The lease agreement has a 64-month
term and commenced during the fourth quarter of 2021.
Future minimum payments pursuant
to the leases are as follows:
(in thousands,
except years)
2022
$ 170
2023
237
2024
220
2025
193
2026
199
Thereafter
17
Total lease payments
1,036
Less: imputed interest
( 260 )
Present value of future lease payments
776
Less: operating lease, current liabilities
( 72 )
Long-term operating lease liabilities
$ 704
During the years ended December 31, 2021 and 2020,
the Company recognized $ 102,000 and $ 52,000 , respectively, in operating lease expense, which is included in general and administrative
expenses in the Company’s consolidated statement of operations.
F- 19
Litigation
The Company
is subject to claims and suits that arise from time to time in the ordinary course of our business. Although management currently believes
that resolving claims against the Company, individually or in aggregate, will not have a material adverse impact in the Company’s
consolidated financial statements, these matters are subject to inherent uncertainties and management’s view of these matters may
change in the future.
Item 9. Changes in and Disagreements with Accountants
on Accounting and Financial Disclosure
None.
Item 9A. Controls and Procedures
Disclosure Controls and Procedures
Evaluation of Disclosure Controls and Procedures
Our management, with the participation of our
Chief Executive Officer and Chief Financial Officer, evaluated the effectiveness of our disclosure controls and procedures as of December
31, 2021. The term “disclosure controls and procedures,” as defined in Rules 13a-15(e) and 15d-15(e) under the Securities
Exchange Act of 1934, as amended (the “Exchange Act”), means controls and other procedures of a company that are designed
to ensure that information required to be disclosed by a company in the reports that it files or submits under the Exchange Act is recorded,
processed, summarized and reported, within the time periods specified in the SEC’s rules and forms. Disclosure controls and procedures
include, without limitation, controls and procedures designed to ensure that information required to be disclosed by a company in the
reports that it files or submits under the Exchange Act is accumulated and communicated to the company’s management, including its
principal executive and principal financial officers, as appropriate to allow timely decisions regarding required disclosure. Management
recognizes that any controls and procedures, no matter how well designed and operated, can provide only reasonable assurance of achieving
their objectives and management necessarily applies its judgment in evaluating the cost-benefit relationship of possible controls and
procedures. Based on the evaluation, our Chief Executive Officer and Chief Financial Officer concluded that our disclosure controls and
procedures were effective at the reasonable assurance level as of December 31, 2021.
Attestation Report of the Registered Public
Accounting Firm
Our independent registered public accounting firm
will not be required to formally attest to the effectiveness of our internal controls over financial reporting for as long as we are an
“emerging growth company” pursuant to the provisions of the Jumpstart Our Business Startups Act.
Management’s Report on Internal Control
Over Financial Reporting
Our CEO and our CFO are responsible for establishing
and maintaining adequate internal control over financial reporting, as such term is defined in Exchange Act Rules 13a-15(f). Management
conducted an assessment of the effectiveness of our internal control over financial reporting as of December 31, 2021. In making this
assessment, management used the criteria described in Internal Control-Integrated Framework (2013) issued by the Committee of Sponsoring
Organizations of the Treadway Commission (“COSO”). Our management concluded that our internal controls over financial reporting
were effective based on those criteria, as of December 31, 2021.
Changes in Internal Control over Financial
Reporting
None.
Item 9B. Other Information
None.
Item 9C. Disclosure Regarding Foreign Jurisdictions
that Prevent Inspections
Not applicable.
74
PART III
Certain information required by Part III
is omitted from this report because the Company will file a definitive proxy statement within 120 days after the end of its fiscal
year pursuant to Regulation 14A (the Proxy Statement) for its annual meeting of stockholders, and certain information included
in the Proxy Statement is incorporated herein by reference.
Item 10. Directors, Executive Officers and
Corporate Governance
The information required by this Item 10
will be set forth in the Proxy Statement and is incorporated in this report by reference.
Item 11. Executive Compensation
The information required by this item will be
set forth in the Proxy Statement and is incorporated in this report by reference.
Item 12. Security Ownership of Certain Beneficial
Owners and Management and Related Stockholder Matters
Equity Compensation Plan Information
The following table provides certain information
with respect to all of our compensation plans in effect as of December 31, 2021:
Plan Category
(A)
Number of Securities to be Issued Upon Exercise of Outstanding Options, Warrants and Rights
(B)
Weighted Average Exercise Price of Outstanding Options, Warrants and Rights
(C)
Number of Securities Remaining Available for Future Issuance Under Equity Compensation Plans (excluding securities reflected in column(A))
Equity Compensation Plans approved by stockholders
4,097,000 (1)
$ 8.67
1,391,525 (2)
Equity Compensation Plans not approved by stockholders
—
—
—
Total
4,097,000
$ 8.67
1,391,525
(1)
Consists of shares subject to outstanding stock options, under the INmune Bio, Inc. 2021 Stock Incentive Plan (the “2021 Plan”), the 2019 Stock Incentive Plan (the “2019 Plan”) and INmune Bio, Inc. 2017 Stock Incentive Plan (the “2017 Plan) some of which are vested and some of which remain subject to the vesting of the respective equity award.
