UNITED
STATES
SECURITIES
AND EXCHANGE COMMISSION
Washington,
D.C. 20549
FORM
10-K
☒
ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d)
OF
THE SECURITIES EXCHANGE ACT OF 1934
For
the fiscal year ended December 31 , 2021
OR
☐
TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d)
OF
THE SECURITIES EXCHANGE ACT OF 1934
For
the transition period from___________ to __________
Commission
file number 001-12830
Lineage
Cell Therapeutics, Inc.
(Exact
name of registrant as specified in its charter)
California
94-3127919
(State or other jurisdiction of
incorporation or organization)
(I.R.S. Employer
Identification No.)
2173
Salk Avenue , Suite 200
Carlsbad ,
California 92008
(Address
of principal executive offices) (Zip Code)
Registrant’s
telephone number, including area code ( 442 ) 287-8990
Securities
registered pursuant to Section 12(b) of the Act
Title
of each class
Trading
Symbol(s)
Name
of each exchange on which registered
Common
stock
LCTX
NYSE
American
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 check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange
Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2)
has been subject to such filing requirements for the past 90 days. Yes ☒ No ☐
Indicate
by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule
405 of Regulation S-T (§ 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, a smaller reporting
company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,”
“smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the Exchange Act.
Large
accelerated filer ☐
Accelerated
filer ☐
Non-accelerated
filer ☒
Smaller
reporting company ☒
Emerging
growth company ☐
If
an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying
with any new or revised financial accounting standards provided 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 ☒
As
of June 30, 2021, the last business day of the registrant’s most recently completed second fiscal quarter, the aggregate market
value of the registrant’s voting and non-voting common equity held by non-affiliates of the registrant was approximately $ 356.8
million.
The
number of common shares outstanding as of March 4, 2022 was 169,709,292
DOCUMENTS INCORPORATED BY REFERENCE
Portions of the registrant’s definitive proxy statement relating
to its 2022 annual meeting of shareholders are incorporated by reference into Part III of this Annual Report on Form 10-K where indicated.
Lineage
Cell Therapeutics, Inc.
Table
of Contents
Page
Number
Part I .
Item
1
Business
6
Item
1A
Risk Factors
33
Item
1B
Unresolved Staff Comments
65
Item
2
Properties
65
Item
3
Legal Proceedings
65
Item
4
Mine Safety Disclosures
66
Part II.
Item
5
Market For Registrant’s Common Equity, Related Stockholder Matters, and Issuer Purchases of Equity Securities
67
Item
6
Reserved
67
Item
7
Management’s Discussion and Analysis of Financial Condition and Results of Operations
68
Item
7A
Quantitative and Qualitative Disclosures about Market Risk
78
Item
8
Financial Statements and Supplementary Data
79
Item
9
Changes in and Disagreements With Accountants on Accounting and Financial Disclosure
121
Item
9A
Controls and Procedures
121
Item
9B
Other Information
121
Item
9C
Disclosure Regarding Foreign Jurisdictions that Present Inspections
121
Part III.
Item
10
Directors, Executive Officers, and Corporate Governance
122
Item
11
Executive Compensation
122
Item
12
Security Ownership of Certain Beneficial Owners and Management, and Related Stockholder Matters
122
Item
13
Certain Relationships and Related Transactions, and Director Independence
122
Item
14
Principal Accountant Fees and Services
122
Part IV.
Item
15
Exhibits and Financial Statements Schedules
123
Item
16
Form 10-K Summary
124
Signatures
125
2 | P a g e
PART
I
FORWARD-LOOKING
STATEMENTS
This
Annual Report on Form 10-K (this “Report”) contains forward-looking statements within the meaning of Section 27A of the Securities
Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended (the “Exchange Act”), that involve
substantial risks and uncertainties. The forward-looking statements are contained principally in Part I, Item 1. “Business,”
Part I, Item 1A. “Risk Factors,” and Part II, Item 7. “Management’s Discussion and Analysis of Financial Condition
and Results of Operations,” but are also contained elsewhere in this Report. In some cases, you can identify forward-looking statements
by the words “may,” “might,” “will,” “could,” “would,” “should,”
“expect,” “intend,” “plan,” “objective,” “anticipate,” “believe,”
“estimate,” “predict,” “project,” “potential,” “continue” and “ongoing,”
or the negative of these terms, or other comparable terminology intended to identify statements about the future. These statements involve
known and unknown risks, uncertainties and other factors that may cause our actual results, levels of activity, performance or achievements
to be materially different from the information expressed or implied by these forward-looking statements. Although we believe that we
have a reasonable basis for each forward-looking statement contained in this Report, we caution you that these statements are based on
a combination of facts and factors currently known by us and our expectations of the future, about which we cannot be certain. Forward-looking
statements include statements about:
●
statements relating to the collaboration and license
agreement with Roche and Genentech and activities expected to occur thereunder, the upfront, milestone and royalty consideration
payable to Lineage and Lineage’s planned use of proceeds therefrom;
●
our
plans to research, develop and commercialize our product candidates;
●
the
initiation, progress, success, cost and timing of our clinical trials and product development activities;
●
the
therapeutic potential of our product candidates, and the disease indications for which we intend to develop our product candidates;
●
our
ability to manufacture our product candidates for clinical development and, if approved, for commercialization, and the timing and
costs of such manufacture;
●
the
performance of third parties in connection with the development and manufacture of our product candidates, including third parties
conducting our clinical trials as well as third-party suppliers and manufacturers;
●
the
potential of our cell therapy platform, and our plans to apply our platform to research, develop and commercialize our product candidates;
●
our
ability to obtain funding for our operations, including funding necessary to initiate and complete clinical trials of our product
candidates;
●
the
size and growth of the potential markets for our product candidates and our ability to serve those markets;
●
the
potential scope and value of our intellectual property rights;
●
our
ability, and the ability of our licensors, to obtain, maintain, defend and enforce intellectual property rights protecting our product
candidates, and our ability to develop and commercialize our product candidates without infringing the proprietary rights of third
parties;
●
our
ability to recruit and retain key personnel;
●
the
effects of the COVID-19 pandemic on our operations; and
●
other
risks and uncertainties, including those described under Part I, Item 1A. Risk Factors of this Report.
3 | P a g e
You
should refer to “Item 1A. Risk Factors” in this Report for a discussion of important factors that may cause our actual results
to differ materially from those expressed or implied by our forward-looking statements. As a result of these factors, we cannot assure
you that the forward-looking statements in this Report will prove to be accurate. Furthermore, if our forward-looking statements prove
to be inaccurate, the inaccuracy may be material. In light of the significant uncertainties in these forward-looking statements, you
should not regard these statements as a representation or warranty by us or any other person that we will achieve our objectives and
plans in any specified time frame, or at all. The forward-looking statements in this Report represent our views as of the date of this
Report. We anticipate that subsequent events and developments may cause our views to change. However, while we may elect to update these
forward-looking statements at some point in the future, we undertake no obligation to publicly update any forward-looking statements,
whether as a result of new information, future events or otherwise, except as required by law. You should, therefore, not rely on these
forward-looking statements as representing our views as of any date subsequent to the date of this Report.
You
should read this Report and the documents that we reference in this Report completely and with the understanding that our actual future
results may be materially different from what we expect. We qualify all of our forward-looking statements by these cautionary statements.
This
Report also contains market data, industry forecasts and other data made by independent parties and by us relating to market size and
growth and other data about our industry. This data involves a number of assumptions and limitations, and you are cautioned not to give
undue weight to such estimates. In addition, projections, assumptions and estimates of our future performance and the future performance
of the markets in which we operate are necessarily subject to a high degree of uncertainty and risk.
All
brand names or trademarks appearing in this Report are the property of their respective owners. Solely for convenience, the trademarks
and trade names in this Report are referred to without the symbols ® and TM , but such references should not
be construed as any indication that their respective owners will not assert, to the fullest extent under applicable law, their rights
thereto.
Unless
the context requires otherwise, references in this report to “Lineage,” “we,” “us,” and “our”
refer to Lineage Cell Therapeutics, Inc. and its consolidated subsidiaries.
RISK
FACTOR SUMMARY
Below
is a summary of the material factors that make an investment in our common shares 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” in Item 1A of Part I of this Report and should be carefully considered,
together with other information in this Report and our other filings with the Securities and Exchange Commission (“Commission”)
before making investment decisions regarding our common shares.
●
We
have incurred operating losses since inception, and we do not know if or when we will attain profitability.
●
We
will continue to spend a substantial amount of our capital on research and development, but we might not succeed in developing products
and technologies that are useful in medicine.
●
The
amount and pace of research and development work that we can do or sponsor, and our ability to commence and complete clinical trials
required to obtain regulatory approval to market our therapeutic and medical device products, depends upon the amount of funds we
have.
●
We
are dependent on our third-party collaboration with Roche to develop and commercialize OpRegen. If Roche is not successful in developing
and commercializing OpRegen, we will lose a significant source of potential revenue.
●
We
will need to issue additional equity or debt securities in order to raise capital needed to pay our operating expenses.
4 | P a g e
●
We
may be subject, directly or indirectly, to federal and state healthcare fraud and abuse laws, including anti-kickback and false claims
laws, transparency laws, and health information privacy and security laws. If we are unable to comply, or have not fully complied,
with such laws, we could face substantial penalties.
●
If
we do not receive regulatory approvals, we will not be permitted to sell our therapeutic and medical device products.
●
Government-imposed
bans or restrictions and religious, moral, and ethical concerns about the use of hES cells could prevent us from developing and successfully
marketing stem cell products.
●
We
expect that the commercial opportunity for some of our products may depend on our ability to obtain reimbursement and continued coverage
from various payors, including government entities and insurance companies.
●
Clinical
studies are costly, time consuming and are subject to risks that could delay or prevent commercialization of our current or future
product candidates.
●
Clinical
and preclinical drug development involves a lengthy and expensive process with an uncertain outcome. The results of early preclinical
trials and clinical trials of our product candidates are not necessarily predictive of future results. Our product candidates may
not have favorable results in later clinical trials, if any, or receive regulatory approval on a timely basis, if at all.
●
Interim,
topline and preliminary data from our 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.
●
The
ongoing COVID-19 pandemic has affected and may adversely affect our operations, including the conduct of our current or future clinical
trials, as well as the operations of third-party partners on whom we rely.
●
Our
intellectual property may be insufficient to protect our products.
●
If
we are unable to obtain and enforce patents and to protect our trade secrets, others could use our technology to compete with us,
which could limit opportunities for us to generate revenues by licensing our technology and selling products.
●
We
may become dependent on possible future collaborations to develop and commercialize many of our product candidates and to provide
the regulatory compliance, sales, marketing and distribution capabilities required for the success of our business.
●
Because
we are engaged in the development of pharmaceutical and cell therapy products, the price of our common shares may rise and fall rapidly.
●
Current
economic and stock market conditions may adversely affect the price of our common shares.
●
Failure or perceived failure to comply with existing
or future laws, regulations, contracts, self-regulatory schemes, standards, and other obligations related to data privacy and security
(including security incidents) could harm our business. Compliance or the actual or perceived failure to comply with such obligations
could negatively affect our operating results and business.
5 | P a g e
ITEM
1.
BUSINESS
Overview
Lineage Cell Therapeutics,
Inc. (“Lineage,” “we,” “us,” or “our”) is a clinical-stage biotechnology company developing
novel cell therapies to address unmet medical needs. Our programs are based on our proprietary cell-based technology and associated
development and manufacturing capabilities. From this platform, we design, develop, and manufacture specialized human cells
with anatomical and physiological functions which are similar or identical to cells found naturally in the human body. These
cells which we manufacture are created by developmental differentiation protocols applied to established and well-characterized,
pluripotent, and self-renewing cell lines. These functional cells are transplanted into patients to either replace or support cells
that are dysfunctional or absent due to degenerative disease or traumatic injury, or are administered as a means of helping the body
mount a more robust and effective immune response to cancer or infectious diseases.
Our strategy is to efficiently
leverage our technology platform and manufacturing capabilities to develop and advance our programs internally or in conjunction with
strategic partners to further enhance their value. As one example, on December 17, 2021, we entered into a Collaboration and License
Agreement with F. Hoffmann-La Roche Ltd and Genentech, Inc., a member of the Roche Group (collectively, “Roche”), wherein
Lineage granted to Roche exclusive worldwide rights to develop and commercialize retinal pigment epithelium
cell therapies, including its proprietary cell therapy known as OpRegen®, for the treatment of ocular disorders, including advanced
dry age-related macular degeneration with geographic atrophy. Roche has paid Lineage a $50.0 million upfront payment under this alliance
and Lineage is eligible to receive up to an additional $620.0 million in certain developmental, regulatory, and commercialization milestone
payments. Lineage also is eligible for tiered double-digit percentage royalties on net sales of OpRegen.
Currently, Lineage is working
with Roche in support of the dry age-related macular degeneration (OpRegen) program and is clinically testing therapies to treat
spinal cord injuries and non-small cell lung cancer, as well as conducting research and preclinical development activities intended
to advance our pipeline into other therapeutic indications and target tissues or organs.
Product
Candidates & Other Programs
We
have several allogeneic, or “off-the-shelf,” cell therapy programs in development:
●
OpRegen ®, a retinal pigment epithelium (“RPE”)
cell replacement therapy currently in a Phase 1/2a multicenter clinical trial for the treatment of advanced dry age-related macular
degeneration (“AMD”) with geographic atrophy (“GA”) (also known as atrophic AMD). There are currently no
therapies approved by the U.S. Food and Drug Administration (“FDA”) for dry AMD. As of December 17, 2021 this program
has been partnered with Roche for further clinical development and commercialization.
●
OPC1 ,
an oligodendrocyte progenitor cell therapy currently in long-term follow-up for a Phase 1/2a multicenter clinical trial for spinal cord
injuries (“SCI”). This clinical trial has been partially funded by the California Institute for Regenerative Medicine (“CIRM”).
●
VAC ,
an allogeneic cancer immunotherapy of antigen-presenting dendritic cells. One of the VAC product candidates, VAC2, is currently in a
Phase 1 clinical trial in non-small cell lung cancer (“NSCLC”). This clinical trial is being funded and conducted by Cancer
Research UK (“CRUK”), one of the world’s largest independent cancer research charities. We also have another VAC-based
product candidate in preclinical development with our partner, Immunomic Therapeutics, Inc. (“ITI”), for the treatment of
glioblastoma multiforme (“GBM”).
●
Other. We have other product candidates in
preclinical development covering a range of therapeutic areas and target tissues or organs. Generally, these candidates are based
on the same pluripotent platform technology and employ a similar guided cell differentiation and transplant approach as our current
clinical-stage products.
In
addition to seeking to create value for shareholders by developing product candidates and other technologies through our clinical development
programs, we also seek to create value from our technologies through partnering and strategic transactions. We founded two companies
that later became publicly traded companies: OncoCyte Corporation (“OncoCyte”) and AgeX Therapeutics, Inc. (“AgeX”).
We continue to hold common stock in OncoCyte as of December 31, 2021.
During
the year ended December 31, 2021, we received approximately $10.1 million in gross proceeds in connection with our sale of shares of
OncoCyte. In August 2020, we also received $24.6 million from Juvenescence Limited (“Juvenescence”), representing principal
and accrued interest under a promissory note we received in connection with our sale of AgeX shares to Juvenescence in August 2018.
6 | P a g e
Corporate
Information
Lineage
is incorporated in the State of California. Our common shares trade on the NYSE American and the Tel Aviv Stock Exchange under the symbol
“LCTX.” Our principal executive offices are at 2173 Salk Avenue, Suite 200, Carlsbad, CA 92008, USA, and our phone number
at that address is +1- (442) 287-8990. Our website address is www.lineagecell.com. The information on, or that can be accessed through
our website is not part of this Report. Lineage routinely uses its website as a means of disclosing material non-public information and
for complying with its disclosure obligations under Regulation FD. We also make available, free of charge through our website, our most
recent annual report on Form 10-K, quarterly reports on Form 10-Q, current reports on Form 8-K and any amendments to those reports as
soon as reasonably practicable after the reports are electronically filed with or furnished to the Securities and Exchange Commission.
2021
Chronological Highlights
We
achieved numerous strategic accomplishments during 2021, including advancing clinical trials and product development in several key programs.
●
In February 2021, we announced an agreement with Neurgain Technologies to evaluate a novel delivery system for OPC1 to treat spinal cord injury, with the goal of eventually supporting a larger-scale clinical trial.
●
In March 2021, we announced the achievement of significant
improvements to OPC1 manufacturing, including to process, purity, and scale.
●
In April 2021, we announced a worldwide license and
development collaboration agreement with ITI, for the development and commercialization of novel cancer immunotherapy agents derived from
the VAC platform utilizing antigens provided by ITI.
●
In June 2021, we announced the second and third known findings of retinal
tissue restoration in dry-AMD patients who received OpRegen RPE cell transplant therapy.
●
In November 2021, we announced the fourth known finding of retinal
tissue restoration in a dry-AMD patient who received OpRegen RPE cell transplant therapy.
●
In December 2021, we announced a collaboration
and license agreement with Roche, pursuant to which we granted Roche exclusive worldwide rights to develop and commercialize RPE
cell therapies, including OpRegen, for the treatment of ocular disorders, including advanced dry AMD with GA.
Business
Strategy
Our goal is to address unmet
medical needs by developing and advancing allogeneic, or “off-the-shelf,” treatments comprised of functional cells derived
by differentiation of pluripotent cells from established and self-renewing cell lines. We direct pluripotent cells to become specific
cell types and use those differentiated cells as treatments to restore diseased or diminished functions, such as impaired vision, loss
of movement and sensation, or to increase immune response to tumors or infectious agents. Significant near-term activities that underlie
our business strategy include:
●
Providing
continuing OpRegen data from the ongoing Phase 1/2a clinical study, which is in the long-term follow-up phase, to our partner Roche;
●
Supplying
OpRegen to support our partner, Roche, in initiating a new clinical study for OpRegen;
7 | P a g e
●
Completing
GMP production of OPC1 through an improved and larger-scale manufacturing process and a new thaw-and-inject formulation;
●
Multiple
FDA interactions to discuss further development of the OPC1 program, including manufacturing improvements, the novel Parenchymal
Spinal Delivery (PSD) device, and a late-stage clinical study;
●
Initiating
clinical performance and safety testing of the novel PSD device for OPC1, with an anticipated amended Investigational New Drug (IND)
submission;
●
Analyzing
data from the ongoing Phase 1 VAC2 clinical study for the treatment of non-small cell lung
cancer;
●
Initiating a clinical study of VAC2, with an anticipated
IND submission;
●
Continuing
development of a dendritic cell-based therapeutic for GBM with our strategic partner;
●
Evaluating
opportunities for new VAC product candidates based on internally identified or partnered tumor antigens/neoantigens;
●
Evaluating
partnership opportunities and expansion of existing collaborations and identification of new collaborations for OPC1 and the VAC
platform, and
●
Evaluating
new programs for the implementation of our directed cell differentiation technology and expertise into adjacent or new therapeutic
areas and tissues or organs.
Cell
Therapy Technology Platform
We
believe we are a leader in pluripotent, cell-based asset development based on directed derivation protocols of cellular lineages and
whole cell manufacturing capabilities. Pluripotent cells, which are widely published as capable of becoming any human cell type, have
potential applications in many areas of medicine with large unmet patient needs, including certain age-related degenerative diseases
and degenerative conditions for which there presently are no cures. We are currently in clinical development for various pluripotent
cell-derived product candidates such as RPE cells, oligodendrocyte progenitor cells and dendritic cells. In addition, we are exploring
the differentiation of pluripotent cells into other cell types that may have therapeutic benefit in other areas of unmet medical need.
8 | P a g e
Examples
of Cell Types Which Can Be Derived from Pluripotent
Stem Cells
Highlighted
cell types indicate currently active clinical programs of Lineage
9 | P a g e
Cellular therapies are often
aimed at regenerating or replacing entire affected cells or tissues and therefore, may have more durable, broader, or more suitable applicability
than many traditional pharmaceutical products which are aimed to influence a single molecular target or group of biological pathways.
Small molecules and biologic therapies that require systemic delivery into the body often have unexpected side effects that can limit
their usefulness. When cell replacement is locally administered, particularly to a specific anatomical compartment, systemic side effects
are usually minimal and well-tolerated. Cell therapy more closely resembles that of transplant medicine, being focused on whether the
transplanted cells are retained or rejected by the body and whether the cells function as expected, rather than causing intolerable or
dose limiting side effects.
A key advantage of our
approach is that it provides us the opportunity to rapidly develop new programs without the extensive and costly steps
traditionally required to develop a new small molecule. Whereas small molecule product development typically requires selection or
validation of a drug target, followed by screening millions of molecules to identify a series of hits, followed by chemical
modification known as structure-activity relationship or “SAR” to develop a hit into a more potent lead, the process of
developing a new cell therapy from pluripotent lines can be comparatively faster because the target cell type is already known and
fully “validated”, insofar as it is well-established in the literature as being the cell type which is dysfunctional or
deficient in the patient. The most critical step in developing a new cell therapy is the establishment of a proprietary and
commercially feasible differentiation protocol which can create the needed cells, a process which avoids mass screening campaigns
and is more readily accomplished via the combination of literature reviews and in-house experience with pluripotent cell
differentiation. This approach can facilitate our pipeline expansion faster and at a lower cost than traditional methods.
In addition to our corporate
headquarters located in San Diego, CA, we have a modern and innovative manufacturing facility in the Bio Park on the campus of the
Hadassah University Hospital in Jerusalem, Israel. The facility includes process development laboratories and a state-of-the-art, current
good manufacturing practice (“cGMP”) cell manufacturing facility. It is designed and equipped to run simultaneous cGMP processes
and to produce a range of cell therapy products for human use in clinical trials as well as improve scalability for potential commercialization.
Currently, all of our cGMP manufacturing processes, including cell banking and product manufacturing for our cell therapy product candidates,
are conducted in this facility.
Novel
Clinical Cell Therapy Pipeline
10 | P a g e
OpRegen
OpRegen
is an ophthalmic product candidate (currently in a Phase 1/2a clinical trial) for the treatment of advanced dry AMD with GA. AMD
is a gradual, progressive, deterioration of the macula, the small sensitive area in the center of the retina that provides clear, high-definition
central vision. AMD affects over 30 million people worldwide and approximately 1.6 million people are diagnosed annually in the United
States. It is a leading cause of vision loss in people over the age of 65 in the developed world. As the area of atrophy begins to include
the fovea (the center of the macula), patients lose their central vision, making facial recognition, reading and driving difficult or
impossible, and often resulting in legal blindness. The exact cause of dry AMD is unknown, but is thought to result from multiple factors,
such as genetics, age, and environmental effects. There are two clinical presentations of AMD, the dry form and the wet form,
or neovascular form (growth of abnormal new blood vessels). Dry AMD typically advances slowly toward GA in which RPE cells and photoreceptors
deteriorate over time. RPE cells support and nourish the retina by metabolizing waste by-products and producing a number of components
useful for photoreceptor health and function. If the metabolic waste products accumulate, lesions known as drusen are generated. Approximately
85-90% of AMD patients suffer from dry AMD, for which there is no FDA-approved medical therapies. Dry AMD may also lead to wet AMD, a
condition for which there are several FDA-approved treatments administered locally to inhibit the growth of new blood vessels, but these
treatments are not effective nor approved for the treatment of dry AMD. Physicians often recommend a healthy diet, exercise and/or nutritional
supplements for dry AMD, but nutritional supplements have shown limited efficacy in delaying the onset of more progressive disease in
longer-term studies. The schematics below show a representation of the process of drusen formation and the goal of cell replacement therapy.
Dry
AMD involves the loss of retina cells, creating an area of geographic atrophy (GA), which causes impaired vision and blindness
We
believe one of the most promising approaches to treat dry AMD is to replace the layer of damaged RPE cells with new, healthy and functional
RPE cells manufactured from a well-characterized cell line. OpRegen is a cell replacement therapy derived from our pluripotent cell technology
in which our proprietary directed-differentiation methods convert pluripotent stem cells into nearly pure populations of RPE cells. Using
this method, OpRegen is grown free of any animal products and consists of human RPE cells with high yield and purity that can be transplanted
directly into the patient’s eye, where the patient’s own RPE cells are missing or dysfunctional. The OpRegen therapeutic
approach is designed to replace damaged or lost RPE cells with the goal of slowing disease progression to preserve and/or restore visual
function.
