Item 7. Management’s Discussion and Analysis
Item
7. Management’s Discussion and Analysis of Financial Condition and Results of Operations.
The following discussion
and analysis of our financial condition and results of operations should be read in conjunction with our consolidated financial
statements and related notes appearing elsewhere in this Annual Report. This discussion contains forward-looking statements
that reflect our plans, estimates and beliefs, and involve risks and uncertainties. Our actual results and the timing
of certain events could differ materially from those anticipated in these forward-looking statements as a result of several
factors, including those discussed in the section titled “Risk Factors” included under Part I, Item 1A and elsewhere in this
Annual Report. See “Special Note Regarding Forward-Looking Statements” in this Annual Report.
Overview
We
are a clinical stage biopharmaceutical company focused on developing drugs that meaningfully improve the lives of patients with rare
cardiopulmonary disease. Our initial focus is on advancing AV-101, our dry powder inhaled formulation of imatinib for the treatment of
pulmonary arterial hypertension, or PAH, a devastating disease impacting approximately 70,000 people in the United States and Europe.
Imatinib, marketed as Gleevec tablets, was originally developed for the treatment of multiple cancers. Oral imatinib also demonstrated
statistically significant improvement on the primary endpoint, six-minute walk distance, and multiple secondary hemodynamic endpoints
in PAH patients in an international Phase 3 trial conducted by Novartis but was poorly tolerated due to adverse events, or AEs, and never
approved for the treatment of PAH. AV-101, delivered using a dry powder inhaler, is designed to provide lung concentrations at or above
those observed with the oral dose while limiting systemic levels of the drug. We have completed a Phase 1 study in healthy volunteers
and AV-101 was generally well-tolerated with no serious adverse events reported. We announced the initiation of Inhaled iMatinib Pulmonary
Arterial Hypertension Clinical Trial (IMPAHCT), our Phase 2b/Phase 3 trial of AV-101 in PAH patients in December 2021, and we
have assembled a team with deep expertise in developing innovative PAH and inhaled therapies and commercializing novel drugs.
We
do not have any products approved for sale and have incurred significant operating losses since our inception and expect to continue
to incur significant operating losses for the foreseeable future.
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Recent
Developments
Initial
Public Offering
In
July 2021, we completed our initial public offering, or IPO, of 9,984,463 shares of our common stock at a price to the public of $14.00
per share, including the exercise in full by the underwriters of their option to purchase 1,302,321 additional shares of our common stock.
Including the option exercise, our aggregate net proceeds from the offering were $126.9 million after deducting underwriting discounts
and commissions and other offering costs. Immediately prior to the closing of our IPO, all outstanding shares of our redeemable convertible
preferred stock were converted into 14,182,854 shares of our common stock.
COVID-19
Pandemic
The
global coronavirus disease 2019, or COVID-19, pandemic continues to evolve, and we will continue to monitor the COVID-19 situation. The
extent of the impact of the ongoing COVID-19 pandemic and its variants on our business, operations and clinical development timelines,
supply chain and plans remains uncertain, and will depend on certain developments, including the duration and spread of the outbreak,
including the identification of new variants of the virus, and its impact on our clinical trial enrollment, trial sites, contract
research organizations, or CROs, third-party manufacturers, and other third parties with whom we do business, as well
as its impact on regulatory authorities and our key scientific and management personnel. The ultimate impact of the ongoing COVID-19
pandemic or a similar health epidemic is highly uncertain and subject to change. To the extent possible, we are conducting business as
usual, with only necessary or advisable modifications to employee travel.
We will continue
to actively monitor the rapidly evolving situation related to COVID-19 and may take further actions that alter our operations, including
those that may be required by federal, state or local authorities, or that we determine are in the best interests of our employees and
other third parties with whom we do business. At this point, the extent to which the ongoing COVID-19 pandemic may affect our business,
operations and clinical development timelines and plans, including the resulting impact on our expenditures and capital needs, remains
uncertain and is subject to change.