(2)
Consists of shares available for future issuance under the 2021 Plan, 2019 Plan and the 2017 Plan. As of December 31, 2021, an aggregate of 1,375,549 shares of common stock were available for issuance under the 2021 Plan, 7,313 shares of common stock were available for issuance under the 2019 Plan and 8,663 shares of common stock were available for issuance under the 2017 Plan.
Other
The other information required by this item will
be set forth in the Proxy Statement and is incorporated in this report by reference.
Item 13. Certain Relationships and Related
Transactions, and Director Independence
The information required by this item will be
set forth in the Proxy Statement and is incorporated in this report by reference.
Item 14. Principal Accounting Fees and Services
The information required by this item will be
set forth in the Proxy Statement and is incorporated in this report by reference.
75
PART IV
Item 15. Exhibits.
Exhibit No.
Description of Exhibit
1.1
Form of Placement Agent Agreement (Incorporated by reference to Exhibit 1.1 to the Registration Statement on Form S-1/A filed with the SEC on November 20, 2018).
1.2
Underwriting Agreement dated July 16, 2020 (Incorporated by reference to Exhibit 1.1 to the Current Report on Form 8-K filed with the SEC on July 16, 2020).
3.1
Certificate of Incorporation (Incorporated by reference to Exhibit 3.1 to the Registration Statement on Form S-1 filed with the SEC on August 30, 2018).
3.2
Bylaws (Incorporated by reference to Exhibit 3.2 to the Registration Statement on Form S-1 filed with the SEC on August 30, 2018).
3.3
Certificate of Designations of Series A Junior Participating Preferred Stock of INmune Bio Inc. (Incorporated by reference to Exhibit 3.1 to the Company’s Current Report on Form 8-K Filed with the SEC on December 30, 2020).
4.1
Description of Securities of INmune Bio, Inc.
4.2
Form of Registrant’s common stock certificate (Incorporated by reference to Exhibit 4.1 to the Registration Statement on Form S-1/A filed with the SEC on September 26, 2018).
4.3
Form of Placement Agent Common Stock Warrant (Incorporated by reference to Exhibit 4.2 to the Registration Statement on Form S-1/A filed with the SEC on September 26, 2018).
4.4
Rights Agreement, dated as of December 30, 2020 (Incorporated by reference to Exhibit 4.1 to the Company’s Current Report on Form 8-K filed with the SEC on December 30, 2020).
4.5
Amendment No. 1 to the Rights Agreement between INmune Bio, Inc. and VStock Transfer, LLC (Incorporated by reference to Exhibit 4.1 to the Company’s Current Report on Form 8-K filed with the SEC on December 21, 2021).
10.1
Form of Subscription Agreement (Incorporated by reference to Exhibit 10.1 to the Registration Statement on Form S-1 filed with the SEC on August 30, 2018).
10.2
License Agreement between INmune Bio, Inc. and Immune Ventures LLC (Incorporated by reference to Exhibit 10.2 to the Registration Statement on Form S-1 filed with the SEC on August 30, 2018).
10.3
Assignment and Assumption Agreement with Immune Ventures LLC (Incorporated by reference to Exhibit 10.3 to the Registration Statement on Form S-1 filed with the SEC on August 30, 2018).
10.4
Exclusive License Agreement by the University of Pittsburgh of the Common Wealth system of Higher Education and Immune Ventures LLC (Incorporated by reference to Exhibit 10.4 to the Registration Statement on Form S-1 filed with the SEC on August 30, 2018).
10.5
First Amendment to Exclusive License Agreement by and between the University of Pittsburgh of the Commonwealth system of Higher Education and Immune Ventures, LLC (Incorporated by reference to Exhibit 10.5 to the Registration Statement on Form S-1 filed with the SEC on August 30, 2018).
10.6
Material Transfer and License Agreement between Anthony Nolan Cord Blood Bank and Immune Bio International LTD. (Incorporated by reference to Exhibit 10.7 to the Registration Statement on Form S-1 filed with the SEC on August 30, 2018).
76
10.7
Employment Agreement between INmune Bio Inc. and Raymond Tesi (Incorporated by reference to Exhibit 10.8 to the Registration Statement on Form S-1 filed with the SEC on August 30, 2018).
10.8
Employment Agreement between INmune Bio Inc. and David Moss (Incorporated by reference to Exhibit 10.9 to the Registration Statement on Form S-1 filed with the SEC on August 30, 2018).