11 | P a g e
OpRegen
is an injection of RPE cells delivered to the retina, to replace lost retinal cells and preserve or restore vision
OpRegen
is intended to be an allogeneic, or “off-the-shelf,” product provided to retinal surgeons in an “easy-to-use”
form for transplantation. We believe OpRegen could have a lasting benefit from a single administration, or once every several years.
This approach differs from other investigational drugs for dry AMD and approved agents currently marketed for wet AMD, such as ranibizumab
(Lucentis ® ) and aflibercept (Eylea ® ), that require repeated, frequent intravitreal injections into the
eye.
12 | P a g e
The
patients in our ongoing Phase 1/2a clinical trial are 50 years of age or older, whose dry AMD has advanced to the GA stage, with absence
of additional concomitant ocular disorders. The trial includes 24 subjects. The first 12 subjects (Cohorts 1-3) were legally blind at
the outset of the trial, with significant progression of GA. Cohort 4 consists of 12 patients with less advanced disease, smaller areas
of GA, and better baseline visual acuity at the outset of the trial. In all 24 subjects, the eye in which the disease has progressed
the most is treated, while their other, untreated eye serves as a measure of disease progression. Following injection, the patients are
followed for 12 months at specified intervals to evaluate the safety and tolerability of OpRegen.
Following
the initial 12-month period, patients are evaluated at longer intervals for up to a total of five years following administration. A secondary
objective of the clinical trial is to examine the ability of transplanted OpRegen to engraft, survive, and modulate disease progression
in the patients. In addition to thorough characterization of visual function, several vision tests are used to quantify stabilization
or improvements in visual function. We also perform anatomical evaluation imaging to assess the restoration of the structure of the retina.
Interim
data have been encouraging and suggest that OpRegen RPE cells are generally well-tolerated when administered by subretinal injection
in patients with GA. Findings on clinical examination by different imaging modalities show improvements in retinal structure and decreases
in drusen, which are collections of waste deposits associated with AMD, as well as durable engraftment of OpRegen cells now extending
to more than five years in the earliest treated patients. Across the study, a trend toward slower GA progression in treated compared
to untreated eyes continues to be present. Of particular note, four subjects in Cohort 4 have shown evidence of retinal tissue restoration,
evidenced by a reduction in size or no growth in the area of atrophy at least 12 months post-treatment and the presence of key retinal
cells that were not observable at baseline study entry. This anatomical effect was accompanied by improvements in visual acuity in all
four subjects. Furthermore, differences in visual acuity between treated and untreated eyes remains statistically significant across
Cohort 4 patients at 15 months post-treatment.
Importantly,
in the safety-focused aspect of the trial, no unexpected ocular adverse events have been observed and those events expected to occur
based on the procedures involved in OpRegen administration, such as vitrectomy, have been predominately mild in severity. The majority
of these subjects had pre-existing epiretinal membranes (“ERMs”) at the time of trial enrollment and in most cases,
experienced new or worsening ERMs following the surgical procedure, which is believed to be partially attributable to the route of administration
via pars plana vitrectomy (“PPV”) and retinotomy. The majority were mild to moderate in severity, though three patients
with severe ERM were successfully treated via a routine surgical procedure where the ERM was removed. These subjects are being monitored
during trial follow-up. Two instances of retinal detachment were reported among all patients, one of which occurred in a patient who
was legally blind prior to treatment. The event was not assigned as related to treatment, procedure or to the combination. The patient
continued for a period of time in the trial following successful surgical repair but has since withdrawn due to other unrelated health
issues. The second case, also successfully repaired, took place in an area of the retina away from the site of the OpRegen transplant
and was thought by the investigators and other reviewers to be related to an existing retinal tear in the patient. The independent data
safety monitoring board (“DSMB”) approved moving to Cohort 4 based on the safety data from the Cohorts 1-3. Cohort
4 incorporated an additional variety of objective and subjective assessments to look for signs of potential efficacy as well as potential
anatomical changes indicative of OpRegen cell function following implantation.
We
completed enrollment in Cohorts 1-3 (12 patients) in the middle of 2018 and as previously reported, OpRegen was well tolerated with no
unexpected systemic serious adverse events (“SAEs”) or ocular adverse events (“AEs”). Importantly, there were
several patients that exhibited improved retinal structure, reduction in drusen, alterations in the pattern of GA progression and indications
of long-term survival of the OpRegen cells. We began enrollment of Cohort 4 shortly thereafter and treated three patients via the traditional
route of administration. In 2019, we amended our clinical protocol to incorporate the Gyroscope Therapeutics, Ltd. Orbit Subretinal Delivery
System (“Orbit SDS”), a single use vitrectomy-free delivery device designed to deliver products to the subretinal
space through a sclerotomy and suprachoroidal approach, and our new thaw and inject formulation into our Phase1/2a clinical trial. In
February 2020, we announced that after reviewing promising preliminary data from the ongoing OpRegen Phase 1/2a clinical trial, our independent
data safety monitoring board removed the protocol-mandated treatment stagger. The COVID pandemic slowed the rate of patient accrual,
but study enrollment was completed on November 10, 2020, with the treatment of the twelfth Cohort 4 patient, seven via the Orbit SDS
and five via PPV/retinotomy. Five different surgeons at four centers successfully delivered OpRegen using the Orbit SDS and there were
no unexpected AEs. Encouraging structural and clinical changes were observed in these better vision patients, including better visual
acuity and increased reading speed.
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In
June 2020, we were able to report the first known example of retinal restoration following OpRegen administration in a Cohort 4 patient
who was treated via the PPV/retinotomy route, with the findings confirmed by several independent reviewers. It is hypothesized that photoreceptor
cells in the transition areas at the boundary of the GA are dysfunctional and dying, but not completely lost. The addition of new RPE
cells may restore the microenvironment in surrounding tissue and contribute to the possibility of restoring function to existing cells
that otherwise, if left untreated, would inevitably progress to further expansion of the atrophic region. Specifically, in this patient,
the area of GA assessed at nine months following OpRegen treatment was approximately 25% smaller than the patient’s pre-treatment
baseline. As reported in November at the 2020 American Academy of Ophthalmology (“AAO”) Annual Meeting, this patient
continued to show signs of a smaller area of GA and improved visual acuity. Further, as reported throughout 2021, this patient continued
to show zero progression of atrophy growth for three full years after treatment. This unprecedented finding supports the view that
dry AMD is not an irreversible, degenerative condition and that some portion of diseased retinal tissue may be recoverable in atrophic
end-stage disease patients.
In
May 2021, we reported at the Association for Research in Vision and Ophthalmology Annual Meeting (“ARVO”) that 83%
of all Cohort 4 patients were at or above baseline visual acuity, based on per protocol scheduled visits ranging from 4.5 months to approximately
three years post-transplant. In contrast, 83% of the patients’ untreated eyes were below baseline entry values at the same time
points. As well, previously reported structural improvements in the retina, decreases in drusen density, and a trend toward slower GA
progression in treated compared to untreated eyes continued.
In
June 2021, we reported that retinal restoration was observed in two additional Cohort 4 patients, evidenced by optical coherence tomography
(“OCT”), bringing the total to three observed cases of retinal tissue restoration. These findings continue to suggest
integration of new RPE cells with functional photoreceptors in areas that previously showed no presence of any of these cells. In addition
to the observed anatomical changes, all three patients’ visual acuity increased above baseline levels.
In
September 2021, it was reported at the Annual Retina Society Meeting that updated interim results of our Phase 1/2a study showed a statistically
significant difference in visual acuity between treated and untreated eyes across Cohort 4 patients, at month nine as well as months
12 and 15 post-transplant. These results, when combined with the previous evidence of retinal restoration in areas previously considered
to be atrophic, suggest that both a structural and functional benefit is possible with OpRegen therapy. Additionally, it was reported
that OpRegen continues to be well tolerated, with no new, unexpected ocular or systemic AEs or SAEs.
In
November 2021, we reported that evidence of retinal restoration was observed in a fourth patient enrolled in the Phase 1/2a clinical
study of OpRegen. Importantly, reduction or no progression for at least one-year post-transplant, was observed in the total area
of GA in all four of these better-vision Cohort 4 patients. In addition, all four retinal restoration patients reported improvements
in their visual acuity, which has been maintained for at least 12 months in all cases. This new and additive finding continues to support
our view that atrophic AMD is not an irreversible, degenerative condition and that some portion of diseased retinal tissue may be recoverable.
In
December 2021, we entered into an exclusive worldwide collaboration and license agreement with Roche, for the development and commercialization
of OpRegen. Roche paid us a $50.0 million upfront payment and we are eligible to receive up to $620.0 million in additional development,
approval, and sales milestone payments, in addition to tiered double-digit royalties. See Note 14 to our consolidated financial statements
included elsewhere in this Report for discussion on the Roche collaboration agreement.
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OPC1
OPC1
is our lead product candidate for the treatment of SCI. SCI occurs when the spinal cord is subjected to a severe crush or contusion injury,
such as that caused by a car or motorcycle accident and typically results in severe functional impairment, including limb paralysis,
aberrant pain signaling, and loss of bladder and sexual function. There are approximately 18,000 new spinal cord injuries annually in
the U.S. (NSCIC SCI Facts and Figures at a Glance (2019)), and there are currently no FDA-approved drugs specifically for the treatment
of SCI, although methylprednisolone, a corticosteroid generally used as an anti-inflammatory drug, is sometimes prescribed on an off-label
basis to reduce acute inflammation in the injured spinal cord immediately after injury. It is believed that to effect substantial benefit
in treating this complex injury, multiple mechanisms of action are required, such as introduction of biologics that preserve surviving
neurons and stimulate new nerve axon outgrowth, suppression of lesion cavity formation at the injury site, generation of new blood vessels
to repair the ischemic damage from injury, and myelination of the demyelinated and newly formed nerve axons. A key therapeutic target
in SCI is replacement of oligodendrocytes that are selectively lost at the injury site. As the sole source of the insulating protein
myelin in the brain and spinal cord, oligodendrocytes wrap around nerve axons and allow conduction of electrical impulses throughout
the central nervous system (“CNS”).
Oligodendrocytes
are the myelinating cells of the CNS and are critical for nerve signal conduction.
OPC1
is an oligodendrocyte progenitor cell therapy derived from our pluripotent cell technology under cGMP conditions using a directed differentiation
method. These cells are stored frozen until ready for use and prepared for direct administration into the injured spinal cord. Based
on preclinical studies, when OPC1 is transplanted into the injured spinal cord, the cells undergo further maturation to generate a replacement
population of oligodendrocytes at the injury site that are capable of remyelinating denuded and newly formed nerve axons. Based on preclinical
studies, prior to their maturation the transplanted oligodendrocyte progenitor cells are believed to stimulate additional reparative
processes, including promotion of neuron survival and nerve axon outgrowth, and induction of blood vessel formation in and around the
injury site. In addition, OPC1 cells rapidly migrate from the injection point to the injury site where they generate a supportive tissue
matrix and suppress cavitation. Cavitation is a destructive process that occurs within the spinal cord following SCI, and typically results
in permanent loss of motor and sensory function. A patient with cavitation can develop a condition known as syringomyelia, which results
in additional neurological and functional damage to the patient and can result in chronic pain. Based on the multiple reparative properties
associated with OPC1, we believe this candidate cell therapy product is ideally suited to treat neurological conditions such as SCI and
other demyelination disorders of the CNS.
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Suppression
of spinal cavitation in a rat contusion model.
Under
a grant for clinical development, the development of OPC1 has been supported by $14.3 million in funds from CIRM, from 2014 through the
date of this Report. We are eligible for and may seek to apply for additional grants from CIRM for the program’s continued development.
Prior
to its acquisition, Asterias Biotherapeutics, Inc. (“Asterias”) was testing OPC1 in two clinical trials: a five patient Phase
1 safety trial and a 25-patient Phase 1/2a dose escalation trial, which we call the SCiStar trial. The SCiStar trial is an open-label,
single-arm trial testing three sequential escalating doses of OPC1 administered at up to 20 million OPC1 cells with subacute, C-4 to
C-7, motor complete (AIS-A or AIS-B) cervical SCI. These individuals have essentially lost all movement below their injury site and experience
severe paralysis of the upper and lower limbs. AIS-A patients have lost all motor and sensory function below their injury site, while
AIS-B patients have lost all motor function but may retain some minimal sensory function below their injury site. OPC1 was administered
21 to 42 days post-injury. Patients continue to be followed by neurological exams and imaging procedures to assess the safety and activity
of the product. Enrollment consisted of five cohorts:
Cohort
Injury Type; OPC1 Dose
# of Patients
Cohort 1
AIS-A; 2 million OPC1 cells (low dose for safety evaluation)
3
Cohort 2
AIS-A; 10 million OPC1 cells
6
Cohort 3
AIS-A; 20 million OPC1 cells*
6
Cohort 4
AIS-B; 10 million OPC1 cells
6
Cohort 5
AIS-B; 20 million OPC1 cells*
4
*
One patient from Cohort 3 and one patient from Cohort 5 were administered 10 million cells.
In
January 2019, top-line 12-month data from the SCiStar trial were announced by Asterias, which included the following key findings:
●
Positive
Safety Profile . Magnetic resonance imaging (“MRI”) scans at 12 months post-injection of OPC1 showed no evidence of
adverse changes in any of the 25 patients.
●
Cell
Engraftment . All three patients in Cohort 1 and 21 of the 22 patients in Cohorts 2-5 had MRI scans at 12 months consistent with
the formation of a tissue matrix at the injury site, which is encouraging evidence that OPC1 cells had engrafted at the injury site
and helped to prevent cavitation.
●
Improved
Motor Function . At 12 months, 21 of the 22 patients who were administered either 10 million or 20 million cells of OPC1 (Cohorts
2-5) recovered at least one motor level on at least one side, and seven of the 22 patients recovered two or more motor levels on
at least one side. Motor level recovery was based on the upper extremity motor score (“UEMS”), as measured by the International
Standards for Neurological Classification of Spinal Cord Injury (“ISNCSCI”). None of these patients saw decreased motor
function following administration of OPC1, and patients consistently retained the motor function recovery seen through six months
or saw further motor function recovery from six to 12 months.
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In
November 2019, we provided an update on the SCiStar trial that highlighted, among other things:
●
Positive
Safety Profile . For the 21 SCiStar trial patients who had follow-up visits at 24 months post-injection of OPC1, MRI scans showed
no evidence of adverse changes, and none of the patients had a decline in their motor function from their 12-month follow-up visit.
There were no unexpected serious adverse events to date in any of these patients.
●
Improved
Motor Function . All 3 Cohort 1 patients continued to be stable 2-4 years post treatment. At 24 months, five of the six Cohort
2 patients recovered at least two motor levels on at least one side, and one Cohort 2 patient recovered three motor levels, which
has been maintained through that patient’s 36-month follow-up visit. Motor level recovery was based on the UEMS as measured
by the ISNCSCI.
In
November 2020, the formal clinical study report (CSR) for the SCiStar study with the above supporting data was submitted to the FDA.
The
FDA designated OPC1 as a Regenerative Medicine Advanced Therapy (“RMAT”), for the treatment of subacute SCI. RMAT is an accelerated
development pathway and includes the ability for increased interfacing with the FDA during clinical development, and granted OPC1 Orphan
Drug Designation, providing a pathway to possible market exclusivity.
In
2019, we transferred all cGMP manufacturing processes, including the establishment of cell banks and the OPC1 process development and
manufacturing for clinical studies, to our cell therapy manufacturing facility in Jerusalem, Israel. Improvements to the manufacturing
process were completed to include enhancements to the production process to ensure robust, controlled, reproducible and commercially
viable scale, and purity of OPC1. We also developed a thaw and inject formulation of OPC1 to facilitate logistics and handling at the
point of care with the elimination of the dose preparation at the clinical site. An information amendment describing the new process,
an improved analytical plan, and a proposed comparability plan was filed with the FDA. Throughout 2021, we manufactured clinical
batches based on the improved process in a thaw and inject formulation in preparation for a larger-scale, late-stage clinical trial.
In February 2021, we announced
an exclusive agreement with Neurgain Technologies, Inc. (“Neurgain”) to evaluate a novel delivery system for OPC1. Preliminary
assessment of prototypes revealed promising compatibility with OPC1 product while simplifying the surgical procedure by providing surgeons
with an instrument that is small, simple to use and would not require stopping the patient’s ventilator to perform the injection,
allowing far more flexibility for accurate delivery to the injury site. We continued to evaluate the Neurgain device throughout 2021
and intend to submit an IND amendment during the third quarter of 2022 for a human safety clinical study to validate the device
and which is intended to support use of the device in a late-stage clinical study to follow.
We
continue work to expand our partnerships with SCI advocacy and support organizations to support their mission to accelerate stem cell
treatments to patients with unmet medical needs and fast-track the development of the most promising stem cell technologies.
VAC
Platform
VAC
is our immuno-oncology platform using dendritic cells loaded with antigens for the treatment of cancer. Cancer afflicts millions worldwide
and is one of the largest unmet clinical needs with current treatment options providing limited efficacy and a wide range of debilitating
side effects. As the most potent type of antigen-presenting cell in the body, dendritic cells instruct our body’s immune system
to attack and eliminate harmful pathogens and unwanted cells, including cancer cells.
Specifically,
to provide a more effective and targeted treatment of non-small cell lung cancer, we are currently developing VAC2 as an allogeneic,
or non-patient specific, cancer vaccine candidate designed to stimulate patient immune responses to an antigen hTERT, which is commonly
expressed in cancerous cells but not in normal adult cells. VAC2 is produced by our pluripotent cell technology using a directed differentiation
method and is comprised of a population of mature dendritic cells to which the hTERT antigen was introduced. To target cancerous cells,
VAC2 is engineered to express the tumor-selective antigen telomerase, which is found in over 85% of all cancers. The tumor antigen is
loaded exogenously into the dendritic cells. The VAC1 autologous program, which preceded VAC2, serves as an effective and encouraging
proof of concept behind our approach to dendritic cell vaccines targeting telomerase, which is the backbone of the VAC2 program.
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Using
pluripotent cells as the starting material for VAC production adds several additional advantages to this therapeutic candidate. Compared
to technologies that rely on the use of a patient’s own blood, our pluripotent cell technology provides a scalable system for production
of a large number of vaccine doses in a single lot, lower manufacturing costs, greater product consistency, and more notably, off-the-shelf
availability to provide broader and immediate access to patients. In addition, we believe that as an allogeneic therapy, VAC has the
potential to stimulate a more robust immune response through an adjuvant effect resulting from the partial immune mismatch between the
VAC cells and patients receiving the therapy. We believe that VAC can be used as a platform technology that can be modified to carry
any antigen, including patient-specific tumor neo-antigens.
In
September 2014, Asterias initiated clinical development of VAC2 by entering into a Clinical Trial and Option Agreement (the “CRUK
Agreement”) with CRUK and Cancer Research Technology Limited (“CRT”), a wholly owned subsidiary of CRUK, under which
CRUK agreed to fund Phase 1 clinical development of VAC2 in NSCLC. CRUK was responsible, at its own cost, for manufacturing clinical
grade VAC2 and for carrying out the Phase 1 clinical trial of VAC2. Patient enrollment began in June 2018, and as of December
31, 2021 seven patients have now completed dosing in the initial aspect of the trial.
In
October 2020, we reported preliminary results of the ongoing Phase 1 clinical study of VAC 2 in non-small cell lung cancer. As reported,
VAC2 demonstrated remarkable potent induction of immune response in all patients dosed to date, with high levels of peripheral antigen-specific
immunogenicity observed at multiple time points. As well, VAC2 appeared to be well tolerated with no unexpected adverse events.
In
April 2021, Lineage entered into a worldwide license and development collaboration agreement with ITI. Lineage licensed to ITI
patents and materials for the development and commercialization of a novel cancer immunotherapy agent derived from the VAC platform utilizing
an antigen provided by ITI, for the treatment of GBM. Under the terms of this agreement, Lineage is entitled to upfront licensing fees
totaling $2.0 million paid over the first year, and up to $67.0 million in development and commercial milestones across multiple indications.
Lineage will also be eligible to receive royalties of up to 10% on net sales of future products.
We
completed the transfer of all cGMP manufacturing processes, including the establishment of cell banks and the VAC2 process development
and manufacturing for clinical studies, to our cell therapy manufacturing facility in Jerusalem, Israel.
Throughout
2021 and early into 2022, we focused on updating and optimizing the manufacturing process for VAC to ensure reliable supply for future
clinical studies and possible commercial development. An improved VAC manufacturing process will be the subject of a key interaction
with FDA in the future to introduce VAC in an IND. We also continue to evaluate additional opportunities for the introduction of new
VAC candidates based on internally identified or partnered tumor antigens to expand the VAC platform.
Collaboration
Agreements
To
accelerate the discovery and advancement of transplanting specific cell types into the body, we have entered into, and intend to seek
other opportunities to form collaborations with a diverse group of strategic partners. We have forged productive collaborations with
pharmaceutical and biotechnology companies, government agencies, academic laboratories, and research institutes with diverse area expertise
and resources in as effort to advance our discovery and development platforms.
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One key principle of our approach
to collaborations is to share rewards and risks of conducting large-scale clinical trials and commercializing a product, but also to
provide the broadest patient population the earliest access to our therapies. Significant on-going collaboration agreements include the
following:
● Roche,
for the development and commercialization of OpRegen a RPE cell therapy for the treatment
of advanced dry age-related macular degeneration with geographic atrophy, currently in Phase
1/2a, as well as for the use in other ocular disorders; and
● ITI,
for
the development and commercialization of a novel cancer immunotherapy agent based on the
VAC platform for the treatment of glioblastoma multiforme.
Roche
Collaboration Agreement
On
December 17, 2021, Lineage and its subsidiary, Cell Cure Neurosciences Ltd. (“Cell Cure”) entered into a Collaboration and
License Agreement (the “Roche Agreement”) with Roche, pursuant to which Lineage granted to Roche exclusive worldwide rights
to develop and commercialize retinal pigment epithelium cell therapies, including its proprietary cell therapy known as OpRegen, for
the treatment of ocular disorders, including advanced dry AMD with GA.
Under
the terms of the Roche Agreement, Roche will assume responsibility for further clinical development and commercialization of OpRegen,
which currently is being evaluated in a Phase 1/2a open-label, dose escalation clinical safety and efficacy study in patients with advanced
dry AMD with GA. Lineage will be responsible for completing activities related to the ongoing clinical study, for which enrollment is
complete, and performing certain manufacturing and process development activities.
Roche
paid Lineage a $50.0 million upfront payment and Lineage is eligible to receive up to an additional $620.0 million in certain developmental,
regulatory and commercialization milestone payments. Lineage is also eligible for tiered double-digit percentage royalties on net sales
of OpRegen. All regulatory and commercial milestone payments, and royalty payments, are subject to the existence of certain intellectual
property rights that cover OpRegen at the time such payments would otherwise become due, and the royalties on net sales of OpRegen are
subject to financial offsets based on the existence of competing products.
The
OpRegen program has been supported in part with contributions made by Hadasit Medical Research Services and Development Ltd. (“Hadasit”),
the technology transfer company of Hadassah Medical Center, and the Israel Innovation Authority (the “IIA”), an independent
agency created to address the needs of global innovation ecosystems. A significant portion of early development on the OpRegen program
occurred at Cell Cure, which was established by the Hadassah Medical Center, where the intellectual property underlying the differentiation
and manufacture of RPE cells originated. In addition, significant monetary support for the OpRegen program was provided by the IIA through
a series of separate research grants, beginning in 2007. Each of these parties’ contributions began when the OpRegen program was
in its earliest stages of development. As a result, and subject to the terms of contracts among the applicable parties and applicable
law, Lineage is obligated to pay Hadasit and the IIA a portion of the upfront, milestone, and royalty payments which may be received
from Roche under the Agreement. Lineage is obligated to pay approximately 24.3% of the upfront payment and any future payments it receives
from Roche to the IIA, up to an aggregate cap on all payments to IIA, which currently stands at approximately $102.7 million.