Components
of Results of Operations
Revenue
We
currently have no products approved for sale, and we have not generated any revenue to date. In the future, we may generate revenue from
collaboration or license agreements we may enter into with respect to our drug candidate, as well as product sales from any approved
product, which approval we do not expect to occur for at least the next several years, if ever. Our ability to generate product revenue
will depend on the successful development and eventual commercialization of AV-101 and any other drug candidates we may pursue. If we
fail to complete the development of AV-101 in a timely manner, or to obtain regulatory approval, our ability to generate future revenue
and our results of operations and financial position would be materially adversely affected.
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Operating
Expenses
Research
and Development
To
date, our research and development expenses have related to the development of AV-101. Research and development expenses are recognized
as incurred and payments made prior to the receipt of goods or services to be used in research and development are capitalized until
the goods or services are received.
Research
and development expenses include:
● external
research and development expenses incurred under agreements with contract research organizations,
or CROs, and consultants to conduct and support clinical trials of AV-101 and our preclinical
studies;
● costs
related to manufacturing AV-101 for use in clinical trials; and
● personnel-related
costs, including salaries, payroll taxes, employee benefits, and stock-based compensation
charges for those individuals involved in research and development efforts.
Our
research and development expenses consist principally of direct costs, such as fees paid to CROs, investigative sites and consultants
in connection with our clinical trials, preclinical and non-clinical studies, and costs related to manufacturing clinical trial materials.
We deploy our personnel related resources across all of our research and development activities. We track direct expenses on a clinical
and non-clinical basis.
We
plan to substantially increase our research and development expenses for the foreseeable future as we continue the development of AV-101.
We cannot determine with certainty the timing of initiation, the duration or the completion costs of current or future clinical trials
and nonclinical studies of AV-101 or any future product candidates due to the inherently unpredictable nature of clinical and preclinical
development. Clinical and preclinical development timelines, the probability of success and development costs can differ materially from
expectations. We will need to raise substantial additional capital in the future.
Our
future clinical development costs may vary significantly based on factors such as:
● per
patient trial costs;
● the
number of trials required for approval;
● the
number of sites included in the trials;
● the
countries in which the trials are conducted;
● the
length of time required to enroll eligible patients;
● the
number of patients that participate in the trials;
● the
number of doses evaluated in the trials;
● the
drop-out or discontinuation rates of patients;
● potential
additional safety monitoring requested by regulatory agencies;
● the
duration of patient participation in the trials and follow-up; and
● the
efficacy and safety profile of the product candidate.
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General
and Administrative
General
and administrative expenses consist primarily of personnel-related costs, including salaries, payroll taxes, employee benefits, and stock-based
compensation charges for those individuals in executive, finance and other administrative functions. Other significant costs include
legal fees relating to intellectual property and corporate matters, professional fees for accounting and consulting services, and insurance
costs. We anticipate that our general and administrative expenses will increase for the foreseeable future to support our continued research
and development activities, pre-commercial preparation activities and commercialization activities for AV-101. We also anticipate increased
expenses related to audit, legal, regulatory, and tax-related services associated with maintaining compliance with exchange listing and
SEC requirements, director and officer insurance premiums, and investor relations costs associated with operating as a public company.
Interest
Income (Expense)
Interest
income consists of interest earned on our cash and cash equivalents and short-term investments. Interest expense consisted of interest
on our convertible promissory notes at a per annum interest rate of 6%. All convertible promissory notes converted into shares of our
Series A redeemable convertible preferred stock in August 2020.
Change
in Fair Value of Convertible Promissory Notes
We
issued convertible promissory notes in 2020 and 2019 for which we elected the fair value option. We adjusted the carrying value of our
convertible promissory notes to their estimated fair value at each reporting date, with any change in fair value of the convertible promissory
notes recorded as an increase or decrease to change in fair value of convertible promissory notes in our statements of operations and
comprehensive loss. All convertible promissory notes and related accrued interest converted into shares of Series A redeemable convertible
preferred stock in August 2020.