10.9
Consulting Agreement between INmune Bio Inc. and Mark Lowdell (Incorporated by reference to Exhibit 10.10 to the Registration Statement on Form S-1 filed with the SEC on August 30, 2018).
10.10
INmune Bio, Inc. 2017 Stock Incentive Plan (Incorporated by reference to Exhibit 10.11 to the Registration Statement on Form S-1 filed with the SEC on August 30, 2018).
10.11
Form of Incentive Option Agreement with employees (Incorporated by reference to Exhibit 10.12 to the Registration Statement on Form S-1 filed with the SEC on August 30, 2018).
10.12
Form of Incentive Option Agreement with non-employee directors (Incorporated by reference to Exhibit 10.13 to the Registration Statement on Form S-1 filed with the SEC on August 30, 2018).
10.13
License Agreement between INmune Bio Inc. and Xencor, Inc. (Incorporated by reference to Exhibit 10.15 to the Registration Statement on Form S-1 filed with the SEC on August 30, 2018).
10.14
Amendment to the Consultancy Agreement between INmune Bio Inc. and Mark Lowdell (Incorporated by reference to Exhibit 10.17 to the Registration Statement on Form S-1 filed with the SEC on August 30, 2018).
10.15
First Amendment to Stock Issuance Agreement (Incorporated by reference to Exhibit 10.20 to the Registration Statement on Form S-1 filed with the SEC on August 30, 2018).
10.16
Form of Waiver of Registration Rights. (Incorporated by reference to Exhibit 10.21 to the Registration Statement on Form S-1/A filed with the SEC on September 26, 2018).
10.17
Form of Subscription Agreement to be used in connection with the Best Efforts Offering (Incorporated by reference to the Registration Statement on Form S-1/A filed with the SEC on September 26, 2018).
10.18
Purchase Agreement between INmune Bio Inc. and Lincoln Park Capital Fund, LLC, dated May 15, 2019 (Incorporated by reference to Exhibit 10.1 to the Current Report on Form 8-K filed with the SEC on May 16, 2019).
10.19
Registration Rights Agreement between INmune Bio Inc. and Lincoln Park Capital Fund, LLC, dated May 15, 2019 (Incorporated by reference to Exhibit 10.2 to the Current Report on Form 8-K filed with the SEC on May 16, 2019).
10.20
Amendment to Securities Purchase Agreement between INmune Bio, Inc. and Raymond J. Tesi (Incorporated by reference to Exhibit 10.1 to the Current Report on Form 8-K filed with the SEC on May 17, 2019).
10.21
Amendment to Securities Purchase Agreement between INmune Bio, Inc. and David J. Moss (Incorporated by reference to Exhibit 10.1 to the Current Report on Form 8-K filed with the SEC on May 17, 2019).
10.22
Sublease between INmune Bio Inc. and CTI-Clinical Trial Services, Inc. (Incorporated by reference to Exhibit 99.1 to the Current Report on Form 8-K filed with the SEC on May 24, 2019).
10.23
Amendment No. 2 to Securities Purchase Agreement between INmune Bio, Inc. and Raymond J. Tesi (Incorporated by reference to Exhibit 10.3 to the Current Report on Form 8-K filed with the SEC on May 24, 2019).
10.24
INmune Bio, Inc. 2019 Stock Incentive Plan (Incorporated by reference to Exhibit 10.29 to the Form 10-K filed with the SEC on March 11, 2020).
10.25
At-the-Market Sales Agreement, dated April 16, 2020 (Incorporated by reference to Exhibit 1.1 to the Current Report on Form 8-K filed with the SEC on April 17, 2020).
10.26
Amendment NO. 1 to At-the-Market Sales Agreement 2020 (Incorporated by reference to Exhibit 1.1 to the Current Report on Form 8-K filed with the SEC on August 19, 2020).
10.27
Employment Agreement effective as of January 1, 2021 between INmune Bio Inc. and Raymond J. Tesi (incorporated by reference to our Annual Report on Form 10-K filed with the SEC on March 4, 2021).
10.28
Employment Agreement effective as of January 1, 2021 between INmune Bio Inc. and David Moss (incorporated by reference to our Annual Report on Form 10-K filed with the SEC on March 4, 2021).
10.29
Form of Securities Purchase Agreement (incorporated by reference to the Current Report on 8-K filed with the SEC on July 15, 2021).
77
10.30
Form of Placement Agency Agreement (incorporated by reference to the Current Report on Form 8-K filed with the SEC on July 15, 2021).
10.31
Lease Agreement dated September 13, 2021 (incorporated by reference to the Current Report on Form 8-K filed with the SEC on September 15, 2021).
10.32
At-the-Market Sales Agreement, dated March 10, 2021 between the Company and BTIG, LLC (incorporated by reference to the Current Report on Form 8-K filed with the SEC on March 11, 2021).