In
addition, pursuant to that certain Second Amended and Restated License Agreement, dated June 15, 2017, between Cell Cure and Hadasit,
as amended (the “Hadasit License)”, and a certain letter agreement entered into on December 17, 2021, by and between Cell
Cure and Hadasit (the “Hadasit Letter Agreement”), Cell Cure is obligated to pay to Hadasit a maximum of 21.5% of the upfront
payment (subject to certain reductions) and any milestone payments, and up to 50% of all royalty payments (subject to a maximum payment
of 5% of net sales of products), Lineage receives from Roche. The Hadasit Letter Agreement generally terminates upon the termination
of the Roche Agreement.
Unless
earlier terminated by either party, the Roche Agreement will expire on a product-by-product and country-by-country basis upon the expiration
of all of Roche’s payment obligations under the Roche Agreement. Roche may terminate the Roche Agreement in its entirety, or on
a product-by-product or country-by-country basis, at any time with advance written notice. Either party may terminate the Roche Agreement
in its entirety with written notice for the other party’s material breach if such party fails to cure the breach. Either party
also may terminate the Roche Agreement in its entirety upon certain insolvency events involving the other party.
19 | P a g e
In
January 2022, Lineage received the $50.0 million upfront payment from Roche. Lineage made a subsequent payment of $12.1 million to the
IIA, pursuant to Lineage’s obligations under the Innovation Law. Additionally, Lineage made a subsequent payment of $8.9
million to Hadasit, pursuant to Lineage’s obligations under the Hadasit License.
ITI
Collaboration Agreement
On
April 16, 2021, Lineage entered a worldwide license and development collaboration with ITI (the “ITI Agreement”). Lineage
is the sole and exclusive owner of the rights to the VAC platform and has licensed to ITI patents and materials for the development and
commercialization of novel cancer immunotherapy agent derived from this platform utilizing an antigen provided by ITI.
Under
terms of the ITI Agreement, Lineage is entitled to upfront licensing fees totaling $2.0 million paid over the first year, and up to $67.0
million in development and commercial milestones across multiple indications. Lineage will also be eligible to receive royalties of
up to 10% on net sales of future products.
Research
Programs
Vision
restoration
In
2017, we expanded our ophthalmology portfolio by acquiring exclusive global rights to technology that allows the generation of three-dimensional
human retinal tissue derived from human pluripotent cells. This tissue contains all the cell types and layers of the human retina and
has shown evidence of functional integration in proof of concept animal models for advanced retinal degeneration. The technology is being
developed to potentially treat or prevent a variety of retinal degenerative diseases and injuries. In 2017, the National Institutes of
Health (“NIH”) awarded us a grant of up to $1.6 million to further develop this innovative, next generation vision restoration
program for retinal diseases and injuries. We completed work under this grant in 2020 and submitted final reports to the NIH.
Demyelination
OPC1
exhibits multiple reparative properties that may have broad applicability to neurological injury and disease, particularly as a treatment
for demyelination. Past research efforts investigated the potential development of OPC1 as a candidate treatment for certain forms of
ischemic stroke and multiple sclerosis (“MS”), two severely debilitating conditions for which demyelination is a central
component to their pathology.
While
we are not actively pursuing OPC1 for MS or ischemic stroke at this time, we may use the results of these studies to guide further preclinical
development of OPC1 for these or other conditions of demyelination or wherever there is depletion or disfunction of myelinated neurons.
Other Programs
We have other product candidates
in preclinical development covering a range of therapeutic areas and target tissues or organs. Generally, these candidates are based
on the same pluripotent platform technology and employ a similar guided cell differentiation and transplant approach as our current clinical-stage
products.
Other
Products
We
also have rights to HyStem, a patented biomaterial that mimics naturally occurring extracellular matrix, the structural network of molecules
surrounding cells in organs and tissues essential to cellular function and tissue structure. HyStem may be useful as a scaffold for cell
replacement and retention. We sold HyStem-related assets and licensed the applicable technology in late 2019, but retained the rights
for other uses, including for Renevia ® , our facial aesthetics product, which received a Conformité Européenne
(CE) Mark in September 2019.
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Investments
and subsidiaries:
The
following tables show the companies in which we have a direct or indirect ownership, their respective principal fields of business, our
percentage ownership as of December 31, 2021, and the country where their principal business is located.
Investments:
Company
Field of Business
Lineage
Ownership
Country
OncoCyte Corporation (1)
Cancer diagnostics
~1 %
USA
Hadasit Bio-Holdings Ltd. (1)
Owns a portfolio of R&D based companies
<2 %
Israel
Subsidiaries:
Company
Field of Business
Lineage Ownership
Country
Cell Cure Neurosciences Ltd.
Manufacturing of Lineage’s cell replacement platform technology
99 % (2)
Israel
Asterias Biotherapeutics, Inc. (3)
Cell based therapeutics to treat neurological conditions and cancer
100 %
USA
ES Cell International Pte. Ltd (4)
Research and clinical grade cell lines
100 %
Singapore
OrthoCyte Corporation (4)
Research in orthopedic diseases and injuries
99.8 %
USA
(1)
These
are publicly traded companies. See Notes to Consolidated Financial Statements: Note 4. Marketable Equity Securities.
(2)
Includes
shares owned by Lineage and ES Cell International Pte. Ltd. (“ESI”).
(3)
Asterias
was acquired by Lineage in March 2019.
(4)
The
operating activities and fields of business listed under these subsidiaries are conducted primarily by Lineage as the parent company.
Patents
and Trade Secrets
We
seek to protect and rely on our proprietary cell-based therapy platform and associated development and manufacturing capabilities and
derived product candidates through a variety of methods, including seeking and maintaining patents intended to cover our products and
compositions, their methods of use and processes for their manufacture, our platform technologies and any other inventions that are commercially
important to the development of our business. We also rely on contractual obligations with employees and third parties to protect our
proprietary rights. For example, in addition to protecting our proprietary rights with patents, we rely on unpatented trade secrets,
improvements, know-how and innovation, and we take steps necessary to protect these rights, including through confidentiality agreements
with our corporate partners, employees, consultants and vendors. We have sought, and intend to continue to seek, appropriate patent protection
for important and strategic components of our proprietary technologies by filing patent applications in the United States and internationally.
We may also file additional patent applications, when appropriate, to cover improvements on our clinical products, clinical product candidates,
and related technologies. There are no assurances that any of our intellectual property rights will guarantee complete or adequate protection
or market exclusivity for our products and product candidates. We also enter into collaborative and other similar arrangements with third
parties, such as license agreements, to in-license and/or out-license intellectual property rights. Our financial success will be dependent,
in part, on our ability to obtain rights to commercially valuable patents, to protect and enforce our intellectual property rights and
to operate without infringing any intellectual property rights of others. From time to time, we assess our patents and pending applications
covering our products and product candidates. If we determine that any patents or patent applications no longer provide adequate or necessary
protection, we may transfer or abandon such patents and patent applications to avoid incurring unnecessary costs.
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We
own or license, directly or through our subsidiaries, several patent families that include hundreds of U.S. and international
patents and patent applications. We cannot be certain that issued patents will be enforceable or provide adequate protection or that
pending applications will result in issued patents.
OpRegen
We
and our subsidiary, Cell Cure, have rights to issued U.S. and international patents and pending patent applications covering OpRegen.
The issued patents have expiration dates ranging from 2028 to 2036. The pending applications, if issued, will have estimated expiration
dates ranging from 2028 to 2041. These U.S. and international issued patents and pending applications also include those in-licensed
from Hadasit, the commercial arm and a wholly owned subsidiary of Hadassah Medical Organization. We also solely own pending U.S. and
Patent Cooperation Treaty (“PCT”) patent applications relating to cryopreserving the cell population and then shipping it
to the clinical trial site so the cells can be immediately thawed and delivered to the patient without further processing. The U.S. patent
applications, and any filed international patent applications based on the PCT applications, if issued, will have estimated expiration
dates in 2038. Pursuant to the Roche Agreement, we have licensed these patent rights to Roche to further develop and commercialize
RPE cell therapies, including OpRegen (see “Roche Collaboration Agreement” description above).
OPC1
We
have numerous U.S. and international issued patents and pending patent applications that are relevant to neural cells, such as oligodendrocyte
progenitor cells, including patent families acquired from Geron Corporation (“Geron”) that are directed to the differentiation
of pluripotent stem cells, including human embryonic stem (“hES”) cells, into various neural cell types, as well as various
culture and purification methods. These U.S. and international issued patents and pending patent applications also include those in-licensed
from the Regents of the University of California. Additionally, there are four patent families with pending patent applications owned
by us directed to improved methods of producing oligodendrocyte progenitor cells, oligodendrocyte progenitor cell compositions and methods
of treatment of spinal cord injury using oligodendrocyte progenitor cells. There is also a patent family directed to improved methods
of producing oligodendrocyte progenitor cells, oligodendrocyte progenitor cell compositions and methods for the treatment of stroke using
oligodendrocyte progenitor cells which is jointly owned with the Regents of the University of California. The expiration dates of the
patents and pending patent applications acquired from Geron and in-licensed from the Regents of the University of California range from
2023 to 2036. The estimated expiration dates of the four patent families with pending applications owned by us range from 2036 to 2042.
The commercial success of OPC1 depends, in part, upon our ability to exclude competition for this product with the existing patent portfolio,
regulatory exclusivity, undisclosed know-how and/or trade secrets, or a combination of these barriers to entry.
VAC
Platform
We
have numerous U.S. and international issued patents and pending patent applications that are relevant to dendritic cells, including patent
families acquired from Geron or in-licensed from third parties that are directed to the differentiation of pluripotent stem cells, including
hES cells, into hematopoietic progenitor cells and immature and mature dendritic cells. In addition, these patent rights include a patent
family with claims directed to immunogenic compositions comprising antigen-presenting dendritic cells and methods of eliciting an anti-telomerase
immune response in a subject by administering to the subject such compositions. The expiration dates of the patents, and the estimated
expiration dates of the pending applications, acquired from Geron or in-licensed to us range from 2022 to 2041. The commercial success
of VAC products depends, in part, upon our ability to exclude competition in these products with this patent portfolio, regulatory exclusivity,
undisclosed know-how and/or trade secrets, or a combination of these barriers to entry.
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General
Risks Related to Obtaining and Enforcing Patent Protection
Because
patent applications are confidential until a patent is issued, we may not know if our competitors have filed patent applications for
technology covered by our pending applications or if we were the first to invent or first to file an application directed toward the
technology that is the subject of our patent applications. Competitors may have filed patent applications or received patents and may
obtain additional patents and proprietary rights that block or compete with our products. In addition, if competitors file patent applications
covering our technology, we may have to participate in interference/derivation proceedings or litigation to determine the right to a
patent. Litigation and interference/derivation proceedings are unpredictable and expensive, such that, even if we are ultimately successful,
our results of operations may be adversely affected by such events. Accordingly, there is a risk that any patent applications that we
file and any patents that we hold or later obtain could be challenged by third parties and be declared invalid in view of third party
patent applications and/or patents. Litigation, interferences, oppositions, inter partes reviews or other proceedings are, have been
and may in the future be necessary in some instances to determine the validity and scope of certain of our proprietary rights, and in
other instances to determine the validity, scope or non-infringement of certain patent rights claimed by third parties to be pertinent
to the manufacture, use or sale of our products. We may also face challenges to our patent and regulatory protections covering our products
by third parties, including manufacturers of generics and biosimilars that may choose to launch or attempt to launch their products before
the expiration of our patent or regulatory exclusivity. Litigation, interference, oppositions, inter partes reviews, administrative challenges
or other similar types of proceedings are unpredictable and may be protracted, expensive and distracting to management. The outcome of
such proceedings could adversely affect the validity and scope of our patent or other proprietary rights, hinder our ability to manufacture
and market our products, require us to seek a license for the infringed product or technology or result in the assessment of significant
monetary damages against us that may exceed any amounts that we may accrue on our financial statements as a reserve for contingent liabilities.
An adverse determination in a judicial or administrative proceeding or a failure to obtain necessary licenses could prevent us from manufacturing
or selling our products. Furthermore, payments under any licenses that we are able to obtain would reduce our profits derived from the
covered products and services.
The
enforcement of patent rights often requires litigation against third-party infringers, and such litigation can be costly to pursue. Even
if we succeed in having new patents issued or in defending any challenge to issued patents, there is no assurance that our patents will
be comprehensive enough to provide us with meaningful patent protection against our competitors.
Employees
As
of December 31, 2021, we had 61 employees, of which 18 were Lineage employees and 43 were employees of our subsidiary,
Cell Cure in Israel and of which 57 were employed on a full-time basis and four were employed on a part-time basis. Eleven employees
hold Ph.D. degrees in one or more fields of science or doctorates in medicine. None of our employees are covered by a collective bargaining
agreement.
Manufacturing
We
maintain an innovative cell therapy manufacturing facility in the Bio Park on the campus of the Hadassah University Hospital in Jerusalem,
Israel. The facility includes process development laboratories and a state-of-the-art, cGMP manufacturing facility. It is designed and
equipped to enable simultaneous cGMP processes and to produce a range of cell therapy products for human use in clinical trials as well
as at a scale suitable for commercial launch. All cGMP manufacturing processes, including cell banks and product manufacturing for our
cell therapy product candidates are conducted in this facility.
We
obtain key components required for the manufacture of our cell therapy product candidates from third-party manufacturers and suppliers,
which include, in some instances, sole source manufacturers and suppliers. We do not currently have long-term commitments or supply agreements
in place to obtain certain key components used in the manufacture of our cell therapy product candidates.
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Licensed
Technology and Product Development Agreements
Lineage
has obtained the right to use technology that we believe has great potential in our product development efforts, and that may be useful
to other companies that are engaged in the research and development of products for human therapeutic and diagnostic use.
Second
Amendment to Clinical Trial and Option Agreement and License Agreement with Cancer Research UK
On
May 6, 2020, Lineage and its wholly owned subsidiary Asterias entered into a Second Amendment to Clinical Trial and Option Agreement
(the “CTOA Amendment”) with CRUK and Cancer Research Technology Limited (“CRT”), which amends the Clinical Trial
and Option Agreement entered into between Asterias, CRUK and CRT dated September 8, 2014, as amended September 8, 2014. Pursuant to the
CTOA Amendment, Lineage assumed all obligations of Asterias and exercised early its option to acquire data generated in the Phase 1 clinical
trial of VAC2 in non-small cell lung cancer being conducted by CRUK. CRUK is continuing to conduct the VAC2 study.
Either
party may terminate the CRT License Agreement for the uncured material breach of the other party. CRT may terminate the CRT License Agreement
in the case of Lineage’s insolvency or if Lineage ceases all development and commercialization of all products under the CRT License
Agreement.
WARF
Agreements
We
have rights to certain U.S and international issued patents, pending patent applications and stem cell lines with the Wisconsin Alumni
Research Foundation (“WARF”) under a Commercial License and Option Agreement entered into between Lineage and WARF in January
2008 and a Non-Exclusive License Agreement entered into between Asterias and WARF in October 2013 (collectively, the “WARF Agreements”).
Under
the WARF Agreements, we have a worldwide non-exclusive license under certain WARF patents and WARF-owned primate (including human) stem
cell lines covered by such patents for use in internal research, and to make, use and sell products that are used as research tools and
products that are discovered or developed through our internal research using such patents and stem cells. We paid upfront license fees
and have agreed to additional payments upon the attainment of specified clinical development milestones, royalties on sales of commercialized
products, and, subject to certain exclusions, a percentage of any payments that we may receive from any sublicenses that we may grant
to use the licensed patents or stem cell lines.
The
WARF Agreements will terminate with respect to licensed patents upon the expiration of the last licensed patent to expire and with respect
to licensed cell lines until terminated by a party. We may terminate the WARF Agreements at any time with prior written notice, and WARF
may terminate the WARF Agreements upon a breach. We have agreed to indemnify WARF and certain other designated affiliated entities from
liability arising out of or relating to the death or injury of any person or damage to property due to the sale, marketing, use or manufacture
of products that are covered by the licensed patents, licensed stem cell lines or inventions or materials developed or derived from the
licensed patents or stem cell lines.
Royalty
Agreement with Geron
In
connection with Asterias’s acquisition of Geron’s stem cell assets, in October 2013, we entered into a royalty agreement
with Geron (the “Royalty Agreement”) pursuant to which we agreed to pay Geron a 4% royalty on net sales (as defined in the
Royalty Agreement) by us or any of our affiliates or sales agents of any products that we develop and commercialize that are covered
by the patents Geron contributed to us. In the case of sales of such products by a person other than us or one of our affiliates or sales
agents, we will be required to pay Geron 50% of all royalties and cash payments received by us or by our affiliate in respect of a product
sale. Royalty payments will be subject to proration in the event that a product covered by a patent acquired from Geron is sold in combination
with another product that is not covered by a patent acquired from Geron. The Royalty Agreement will terminate at the expiration or termination
date of the last issued patent contributed by Geron under the Royalty Agreement. We estimate that the latest patent expiration date will
be in 2033.
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Government
Regulation
Government
authorities at the federal, state and local level, and in other countries, extensively regulate among other things, the development,
testing, manufacture, quality, approval, safety, efficacy, distribution, labeling, packaging, storage, record keeping, marketing, import/export
and promotion of drugs, biologics, and medical devices. Authorities also heavily regulate many of these activities for human cells, tissues,
and cellular and tissue-based products (“HCT/Ps”).
FDA
and Foreign Regulation of Therapeutic Products
The
FDA and foreign regulatory authorities will regulate our proposed products as drugs, biologics or medical devices, depending upon such
factors as the use to which the product will be put, the chemical composition, and the interaction of the product with the human body.
In the United States, the FDA regulates drugs and biologics under the Federal Food, Drug and Cosmetic Act (“FDCA”), the Public
Health Service Act (“PHSA”), and implementing regulations. In addition, establishments that manufacture human cells, tissues,
and HCT/Ps are subject to additional registration and listing requirements, including current good tissue practice regulations. Certain
cell therapy proposed products will be reviewed by the FDA staff in its Center for Biologics Evaluation and Research Office of Tissues
and Advanced Therapies.
Our
domestic human drug and biologic products will be subject to rigorous FDA review and approval procedures. After testing in animals to
evaluate the potential efficacy and safety of the product candidate, an IND submission must be made to the FDA to obtain authorization
for human testing. Extensive clinical testing, which is generally done in three phases, must then be undertaken to demonstrate optimal
use, safety, and efficacy of each product in humans. Each clinical trial is conducted under the auspices of an independent Institutional
Review Board (“IRB”). The IRB will consider, among other things, ethical factors, the safety of human subjects, and the possible
liability of the institution.
Phase 1 clinical trials are conducted
in a small number of healthy volunteers or volunteers with the target disease or condition to assess safety. Phase 2 clinical trials
are conducted with groups of patients afflicted with the target disease or condition in order to determine preliminary efficacy, optimal
dosages and expanded evidence of safety. In some cases, an initial trial is conducted in diseased patients to assess both preliminary
safety and preliminary efficacy, in which case it is referred to as a Phase 1/2 clinical trial. Phase 3 clinical trials
are large-scale, multi-center, comparative trials and are conducted with patients afflicted with the target disease or condition in order
to provide enough data to demonstrate the efficacy and safety required by the FDA. The FDA closely monitors the progress of each of the
three phases of clinical testing and may, at its discretion, re-evaluate, alter, suspend or terminate the clinical trial based upon the
data which have been accumulated to that point and its assessment of the risk/benefit ratio to the intended patient population. All adverse
events must be reported to the FDA. Monitoring of all aspects of the trial to minimize risks is a continuing process.
No
action can be taken to market any therapeutic product in the U.S. until an appropriate New Drug Application (“NDA”) or Biologics
License Application (“BLA”) has been approved by the FDA. Submission of the application is not a guarantee that the FDA will
find it complete and accept it for filing. If an application is accepted for filing, following the FDA’s review, the FDA may grant
marketing approval, or deny the application by way of a Complete Response Letter if it determines that the application does not provide
an adequate basis for approval. FDA regulations also restrict the export of therapeutic products for clinical use prior to FDA approval.
Before approving a BLA, the FDA will inspect the facilities at which the product is manufactured. The FDA will not approve the product
unless it determines that the manufacturing processes and facilities are in compliance with cGMP requirements and adequate to assure
consistent production of the product within required specifications including gene therapy products (“GTPs”) to the extent
applicable. These are FDA regulations and guidance documents that govern the methods used in, and the facilities and controls used for,
the manufacture of HCT/Ps. The primary intent of the GTP requirements is to ensure that cell and tissue-based products are manufactured
in a manner designed to prevent the introduction, transmission and spread of communicable disease. FDA regulations also require HCT/P
establishments to register and list their HCT/Ps with the FDA and, when applicable, to evaluate donors through screening and testing.
Additionally, before approving a BLA, the FDA will typically inspect one or more clinical sites to assure that the clinical trials were
conducted in compliance with IND trial requirements and GCP requirements. To maintain compliance with cGMPs, GTPs, and GCPs, an
applicant must incur significant expenditure of time, money and effort in the areas of training, record keeping, production, and quality
control.
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To date, the FDA has not granted
marketing approval to any pluripotent stem cell-based therapeutic products, and it is possible that the FDA or foreign regulatory
agencies may subject our product candidates to additional or more stringent review than drugs or biologics derived from other technologies.
The
FDA offers several programs to expedite development of products that treat serious or life-threatening illnesses and that provide meaningful
therapeutic benefits to patients over existing treatments. A drug is eligible for designation as an RMAT if: the drug is a regenerative
medicine therapy, which is defined as a cell therapy, therapeutic tissue engineering product, human cell and tissue product or any combination
product using such therapies or products, except for those regulated solely under certain other sections; the drug is intended to treat,
modify, reverse or cure a serious or life-threatening disease or condition; and preliminary clinical evidence indicates that the drug
has the potential to address unmet medical needs for such disease or condition. Some of our current and future products may be eligible
for RMAT designation.
Under
the Orphan Drug Act, the FDA may grant orphan designation to a drug or biologic intended to treat a rare disease or condition, which
is a disease or condition that affects fewer than 200,000 individuals in the United States, or if it affects more than 200,000 individuals
in the United States, there is no reasonable expectation that the cost of developing and making available a drug or biologic for this
type of disease or condition will be recovered from sales in the United States for that drug or biologic. Orphan drug designation must
be requested before submitting a BLA. After the FDA grants orphan drug designation, the generic identity of the therapeutic agent and
its potential orphan use are disclosed publicly by the FDA. The orphan drug designation does not convey any advantage in, or shorten
the duration of, the regulatory review or approval process.
If
a product that has orphan drug designation subsequently receives the first FDA approval for the disease for which it has such designation,
the product may be entitled to orphan drug exclusivity, which means that the FDA may not approve any other applications, including a
full BLA, to market the same biologic for the same indication for seven years, except in limited circumstances, such as a showing of
clinical superiority to the product with orphan drug exclusivity. Orphan drug exclusivity does not prevent FDA from approving a different
drug or biologic for the same disease or condition, or the same drug or biologic for a different disease or condition. Among the other
benefits of orphan drug designation are tax credits for certain research and a waiver of the BLA application fee. A designated orphan
drug may not receive orphan drug exclusivity if it is approved for a use that is broader than the indication for which it received orphan
designation. In addition, exclusive marketing rights in the United States may be lost if the FDA later determines that the request for
designation was materially defective or if the manufacturer is unable to assure sufficient quantities of the product to meet the needs
of patients with the rare disease or condition.
Combination
Products
If
we develop any products that are used with medical devices, they may be considered combination products, which are defined by the FDA
to include products comprised of two or more regulated components or parts such as a biologic and a device. When regulated independently,
biologics and devices each have their own regulatory requirements. However, the regulatory requirements for a combination product comprised
of a biologic administered with a delivery device can be more complex, because in addition to the individual regulatory requirements
for each component, additional combination product regulatory requirements may apply. The Office of Combination Products at the FDA coordinates
the review of such products and determines the primary mode of action of a combination product. The definition and regulatory requirements
for combination products may differ significantly among countries in which we may seek approval of our product candidates.