Prior
to their conversion into our Series A redeemable convertible preferred stock issued in August 2020, the fair value of convertible promissory
notes issued through July 2020 was estimated using a scenario-based analysis that estimated the fair value of the convertible promissory
notes based on the probability-weighted present value of expected future investment returns, considering possible outcomes available
to the noteholders, including conversions in subsequent equity financings, change of control transactions, settlement and dissolution.
Results
of Operations
Comparison
of the Years Ended December 31, 2021 and December 31, 2020
The
following table summarizes our results of operations for the years ended December 31, 2021 and December 31, 2020 (in thousands):
Years
Ended December 31,
2021
2020
Change
Operating
expenses:
Research
and development
$ 14,987
$ 7,940
$ 7,047
General
and administrative
8,035
949
7,086
Total
operating expenses
23,022
8,889
14,133
Loss
from operations
(23,022 )
(8,889 )
(14,133 )
Other
income (expense):
Interest
income (expense)
65
(75 )
140
Change
in fair value of convertible promissory notes
-
(644 )
644
Other
expense
(3 )
(3 )
-
Total
other income (expense)
62
(722 )
784
Net
loss before income taxes
(22,960 )
(9,611 )
(13,349 )
Provision
for income taxes
3
-
3
Net
loss
$ (22,963 )
$ (9,611 )
$ (13,352 )
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Research
and Development Expenses
Research
and development expenses for the year ended December 31, 2021 were $15.0 million compared to $7.9 million for the year ended December
31, 2020. The increase of $7.0 million was primarily due to increases of $4.1 million in clinical trial costs, $2.8 million in
manufacturing costs, $0.8 million in payroll, $0.4 million in stock-based compensation and $0.1 million in professional fees, partially
offset by lower pre-clinical related costs of $1.2 million.
General
and Administrative Expenses
General
and administrative expenses for the year ended December 31, 2021 were $8.0 million compared to $0.9 million for the year ended December
31, 2020. The increase of $7.1 million was primarily due to increases of $1.5 million in payroll, $1.6 million in stock-based compensation,
$2.1 million in professional services related to other consulting expenses, corporate legal fees
and audit and accounting services, $1.4 million in insurance expense and $0.5 million in other operating expenses.
Total
Other Income (Expense)
Other
income for the year ended December 31, 2021 was $0.1 million compared to $0.7 million of other expense for the year ended December 31,
2020. The change of $0.8 million was due to the change in fair value of the convertible promissory notes and interest expense on the
convertible promissory notes for the year ended December 31, 2020 and interest earned on the Company’s cash and cash equivalents
and short-term investments for the year ended December 31, 2021.
Liquidity
and Capital Resources
From
our inception through December 31, 2021, we have received aggregate net proceeds of $79.4 million from the sale of shares of our convertible
preferred stock and $5.0 million from convertible promissory notes to related parties. In July 2021, we completed our IPO with
aggregate net proceeds from the offering of $126.9 million, after deducting underwriting discounts and commissions
and offering costs.
Future
Funding Requirements
We
have prepared operating plans and cash flow forecasts which indicate that our existing cash and cash equivalents and short-term investments
on-hand of $167.4 million will be sufficient to fund our planned operations into the second half of 2025. However, our forecast of the
period of time through which our financial resources will be adequate to support our operations is a forward-looking statement that involves
risks and uncertainties, and actual results could vary materially. We have based this estimate on assumptions that may prove to be wrong,
and we could deplete our capital resources sooner than we expect. Additionally, the process of conducting clinical trials is costly,
and the timing of progress and expenses in these trials is uncertain.