10.33
Financial Advisory Agreement dated March 29, 2021 between the Company and National Securities Corp. (incorporated by reference to the Current Report on Form 8-K filed with the SEC on March 29, 2021).
10.34
INmune Bio, Inc. 2021 Stock Incentive Plan (incorporated by reference to the Current Report on Form 8-K filed with the SEC on June 3, 2021).
10.35
Option Cancellation Agreement between the Company and Xencor, Inc. (incorporated by reference to the Current Report on Form 8-K filed with the SEC on June 15, 2021).
10.36
First Amendment to License Agreement (incorporated by reference to the Current Report on Form 8-K filed with the SEC on June 15, 2021).
10.37
Loan and Security Agreement (incorporated by reference to the Current Report on Form 8-K filed with the SEC on June 15, 2021).
10.38
Warrant to purchase common stock issued to SVB Innovation Credit Fund VIII, L.P. (incorporated by reference to the Current Report on Form 8-K filed with the SEC on June 15, 2021).
10.39
Warrant to purchase common stock issued to Silicon Valley Bank (incorporated by reference to the Current Report on Form 8-K filed with the SEC on June 15, 2021).
10.40
Form of nonqualified stock option agreement option agreement between the Company and non-employee directors (incorporated by reference to the Current Report on Form 8-K filed with the SEC on June 24, 2021).
10.41
Form of incentive stock option agreement between the Company and employees (incorporated by reference to the Current Report on Form 8-K filed with the SEC on June 24, 2021).
10.42
Securities Purchase Agreement (incorporated by reference to the Current Report on Form 8-K filed with the SEC on July 15, 2021).
10.43
Placement Agency Agreement (incorporated by reference to the Current Report on Form 8-K filed with the SEC on July 15, 2021).
10.44
Lease Agreement dated September 13, 2021 (incorporated by reference to the Current Report on Form 8-K filed with the SEC on September 15, 2021).
10.45
Amendment No. 1 to Rights Agreement (incorporated by reference to the Current Report on Form 8-K filed with the SEC on December 20, 2021).
21.1
Subsidiaries (incorporated by reference to our Annual Report on Form 10-K filed with the SEC on March 4, 2021).
23.1
Consent of Marcum LLP, independent registered public accounting firm.
31.1
Certification of principal executive officer pursuant to Section 3.02 of the Sarbanes-Oxley Act of 2002.
31.2
Certification of principal financial officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.
32.1
Certification of principal executive officer pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.
32.2
Certification of principal financial officer pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.
101.INS
Inline XBRL
Instance Document
101.SCH
Inline XBRL Taxonomy
Extension Schema Document
101.CAL
Inline XBRL Taxonomy
Extension Calculation Linkbase Document
101.DEF
Inline XBRL Taxonomy
Extension Definition Linkbase Document
101.LAB
Inline XBRL Taxonomy
Extension Label Linkbase Document
101.PRE
Inline XBRL Taxonomy
Extension Presentation Linkbase Document
104
Cover Page Interactive Data File (formatted as Inline XBRL and contained
in Exhibit 101)
Item 16. Form 10-K Summary
None.
78
SIGNATURES
Pursuant to the requirements of Section 13 or
15(d) of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned,
thereunto duly authorized.
INMUNE BIO INC.
/s/ Raymond J. Tesi, M.D.
Dated: March 3, 2022
Raymond J. Tesi, M.D.
Chief Executive Officer
(Principal Executive Officer)
/s/ David J. Moss
Dated: March 3, 2022
David J. Moss
Chief Financial Officer
(Principal Financial and Accounting Officer)
Pursuant to the requirements of the Securities
Exchange Act of 1934, this report has been signed below by the following persons on behalf of the registrant and in the capacities and
on the dates indicated.
Signature
Title
Date
/s/ Raymond J. Tesi, M.D.
Raymond J. Tesi, M.D.
President, Chief Executive Officer and Director
(Principal Executive Officer)
March 3, 2022
/s/ David J. Moss
David J. Moss
Chief Financial Officer, Treasurer, Secretary
(Principal Financial and Accounting Officer)
March 3, 2022
/s/ Timothy Schroeder
Timothy Schroeder
Director
March 3, 2022
/s/ J. Kelly Ganjei
J. Kelly Ganjei
Director
March 3, 2022
/s/ Scott Juda, JD
Scott Juda, JD
Director
March 3, 2022
/s/ Edgardo Baracchini
Edgardo Baracchini
Director
March 3, 2022
/s/ Marcia Allen
Marcia Allen
Director
March 3, 2022
79
Text extracted from the filing as submitted to EDGAR. Formatting, tables and exhibits are simplified for reading; the original document is authoritative for anything you rely on.