FDA
Regulation of Manufacturing
The
FDA regulates the manufacturing process of pharmaceutical products, human tissue and cell products, and medical devices, requiring that
they be produced in compliance with cGMP. See “Manufacturing.” The FDA regulates and inspects equipment, facilities, laboratories
and processes used in the manufacturing and testing of products prior to providing approval to market products. If after receiving approval
from the FDA, a material change is made to manufacturing equipment or to the location or manufacturing process, additional regulatory
review may be required. The FDA also conducts regular, periodic visits to re-inspect the equipment, facilities, laboratories and processes
of manufacturers following an initial approval. If, as a result of those inspections, the FDA determines that equipment, facilities,
laboratories or processes do not comply with applicable FDA regulations and conditions of product approval, the FDA may seek civil, criminal
or administrative sanctions and/or remedies against the manufacturer, including suspension of manufacturing operations. Issues pertaining
to manufacturing equipment, facilities or processes may also delay the approval of new products undergoing FDA review.
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FDA
Regulation of Advertising and Product Promotion
The
FDA also regulates the content of advertisements used to market pharmaceutical and biologic products. Claims made in advertisements concerning
the safety and efficacy of a product, or any advantages of a product over another product, must be supported by clinical data filed as
part of an NDA, a BLA, or an amendment to an NDA or a BLA, and must be consistent with the FDA-approved labeling and dosage information
for that product.
Pharmaceutical
and biologic products may be promoted only for the approved indications in accordance with the approved label. The FDA and other agencies
actively enforce the laws and regulations prohibiting the promotion of off-label uses, and a company that is found to have improperly
promoted off-label may be subject to significant liability. However, physicians may, in their independent medical judgment, prescribe
legally available products for off-label uses. The FDA does not regulate the behavior of physicians in their choice of treatments but
the FDA does restrict manufacturer’s communications on the subject of off-label use of their products.
Foreign
Regulation
Sales
of pharmaceutical products outside the U.S. are subject to foreign regulatory requirements that vary widely from country to country.
Even if FDA approval has been obtained, approval of a product by comparable regulatory authorities of foreign countries must be obtained
prior to the commencement of marketing the product in those countries. The time required to obtain such approval may be longer or shorter
than that required for FDA approval.
Federal
Funding and State Regulations
Effective
July 7, 2009, the NIH adopted guidelines on the use of hES cells in federally funded research. The central focus of the guidelines is
to assure that hES cells used in federally funded research are derived from human embryos that were created for reproductive purposes,
are no longer needed for this purpose, and are voluntarily donated for research purposes with the informed written consent of the donors.
hES cells that were not derived in compliance with the guidelines, are not eligible for use in federally funded research.
The
state of California has adopted legislation and regulations that require institutions that conduct stem cell research to notify, and
in certain cases obtain approval from, a Stem Cell Research Oversight Committee (“SCRO Committee”) before conducting the
research. Under certain California regulations, all hES cell lines used in our research must be acceptably derived. California regulations
further require certain records to be maintained with respect to stem cell research and the materials used. Lineage programs that involve
the use of stem cells have been reviewed by a SCRO Committee to confirm compliance with federal and state guidelines.
The
hES cell lines that we use are all on the NIH registry of lines that have been reviewed and meet standards for federal funding grants.
All of our research programs utilize stem cells from established and well-characterized cell lines and which are capable of self-renewal
and expansion through normal cellular division (mitosis). Our research programs do not require new tissue or cells from donors of any
kind.
Health
Insurance Portability and Accountability Act and Other Health Information Privacy and Security Laws
The
Health Insurance Portability and Accountability Act (“HIPAA”), as amended by the Health Information Technology for Economic
and Clinical Health Act (“HITECH”), and their respective implementing regulations impose obligations on “covered entities,”
including certain healthcare providers, health plans, and healthcare clearinghouses, as well as their respective “business associates”
that create, receive, maintain or transmit individually identifiable health information for or on behalf of a covered entity, and their
subcontractors that use, disclose, access, or otherwise process individually identifiable protected health information, with respect
to protecting the privacy, security, and transmission of protected health information. HIPAA also regulates standardization of data content,
codes and formats used in healthcare transactions and standardization of identifiers for covered health plans and providers. Penalties
for violations of HIPAA regulations include civil and criminal penalties. Additionally, HITECH created four new tiers of civil monetary
penalties, amended HIPAA to make civil and criminal penalties directly applicable to business associates, and gave state attorneys general
new authority to file civil actions for damages or injunctions in U.S. federal courts to enforce HIPAA and seek attorneys’ fees
and costs associated with pursuing federal civil actions. In addition, certain state and foreign laws also govern the privacy and security
of health information in some circumstances, many of which differ from each other in significant ways and often are not preempted by
HIPAA, thus complicating compliance efforts.
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Privacy and Data Security Laws
In the ordinary course of
our business, we may process personal data and other sensitive information. Accordingly, we are, or may become, subject to numerous data
privacy and security obligations, including federal, state, local, and foreign laws, regulations, guidance, and industry standards related
to data privacy, security, and protection. Such obligations may include, without limitation, the Federal Trade Commission Act, the California
Consumer Privacy Act of 2018 (“CCPA”), Israel’s Protection of Privacy Law 5741-1981 (“PPL”), the European
Union’s General Data Protection Regulation 2016/679 (“EU GDPR”), the EU GDPR as it forms part of United Kingdom (“UK”)
law by virtue of section 3 of the European Union (Withdrawal) Act 2018 (“UK GDPR”), and the ePrivacy Directive. In addition,
several states within the United States have enacted or proposed data privacy laws. For example, Virginia passed the Consumer Data Protection
Act, and Colorado passed the Colorado Privacy Act.
The CCPA and EU GDPR are
examples of the increasingly stringent and evolving regulatory frameworks related to personal data processing that may increase our compliance
obligations and exposure for any noncompliance. For example, the CCPA imposes obligations on covered businesses to provide specific disclosures
related to a business’s collection, use, and disclosure of personal data and a requirement to respond to certain requests from
California residents related to their personal data (for example, requests to know of the business’s personal data processing activities,
to delete the individual’s personal data, and to opt out of certain personal data disclosures). Also, the CCPA provides for civil
penalties and a private right of action for certain data breaches. In addition, the California Privacy Rights Act of 2020 (“CPRA”),
effective January 1, 2023, will expand the CCPA. The CPRA will, among other things, give California residents the ability to limit use
of certain sensitive personal data, establish restrictions on personal data retention, expand the types of data breaches that are subject
to the CCPA’s private right of action, and establish a new California Privacy Protection Agency to implement and enforce the new
law. U.S. federal and state consumer protection laws require us to publish statements that accurately and fairly describe how we handle
personal data and choices individuals may have about the way we handle their personal data
Foreign data privacy and
security laws (including but not limited to the EU GDPR and UK GDPR) impose significant and complex compliance obligations on entities
that are subject to those laws. As one example, the EU GDPR applies to any company established in the EEA and to companies established
outside the EEA that process personal data in connection with the offering of goods or services to data subjects in the EEA or the monitoring
of the behavior of data subjects in the EEA. These obligations may include limiting personal data processing to only what is necessary
for specified, explicit, and legitimate purposes; requiring a legal basis for personal data processing; requiring the appointment of
a data protection officer in certain circumstances; increasing transparency obligations to data subjects; requiring data protection impact
assessments in certain circumstances; limiting the collection and retention of personal data; increasing rights for data subjects; formalizing
a heightened and codified standard of data subject consents; requiring the implementation and maintenance of technical and organizational
safeguards for personal data; mandating notice of certain personal data breaches to the relevant supervisory authority(ies) and affected
individuals; and mandating the appointment of representatives in the UK and/or the EU in certain circumstances.
Federal
and State Fraud and Abuse Laws
A
variety of federal and state laws prohibit fraud and abuse. These laws are interpreted broadly and enforced aggressively by various state
and federal agencies, including the Centers for Medicare & Medicaid Services (“CMS”), the Department of Justice, the
Office of Inspector General for the U.S. Department of Health and Human Services (“HHS”), and various state agencies. In
addition, the Medicare and Medicaid programs increasingly use a variety of contractors to review claims data and to identify improper
payments as well as fraud and abuse. These contractors include Recovery Audit Contractors, Medicaid Integrity Contractors and Zone Program
Integrity Contractors. In addition, CMS conducts Comprehensive Error Rate Testing audits, the purpose of which is to detect improper
Medicare payments. Any overpayments identified must be repaid unless a favorable decision is obtained on appeal. In some cases, these
overpayments can be used as the basis for an extrapolation, by which the error rate is applied to a larger universe of claims, and which
can result in even higher repayments.
The
federal Anti-Kickback Statute prohibits, among other things, knowingly and willfully offering, paying, soliciting, receiving, or providing
remuneration, directly or indirectly, to induce or in return for either the referral of an individual, or the furnishing, recommending,
or arranging for the purchase, lease or order of any healthcare item or service reimbursable, in whole or in part, under a federal healthcare
program. The definition of “remuneration” has been broadly interpreted to include anything of value, including gifts, discounts,
credit arrangements, payments of cash, ownership interests and providing anything at less than its fair market value. Recognizing that
the federal Anti- Kickback Statute is broad and may prohibit certain common activities within the healthcare industry, the Office of
Inspector General for HHS has issued a series of statutory exceptions and regulatory “safe harbors.” However, these exceptions
and safe harbors are drawn narrowly and require strict compliance in order to offer protection from prosecution under the federal Anti-Kickback
Statute. Although full compliance with these provisions ensures against prosecution under the federal Anti-Kickback Statute, the failure
of a transaction or arrangement to fit within a specific safe harbor does not necessarily mean that the transaction or arrangement is
illegal or that prosecution under the federal Anti-Kickback Statute will be pursued. However, conduct and business arrangements that
do not fully satisfy all requirements of an applicable safe harbor may result in increased scrutiny by government enforcement authorities
and would be evaluated on a case-by-case basis based on a cumulative review of their facts and circumstances. Additionally, the Patient
Protection and Affordable Care Act, as amended by the Healthcare and Education Reconciliation Act (collectively, the “ACA”)
codified case law 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 federal False Claims Act.
The
federal civil and criminal false claims laws, including the federal False Claims Act, which can be enforced by private citizens on behalf
of the government, through civil whistleblower or qui tam actions, and civil monetary penalty laws, which prohibit, among other things,
individuals or entities from knowingly presenting, or causing to be presented, claims for payment from Medicare, Medicaid, or other third-party
payors that are false or fraudulent. Pharmaceutical and other healthcare companies have been prosecuted under these laws for alleged
off-label promotion of drugs, purportedly concealing price concessions in the pricing information submitted to the government for government
price reporting purposes, and allegedly providing free product to customers with the expectation that the customers would bill federal
healthcare programs for the product. As a result of a modification made by the Fraud Enforcement and Recovery Act of 2009, a claim includes
“any request or demand” for money or property presented to the U.S. government. In addition, manufacturers can be held liable
under the federal False Claims Act even when they do not submit claims directly to government payors if they are deemed to “cause”
the submission of false or fraudulent claims.
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HIPAA also created new federal
crimes, including healthcare fraud and false statements relating to healthcare matters. The healthcare fraud statute prohibits knowingly
and willfully executing a scheme to defraud any healthcare benefit program, including private third-party payers. The false statements
statute prohibits 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. Similar to the federal
Anti-Kickback Statute, a person or entity does not need to have actual knowledge of the statute or specific intent to violate it in order
to have committed a violation.
The
federal Physician Payments Sunshine Act which require 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 certain exceptions) to report annually
to CMS information related to payments or other transfers of value made to physicians (defined to include doctors, dentists, optometrists,
podiatrists, and chiropractors), certain other healthcare professionals (such as physician assistants and nurse practitioners), and teaching
hospitals, as well as ownership and investment interests held by physicians and their immediate family members.
Many
states have laws similar to the federal laws described above and the state laws may be broader in scope and may apply regardless of payor,
such as state anti-kickback and false claims laws that may apply to sales or marketing arrangements and claims involving healthcare items
or services reimbursed by non-governmental third party payors, including private insurers, or that apply regardless of payor, state laws
that require pharmaceutical companies to comply with the pharmaceutical industry’s voluntary compliance guidelines and the relevant
compliance guidance promulgated by the federal government, state and local laws that require drug manufacturers to report information
related to payments and other transfers of value to physicians and other healthcare providers or marketing expenditures, state laws that
require the reporting of information related to drug pricing, and state and local laws requiring the registration of pharmaceutical sales
representatives.
Additionally,
the U.S. Foreign Corrupt Practices Act (“FCPA”) prohibits U.S. corporations and their representatives from offering, promising,
authorizing or making payments to any foreign government official, government staff member, political party or political candidate in
an attempt to obtain or retain business abroad. The scope of the FCPA includes interactions with certain healthcare professionals in
many countries. Other countries have enacted similar anti-corruption laws and/or regulations.
If
our operations are found to be in violation of any of the laws described above, or any other governmental regulations that apply to us,
we may be subject to significant civil, criminal and administrative penalties, including sanctions, damages, disgorgement, monetary
fines, possible exclusion from participation in Medicare, Medicaid and other federal healthcare programs, imprisonment, integrity oversight
and reporting obligations, contractual damages, reputational harm, diminished profits and future earnings, and curtailment or restructuring
of our operations.
Coverage
and Reimbursement
Patients
generally rely on third-party payors to reimburse part or all of the costs associated with medical products. Accordingly, market acceptance
of medical products can depend on the extent to which third-party coverage and reimbursement is available from government health administration
authorities, private healthcare insurers and other healthcare funding organizations. No uniform policy for coverage and reimbursement
exists in the United States, and coverage and reimbursement can differ significantly from payor to payor. Decisions regarding whether
to cover any of our product candidates, if approved, the extent of coverage and amount of reimbursement to be provided are made on a
plan-by-plan basis. Third-party payors often rely upon Medicare coverage policy and payment limitations in setting their own reimbursement
rates, but also have their own methods and approval process apart from Medicare determinations. As a result, the coverage determination
process is often a time-consuming and costly process that will require us to provide scientific and clinical support for the use of our
product candidates to each payor separately, with no assurance that coverage and adequate reimbursement will be applied consistently
or obtained in the first instance. Pharmaceutical companies may be required to provide specified rebates or discounts on the products
it sells to certain government funded programs, including Medicare and Medicaid, and those rebates or discounts have increased over time.
The ACA increased many of these mandatory discounts and rebates required and imposed a new branded prescription pharmaceutical manufacturers
and importers fee payable each year by certain pharmaceutical companies and manufacturers.
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Outside
of the United States, the proposed pricing for a drug must be approved before it may be lawfully marketed. The requirements governing
drug pricing vary widely from country to country. For example, the EU provides options for its member states to restrict the range of
medicinal products for which their national health insurance systems provide reimbursement and to control the prices of medicinal products
for human use. A member state may approve a specific price for the medicinal product, or it may instead adopt a system of direct or indirect
controls on the profitability of the company placing the medicinal product on the market. Historically, products launched in the EU do
not follow price structures of the United States and generally tend to be significantly lower.
Healthcare
Reform
The United States and some foreign
jurisdictions are considering or have enacted a number of reform proposals to change the healthcare system. There is significant interest
in promoting changes in healthcare systems with the stated goals of containing healthcare costs, improving quality or expanding access.
In the United States, the pharmaceutical industry has been a particular focus of these efforts and has been significantly affected by
federal and state legislative initiatives, including those designed to limit the pricing, coverage, and reimbursement of pharmaceutical
and biopharmaceutical products, especially under government-funded healthcare programs, and increased governmental control of drug pricing.
In March 2010, the ACA was signed into law, which substantially changed
the way healthcare is financed by both governmental and private insurers in the United States, and significantly affected the pharmaceutical
industry. The ACA contains a number of provisions of particular import to the pharmaceutical and biotechnology industries, including,
but not limited to, those governing enrollment in federal healthcare programs, 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, and annual
fees based on pharmaceutical companies’ share of sales to federal healthcare programs. Since its enactment, there have been judicial,
Congressional, and executive branch challenges to certain aspects of the ACA. For example, legislation enacted in 2017, informally known
as the Tax Cuts and Jobs Act (the “2017 Tax Act”), among other things, removes penalties for not complying with ACA’s
individual mandate to carry health insurance. On June 17, 2021, the U.S. Supreme Court dismissed a challenge on procedural grounds that
argued the ACA is unconstitutional in its entirety because the individual mandate was repealed by Congress. Thus, the ACA will remain
in effect in its current form. Moreover, on January 28, 2021, President Biden issued an executive order that initiated a special enrollment
period for purposes of obtaining health insurance coverage through the ACA marketplace, which began on February 15, 2021 and remained
open through August 15, 2021. The executive order also instructed certain governmental agencies to review and reconsider their existing
policies and rules that limit access to healthcare, including among others, reexamining Medicaid demonstration projects and waiver programs
that include work requirements, and policies that create unnecessary barriers to obtaining access to health insurance coverage through
Medicaid or the ACA. It is possible that the ACA will be subject to judicial or Congressional challenges in the future. It is unclear
how any such challenges and other litigation, and the healthcare reform measures of the Biden administration will impact the ACA.
In
addition, other legislative changes have been proposed and adopted since the ACA was enacted. On August 2, 2011, the Budget Control Act
of 2011 was signed into law, which includes reductions to Medicare payments to providers of 2% per fiscal year, which went into effect
on April 1, 2013 and, due to subsequent legislative amendments to the statute, will remain in effect through 2031, except for a temporary
suspension from May 1, 2020 through March 31, 2022 due to the COVID-19 pandemic, unless additional Congressional action is taken. Under
current legislation, the actual reduction in Medicare payments will vary from 1% in 2022 to up to 3% in the final fiscal year of this
sequester. On January 2, 2013, the American Taxpayer Relief Act of 2012 was signed into law, which, among other things, reduced Medicare
payments to several providers, including hospitals, and increased the statute of limitations period for the government to recover overpayments
to providers from three to five years. Further, on March 11, 2021, President Biden signed the American Rescue Plan Act of 2021 into law,
which eliminates the statutory Medicaid drug rebate cap, currently set at 100% of a drug’s average manufacturer price, for single
source and innovator multiple source drugs, beginning January 1, 2024. Congress is considering additional health reform measures.
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Moreover,
there has recently been heightened governmental scrutiny over the manner in which manufacturers set prices for their marketed products,
which has resulted in several presidential executive orders, Congressional inquiries and proposed and enacted federal and state legislation
designed to, among other things, bring more transparency to product pricing, review the relationship between pricing and manufacturer
patient programs, and reform government program reimbursement methodologies for drug products. For example, on July 24, 2020 and September
13, 2020, the Trump administration announced several executive orders related to prescription drug pricing that attempted to implement
several of the administration’s proposals. As a result, the FDA concurrently released a final rule and guidance in September 2020
providing pathways for states to build and submit importation plans for drugs from Canada. Further, on November 20, 2020, the HHS finalized
a regulation removing safe harbor protection for price reductions from pharmaceutical manufacturers to plan sponsors under Medicare Part
D, either directly or through pharmacy benefit managers, unless the price reduction is required by law. The implementation of the rule
has been delayed by the Biden administration from January 1, 2022 to January 1, 2023 in response to ongoing litigation. The rule also
creates a new safe harbor for price reductions reflected at the point-of-sale, as well as a new safe harbor for certain fixed fee arrangements
between pharmacy benefit managers and manufacturers, the implementation of which have also been delayed by the Biden administration until
January 1, 2023. On November 20, 2020, CMS issued an interim final rule implementing President Trump’s Most Favored Nation executive
order, which would tie Medicare Part B payments for certain physician-administered drugs to the lowest price paid in other economically
advanced countries. The Most Favored Nation regulations mandate participation by identified Medicare Part B providers and will apply
in all U.S. states and territories for a seven-year period beginning January 1, 2021, and ending December 31, 2027. As a result of litigation
challenging the Most Favored Nation model, on December 27, 2021 CMS published a final rule that rescinds the Most Favored Nation model
interim final rule. Further, in July 2021, the Biden administration released an executive order that included multiple provisions aimed
at prescription drugs. In response to President Biden’s executive order, on September 9, 2021, the HHS released a Comprehensive
Plan for Addressing High Drug Prices that outlines principles for drug pricing reform. The plan sets out a variety of potential legislative
policies that Congress could pursue as well as potential administrative actions HHS can take to advance these principles. No legislation
or administrative actions have been finalized to implement these principles. At the state level, legislatures have increasingly passed
legislation and implemented regulations designed to control pharmaceutical product pricing, including price or patient reimbursement
constraints, discounts, restrictions on certain product access and marketing cost disclosure and transparency measures, and, in some
cases, designed to encourage importation from other countries and bulk purchasing. Further, it is possible that additional governmental
action is taken in response to the COVID-19 pandemic.
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Major
Customers and Sources of Revenues
Major
Sources of Revenues
The
following table shows our major sources of revenues, as a percentage of total revenues, that were recognized during the years ended December
31, 2021 and 2020:
Year Ended December 31,
Sources of Revenues
2021
2020
Royalties
63.9 %
42.3 %
Collaboration revenues
25.8 %
- %
IIA grant income (Cell Cure Neurosciences Ltd, Israel)
10.3 %
36.5 %
NIH grant income
- %
21.2 %
Geographic
Area
Year Ended December 31,
2021
2020
United States
$ 3,895
$ 1,160
Foreign (1)
446
666
Total revenues
$ 4,341
$ 1,826
(1) Foreign
revenues are primarily generated from grants in Israel.
Marketing
Therapeutic
Products and Medical Devices
Because
our therapeutic product candidates and medical devices are still in the research and development stage, we will not initially need to
have our own marketing personnel. If we or our subsidiaries are successful in developing marketable therapeutic products and medical
devices, we will need to build our own marketing and distribution capability for those products, which would require the investment of
significant financial and management resources, or we and our subsidiaries will need to find collaborative marketing partners, independent
sales representatives, or wholesale distributors for the commercial sale of those products.
If
we market products through arrangements with third parties, we may pay sales commissions to sales representatives or we may sell or consign
products to distributors at wholesale prices. This means that our gross profit from product sales may be less than would be the case
if we were to sell our products directly to end users at retail prices through our own sales force. On the other hand, selling to distributors
or through independent sales representatives would allow us to avoid the cost of hiring and training our own sales employees. There can
be no assurance we will be able to negotiate distribution or sales agreements with third parties on favorable terms to justify our investment
in our products or achieve sufficient revenues to support our operations.
Competition
We
face substantial competition in all fields of business in which we engage. That competition is likely to intensify as new products and
technologies reach the market. Superior new products are likely to sell for higher prices and generate higher profit margins if acceptance
by the medical community is achieved. Those companies that are successful at being the first to introduce new products and technologies
to the market may gain significant economic advantages over their competitors in the establishment of a customer base and track record
for the performance of their products and technologies. Such companies will also benefit from revenues from sales that could be used
to strengthen their research and development, production, and marketing resources. Companies engaged in the medical products industry
face the risk of obsolescence of their products and technologies as more advanced or cost-effective products and technologies are developed
by competitors. As the industry matures, companies will compete based upon the performance and cost-effectiveness of their products.
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Products
for Regenerative Medicine
The
cell therapy industry is characterized by rapidly evolving technology and intense competition. Our competitors include major multinational
pharmaceutical companies, specialty biotechnology companies, and chemical and medical products companies operating in the fields of regenerative
medicine, cell therapy, tissue engineering, and tissue regeneration. Many of these companies are well established and possess technical,
research and development, financial, and sales and marketing resources significantly greater than ours. In addition, certain smaller
biotech companies have formed strategic collaborations, partnerships, and other types of joint ventures with larger, well-established
industry competitors that afford the smaller companies’ potential research and development as well as commercialization advantages.
Academic institutions, governmental agencies, and other public and private research organizations are also conducting and financing research
activities, which may produce products directly competitive to those we are developing.
We
believe that some of our competitors are trying to develop pluripotent cells and human embryonic progenitor cell-based technologies and
products that may compete with our stem cell products based on efficacy, safety, cost, and intellectual property positions.
We may also face competition
from companies that have filed patent applications relating to the propagation and differentiation of stem cells. We may be required to
seek licenses from these competitors to commercialize certain products proposed by us, and such licenses may not be granted.
ITEM
1A.