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Our
future capital requirements will depend on many factors, including:
● the
type, number, scope, results, costs and timing of preclinical studies and clinical trials
of AV-101, including changes to our development plan based on feedback received from regulatory
authorities, and preclinical studies or clinical trials of other potential drug candidates
or indications we may choose to pursue in the future;
● the
costs and timing of manufacturing for AV-101 or any other product candidates, including commercial
scale manufacturing;
● the
costs, timing and outcome of regulatory review and approval of AV-101 or any other drug candidates;
● the
costs of obtaining, maintaining and enforcing our patents and other intellectual property
rights;
● our
efforts to enhance operational systems and hire additional personnel to satisfy our obligations
as a public company, including enhanced internal controls over financial reporting;
● the
costs associated with hiring additional personnel and consultants as our business grows,
including additional clinical development personnel;
● the
terms and timing of establishing and maintaining collaborations, licenses and other similar
arrangements;
● the
timing and amount of the milestone or other payments we must make to any future licensors,
if we enter into any license agreements;
● the
costs and timing of establishing or securing sales and marketing capabilities if AV-101 or
any other product candidate is approved;
● our
ability to achieve sufficient market acceptance, coverage and adequate reimbursement from
third- party payors and adequate market share and revenue for any approved products;
● patients’
ability and willingness to pay out-of-pocket costs for any approved products in the absence
of coverage and/or adequate reimbursement from third-party payors; and
● costs
associated with any products or technologies that we may in-license or acquire.
Until
such time, if ever, as we can generate substantial product revenue to support our cost structure, we expect to finance our cash needs
through equity offerings, debt financings, or other capital sources, potentially including collaborations, licenses and other similar
arrangements. However, we may be unable to raise additional funds or enter into such other arrangements when needed on favorable terms
or at all. To the extent that we raise additional capital through the sale of equity or convertible debt securities, the ownership interest
of our stockholders will be or could be diluted, and the terms of these securities may include liquidation or other preferences that
adversely affect the rights of our common stockholders. Debt financing and equity financing, if available, may involve agreements that
include covenants limiting or restricting our ability to take specific actions, such as incurring additional debt, making capital expenditures
or declaring dividends. If we raise funds through collaborations, or other similar arrangements with third parties, we may have to relinquish
valuable rights to our technologies, future revenue streams, research programs or drug candidates or grant licenses on terms that may
not be favorable to us and/or may reduce the value of our common stock. Our failure to raise capital or enter into such other arrangements
when needed could have a negative impact on our financial condition and on our ability to pursue our business plans and strategies. If
we are unable to raise additional funds through equity or debt financings when needed, we may be required to delay, limit, reduce or
terminate our product development or future commercialization efforts or grant rights to develop and market our drug candidates even
if we would otherwise prefer to develop and market such drug candidates ourselves.
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Contractual Obligations and Commitments
In
August 2021, we entered into a lease agreement, or the Waltham Lease, for approximately 5,000 square feet of office space in Waltham,
Massachusetts. The base rent under the Waltham Lease is $43.00 per rentable square foot, or approximately $18,000 per month and is subject
to scheduled annual increases of $1.00 per rentable square foot during the lease term. The term of the Waltham Lease is thirty-nine months,
unless extended or earlier terminated pursuant to the terms of the Waltham Lease. We have the option to extend the Waltham Lease for
one additional period of three years.
As
of December 31, 2021, we do not have any other operating lease obligations, long-term debt obligations, capital lease obligations, purchase
obligations or long-term liabilities.
We
enter into contracts in the normal course of business for contract research services, contract manufacturing services, professional services
and other services and products for operating purposes. These contracts generally provide for termination after a notice period, and,
therefore, are cancelable contracts and not included above.
Cash
Flows
Comparison
of the Years Ended December 31, 2021 and December 31, 2020
The
following table sets forth a summary of the net cash flow activity for the years ended December 31, 2021 and December 31, 2020 (in thousands):
Years
Ended December 31,
2021
2020
Net
cash used in operating activities
$ (27,399 )
$ (7,859 )
Net
cash used in investing activities
(113,434 )
-
Net
cash provided by financing activities
190,457
8,918
Net
increase in cash
$ 49,624
$ 1,059
Operating
Activities
Net
cash used in operating activities for the year ended December 31, 2021 was $27.4 million, consisting primarily of our net loss incurred
during the period of $23.0 million adjusted for $2.1 million of noncash charges and $6.5 million for net changes in operating
assets and liabilities. Noncash charges consisted primarily of $2.0 million in stock-based compensation expense. The net change in operating
assets and liabilities related to a $6.8 million increase in prepaid expenses and other current assets and a $0.3 million increase in
other long-term assets partially offset by a $0.6 million increase in accounts payable.