RISK
FACTORS
An
investment in our common shares involves a high degree of risk. You should carefully consider the following risk factors, as well as
the other information in this Report, before deciding whether to purchase, hold or sell our common shares. The occurrence of any of the
following risks could harm our business, financial condition, results of operations and/or growth prospects or cause our actual results
to differ materially from those contained in forward-looking statements we have made in this Report and those we may make from time to
time. You should consider all of the risk factors described when evaluating our business.
Risks
Related to Our Business Operations and Capital Requirements
We
have incurred operating losses since inception, and we do not know if or when we will attain profitability.
Our
total operating losses for the fiscal years ended December 31, 2021 and 2020 were $49.2 million and $26.4 million, respectively, and
we had an accumulated deficit of $337.1 million as of December 31, 2021. Since inception, we have incurred significant operating losses
and have funded our operations primarily through sales of our equity securities and the equity securities of former subsidiaries, receipt
of research grants, royalties on product sales, license revenues, sales of research products, and revenues from subscription fees and
advertising revenue from database products of a former subsidiary. Substantially all of our losses have resulted from expenses incurred
in connection with our research and development programs and from general and administrative costs associated with our operations. All
of our product candidates will require substantial additional development time and resources before we would be able to apply for or
receive regulatory approvals. We expect to continue to incur losses for the foreseeable future, and we anticipate these losses will increase
substantially as we continue our development of, seek regulatory approval for and potentially commercialize any of our product candidates
and seek to identify, assess, acquire, in-license or develop additional product candidates.
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To
become and remain profitable, we must succeed in developing and eventually commercializing products that generate significant revenue.
This will require us to be successful in a range of challenging activities, including completing clinical trials and preclinical trials
of our product candidates, obtaining regulatory approval for these product candidates and manufacturing, marketing and selling any products
for which we may obtain regulatory approval. In addition, we are attempting to develop new medical products and technology. We may never
succeed in these activities and, even if we do, may never generate revenues that are significant enough to achieve profitability.
We
will continue to spend a substantial amount of our capital on research and development, but we might not succeed in developing products
and technologies that are useful in medicine.
We
are attempting to develop new medical products and technology. These new products and technologies might not prove to be safe and efficacious
in the human medical applications for which they are being developed. Our research and development activities are costly, time consuming,
and their results are uncertain. We incurred research and development expenses amounting to approximately $33.9 million and $12.3 million
during the fiscal years ended December 31, 2021 and 2020, respectively. If we successfully develop a new technology or product, refinement
of the new technology or product and definition of the practical applications and limitations of the technology or product may take years
and require large sums of money. Clinical trials of new therapeutic products, particularly those products that are regulated as biologics,
drugs, or devices, are very expensive and take years to complete. We may not have the financial resources to fund clinical trials on
our own and we may have to enter into licensing or collaborative arrangements with others. Any such arrangements may be dilutive to our
ownership or economic interest in the products we develop, and we might have to accept royalty payments on product sales rather than
receiving the gross revenues from product sales. In addition, we may discontinue one or more of the research or product development programs.
Our product and technology development programs may be delayed or discontinued should adequate funding on acceptable terms not be available.
The
amount and pace of research and development work that we can do or sponsor, and our ability to commence and complete clinical trials
required to obtain regulatory approval to market our therapeutic and medical device products, depends upon the amount of funds we have.
At
December 31, 2021, we had $58.4 million of cash, cash equivalents and marketable equity securities. There can be no assurance that we
will be able to raise additional funds on favorable terms or at all, or that any funds raised will be sufficient to permit us to develop
and market our products and technology, if and when approved. Our ability to raise additional funds may be adversely impacted by deteriorating
global economic conditions and the disruptions to and volatility in the credit and financial markets in the United States and worldwide
resulting from the ongoing COVID-19 pandemic. Unless we are able to generate sufficient revenue or raise additional funds when needed,
it is likely that we will be unable to continue our planned activities, even if we make progress in our research and development projects.
We may have to postpone or limit the pace of our research and development work and planned clinical trials of our product candidates
unless our cash resources increase through a growth in revenues, royalties, license fees, equity financings or borrowings.
We
are dependent on our third-party collaboration with Roche to develop and commercialize OpRegen. If Roche is not successful in developing
and commercializing OpRegen and/or Roche terminates the collaboration, we will lose a significant source of potential revenue.
We
currently have a collaboration and license agreement with Roche, pursuant to which we license to Roche rights to develop and commercialize
our retinal pigment epithelium cell therapies, including OpRegen (the “Licensed Products”), for the treatment of ocular disorders,
including age-related macular degeneration with geographic atrophy. Roche is obligated to pay us milestone payments upon the achievement
of specified developmental, regulatory and commercialization milestones. In addition, Roche is obligated to pay us royalties upon sales
of the Licensed Products. All regulatory and commercial milestone payments, and royalty payments, are subject to the existence
of certain intellectual property rights that cover OpRegen at the time such payments would otherwise become due, and the royalties on
net sales of OpRegen are subject to financial offsets based on the existence of competing products.
We are relying on Roche to
develop and commercialize the Licensed Products, and if Roche is not able to develop and commercialize the Licensed Products, determines
not to continue to pursue development and commercialization of the Licensed Products, or determines to terminate the collaboration
at any time in its sole discretion, we will not receive any future milestone or royalty payments under the agreement which would
harm our business, business prospects, financial condition and results of operations.
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Roche may determine not
to pursue development and commercialization and/or terminate the collaboration for many reasons, including: delays in development, manufacture
or clinical supply of OpRegen; Roche may believe that data generated in clinical trials for OpRegen may be negative, inconclusive, or
do not otherwise demonstrate adequate efficacy or clinical benefit to warrant further development or commercialization; Roche may not
dedicate the resources necessary to carry OpRegen through clinical development; Roche may conclude that the commercial potential of OpRegen
does not meet its internal thresholds or yield a timely return on its investment in OpRegen; Roche may choose not to develop and commercialize
OpRegen in certain, or any, markets or for one or more indications, if at all; Roche may change the focus of its development or commercialization
efforts or prioritize other programs more highly and, accordingly, reduce the efforts and resources allocated to OpRegen; Roche may be
unable to obtain regulatory clearances or approvals to continue clinical development or commercialization of OpRegen in a timely manner,
or at all; the failure to develop a commercially viable formulation and/or manufacturing process for OpRegen; or the loss or impairment
of intellectual property rights related to OpRegen.
If Roche terminates the collaboration:
we would no longer have the right to receive any milestone payments or royalties thereunder; further development of OpRegen, if any,
would be significantly delayed or terminated; we would bear all risks and costs related to any further clinical development, manufacturing,
regulatory approval and commercialization OpRegen, if any; we might determine that the commercial potential of OpRegen does not warrant
further development of OpRegen; we would need to raise additional capital if we were to choose to pursue OpRegen development on our own,
or we would need to establish alternative collaborations with third parties, which might not be possible in a timely manner, or at all;
and if we were to choose to pursue OpRegen development independently, we would need to work collaboratively with Roche to transfer the
OpRegen program back to us, and such a transfer might take significant amounts of time, would be resource intensive and costly, and might
not be feasible. As a result, any loss or termination of rights under the collaboration will cause us to lose a significant source of
potential revenue, which would have a material and adverse effect on our company, financial condition and results of operations.
We
will need to issue additional equity or debt securities in order to raise additional capital needed to pay our operating expenses.
We
expect to continue to incur substantial research and product development expenses and will need to raise additional capital to pay operating
expenses until we are able to generate sufficient revenues from product sales, royalties and license fees. Our ability to raise additional
equity or debt capital will depend, not only on progress made in developing new products and technologies, but also on access to capital
and conditions in the capital markets. We believe that our cash, cash equivalents and marketable securities as of December 31, 2021 will
be sufficient to fund our planned operations for at least the next 12 months after the issuance of this Report. We have based these estimates
on assumptions that may prove to be wrong, and we may use our capital resources sooner than we currently expect. Our operating plans
and other demands on our cash resources may change as a result of many factors currently unknown to us, and we may need to seek additional
funds sooner than planned. Any equity capital raise could result in the dilution of the interests of shareholders or may otherwise limit
our ability to finance further in the future, which may negatively impact our business and operations. Any debt capital financing may
involve covenants that restrict our operations, including limitations on additional borrowing and on the use of our assets. If we raise
capital through licensing arrangements, it may be necessary to grant licenses on terms that are not favorable to us. There can be no
assurance that we will be able to raise capital on favorable terms, or at all, or at times and in amounts needed to successfully finance
product development, clinical trials, and general operations.
Lawsuits
have been filed and other lawsuits may be filed against Lineage and certain members of the Lineage and Asterias boards of directors relating
to our acquisition of Asterias (the “Asterias Merger”). An adverse ruling in any such lawsuit may result in additional payments
and costs.
A
putative class action lawsuit alleging breach of fiduciary duties in connection with the Asterias Merger is pending in the Delaware Chancery
Court. The defendants are certain former members of Asterias’ board of directors and our company’s board of directors. The
complaint alleges that the merger process was conflicted, that the consideration was inadequate, and that the proxy statement filed by
Asterias was misleading. The complaint seeks, among other things, certification of a class, rescission of the merger or monetary damages,
and attorneys’ fees and costs. The parties are currently engaged in discovery. A five-day trial before the Delaware Chancery Court
is currently scheduled for October 17-21, 2022.
Lineage
believes the allegations in the action lack merit and intends to vigorously defend the claims asserted. It is impossible at this time
to assess whether the outcome of this proceeding will have a material adverse effect on Lineage’s results of operations, cash flows
or financial position. Additional lawsuits arising out of or relating to the merger agreement and/or the merger may be filed in the future.
Changes
in tax laws or regulations that are applied adversely to us or our customers may have a material adverse effect on our business, cash
flow, financial condition or results of operations.
New
income, sales, use or other tax laws, statutes, rules, regulations or ordinances could be enacted at any time, which could adversely
affect our business operations and financial performance. Further, existing tax laws, statutes, rules, regulations or ordinances could
be interpreted, changed, modified or applied adversely to us. For example, the Biden administration and Congress have proposed various
U.S. federal tax law changes, which if enacted could have a material impact on our business, cash flow, financial condition or results
of operations. In addition, it is uncertain if and to what extent various states will conform to the federal tax laws. Future tax reform
legislation could have a material impact on the value of our deferred tax assets, could result in significant one-time charges, and could
increase our future U.S. tax expense.
Our
ability to use net operating losses and other tax attributes to offset future taxable income or taxes may be subject to limitations.
As
of December 31, 2021, we had net operating loss (“NOL”) carryforwards for U.S. federal and state tax purposes of approximately
$155.6 million and $151.8 million, respectively. In addition, the Company has U.S. federal and California research and
development (R&D) credit carryforwards of $3.7 million and $5.8 million, respectively. Included in these amounts are NOLs and R&D
credits acquired through the merger with Asterias (see below). A portion of the federal and state NOL carryforwards will begin to expire,
if not utilized, in varying amounts between 2032 and 2037. NOLs that expire unused will be unavailable to offset future income
tax liabilities. Under federal income tax law, federal NOLs incurred in tax years beginning after December 31, 2017, may be carried forward
indefinitely, but the deductibility of such NOLs in tax years beginning after December 31, 2021, is limited to 80% of taxable income.
The federal R&D credits expire in varying amounts between 2021 and 2041, the California credits have no expiration date. It
is uncertain if and to what extent various states that we may operate in will conform to the federal tax law. In addition, under Sections
382 and 383 of the Internal Revenue Code of 1986, as amended (the “IRC”), and corresponding provisions of state law, if a
corporation undergoes an “ownership change,” which is generally defined as a greater than 50% change, by value, in its equity
ownership over a three-year period, the corporation’s ability to use its pre-change NOL carryforwards and other pre-change tax
attributes to offset its post-change income or taxes may be limited. We may experience ownership changes in the future as a result of
subsequent shifts in our stock ownership, some of which may be outside of our control. If an ownership change occurs and our ability
to use our NOL carryforwards is materially limited, it would harm our future operating results by effectively increasing our future tax
obligations. In addition, at the state level, there may be periods during which the use of net operating loss carryforwards is suspended
or otherwise limited, which could accelerate or permanently increase state taxes owed. For example, in 2020 California enacted A.B. 85
which imposed limits on the usability of California state net operating losses and certain tax credits in tax years beginning after 2019
and before 2023.
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As
part of the merger with Asterias, we acquired various tax attribute carryforwards. As the merger triggered an ownership change, the acquired
net operating loss carryforwards and credit are subject to limitation under Section 382 of the Internal Revenue Service Code. Accordingly,
Lineage will only be able to utilize federal and California NOLs of $52.8 million and $41.9 million, respectively, as well as California
research and development credits of $2.4 million. Because of the annual limitation, the total amount of these NOLs is not immediately
available to offset future income. The California research and development credit of $2.4 million has no expiration date.
Taxing
authorities could reallocate our taxable income among our subsidiaries, which could increase our overall tax liability.
We
are organized in the United States, and currently have subsidiaries in Israel and Singapore. If we succeed in growing our business, we
expect to conduct increased operations through subsidiaries in various tax jurisdictions pursuant to transfer pricing arrangements between
us and our subsidiaries. If two or more affiliated companies are located in different countries, the tax laws or regulations of each
country generally will require that such arrangements be priced the same as those between unrelated companies dealing at arm’s
length and that appropriate documentation is maintained to support the value of such arrangements. Our transfer pricing policies were
formulated with the assistance of third-party experts. We are in the process of obtaining a formal transfer pricing report. However,
after we receive such report, we do not intend to amend our returns for prior years. Whether we obtain a formal transfer pricing study
with outside experts or not, our transfer pricing procedures will not be binding on applicable tax authorities.
If
tax authorities in any of these countries were to successfully challenge our transfer prices as not reflecting arm’s length transactions,
they could require us to adjust our transfer prices and thereby reallocate our income to reflect these revised transfer prices, which
could result in a higher tax liability to us. In addition, if the country from which the income is reallocated does not agree with the
reallocation, both countries could tax the same income, resulting in double taxation. If tax authorities were to allocate income to a
higher tax jurisdiction, subject our income to double taxation or assess interest and penalties, it would increase our tax liability,
which could adversely affect our financial condition, results of operations and cash flows.
Our
business and operations could suffer in the event of system failures.
Despite
the implementation of security measures, our internal computer systems and those of our contractors and consultants are vulnerable to
damage from computer viruses, unauthorized access, natural disasters including earthquakes and tsunamis, terrorism, war, and telecommunication
and electrical failures. Such events could cause significant interruption of our operations and development programs. For example, the
loss of data for our product candidates could result in delays in our regulatory filings and development efforts and significantly increase
our costs. To the extent that any disruption or security breach was to result in a loss of or damage to our data, or inappropriate disclosure
of confidential or proprietary information, we could incur liability and the development of our product candidates could be delayed.
36 | P a g e
In
addition, our product candidates are manufactured by starting with cells that are stored in a cryopreserved master cell bank. While we
believe we have adequate backup should any cell bank be lost in a catastrophic event, we or our third-party suppliers and manufacturers
could lose multiple cell banks, which would severely affect our manufacturing activities. We cannot assure you that any stability or
other issues relating to the manufacture of any of our product candidates or products will not occur in the future. Any delay or interruption
in the supply of clinical trial supplies could delay the completion of planned clinical trials, increase the costs associated with maintaining
clinical trial programs and, depending upon the period of delay, require us to commence new clinical trials at additional expense or
terminate clinical trials completely. Any adverse developments affecting clinical or commercial manufacturing of our product candidates
or products may result in shipment delays, inventory shortages, lot failures, product withdrawals or recalls or other interruptions in
the supply of our product candidates or products. Accordingly, failures or difficulties faced at any level of our supply chain could
adversely affect our business and delay or impede the development and commercialization of any of our product candidates or products
and could have an adverse effect on our business, prospects, financial condition and results of operations.
Our
business could be adversely affected if we lose the services of the key personnel upon whom we depend or if we fail to attract senior
management and key scientific personnel.
We
believe that our continued success depends to a significant extent upon our efforts and ability to retain highly qualified personnel,
including our Chief Executive Officer, Brian Culley. All of our officers and other employees are at-will employees and may terminate
their employment with us at any time with no advance notice. The loss of the services of Mr. Culley or other members of our senior management
could have a material adverse effect on us. Further, the replacement of any of such individuals likely would involve significant time
and costs and may significantly delay or prevent the achievement of our business and clinical objectives and would harm our business.
In
addition, we could experience difficulties attracting qualified employees in the future. For example, competition for qualified personnel
in the biotechnology and medical device field is intense due to the limited number of individuals who possess the skills and experience
required by our industry. We will need to hire additional personnel, including experienced sales representatives, as we expand our clinical
development and commercial activities. We may not be able to attract quality personnel on acceptable terms, or at all. In addition, to
the extent we hire personnel from competitors, we may be subject to allegations that they have been improperly solicited or that they
have divulged proprietary or other confidential information or that their former employers own their research output.
The
value of our investments in public companies fluctuates based on their respective stock prices and could be negatively affected by business,
regulatory and other risks applicable to them.
As
of December 31, 2021, we had an equity investment in OncoCyte, a U.S. publicly traded company. As of December 31, 2021, the value of
our investment in OncoCyte was approximately $2.4 million based on its closing stock price as of that date. If OncoCyte were to have
delays in clinical trials or commercialization activities or otherwise realize the specific business, regulatory and other risks applicable
to them, the value of its common stock and the valuation of our investment could be negatively affected. If OncoCyte were to fail and
ultimately cease operations, we may lose the entire value of our investment. In addition, the value of our marketable equity securities
may be significantly and adversely impacted by deteriorating global economic conditions and the disruptions to and volatility in the
credit and financial markets in the United States and worldwide resulting from the ongoing COVID-19 pandemic.
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Risks
Related to Government Regulation
We
may be subject, directly or indirectly, to federal and state healthcare fraud and abuse laws, including anti-kickback and false claims
laws, transparency laws, and health information privacy and security laws. If we are unable to comply, or have not fully complied, with
such laws, we could face substantial penalties.
Our
current and future operations may be subject to various federal and state fraud and abuse laws, including, without limitation, the federal
Anti-Kickback Statute, the federal False Claims Act, and healthcare professional transparency laws and regulations. These laws may impact,
among other things, our research activities and our proposed sales, marketing, and education programs. In addition, we may be subject
to patient privacy regulation by both the federal government and the states in which we conduct our business. The laws that may affect
our ability to operate include:
●
the
federal Anti-Kickback Statute, which prohibits, among other things, persons and entities from knowingly and willfully soliciting,
receiving, offering or paying remuneration, directly or indirectly, to induce, or in return for, the purchase or recommendation of
an item or service reimbursable under a federal healthcare program, such as the Medicare and Medicaid programs;
●
federal
civil and criminal false claims laws, including the federal False Claims Act, and civil monetary penalty laws, which prohibit, among
other things, individuals or entities from knowingly presenting, or causing to be presented, claims for payment from Medicare, Medicaid,
or other third-party payors that are false or fraudulent;
●
HIPAA,
which created new federal criminal statutes that prohibit, among other things, executing a scheme to defraud any healthcare benefit
program and making false statements relating to healthcare matters;
●
HIPAA,
as amended by HITECH and their implementing regulations, which imposes certain requirements on “covered entities,” including
certain healthcare providers, health plans, and healthcare clearinghouses, as well as their respective “business associates”
that create, receive, maintain or transmit individually identifiable health information for or on behalf of a covered entity, and
their subcontractors that use, disclose, access, or otherwise process individually identifiable protected health information, relating
to the privacy, security, and transmission of individually identifiable health information;
●
The
Physician Payments Sunshine Act which requires manufacturers of drugs, devices, biologics, and medical supplies for which payment
is available under Medicare, Medicaid or the Children’s Health Insurance Program (with certain exceptions) to report annually
to the CMS, information related to payments and other transfers of value to physicians (defined to include doctors, dentists, optometrists,
podiatrists, and chiropractors), certain other healthcare professionals (such as physician assistants and nurse practitioners), and
teaching hospitals, and ownership and investment interests held by physicians and their immediate family members and applicable group
purchasing organizations; and
●
state
law equivalents of each of the above federal laws, such as anti-kickback and false claims laws that may apply to items or services
reimbursed by any third-party payors, including commercial insurers, state laws that require pharmaceutical companies to comply with
the pharmaceutical industry’s voluntary compliance guidelines and the relevant compliance guidance promulgated by the federal
government, or otherwise restrict payments that may be made to healthcare providers and other potential referral sources; state laws
that require drug manufacturers to report information related to payments and other transfers of value to physicians and other healthcare
providers, marketing expenditures, or drug pricing, state and local laws that require the registration of pharmaceutical sales representatives,
and state laws governing the privacy and security of health information in certain circumstances, many of which differ from each
other in significant ways and may not have the same effect, thus complicating compliance efforts.
Because
of the breadth of these laws and the narrowness of the statutory exceptions and regulatory safe harbors available, it is possible that
some of our business activities could be subject to challenge under one or more of such laws. In addition, recent healthcare reform
legislation has strengthened these laws.
If
our operations are found to be in violation of any of the laws described above or any other governmental regulations that apply, we may
be subject to significant penalties, including administrative, civil and criminal penalties, damages, fines, disgorgement, exclusion
from participation in government healthcare programs, such as Medicare and Medicaid, integrity oversight and reporting obligations, imprisonment,
and the curtailment or restructuring of our operations, any of which could adversely affect our ability to operate our business and our
results of operations.
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If
we do not receive regulatory approvals, we will not be permitted to sell our therapeutic and medical device products.
The
therapeutic and medical device products that we and our subsidiaries develop cannot be sold until the FDA and corresponding foreign regulatory
authorities approve the products for medical use. The need to obtain regulatory approval to market a new product means that:
●
We
will have to conduct expensive and time-consuming clinical trials of new products. The full cost of conducting and completing clinical
trials necessary to obtain FDA and foreign regulatory approval of a new product cannot be presently determined but could exceed our
current financial resources.
●
Clinical
trials and the regulatory approval process for a pharmaceutical or cell-based product can take several years to complete. As a result,
we will incur the expense and delay inherent in seeking FDA and foreign regulatory approval of new products, even if the results
of clinical trials are favorable.
●
Data
obtained from preclinical and clinical studies is susceptible to varying interpretations and regulatory changes that could delay,
limit, or prevent regulatory agency approvals.
●
Because
the therapeutic products we are developing with pluripotent stem cell technology involve the application of new technologies and
approaches to medicine, the FDA or foreign regulatory agencies may subject those products to additional or more stringent review
than drugs or biologics derived from other technologies.
●
A
product that is approved may be subject to restrictions on use.
●
The
FDA can recall or withdraw approval of a product, if it deems necessary.
●
We
will face similar regulatory issues in foreign countries.
Government-imposed
bans or restrictions and religious, moral, and ethical concerns about the use of hES cells could prevent us from developing and successfully
marketing stem cell products.
Government-imposed
bans or restrictions on the use of embryos or hES cells in research and development in the United States and abroad could generally constrain
stem cell research, thereby limiting the market and demand for our products. During March 2009, the federal government, pursuant to a
presidential executive order, lifted certain restrictions on federal funding of research involving the use of hES cells, and in accordance
with the executive order, the NIH has adopted guidelines for determining the eligibility of hES cell lines for use in federally funded
research. The central focus of the guidelines is to assure that hES cells used in federally funded research were derived from human embryos
that were created for reproductive purposes, were no longer needed for this purpose, and were voluntarily donated for research purposes
with the informed written consent of the donors. The hES cells that were derived from embryos created for research purposes rather than
reproductive purposes, and other hES cells that were not derived in compliance with the guidelines, are not eligible for use in federally
funded research. California law requires that stem cell research be conducted under the oversight of aSCRO. Many kinds of stem cell research,
including the derivation of new hES cell lines, may only be conducted in California with the prior written approval of the SCRO. A SCRO
could prohibit or impose restrictions on the research that we plan to do. The use of hES cells may give rise to religious, moral, and
ethical issues. These considerations could lead to more restrictive government regulations or could generally constrain stem cell research,
thereby limiting the market and demand for our products.
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We
expect that the commercial opportunity for some of our products may depend on our ability to obtain and maintain reimbursement and continued
coverage from various payors, including government entities and insurance companies.
If
these third-party payors do not consider our products to be cost-effective compared to other therapies, they may not cover our products
as a benefit under their plans or, if they do, the level of payment may not be sufficient to allow us to sell our products on a profitable
basis.
For
example, in the United States, healthcare providers are reimbursed for covered services and products they deliver through Medicare, Medicaid
and other government healthcare programs, as well as through private payers. No uniform policy for coverage and reimbursement exists
in the United States, and coverage and reimbursement can differ significantly from payor to payor. Decisions regarding whether to cover
any of our product candidates, if approved, the extent of coverage and amount of reimbursement to be provided are made on a plan-by-plan
basis. Third-party payors often rely upon Medicare coverage policy and payment limitations in setting their own reimbursement rates,
but also have their own methods and approval process apart from Medicare determinations. As a result, the coverage determination process
is often a time-consuming and costly process that will require us to provide scientific and clinical support for the use of our product
candidates to each payor separately, with no assurance that coverage and adequate reimbursement will be applied consistently or obtained
in the first instance. We may be required to provide specified rebates or discounts on the products we sell to certain government funded
programs, including Medicare and Medicaid, and those rebates or discounts have increased over time. The Patient Protection and Affordable
Care Act, as amended by the Healthcare and Education Reconciliation Act (collectively, the “ACA”), enacted in 2010,
increased many of the mandatory discounts and rebates and imposed a new branded prescription pharmaceutical manufacturers and importers
fee payable each year by certain manufacturers.
If
we are unable to establish or sustain coverage and adequate reimbursement for any product candidates from third-party payors, the adoption
of those products and sales revenue will be adversely affected, which, in turn, could adversely affect the ability to market or sell
those product candidates, if approved. Further, coverage policies and third-party payor reimbursement rates may change at any time. Therefore,
even if favorable coverage and reimbursement status is attained, less favorable coverage policies and reimbursement rates may be implemented
in the future.
We
face similar issues outside of the United States. In some non-U.S. jurisdictions, the proposed pricing for a drug must be approved before
it may be lawfully marketed. The requirements governing drug pricing vary widely from country to country. For example, the EU provides
options for its member states to restrict the range of medicinal products for which their national health insurance systems provide reimbursement
and to control the prices of medicinal products for human use. A member state may approve a specific price for the medicinal product,
or it may instead adopt a system of direct or indirect controls on the profitability of the company placing the medicinal product on
the market. There can be no assurance that any country that has price controls or reimbursement limitations for pharmaceutical products
will allow favorable reimbursement and pricing arrangements for any of our products. Historically, products launched in the EU do not
follow price structures of the United States and generally tend to be significantly lower.
Disruptions
at the FDA and other government agencies caused by funding shortages or global health concerns could negatively impact our business.
The
ability of the FDA to review and approve proposed clinical trials or new product candidates can be affected by a variety of factors,
including, but not limited to, government budget and funding levels, ability to hire and retain key personnel and accept the payment
of user fees, statutory, regulatory, and policy changes, and other events that may otherwise affect the FDA’s ability to perform
routine functions. Average review times at the agency have fluctuated in recent years as a result. In addition, government funding of
other government agencies that fund research and development activities is subject to the political process, which is inherently fluid
and unpredictable.
Disruptions
at the FDA and other agencies may also slow the time necessary for new product candidates to be reviewed and/or approved by necessary
government agencies, which would adversely affect our business. For example, over the last several years, including for 35 days beginning
on December 22, 2018, the U.S. government has shut down several times and certain regulatory agencies, such as the FDA, have had to furlough
critical FDA employees and stop critical activities.
Separately,
in response to the global COVID-19 pandemic, FDA inspections were interrupted and restarted on a risk-based basis. Regulatory authorities
outside the United States may adopt similar restrictions or other policy measures in response to the COVID-19 pandemic. If a prolonged
government shutdown occurs, or if global health concerns continue to prevent the FDA or other regulatory authorities from conducting
their regular inspections, reviews, or other regulatory activities, it could significantly impact the ability of the FDA or other regulatory
authorities to timely review and process our regulatory submissions, which could have a material adverse effect on our business.
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The
ACA and future changes to that law may adversely affect our business.
As
a result of the adoption of the ACA, in the United States, substantial changes have been made to the system for paying for healthcare
in the United States. Among the ACA’s provisions of importance to our industry are that it:
●
created
the branded prescription pharmaceutical manufacturers and importers annual fee;
●
increased
the statutory minimum rebates a manufacturer must pay under the Medicaid Drug Rebate Program, to 23.1% and 13% of the average manufacturer
price for most branded and generic drugs, respectively and capped the total rebate amount for innovator drugs at 100% of the Average
Manufacturer Price. However, on March 11, 2021, President Biden signed the American Rescue Plan Act of 2021 into law, which eliminates
the statutory Medicaid drug rebate cap for single source and innovator multiple source drugs, beginning January 1, 2024;
●
created
new methodology by which rebates owed by manufacturers under the Medicaid Drug Rebate Program are calculated for certain drugs and
biologics that are inhaled, infused, instilled, implanted or injected;
●
extended
manufacturers’ Medicaid rebate liability to covered drugs dispensed to individuals who are enrolled in Medicaid managed care
organizations;
●
expanded
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 individuals with income at or below 133% of the federal poverty level, thereby
potentially increasing manufacturers’ Medicaid rebate liability;
●
expanded
the entities eligible for discounts under the Public Health program;
●
created
a new Patient-Centered Outcomes Research Institute to oversee, identify priorities in, and conduct comparative clinical effectiveness
research, along with funding for such research;
●
established
a Center for Medicare & Medicaid Innovation at CMS to test innovative payment and service delivery models to lower Medicare and
Medicaid spending, potentially including prescription drug spending; and
●
created
a licensure framework for follow on biologic products.
There
have been executive, judicial and Congressional challenges to certain aspects of the ACA. While Congress has not passed comprehensive
repeal legislation, it has enacted laws that modify certain provisions of the ACA such as removing penalties, starting January 1, 2019,
for not complying with the ACA’s individual mandate to carry health insurance, and eliminating the implementation of certain ACA-mandated
fees. For example, on June 17, 2021, the United States Supreme Court dismissed a challenge on procedural grounds that argued the ACA
is unconstitutional in its entirety because the “individual mandate” was repealed by Congress. Thus, the ACA will remain
in effect in its current form. Moreover, prior to the United States Supreme Court ruling, on January 28, 2021, President Biden issued
an executive order that initiated a special enrollment period for purposes of obtaining health insurance coverage through the ACA marketplace,
which began February 15, 2021 and remained open through August 15, 2021. The executive order also instructed certain governmental agencies
to review and reconsider their existing policies and rules that limit access to healthcare, including among others, reexamining Medicaid
demonstration projects and waiver programs that include work requirements, and policies that create unnecessary barriers to obtaining
access to health insurance coverage through Medicaid or the ACA. It is possible that the ACA will be subject to judicial or Congressional
challenges in the future. It is unclear how any such challenges, other litigation, and the healthcare reform measures of the Biden administration
will impact the ACA.
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In
addition, other legislative changes have been proposed and adopted since the ACA was enacted. For example, the Budget Control Act of
2011, includes reductions to Medicare payments to providers of 2% per fiscal year, which went into effect on April 1, 2013 and, due to
subsequent legislative amendments to the statute, will remain in effect through 2031, with the exception of a temporary suspension from
May 1, 2020 through March 31, 2022, unless additional Congressional action is taken. Under current legislation, the actual reduction
in Medicare payments will vary from 1% in 2022 to up to 3% in the final fiscal year of this sequester. On January 2, 2013, the American
Taxpayer Relief Act of 2012 was signed into law, which, among other things, reduced Medicare payments to several providers, including
hospitals, and increased the statute of limitations period for the government to recover overpayments to providers from three to five
years. Additionally, Congress is considering additional health reform measures.
Further,
there has been heightened governmental scrutiny in the United States of pharmaceutical pricing practices in light of the rising cost
of prescription drugs and biologics. Such scrutiny has resulted in several recent presidential executive orders, congressional inquiries
and proposed and enacted federal and state legislation designed to, among other things, bring more transparency to product pricing, review
the relationship between pricing and manufacturer patient programs, and reform government program reimbursement methodologies for products.
At the federal level, the Trump administration used several means to propose or implement drug pricing reform, including through federal
budget proposals, executive orders and policy initiatives. For example, on July 24, 2020 and September 13, 2020, the Trump administration
announced several executive orders related to prescription drug pricing that attempted to implement several of the administration’s
proposals. As a result, the FDA concurrently released a final rule and guidance in September, 2020, providing pathways for states to
build and submit importation plans for drugs from Canada. Further, on November 20, 2020, the U.S. Department of Health & Human Services
(“HHS”) finalized a regulation removing safe harbor protection for price reductions from pharmaceutical manufacturers to
plan sponsors under Medicare Part D, either directly or through pharmacy benefit managers, unless the price reduction is required by
law. The implementation of the rule has been delayed by the Biden administration from January 1, 2022 to January 1, 2023 in response
to ongoing litigation. The rule also creates a new safe harbor for price reductions reflected at the point-of-sale, as well as a new
safe harbor for certain fixed fee arrangements between pharmacy benefit managers and manufacturers, the implementation of which have
also been delayed by the Biden administration until January 1, 2023. On November 20, 2020, CMS issued an interim final rule implementing
President Trump’s Most Favored Nation executive order, which would tie Medicare Part B payments for certain physician-administered
drugs to the lowest price paid in other economically advanced countries. The Most Favored Nation regulations mandate participation by
identified Medicare Part B providers and will apply in all U.S. states and territories for a seven-year period beginning January 1, 2021,
and ending December 31, 2027. As a result of litigation challenging the Most Favored Nation model, on December 27, 2021, CMS published
a final rule that rescinds the Most Favored Nation model interim final rule. Further, in July 2021, the Biden administration released
an executive order that included multiple provisions aimed at prescription drugs. In response to President Biden’s executive order,
on September 9, 2021, the HHS released a Comprehensive Plan for Addressing High Drug Prices that outlines principles for drug pricing
reform. The plan sets out a variety of potential legislative policies that Congress could pursue as well as potential administrative
actions HHS can take to advance these principles. No legislation or administrative actions have been finalized to implement these principles.
Additionally, based on a recent executive order, the Biden administration expressed its intent to pursue certain policy initiatives to
reduce drug prices. At the state level, legislatures have increasingly passed legislation and implemented regulations designed to control
pharmaceutical product pricing, including price or patient reimbursement constraints, discounts, restrictions on certain product access
and marketing cost disclosure and transparency measures, and, in some cases, designed to encourage importation from other countries and
bulk purchasing.
In
addition, it is possible that additional governmental action is taken in response to the COVID-19 pandemic.
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If
we fail to comply with the extensive legal and regulatory requirements affecting the healthcare industry, we could face increased costs,
penalties and a loss of business.
Our activities, and the activities
of our collaborators, distributors and other third-party providers, are subject to extensive government regulation and oversight both
in the U.S. and in foreign jurisdictions. The FDA and comparable agencies in other jurisdictions will directly regulate many of our most
critical business activities, including the conduct of preclinical and clinical studies, product manufacturing, future advertising and
promotion, product distribution, adverse event reporting and product risk management. Our current and future interactions in the U.S.
or abroad with physicians and other healthcare providers that may prescribe or purchase our products once commercialized are also subject
to government regulation designed to prevent fraud and abuse in the sale and use of the products and place greater restrictions on the
marketing practices of healthcare companies. Healthcare companies are facing heightened scrutiny of their relationships with healthcare
providers from anti-corruption enforcement officials. In addition, healthcare companies have been the target of lawsuits and investigations
alleging violations of government regulation, including claims asserting submission of incorrect pricing information, impermissible off-label
promotion of pharmaceutical products, payments intended to influence the referral of healthcare business, submission of false claims for
government reimbursement, antitrust violations or violations related to environmental matters. Risks relating to compliance with laws
and regulations may be heightened as we bring products to the market globally.
Regulations governing the healthcare
industry are subject to change, with possibly retroactive effect, including:
●
new laws, regulations or judicial decisions, or new interpretations of
existing laws, regulations or decisions, related to healthcare availability, pricing or marketing practices, compliance with wage and
hour laws and other employment practices, method of delivery, payment for healthcare products and services, compliance with health information
and data privacy and security laws and regulations, tracking and reporting payments and other transfers of value made to physicians and
teaching hospitals, extensive anti-bribery and anti-corruption prohibitions, product serialization and labeling requirements and used
product take-back requirements;
●
changes
in the FDA and foreign regulatory approval processes that may delay or prevent the approval of new products and result in lost market
opportunity;
●
requirements
that provide for increased transparency of clinical trial results and quality data, such as the EMA’s clinical transparency
policy, which could impact our ability to protect trade secrets and competitively sensitive information contained in approval applications
or could be misinterpreted leading to reputational damage, misperception or legal action which could harm our business; and
●
changes
in FDA and foreign regulations that may require additional safety monitoring, labeling changes, restrictions on product distribution
or use, or other measures after the introduction of our products to market, which could increase our costs of doing business, adversely
affect the future permitted uses of approved products, or otherwise adversely affect the market for our products.
Violations
of governmental regulation may be punishable by criminal and civil sanctions against us, including fines and civil monetary penalties
and exclusion from participation in government programs, including Medicare and Medicaid, as well as against executives overseeing our
business. In addition to penalties for violation of laws and regulations, we could be required to repay amounts we received from government
payors or pay additional rebates and interest if we are found to have miscalculated the pricing information we have submitted to the
government. We cannot ensure that our compliance controls, policies and procedures will in every instance protect us from acts committed
by our employees, collaborators, partners or third-party providers that would violate the laws or regulations of the jurisdictions in
which we operate. Whether or not we have complied with the law, an investigation into alleged unlawful conduct could increase our expenses,
damage our reputation, divert management time and attention and adversely affect our business.
Even
if we receive approval for our products, we may be subject to extensive regulatory obligations in order to commercialize our products.
Even
after initial FDA or foreign regulatory agency approval has been obtained, further studies may be required to provide additional data
on safety or to gain approval for the use of a product as a treatment for clinical indications other than those initially targeted. Use
of a product during testing and after marketing could reveal side effects that could delay, impede, or prevent marketing approval, result
in a regulatory agency-ordered product recall, or in regulatory agency-imposed limitations on permissible uses or in withdrawal of approval.
For example, if the FDA or foreign regulatory agency becomes aware of new safety information after approval of a product, it may require
us to conduct further clinical trials to assess a known or potential serious risk and to assure that the benefit of the product outweigh
the risks. If we are required to conduct such a post-approval study, periodic status reports must be submitted to the FDA or foreign
regulatory agency. Failure to conduct such post-approval studies in a timely manner may result in substantial civil or criminal penalties.
Data resulting from these clinical trials may result in expansions or restrictions to the labeled indications for which a product has
already been approved. Any of these requirements or actions may negatively impact our business or operations.
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If
we are deemed to be an investment company, we may have to institute burdensome compliance requirements and our activities may be restricted.
An
entity that, among other things, is or holds itself out as being engaged primarily, or proposes to engage primarily, in the business
of investing, reinvesting, owning, trading or holding certain types of securities would be deemed an investment company under the Investment
Company Act of 1940, as amended (the “1940 Act”). Based on the securities we hold, including our equity ownership in publicly
traded companies, we may not meet the requirements for an exemption promulgated under the 1940 Act. If we are deemed to be an investment
company under the 1940 Act, we would be subject to additional limitations on operating our business, including limitations on the issuance
of securities, which may make it difficult for us to raise capital.
Risks
Related to Our Clinical Development and Commercial Operations
Clinical
studies are costly, time consuming and are subject to risks that could delay or prevent commercialization of our current or future product
candidates.
We
cannot guarantee that any clinical studies will be conducted as planned or completed on schedule, if at all. A failure of one or more
clinical studies can occur at any stage of development. Events that may prevent successful or timely completion of clinical development
include but are not limited to:
●
inability
to generate satisfactory preclinical, toxicology, or other in vivo or in vitro data or diagnostics to support the initiation
or continuation of clinical studies necessary for product approval;
●
delays
in securing clinical investigators and agreeing on acceptable terms with contract research organizations (“CROs”) and
clinical trial sites, the terms of which can be subject to extensive negotiation and may vary significantly among CROs and clinical
trial sites;
●
delays
in obtaining required IRB approval at each clinical trial site;
●
failure
to obtain permission from regulatory authorities to conduct a clinical trial after review of an IND or equivalent foreign application
or amendment;
●
slower
than anticipated rates of patient recruitment and enrollment (including as a result of actual or threatened public health emergencies
and outbreaks of disease such as the current COVID-19 pandemic), failing to reach the targeted number of patients due to competition
for patients from other trials, or patients dropping out of our clinical studies once enrolled;
●
failure
by clinical sites or our CROs or other third parties to adhere to clinical trial requirements or report complete findings;
●
failure
to perform the clinical studies in accordance with the FDA’s good clinical practices requirements or applicable foreign regulatory
guidelines;
●
occurrence
of adverse events associated with our product candidates or with product candidates of third parties that may have characteristics
similar to or perceived to be similar to our product candidates;
44 | P a g e
●
negative
or inconclusive results from our clinical trials which may result in our deciding, or regulators requiring us, to conduct additional
clinical studies or to curtail or abandon development programs for a product candidate;
●
unforeseen
side effects, possibly resulting in the FDA or other regulatory authorities denying approval of our product candidates;
●
approval
and introduction of new therapies or changes in standards of practice or regulatory guidance that render our clinical trial endpoints
or the targeting of our proposed indications obsolete;
●
inability
to monitor patients adequately during or after treatment or problems with investigator or patient compliance with the trial protocols;
●
inability
or unwillingness of medical investigators to follow our clinical protocols;
●
unavailability
of clinical trial supplies;
●
inability
to use clinical trial results from foreign jurisdictions to support U.S. regulatory approval;
●
changes
in regulatory requirements and guidance that require amending or submitting new clinical protocols;
●
the
cost of clinical studies of our product candidates; and
●
delays
in agreeing on acceptable terms with third-party manufacturers and the time for manufacture of sufficient quantities of our product
candidates for use in clinical studies.
Any
inability to successfully complete clinical development and obtain regulatory approval could result in additional costs to us or impair
our ability to generate revenue. Clinical trial delays could also shorten any periods during which our products have patent protection
and may allow competitors to develop and bring products to market before we do and may harm our business and results of operations.
Clinical
and preclinical drug development involves a lengthy and expensive process with an uncertain outcome. The results of early preclinical
trials and clinical trials of our product candidates are not necessarily predictive of future results. Our product candidates may not
have favorable results in later clinical trials, if any, or receive regulatory approval on a timely basis, if at all.
Clinical
and preclinical drug development is expensive and can take many years to complete, and its outcome is inherently uncertain. Our clinical
trials may not be conducted as planned or completed on schedule, if at all, and failure can occur at any time during the preclinical
or clinical trial process. All of our product candidates will require substantial additional development, and no assurances can
be given that the development of any of our product candidates will ultimately be successful. Although we may from time to time disclose
results from preclinical testing or preliminary data or interim results from our clinical studies of our product candidates, and earlier
clinical studies, including clinical studies with similar product candidates, these are not necessarily predictive of future results,
including clinical trial results. The historical failure rate for product candidates in our industry is high.
The
results of our current and future clinical trials may differ from results achieved in earlier preclinical and clinical studies for a
variety of reasons, including:
●
we
may not demonstrate the potency and efficacy benefits observed in previous studies;
●
our
efforts to improve, standardize and automate the manufacture of our product candidates, including OpRegen ® ,
OPC1 and VAC2, and any resulting deviations in the manufacture of our product candidates, may adversely affect the safety, purity,
potency or efficacy of such product candidates;
45 | P a g e
●
differences
in trial design, including differences in size, eligibility criteria, and patient populations;
●
advancements
in the standard of care may affect our ability to demonstrate efficacy or achieve trial endpoints in our current or future clinical
trials;
●
safety
issues or adverse events in patients that enroll in our current or future clinical trials; and
●
results
in preclinical and clinical tests may not be repeated in subsequent tests or be predictive of future results.
In
September 2021, we provided updates to the fully enrolled 24 patient Phase 1/2a open-label trial for OpRegen. Data presented showed that
restoration of retinal tissue previously reported in three patients had been maintained for up to nine months in the two most recent
restoration patients and for up to 33 months in the first case of restoration. These three patients exhibited optical coherence tomography
(OCT) evidence of newly integrated RPE cells, and layers of retinal tissue (i.e., outer plexiform, outer nuclear layer, ellipsoid
zone) in areas that previously showed no presence of these structures at baseline. All three of these patient’s visual acuities
increased above baseline levels within 6 months post-transplant. Overall, the best corrected visual acuity of the better vision Cohort
4 patients has improved or remained stable in 8/12 (67%) OpRegen treated eyes while decreasing in 9/12 (75%) of their respective fellow
eyes. All of these patients are being closely monitored for additional evidence of clinical benefit.
Specifically,
additional data presented showed that as patients continued to progress into post-operative follow-up, eyes receiving OpRegen trended
toward improvement in visual acuity, a secondary objective under the study, while their untreated eyes typically lost visual acuity,
as expected with this progressive disease. As additional patients have reached longer periods post-treatment, differences in visual acuity
between treated and untreated eyes across Cohort 4 patients became statistically significant beginning at month 9 (P = 0.0085), as well
as months 12 (P = 0.0220) and 15 (P = 0.0273) as determined via 2-sided Wilcoxon Signed Rank (using NCSS, LLC statistical software).
These results, when combined with the OCT findings, suggest that both a structural and functional benefit is possible with OpRegen therapy.
The totality of these findings supports the view that atrophic AMD is not an irreversible degenerative condition. OpRegen has been well
tolerated with no unexpected adverse events, and evidence of durable engraftment of OpRegen RPE cells have extended to more than five
years post-transplant in earliest treated patients. However, we do not know how OpRegen will perform in future clinical trials.
It
is not uncommon to observe results in clinical trials that are unexpected based on preclinical trials and early clinical trials, and
many product candidates fail in clinical trials despite very promising early results. Moreover, preclinical and clinical data may be
susceptible to varying interpretations and analyses. Several companies in the biotechnology industry have suffered significant setbacks
in clinical development even after achieving promising results in earlier studies.
Further,
as a result of the COVID-19 pandemic, if patients drop out of our clinical trials, miss scheduled doses or follow-up visits or otherwise
fail to follow clinical trial protocols, or if our clinical trials are otherwise disrupted due to COVID-19 or actions taken to slow its
spread, the integrity of data from our clinical trials may be compromised or not accepted by the FDA or other regulatory authorities,
which would represent a significant setback for the applicable program.
Even
if our current and planned clinical trials are successful, we will need to conduct additional clinical trials, which may include registrational
trials, trials in additional patient populations or under different treatment conditions, and trials using different manufacturing protocols,
processes, materials or facilities or under different manufacturing conditions, before we are able to seek approvals for our product
candidates from the FDA and regulatory authorities outside the United States to market and sell these product candidates. Our failure
to meet the requirements to support marketing approval for our product candidates in our ongoing and future clinical trials would substantially
harm our business and prospects. For the foregoing reasons, our ongoing and planned clinical trials may not be successful, which could
have a material adverse effect on our business, financial condition and results of operations.
46 | P a g e
Interim,
topline and preliminary data from our 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 publicly disclose preliminary or topline data from our clinical trials, which is based on a preliminary analysis
of then-available data, and the results and related findings and conclusions are subject to change following a more comprehensive review
of the data related to the particular trial. We also make assumptions, estimations, calculations and conclusions as part of our analyses
of data, and we may not have received or had the opportunity to fully and carefully evaluate all data. As a result, the topline results
that we report may differ from future results of the same studies, or different conclusions or considerations may qualify such results,
once additional data have been received and fully evaluated. Topline 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, topline data
should be viewed with caution until the final data are available. From time to time, we may also disclose interim data from our 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. Adverse differences between preliminary or
interim data and final data could significantly harm our business prospects.