Net
cash used in operating activities for the year ended December 31, 2020 was $7.9 million, consisting primarily of our net loss incurred
during the period of $9.6 million adjusted for $0.8 million of noncash charges and $1.0 million for net changes in operating assets and
liabilities. Noncash charges consisted primarily of $0.6 million in change in fair value of convertible promissory notes to related party.
The net change in operating assets and liabilities related to a $1.0 million increase in accounts payable and accrued and other current
liabilities partially offset by a $0.1 million increase in prepaid and other current assets.
Investing
Activities
Net
cash used by investing activities for the year ended December 31, 2021 of $113.4 million was comprised of purchases of short-term investments
of $113.2 million using the proceeds from our initial public offering in July 2021 and purchases of property and equipment of $0.2 million
for purchases of property and equipment to support our research activities and leasehold improvements,
furniture and fixtures for our office space in Waltham, Massachusetts.
Financing
Activities
Net
cash provided by financing activities for the year ended December 31, 2021 was $190.5 million due to $63.6 million in net proceeds received
from the First Milestone Closing, Second Milestone Closing and Third Milestone Closing of Series A redeemable convertible preferred stock,
net of issuance of costs, and $126.9 million in net proceeds from the issuance of common stock, net of issuance costs, in connection
with the closing of the Company’s IPO on July 2, 2021.
Net
cash provided by financing activities for the year ended December 31, 2020 was $8.9 million, primarily related to $6.4 million in net
proceeds received from the sale of Series A redeemable convertible preferred stock and through the issuance and conversion of $2.5 million
of convertible promissory notes to related parties issued in July 2020.
97
Critical
Accounting Policies and Estimates
Our
consolidated financial statements are prepared in accordance with generally accepted accounting principles in the United States, or
U.S. GAAP .
The preparation of our consolidated financial statements requires us to make estimates and assumptions that affect the reported amounts
of assets, liabilities, expenses and the related disclosures of contingent liabilities in our consolidated financial statements and accompanying
notes. We base our estimates and assumptions on historical experience and other factors that we believe to be reasonable under the circumstances.
We evaluate our estimates and judgments on an ongoing basis. Actual results may differ significantly from these estimates under different
assumptions, judgments or conditions.
S ee
Note 2 to our consolidated financial statements included in Part II, Item 8 of this Annual Report on Form 10-K for a summary of significant
accounting policies and the effect on our consolidated financial statements.
Research
and Development Expenses
We
are required to estimate our expenses resulting from obligations under contracts with vendors, consultants and CROs, in connection with
conducting research and development activities. The financial terms of these contracts are subject to negotiations, which vary from contract
to contract and may result in payment flows that do not match the periods over which materials or services are provided under such contracts.
We reflect research and development expenses in our consolidated financial statements by matching those expenses with the period in which
services and efforts are expended. We account for these expenses according to the progress of the preclinical or clinical study as measured
by the timing of various aspects of the study or related activities. We determine clinical trial cost estimates through review of the
underlying contracts along with preparation of financial models taking into account discussions with research and other key personnel
and outsider service providers as to the progress of studies or other services being conducted. During the course of a study, we adjust
our rate of expense recognition if actual results differ from our estimates.
Emerging
Growth Company Status
As
an emerging growth company under the Jumpstart Our Business Startups Act of 2012, or the JOBS Act, we can take advantage of an extended
transition period for complying with new or revised accounting standards. This allows an emerging growth company to delay the adoption
of certain accounting standards until those standards would otherwise apply to private companies. We have elected to “opt out”
of such extended transition period, which means that when a standard is issued or revised and it has different application dates for
public or private companies, we will adopt the new or revised standard at the time public companies adopt the new or revised standard.
The decision to opt out of the extended transition period under the JOBS Act is irrevocable.
Recently
Issued Accounting Pronouncements
We
have reviewed all recently issued accounting pronouncements by the FASB and other standard-setting bodies and have determined
that such standards that do not require adoption until a future date are not expected to have a material impact on our consolidated financial statements, if adopted, or do not otherwise apply to our operations.