Further,
others, including regulatory agencies, may not accept or agree with our assumptions, estimates, calculations, conclusions or analyses
or may interpret or weigh the importance of data differently, which could impact the value of the particular program, the approvability
or commercialization of the particular product candidate or product and our company in general. In addition, the information we choose
to publicly disclose regarding a particular trial is based on what is typically extensive information, and you or others may not agree
with what we determine is the material or otherwise appropriate information to include in our disclosure, and any information we determine
not to disclose may ultimately be deemed significant with respect to future decisions, conclusions, views, activities or otherwise regarding
a particular product candidate or our business. If the topline data that we report differ from actual results, or if others, including
regulatory authorities, disagree with the conclusions reached, our ability to obtain approval for, and commercialize, our product candidates
may be harmed, which could harm our business, operating results, prospects or financial condition.
Because
we have multiple cell therapy programs in clinical development, we may expend our limited resources to pursue a particular product candidate
and fail to capitalize on product candidates that may be more profitable or for which there is a greater likelihood of success.
We
have three cell therapy programs in clinical development. OpRegen is currently in a Phase 1/2a multicenter clinical trial for the treatment
of dry AMD, OPC-1 is currently in a Phase 1/2a clinical trial for subacute spinal cord injuries, and VAC2 is in a Phase 1 clinical trial
in non-small cell lung cancer. As a result of these and other future clinical trials for these product candidates or any of our future
product candidates it may make our decision as to which product candidates to focus on more difficult and we may forgo or delay
pursuit of opportunities with other product candidates that could have had greater commercial potential or likelihood of success.
Our
resource allocation decisions may cause us to fail to capitalize on viable commercial products or profitable market opportunities. Our
spending on current and future research and development programs and product candidates may not yield any commercially viable products.
If we do not accurately evaluate the commercial potential or target market for a particular product candidate, we may relinquish valuable
rights to that product candidate through future collaborations, licenses and other similar arrangements in cases in which it would have
been more advantageous for us to retain sole development and commercialization rights to such product candidate.
Additionally,
we may pursue additional in-licenses or acquisitions of development-stage assets or programs, which entails additional risk to us. Identifying,
selecting and acquiring promising product candidates requires substantial technical, financial and human resources expertise. Efforts
to do so may not result in the actual acquisition or license of a particular product candidate, potentially resulting in a diversion
of our management’s time and the expenditure of our resources with no resulting benefit. For example, if we are unable to identify
programs that ultimately result in approved products, we may spend material amounts of our capital and other resources evaluating, acquiring
and developing products that ultimately do not provide a return on our investment.
47 | P a g e
The commercial success of any of our current or
future product candidates will depend upon the degree of market acceptance by physicians, patients, third-party payors, other healthcare
providers and others in the medical community.
Even
if a product candidate obtains regulatory approval, its commercial success will depend in part on physicians, patients, third-party payors,
other healthcare providers and others in the medical community accepting our product candidates as medically useful, cost-effective,
and safe. Any product we bring to the market may not gain market acceptance by such parties. The degree of market acceptance of any of
our products will depend on several factors, including without limitation:
●
the
efficacy of the product as demonstrated in clinical trials and potential advantages over competing treatments;
●
the
prevalence and severity of the disease and any side effects;
●
the
clinical indications for which approval is granted, including any limitations or warnings contained in a product’s approved
labeling;
●
the
convenience and ease of administration;
●
the
cost of treatment, particularly as additive to existing treatments;
●
the
willingness of the patients and physicians to accept and use these therapies;
●
the
marketing, sales and distribution support for the products;
●
the
publicity concerning our products or competing products and treatments; and
●
the
pricing and availability of coverage and adequate reimbursement by third-party payors and government authorities.
Even if a product displays a favorable
efficacy and safety profile upon approval, market acceptance of the product will be uncertain. Efforts to educate the medical community
and third-party payors on the benefits of the products may require significant investment and resources and may never succeed. If our
products fail to achieve an adequate level of acceptance by physicians, patients, third-party payors, other healthcare providers and others
in the medical community, we will not be able to generate sufficient revenue to become or remain profitable.
If
the market opportunities for our product candidates are smaller than we believe and estimate they are, we may not meet our revenue expectations
and our business may suffer.
Our
projections of the number of potential users in the markets we are attempting to address are based on our beliefs and estimates. Our
estimates have been derived from a variety of sources, including market research and publications and scientific literature estimating
the total number of potential patients and currently approved or used therapies. Our estimates are also based on assumptions regarding
the potential size of the market assuming broad regulatory approval or potential usage by physicians beyond the approved label. Any of
our estimates may prove to be incorrect. The scope of approval and potential use of any product candidate may be significantly narrower,
and the number of patients may turn out to be lower than expected. Competitive products or approaches may be approved or come into use
and the potentially addressable patient population for each of our product candidates may be limited or may not be amenable to treatment
with our product candidates, and new patients may become increasingly difficult to identify or gain access to, any which could adversely
affect our results of operations and our business.
Sales
of the products we may develop will be adversely affected by the availability of competing products.
Our products and product candidates
will face substantial competition, whether through the development of safer and more effective alternatives to our products, lower costs
to administer than our products or other forms of competition such as more favorable distribution, reimbursement and pricing or formulary
and healthcare provider acceptance.
48 | P a g e
The
cell therapy industry is characterized by rapidly evolving technology and intense competition. Our competitors include major multinational
pharmaceutical companies, specialty biotechnology companies, and chemical and medical products companies operating in the fields of regenerative
medicine, cell therapy, tissue engineering, and tissue regeneration. Many of these companies are well established and possess technical,
research and development, financial, and sales and marketing resources significantly greater than ours. In addition, certain smaller
biotechnology companies have formed strategic collaborations, partnerships, and other types of joint ventures with larger, well-established
industry competitors that afford the smaller companies’ potential research and development as well as commercialization advantages.
Academic institutions, governmental agencies, and other public and private research organizations are also conducting and financing research
activities, which may produce products directly competitive to those we are developing.
We
believe that some of our competitors are trying to develop pluripotent cells and human embryonic progenitor cell (“hEPC”)
based technologies and products that may compete with our stem cell products based on efficacy, safety, cost, and intellectual property
positions. Ocata, which was acquired by a subsidiary of Astellas Pharma Inc., and Retinal Patch Technologies Inc. are conducting clinical
trials of hES cell products designed to treat age-related macular degeneration. If their products are proven to be safe and effective,
they may reach the market ahead of OpRegen.
We
may also face competition from companies that have filed patent applications relating to the propagation and differentiation of stem
cells. Those companies include Ocata, which in 2015 had certain U.S. patents issue with claims directed to methods of producing RPE cells
and isolating and purifying such cells. We may be required to seek licenses from these competitors in order to commercialize certain
products proposed by us, and such licenses may not be granted.
Competitive
products may make any products we develop obsolete or noncompetitive before we recover the expense of developing and commercializing
our product candidates. If we are unable to compete effectively, our opportunity to generate revenue from the sale of our products we
may develop, if approved, could be adversely affected.
We
will face risks related to our own manufacturing capabilities and those related to our reliance on third parties to manufacture products,
including those related to product acquisition costs, production delays, and supply shortages that could impair our ability to complete
the development and commercialization of our product candidates.
The
manufacture of medical products is complex and requires significant expertise and capital investment, including the development of advanced
manufacturing techniques and process controls. Although we have manufacturing capability through Cell Cure for OpRegen, OPC1, and VAC2
in Israel, we will need greater manufacturing capacity if we are to successfully commercialize our products. Unless we can raise the
capital required to construct our own commercial scale manufacturing facilities and can develop the expertise to manage and operate a
manufacturing facility of our own, we may need to rely on third-party manufacturers to manufacture any products we develop. There is
no assurance that we will be able to identify manufacturers on acceptable terms or at all. Regardless of whether we do our own manufacturing
or rely on third parties to manufacture products for us, we will face risks related to the manufacture of our products including these
risks:
●
We
or any third-party manufacturers might not timely formulate and manufacture our products or produce the quantity and quality required
to meet our clinical and commercial needs, if any.
●
We
or any third-party manufacturers may not execute our manufacturing procedures appropriately.
●
Any
third-party manufacturers we engage may not perform as agreed or may not remain in the contract manufacturing business for the time
required to supply our clinical trials or to successfully produce, store and distribute our products on a commercial scale.
49 | P a g e
●
We
or any third-party manufacturers will be subject to ongoing periodic unannounced inspection by the FDA and corresponding state agencies
to ensure strict compliance with cGMP, and other government regulations and corresponding foreign standards. We will not have control
over third-party manufacturers’ compliance with applicable regulations and standards.
●
We
may not own, or may have to share, the intellectual property rights to any improvements made by our third-party manufacturers in
the manufacturing process for our product candidates.
●
We
may not obtain licenses for third-party intellectual property rights needed by manufacturers to produce our products.
●
Third-party
manufacturers could breach or terminate their agreements with us.
●
We
or third-party manufacturers may experience manufacturing difficulties as a result of resource constraints, labor disputes, unstable
political environments, natural disasters, public health crises such as pandemics and epidemics, political crises such as terrorism,
war, political insecurity or other conflict, or other events outside of our or our third-party manufacturers control (including as
a result of actual or threatened public health emergencies and outbreaks of disease such as the current COVID-19 pandemic). This
may result in business closures that affect us and our third-party manufacturers.
In
addition, we may rely on third parties to perform release testing on our product candidates prior to delivery to patients. If these tests
are not appropriately conducted and test data are not reliable, patients could be put at risk of serious harm which could result in product
liability suits.
If
we or any third-party manufacturers we may engage were to encounter any of these difficulties, our ability to provide our product candidates
to patients in clinical trials or to the medical marketplace would be jeopardized. Any delay or interruption in the supply of clinical
trial supplies could delay the completion of clinical trials, increase the costs associated with maintaining clinical trial programs
and, depending upon the period of delay, could require us to either commence new clinical trials at additional expense or terminate clinical
trials completely. Each risk could delay our clinical trials, any approval of our product candidates by the FDA, or the commercialization
of our product candidates, and could result in higher costs or deprive us of potential product revenue.
Any
cell-based products that receive regulatory approval may be difficult and expensive to manufacture profitably.
Cell-based
products are among the more expensive biologic products to manufacture in accordance with cGMP. We do not yet have sufficient information
to reliably estimate the cost of commercially manufacturing any of our product candidates. Excessive manufacturing costs could make our
product candidates too expensive to compete in the medical marketplace with alternative products manufactured by our competitors or might
result in third party payors such as health insurers and Medicare, declining to cover our products or setting reimbursement levels too
low for us to earn a profit from the commercialization of one or more of our products.
The ongoing COVID-19 pandemic has affected and
may adversely affect our operations, including the conduct of our current or future clinical trials, as well as the operations of
third-party partners on whom we rely.
In
December 2019, a novel strain of coronavirus and the resulting illness known as COVID-19 emerged in Wuhan, China. The outbreak has now
spread to other countries and has been declared a pandemic by the World Health Organization.
The
COVID-19 pandemic has resulted in travel and other restrictions in order to reduce the spread of the disease, including a California
executive order and several other state and local orders across the country, which, among other things, direct individuals to shelter
at their places of residence, direct businesses and governmental agencies to cease non-essential operations at physical locations, prohibit
certain non-essential gatherings, and order cessation of non-essential travel. In response to these public health directives and orders,
we have implemented work-from-home policies for our employees. The effects of the executive order, the shelter-in-place order and our
work-from-home policies may negatively impact productivity, disrupt our business and delay our clinical programs and timelines, the magnitude
of which will depend, in part, on the length and severity of the restrictions and other limitations on our ability to conduct our business
in the ordinary course. These and similar, and perhaps more severe, disruptions in our operations could negatively impact our business,
operating results and financial condition.
50 | P a g e
As
COVID-19 continues to impact the United States and Israel, we have experienced and may continue to experience disruptions that could
adversely affect our operations and clinical trials, including:
●
delays
or difficulties in conducting follow-up visits with patients in our clinical trials, particularly patients for our
OpRegen Phase 1/2a clinical trial, who are older and who may be at higher risk of complications from COVID-19;
●
delays
or difficulties in clinical site initiation, including difficulties in recruiting clinical site investigators and staff;
●
diversion
of healthcare resources away from the conduct of clinical trials;
●
interruption
of key clinical trial activities, such as clinical trial site monitoring, due to limitations on travel;
●
limited
availability of our employees and the staff of our current clinical sites due to sickness or social distancing measures;
●
manufacturing
difficulties for us and our suppliers of raw materials caused by business closures;
●
delays
in clinical sites receiving the supplies and materials needed to conduct our clinical trials, including interruption in global shipping
that may affect the transport of clinical trial materials;
●
changes
in local regulations as part of a response to the COVID-19 outbreak which may require us to change the ways in which our clinical
trials are conducted, which may result in unexpected costs, or to discontinue the clinical trials altogether;
●
interruption
or delays in the operations of the FDA or other regulatory authorities, which may impact review and approval timelines;
●
risk
that participants enrolled in our clinical trials will acquire COVID-19 while the clinical trial is ongoing, which could impact the
results of the clinical trial, including by increasing the number of observed adverse events; and
●
refusal
of the FDA to accept data from clinical trials in affected geographies.
These
and other disruptions in our operations and the global economy could negatively impact our business, operating results and financial
condition. The extent to which the COVID-19 pandemic affects our operations will depend on future developments, which are highly uncertain
and cannot be predicted with confidence, including the duration and severity of the pandemic, and the actions that may be required to
contain the COVID-19 pandemic or treat its impact.
Our
clinical trials have been, and may in the future be, affected by the COVID-19 pandemic. In particular, some sites paused enrollment to focus on, and direct resources to, the COVID-19 pandemic or adhere to
national or local guidelines, while at other sites, patients may decide not to enroll or continue participating in follow-up visits as
part of the ongoing clinical trial, as a result of the pandemic. We are unable to predict with confidence the duration of such patient
enrollment delays or missed study visits, as the COVID-19 pandemic continues or gets worse. If patient enrollment or study follow-up
is delayed for an extended period of time, our clinical trials could be delayed or otherwise adversely affected. Our inability to enroll
or follow a sufficient number of patients for any of our current or future clinical trials could result in significant delays or may
require us to abandon one or more clinical trials altogether.
51 | P a g e
Our
ongoing or planned clinical trials may also be impacted by interruptions or delays in the operations of the FDA and comparable foreign
regulatory agencies.
In
addition, quarantines, shelter-in-place and similar government orders, or the perception that such orders, shutdowns or other restrictions
on the conduct of business operations could occur, related to COVID-19 or other infectious diseases could impact personnel at our CROs
or third-party manufacturing facilities upon which we rely, or the availability or cost of materials, which could disrupt the supply
chain for our product candidates. To the extent our suppliers and service providers are unable to comply with their obligations under
our agreements with them or they are otherwise unable to deliver or are delayed in delivering goods and services to us due to the COVID-19
pandemic, our ability to continue meeting clinical supply demand for our product candidates or otherwise advancing development of our
product candidates may become impaired.
The
spread of COVID-19 and actions taken to reduce its spread may also materially affect us economically. While the potential economic impact
brought by, and the duration of, the COVID-19 pandemic may be difficult to assess or predict, there could be a significant disruption
of global financial markets, reducing our ability to access capital, which could in the future negatively affect our liquidity and financial
position. In addition, the trading prices for other biotechnology companies have been volatile as a result of the COVID-19 pandemic.
As a result, we may face difficulties raising capital through sales of our common shares or such sales may be on unfavorable terms.
COVID-19
and actions taken to reduce its spread continue to rapidly evolve. The extent to which COVID-19 may impede the development of our product
candidates, reduce the productivity of our employees, disrupt our supply chains, delay our clinical trials, reduce our access to capital
or limit our business development activities, will depend on future developments, which are highly uncertain and cannot be predicted
with confidence.
In
addition, to the extent the ongoing COVID-19 pandemic adversely affects our business and results of operations, it may also have the
effect of heightening many of the other risks and uncertainties described in this ‘‘Risk Factors’’ section.
The
withdrawal of the United Kingdom (the “U.K.”) from the EU, commonly referred to as “Brexit,” may adversely impact
our ability to obtain regulatory approvals of our product candidates in the EU and the U.K., result in restrictions or imposition of
taxes and duties for importing our product candidates into the EU and the U.K., and may require us to incur additional expenses in order
to develop, manufacture and commercialize our product candidates in the EU and the U.K.
Following
the result of a referendum in 2016, the U.K. left the EU on January 31, 2020, commonly referred to as Brexit. Pursuant to the formal
withdrawal arrangements agreed between the U.K. and the EU, the U.K. was subject to a transition period until December 31, 2020 (the
“Transition Period”) during which EU rules continued to apply. A trade and cooperation agreement (the “Trade and Cooperation
Agreement”) that outlines the future trading relationship between the United Kingdom and the European Union provisionally applied
from January 1, 2021, and formally entered into force on May 1, 2021.
Since
a significant proportion of the regulatory framework in the U.K. applicable to our business and our product candidates is derived from
EU directives and regulations, Brexit has had, and will continue to have, a material impact upon the regulatory regime with respect to
the development, manufacture, importation, approval and commercialization of our product candidates in the U.K. or the EU (to the extent
any development or manufacture of our product candidates takes place in the U.K.). For example, Great Britain is no longer covered by
the centralized procedures for obtaining EU-wide marketing authorization from the European Medicines Agency and a separate process for
authorization of drug products, including our product candidates, will be required in Great Britain. Any delay in obtaining, or an inability
to obtain, any marketing approvals, as a result of Brexit or otherwise, would prevent us from commercializing our product candidates
in the U.K. and restrict our ability to generate revenue and achieve and sustain profitability. For medical devices, such as Renevia,
CE marking remains applicable in Northern Ireland and will continue to be recognized in the rest of the United Kingdom (i.e.,
Great Britain) until 30 June 2023. Any devices placed on the market in Great Britain must be registered with the MHRA. The United Kingdom
has also adopted a new UK Conformity Assessment (“UKCA”), mark, which may be used in Great Britain on a voluntary basis until
June 30, 2023 and will be mandatory thereafter. The requirements for the UKCA for medical devices are based on the requirements set out
in the EU Medical Devices Directive (93/42/EEC), rather than the Medical Devices Regulation that applies in the European Union and has
repealed the directive.
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While
the Trade and Cooperation Agreement provides for the tariff-free trade of medicinal products between the U.K. and the EU, there may be
additional non-tariff costs to such trade which did not exist prior to the end of the Transition Period. Further, should the U.K. diverge
from the EU from a regulatory perspective, tariffs could be put into place in the future. We could therefore, both now and in the future,
face significant additional expenses (when compared to the position prior to the end of the Transition Period) to operate our business,
which could significantly and materially harm or delay our ability to generate revenues or achieve profitability of our business. Any
further changes in international trade, tariff and import/export regulations as a result of Brexit or otherwise may impose unexpected
duty costs or other non-tariff barriers on us. These developments, or the perception that any of them could occur, may significantly
reduce global trade and, in particular, trade between the affected nations and the U.K.
We
face potential product liability, and, if successful claims are brought against us, we may incur substantial liability and costs. If
the use or misuse of our products or product candidates harm patients or is perceived to harm patients even when such harm is unrelated
to our products or product candidates, our regulatory approvals could be revoked, suspended or otherwise negatively affected, and we
could be subject to costly and damaging product liability claims.
We
face the risk of incurring liabilities to clinical trial patients if they are injured as a result of their participation in our clinical
trials. In the event we commercialize Renevia in the EU or in other countries that recognize the CE Mark, we will also face product liability
risks associated with the use of Renevia by consumers. If any claims are made and if liability can be established, the amount of any
liability we or our affiliates may incur, could exceed any insurance coverage in effect, and the amount of the liability could be material
to our financial condition.
The
use or misuse of our product candidates in clinical trials and the sale of any products for which we obtain marketing approval, including
Renevia, exposes us to the risk of product liability claims. Product liability claims might be brought against us by consumers, healthcare
providers, pharmaceutical companies or others selling or otherwise coming into contact with our products. There is a risk that our product
candidates may induce adverse events. If we cannot successfully defend against product liability claims, we could incur substantial liability
and costs. In addition, regardless of merit or eventual outcome, product liability claims may result in:
●
impairment
of our business reputation;
●
initiation
of investigations by regulators;
●
withdrawal
of clinical trial participants;
●
costs
due to related litigation;
●
distraction
of management’s attention from our primary business;
●
substantial
monetary awards to patients or other claimants;
●
the
inability to commercialize our product candidates;
●
product
recalls, withdrawals or labeling, marketing or promotional restrictions; and
●
decreased
demand for our product candidates, if approved for commercial sale.
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We
believe our current product liability insurance coverage is appropriate in light of our clinical programs; however, we may not be able
to maintain insurance coverage at a reasonable cost or in sufficient amounts to protect us against losses due to liability. If and when
we obtain marketing approval for product candidates, we intend to increase our insurance coverage to include the sale of commercial products;
however, we may be unable to obtain product liability insurance on commercially reasonable terms or in adequate amounts. Significant
damages have been awarded in class action lawsuits based on drugs or medical treatments that had unanticipated adverse effects. A successful
product liability claim or series of claims brought against us could cause our stock price to decline and, if the amount of damages exceeds
our insurance coverage, could adversely affect our results of operations and business.
Cell
Cure has received Israeli government grants for certain of its research and development activities. The terms of these grants may require
Cell Cure to seek approvals and to satisfy specified conditions to manufacture products and transfer or license grant-supported technologies
outside of Israel. In the context of such approvals, Cell Cure will be required to pay penalties in addition to the repayment of the
grants. Such grants are applied for on a yearly basis and may not be available or only partially granted in the future, which would increase
our costs.
Cell
Cure has received Israeli government grants for certain of its research and development activities. The terms of these grants require
prior approval and the satisfaction of specified conditions to manufacture products and transfer or license technologies outside of Israel.
Under
the Encouragement of Research, Development and Technological Innovation in the Industry Law 5744-1984 (formerly known as the Law for
the Encouragement of Research and Development in Industry 5744-1984), and the regulations, guidelines, rules, procedures and benefit
tracks thereunder (collectively, the “Innovation Law”), annual research and development programs that meet specified criteria
and are approved by a committee of the IIA are eligible for grants. The grants awarded are typically up to 50% of the project’s
expenditures, as determined by the IIA committee and subject to the benefit track under which the grant was awarded. A company that receives
a grant from the IIA (a “Grant Recipient”), is typically required to pay royalties to the IIA on income generated from products
incorporating know-how developed using such grants (including income derived from services associated with such products) or on all revenues
of the Grant Recipient (depending upon the terms of the approval letters issued by the IIA), until 100% of the U.S. dollar-linked grant
plus annual LIBOR interest is repaid. In general, the rate of such royalties varies between 3% to 5%.
The
obligation to pay royalties is contingent on actual revenues being generated from such products and services or actual revenues being
generated by the Grant Recipient in general (as the case may be). In the absence of such revenues, no payment of royalties is required.
It should be noted that the restrictions under the Innovation Law will continue to apply even after the repayment of such royalties in
full by the Grant Recipient including restrictions on the sale, transfer or licensing to a non-Israeli entity of know-how developed as
part of the programs under which the grants were given.
The
terms of the grants under the Innovation Law also (generally) require that the products developed as part of the programs under which
the grants were given be manufactured in Israel and that the know-how developed thereunder may not be transferred outside of Israel,
unless prior written approval is received from the IIA (such approval is not required for the transfer of a portion of the manufacturing
capacity which does not exceed, in the aggregate, 10% of the portion declared to be manufactured outside of Israel in the applications
for funding (in which case only notification is required), and additional payments are required to be made to IIA). It should be noted
that this does not restrict the export of products that incorporate the funded know-how.
The
Innovation Law restricts the ability to transfer or license know-how funded by IIA outside of Israel. Transfer of IIA-funded know-how
outside of Israel requires prior approval and is subject to approval and payment of a redemption fee, which can be substantial, to the
IIA calculated according to the relevant formulas provided under the Innovation Law. A transfer or license for the purpose of the Innovation
Law is generally interpreted very broadly and include, inter alia, any actual sale or assignment of the IIA-funded know-how, any license
to further develop or otherwise exploit the IIA-funded know-how or the products resulting from such IIA-funded know-how or any other
transaction, which, in essence, constitutes a transfer of the IIA-funded know-how. Generally, a mere license solely to market or distribute
products resulting from the IIA-funded know-how would not be deemed a transfer or license for the purpose of the Innovation Law.
54 | P a g e
Part
of Cell Cure’s research and development efforts have been financed, partially, through grants that it has received from the IIA
and when we acquired our holdings in Cell Cure, we undertook in writing, vis-à-vis the IIA, to abide by, and to ensure the abidance
of Cell Cure to, the Innovation Law. We therefore must comply with the requirements of the Innovation Law and related regulations.
The
OpRegen program has been supported in part by the IIA through a series of separate research grants, beginning in 2007. As a result, and
subject to the requirements of the Innovation Law, we are obligated to pay the IIA a portion of the upfront, milestone, and royalty payments
which may be received from Roche under the Roche Agreement. Lineage is obligated to pay approximately 24.3% of the upfront payment and
any future payments it receives from Roche to the IIA, up to an aggregate cap on all payments to IIA, which currently stands at approximately
$102.7 million. In January 2022, we received the $50.0 million upfront payment from Roche. We made a subsequent payment of $12.1 million
to the IIA, pursuant to our obligations under the Innovation Law.
The
restrictions under the Innovation Law may impair our ability to enter into any future agreements which involve IIA-funded products or
know-how without the approval of IIA, or limit the economic benefit that we might derive under such agreements. We cannot be certain
that any approval of IIA will be obtained on terms that are acceptable to us, or at all. We may not receive the required approvals should
we wish to transfer or license IIA-funded know-how, manufacturing and/or development outside of Israel in the future. Furthermore, in
the event that we undertake a transaction involving the transfer to a non-Israeli entity of know-how developed with IIA-funding pursuant
to a merger or similar transaction, the consideration available to our shareholders may be significantly reduced by the amounts we are
required to pay to the IIA. Any approval, if given, will generally be subject to additional financial obligations. Failure to comply
with the requirements under the Innovation Law may subject Cell Cure to mandatory repayment of grants received by it (together with interest
and penalties), as well as expose its directors and management to criminal proceedings. In addition, the IIA may from time-to-time
conduct royalty audits. Further grants may not be approved or reduced in the future, which would increase our costs. IIA approval
is not required for the marketing or distribution of products resulting from the IIA-funded research or development in the ordinary course
of business.
Our
international business exposes us to business, regulatory, political, operational, financial and economic risks associated with doing
business outside of the United States.
Cell
Cure is our 99% owned subsidiary located in Jerusalem, Israel. OpRegen is currently manufactured at Cell Cure and we anticipate transitioning
some or all of the manufacturing of OPC1 and VAC2 to Cell Cure as well. A portion of our OpRegen Phase 1/2a clinical trial has been conducted
at sites in Israel. Conducting operations internationally involves a number of risks, including:
●
difficulty
in staffing and managing foreign operations;
●
failure
by us to obtain the appropriate regulatory approvals;
●
logistics
and regulations associated with shipping drug product or patient samples, including infrastructure conditions and transportation
delays;
●
financial
risks, such as longer payment cycles and exposure to foreign currency exchange rate fluctuations;
●
subject
to tax on Global Intangible Low Tax Income (“GILTI”)
earned by foreign subsidiaries;
●
political
and economic instability, including wars, terrorism, and political unrest, outbreak of disease, boycotts, curtailment of trade and
other business restrictions;
●
multiple,
conflicting and changing laws and regulations such as tax laws, export and import restrictions, employment laws, data and privacy
laws, regulatory requirements and other governmental approvals, permits and licenses; and
●
regulatory
and compliance risks that may fall within the purview of the U.S. Foreign Corrupt Practices Act, UK Bribery Act, anti-boycott laws
and other anti-corruption laws.
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Any
of these factors could significantly harm our international operations and, consequently, our results of operations. In addition, any
failure to comply with applicable legal and regulatory obligations could impact us in a variety of ways that include, but are not limited
to, significant criminal, civil and administrative penalties, including imprisonment of individuals, fines and penalties, denial of export
privileges, seizure of shipments, and restrictions on certain business activities. Also, the failure to comply with applicable legal
and regulatory obligations could result in the disruption of our clinical trial activities.
Our
international operations could be affected by changes in laws, trade regulations, labor and employment regulations, and procedures and
actions affecting approval, production, pricing, reimbursement and marketing of tests, as well as by inter-governmental disputes. Any
of these changes could adversely affect our business.
Our
success internationally will depend, in part, on our ability to develop and implement policies and strategies that are effective in anticipating
and managing these and other risks in Israel. Failure to manage these and other risks may have a material adverse effect on our operations
in Israel and on our business as a whole.
Risks
Related to our Intellectual Property
Our
intellectual property may be insufficient to protect our products.
Our
patents and patent applications are directed to compositions of matter, formulations, methods of use and/or methods of manufacturing,
as appropriate. In addition to patenting our own technology and that of our subsidiaries, we have licensed patents and patent applications
for certain stem cell technology, hEPC, and hES cell lines, hydrogel technology and other technology from other companies.
The
patent positions of pharmaceutical and biotechnology companies, including ours, are generally uncertain and involve complex legal and
factual questions. Our business could be negatively affected by any of the following:
●
the
claims of any patents that are issued may not provide meaningful protection, may not provide a basis for commercially viable products
or may not provide us with any competitive advantages;
●
our
patents may be challenged by third parties;
●
others
may have patents that relate to our technology or business that may prevent us from marketing our product candidates unless we are
able to obtain a license to those patents;
●
the
pending patent applications to which we have rights may not result in issued patents;
●
our
patents may have terms that are inadequate to protect our competitive position on our products;
●
we
may not be successful in developing additional proprietary technologies that are patentable.
In
addition, others may independently develop similar or alternative technologies, duplicate any of our technologies and, if patents are
licensed or issued to us, design around the patented technologies licensed to or developed by us. As an example, Astellas’ patent
portfolio with respect to the manufacture of its RPE products could adversely impact our rights to manufacture OpRegen. Moreover, we
could incur substantial costs in litigation if we have to defend ourselves in patent lawsuits brought by third parties or if we initiate
such lawsuits.
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If
we are unable to obtain and enforce patents and to protect our trade secrets, others could use our technology to compete with us, which
could limit opportunities for us to generate revenues by licensing our technology and selling products.
Our
success will depend in part on our ability to obtain and enforce patents and maintain trade secrets in the United States and in other
countries. If we are unsuccessful at obtaining and enforcing patents, our competitors could use our technology and create products that
compete with our products, without paying license fees or royalties to us. The preparation, filing, and prosecution of patent applications
can be costly and time consuming. Our limited financial resources may not permit us to pursue patent protection of all of our technology
and products in all key markets. Even if we are able to obtain issued patents covering our technology or products, we may have to incur
substantial legal fees and other expenses to enforce our patent rights to protect our technology and products from infringing uses. We
may not have the financial resources to finance the litigation required to preserve our patent and trade secret rights. Litigation, interferences,
oppositions, inter partes reviews or other proceedings are, have been and may in the future be necessary in some instances to determine
the validity and scope of certain of our proprietary rights, and in other instances to determine the validity, scope or non-infringement
of certain patent rights claimed by third parties to be pertinent to the manufacture, use or sale of our products. This means that patents
owned or licensed by us may be lost if the outcome of a proceeding is unfavorable to us.
There
is no certainty that our pending or future patent applications will result in the issuance of patents.
Our
success depends in part on our ability to obtain and defend patent and other intellectual property rights that are important to the commercialization
of our products and product candidates. The degree of patent protection that will be afforded to our products and processes in the U.S.
and in other important markets remains uncertain and is dependent upon the scope of protection decided upon by the patent offices, courts,
administrative bodies and lawmakers in these countries. We can provide no assurance that we will successfully obtain or preserve patent
protection for the technologies incorporated into our products and processes, or that the protection obtained will be of sufficient breadth
and degree to protect our commercial interests in all countries where we conduct business. If we cannot prevent others from exploiting
our inventions, we will not derive the benefit from them that we currently expect. Furthermore, we can provide no assurance that our
products will not infringe patents or other intellectual property rights held by third parties.
In
Europe, there is uncertainty about the eligibility of hES cell subject matter for patent protection. The European Patent Convention prohibits
the granting of European patents for inventions that concern “uses of human embryos for industrial or commercial purposes.”
A recent decision at the Court of Justice of the European Union interpreted parthenogenetically produced hES cells as patentable subject
matter. Consequently, the European Patent Office now recognizes that human pluripotent stem cells (including human ES cells) can be created
without a destructive use of human embryos as of June 5, 2003, and patent applications relating to hES cell subject matter with a filing
and priority date after this date are no longer automatically excluded from patentability under Article 53 (a) EPC and Rule 28(c) EPC.
A
Patent Cooperation Treaty patent application related to OpRegen was filed on May 25, 2021, directed to the restoration of the anatomy
or functionality of a retina with OpRegen. As with all patent applications, there is no certainty that this or any of our other pending
or future patent applications will result in the issuance of patents.
Intellectual
property we may develop using grants received from governments are subject to rights maintained by those governments.
Research
and development we perform that is funded by grants from government, and any intellectual property that we create using those grants,
is subject to certain rights of the government entities to require that we license or grant rights to the intellectual property developed
using government funding in certain circumstances.
There
is no certainty that we will be able to obtain licenses to intellectual property rights owned by third parties.
There
are no assurances that any of our intellectual property rights will guarantee protection or market exclusivity for our products and product
candidates. In such cases, we may need to obtain enabling licenses from third parties to protect our products and product candidates,
try to secure market exclusivity or avoid infringing on the intellectual property rights of third parties. If we are unable to fully
protect our product candidates or achieve market exclusivity for our products and product candidates, our financial success will be dependent,
in part, on our ability to protect and enforce our intellectual property rights, to operate without infringing upon the proprietary rights
of others, or, when necessary, our ability to obtain enabling licenses.
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If
we fail to meet our obligations under license agreements, we may lose our rights to key technologies on which our business depends.
Our
business depends on several critical technologies that are based in part on technology licensed from third parties. Those third-party
license agreements impose obligations on us, including payment obligations and obligations to pursue development of commercial products
under the licensed patents or technology. If a licensor believes that we have failed to meet our obligations under a license agreement,
the licensor could seek to limit or terminate our license rights, which could lead to costly and time-consuming litigation and, potentially,
a loss of the licensed rights. During the period of any such litigation, our ability to carry out the development and commercialization
of potential products, and our ability to raise any capital that we might then need, could be significantly and negatively affected.
If our license rights were restricted or ultimately lost, we would not be able to continue to use the licensed technology in our business.
Risks
Related to our Dependence on Third Parties
We
may become dependent on possible future collaborations to develop and commercialize many of our product candidates and to provide the
regulatory compliance, sales, marketing and distribution capabilities required for the success of our business.
We
may enter into various kinds of collaborative research and development and product marketing agreements to develop and commercialize
our products. The expected future milestone payments and cost reimbursements from collaboration agreements could provide an important
source of financing for our research and development programs, thereby facilitating the application of our technology to the development
and commercialization of our products, but there are risks associated with entering into collaboration arrangements.
There
is a risk we could become dependent upon one or more collaborative arrangements. A collaborative arrangement upon which we might depend
might be terminated by our collaboration partner or a partner might determine not to actively pursue the development or commercialization
of our products. A collaboration partner also may not be precluded from independently pursuing competing products and drug delivery approaches
or technologies.
There
is a risk that a collaboration partner might fail to perform its obligations under the collaborative arrangements or may be slow in performing
its obligations. In addition, a collaboration partner may experience financial difficulties at any time that could prevent it from having
available funds to contribute to the collaboration. If a collaboration partner fails to conduct its product development, commercialization,
regulatory compliance, sales and marketing or distribution activities successfully and in a timely manner, or if it terminates or materially
modifies its agreements with us, the development and commercialization of one or more product candidates could be delayed, curtailed
or terminated because we may not have sufficient financial resources or capabilities to continue such development and commercialization
on our own.
We
do not have the ability to independently conduct clinical trials required to obtain regulatory approvals for our product candidates.
We
will need to rely on third parties, such as CROs, data management companies, contract clinical research associates, medical institutions,
clinical investigators and contract laboratories to conduct any clinical trials we may undertake for our product candidates. We may also
rely on third parties to assist with preclinical development of our product candidates. If we outsource clinical trials, we may not directly
control the timing, conduct and expense of our clinical trials. If we enlist third parties to conduct clinical trials and they fail to
perform their contractual duties or regulatory obligations or fail to meet expected deadlines, if they need to be replaced or if the
quality or accuracy of the data they obtain is compromised due to failing to adhere to our clinical protocols or regulatory requirements
or for other reasons, our preclinical development activities or clinical trials may be extended, delayed, suspended or terminated, and
we may not obtain regulatory approval for or successfully commercialize our product candidates.
In
addition, quarantines, shelter-in-place and similar government orders, or the perception that such orders, shutdowns or other restrictions
on the conduct of business operations could occur, related to COVID-19 or other infectious diseases could impact personnel at these third
parties, which could disrupt our clinical timelines, which could have a material adverse impact on our business, prospects, financial
condition and results of operations.
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We
have relied on CIRM to fund past clinical trials of OPC1 and we do not know if they will provide additional funding for future studies
of OPC1.
We
received $14.3 million of funding from CIRM to support clinical development of OPC1. We intend to apply for additional CIRM grants, if
available; however, we cannot provide any assurance that such grants will be awarded. If we are unable to obtain another CIRM grant,
we will need to raise funds through other mechanisms to support future clinical studies of OPC1, which may take additional time and effort.
If capital is not immediately available, this may force us to amend, delay, or discontinue the clinical trial and development work for
OPC1 until funding is secured.
We
may need to rely on marketing partners or contract sales companies.
If
we are able to develop our product candidates and obtain necessary regulatory approvals, we may need to rely on marketing, selling or
distributing partners. If we do not partner for commercial services, we will depend on our ability to build our own marketing, selling
and distribution capabilities, which would require the investment of significant financial and management resources, or we will need
to find collaborative marketing partners, sales representatives or wholesale distributors for the commercial sale of our products.
If
we market products through arrangements with third parties, we may pay sales commissions to sales representatives or we may sell or consign
products to distributors at wholesale prices. As a result, our gross profit from product sales may be lower than it would be if we sold
our products directly to end users at retail prices through our own sales force. There can be no assurance we will be able to negotiate
distribution or sales agreements with third parties on favorable terms to justify our investment in our products or achieve sufficient
revenues to support our operations.
Risks
Pertaining to Our Common Shares
Because
we are engaged in the development of pharmaceutical and stem cell therapy products, the price of our common shares may rise and fall
rapidly.
The
market price of our common shares, like that of the shares of many biotechnology companies, has been highly volatile. The price of our
common shares may rise rapidly in response to certain events, such as the commencement of clinical trials of an experimental new therapy,
even though the outcome of those trials and the likelihood of ultimate FDA approval of a therapeutic product remain uncertain. Similarly,
prices of our common shares may fall rapidly in response to certain events such as unfavorable results of clinical trials or a delay
or failure to obtain FDA approval. For example, from January 1, 2021 through March 4, 2022 the closing price of our common shares
has ranged between $1.26 and $3.10 per share. In addition, the failure of our earnings to meet analysts’ expectations could
result in a significant rapid decline in the market price of our common shares.
Because
we do not pay cash dividends, our common shares may not be a suitable investment for anyone who needs to earn dividend income.
We
do not pay cash dividends on our common shares. For the foreseeable future, we anticipate that any earnings generated in our business
will be used to finance the growth of our business and will not be paid out as dividends to holders of our common shares. This means
that our common shares may not be a suitable investment for anyone who needs to earn income from their investments.
Insiders
continue to have substantial influence over our company, which could limit your ability to influence the outcome of key transactions,
including a change of control.
Our
directors, executive officers and their affiliates, in the aggregate, owned approximately 24.5% of our outstanding common shares as of
December 31, 2021. As a result, these shareholders, if acting together, will be able to heavily influence or control matters requiring
approval by our shareholders, including the election of directors and the approval of mergers, acquisitions or other extraordinary transactions.
They may also have interests that differ from yours and may vote in a way with which you disagree, and which may be averse to your interests.
This concentration of ownership may have the effect of delaying, preventing or deterring a change of control of our company, could deter
certain public investors from purchasing our common shares and might ultimately affect the market price of our common shares.
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If
we or our subsidiaries issue additional common shares or preferred shares, investors in our common shares may experience dilution of
their ownership interests.
We
and our subsidiaries may issue additional common shares or other securities convertible into or exercisable for common shares to raise
additional capital or to hire or retain employees or consultants, or in connection with future acquisitions of companies or licenses
to technology or rights, or for other business purposes. The future issuance of additional securities may be dilutive to our shareholders
and may create downward pressure on the trading price of our common shares.
We
are currently authorized to issue an aggregate of 252,000,000 shares of capital stock consisting of 250,000,000 common shares and 2,000,000
“blank check” preferred shares, which means we may issue, without shareholder approval, one or more series of preferred
stock having such designation, powers, privileges, preferences, including preferences over our common shares respecting dividends and
distributions, terms of redemption and relative participation, optional, or other rights, if any, of the shares of each such series of
preferred stock and any qualifications, limitations or restrictions thereof, as our board of directors may determine. The terms of one
or more series of preferred stock could dilute the voting power or reduce the value of our common shares. Any preferred shares may also
be convertible into common shares on terms that would be dilutive to holders of common shares. Our subsidiaries may also issue their
own preferred shares with a similar impact on our ownership of the subsidiaries.
As
of December 31, 2021, Lineage had 169,477,347 common shares outstanding, 14,883,344 common shares reserved for issuance upon the exercise
of outstanding options under our employee stock option plans, and 30,900 common shares reserved for issuance upon the vesting
and settlement of restricted stock units under our equity incentive plan.
On
May 1, 2020, Lineage entered into the Sales Agreement, pursuant to which Lineage may offer and sell, from time to time, through Cantor
Fitzgerald, common shares of Lineage (“ATM Shares”) having an aggregate offering price of up to $25.0 million. Lineage is
not obligated to sell any ATM Shares. Subject to the terms and conditions of the Sales Agreement, Cantor Fitzgerald has agreed to use
commercially reasonable efforts, consistent with its normal trading and sales practices, applicable state and federal law, rules and
regulations, and the rules of the NYSE American, to sell the ATM Shares from time to time based upon Lineage’s instructions, including
any price, time or size limits specified by Lineage. Under the Sales Agreement, Cantor Fitzgerald may sell the ATM Shares by any method
deemed to be an “at-the-market” offering as defined in Rule 415(a)(4) under the Securities Act of 1933, as amended, or by
any other method permitted by law, including in privately negotiated transactions. Cantor Fitzgerald’s obligations to sell the
ATM Shares are subject to satisfaction of certain conditions, including the continued effectiveness of Lineage’s Registration Statement
on Form S-3 (File No. 333-237975), which was filed with the Commission on May 1, 2020 and was declared effective on May 8, 2020. The
Sales Agreement replaced the previous sales agreement with Cantor that had been entered into in April 2017.
On
March 5, 2021, Lineage filed a prospectus supplement with the SEC in connection with the offer and sale of an additional $25.0 million
of common shares under the Sales Agreement increasing the total offering to $50.0 million. As of December 21, 2021, $14.1 million remained
available for sale under the Sales Agreement. On December 21, 2021, Lineage filed a prospectus supplement with the SEC in connection
with the offering and sale of up to $64.1 million of common shares (the “New Sales Agreement”), with Cantor Fitzgerald as
the sales agent, no additional sales will be made under the Sales Agreement. The $64.1 million under the New Sales Agreement which may
be issued are registered pursuant to Lineage’s effective shelf registration on Form S-3 (File No. 333-237975), as filed with the
SEC on May 1, 2020 and declared effective on May 8, 2020 (the “May 2020 Registration Statement”), and Lineage’s effective
shelf registration statement on Form S-3 (File No. 333-254167), which was filed with the SEC on March 5, 2021 and declared effective
on March 19, 2021. As of December 31, 2021, under the Sales Agreement, Lineage had issued 14,908,735 common shares at a weighted average
price per share of $2.41 for gross proceeds of $35.9 million. As of December 31, 2021, under the New Sales Agreement, Lineage had issued
108,200 common shares at a weighted average price per share of $2.55 for gross proceeds of $0.3 million (which includes $0.2 million
of cash in transit related to a 2021 transaction that settled in early 2022). As a result, as of December 31, 2021, $63.9 million remained
available for issuance under the New Sales Agreement.
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The
operation of some of our subsidiaries has been financed in part through the sale of shares of capital stock and warrants to purchase
securities of those subsidiaries to private investors. Future sales of such securities by our subsidiaries could reduce our ownership
interest in the applicable subsidiary, and correspondingly dilute our shareholder’s ownership interests in our consolidated enterprise.
Certain of our subsidiaries also have their own stock option plans and the exercise of stock options or the sale of restricted stock
under those plans would also reduce our ownership interest in the applicable subsidiary, with a resulting dilutive effect on the ownership
interest of our shareholders in our consolidated enterprise.
General
Risk Factors
We
are subject to stringent and changing obligations related to data privacy and security. Our actual or perceived failure to comply with
such obligations could lead to regulatory investigations or actions; litigation; fines and penalties; disruptions of our business operations;
reputational harm; loss of revenue or profits; and other adverse business consequences.
In
the ordinary course of business, we collect, receive, store, process, generate, use, transfer, disclose, make accessible, protect, secure,
dispose of, transmit, and share (collectively, processing) personal data and other sensitive information, including proprietary and confidential
business data, trade secrets, intellectual property, data we collect about trial participants in connection with clinical trials, and
sensitive third-party data. Our data processing activities subject us to numerous data privacy and security obligations, such as various
laws, regulations, guidance, industry standards, external and internal privacy and security policies, contracts, and other obligations
that govern the processing of personal data by us and on our behalf.
In
the United States, federal, state, and local governments have enacted numerous data privacy and security laws, including data breach
notification laws, personal data privacy laws, and consumer protection laws. For example, HIPAA, as amended by HITECH, imposes specific
requirements relating to the privacy, security, and transmission of individually identifiable health information. In addition, the CCPA
imposes obligations on covered businesses. These obligations include, but are not limited to, providing specific disclosures in privacy
notices and affording California residents certain rights related to their personal data. The CCPA allows for statutory fines for noncompliance
(up to $7,500 per violation) and includes a private right of action for certain data breaches. Although the CCPA exempts some data processed
in the context of clinical trials, the CCPA may increase compliance costs and potential liability with respect to other personal data
we maintain about California residents. In addition, it is anticipated that the CPRA, effective January 1, 2023, will expand the CCPA.
The CPRA establishes a new California Privacy Protection Agency to implement and enforce the CPRA, which could increase the risk of enforcement.
Other states have enacted data privacy laws. For example, Virginia passed the Consumer Data Protection Act, and Colorado passed the Colorado
Privacy Act, both of which become effective in 2023. In addition, data privacy and security laws have been proposed at the federal, state,
and local levels in recent years, which could further complicate compliance efforts.
Outside
the United States, an increasing number of laws, regulations, and industry standards apply to data privacy and security. For example,
the EU GDPR and the UK GDPR impose strict requirements for processing personal data. Under the EU GDPR, government regulators may impose
temporary or definitive bans on data processing, as well as fines of up to 20 million euros or 4% of annual global revenue, whichever
is greater. Further, individuals may initiate litigation related to processing of their personal data. In addition, Israel’s PPL
and the regulations promulgated thereunder impose certain obligations with respect to the manner personal data is processed. Under the
PPL, government regulators may issue fines or sanctions.
Certain
jurisdictions have enacted data localization laws and cross-border personal data transfer laws, which could make it more difficult to
transfer information across jurisdictions (such as transferring or receiving personal data that originates in the EU or in other foreign
jurisdictions). Existing mechanisms that facilitate cross-border personal data transfers may change or be invalidated. For example, absent
appropriate safeguards or other circumstances, the EU GDPR generally restricts the transfer of personal data to countries outside of
the European Economic Area, or EEA, such as the United States, that the European Commission does not consider to provide an adequate
level of data privacy and security. The European Commission released a set of “Standard Contractual Clauses” (“SCCs”),
that are designed to be a valid mechanism to facilitate personal data transfers out of the EEA to these jurisdictions. Currently, these
SCCs are a valid mechanism to transfer personal data outside of the EEA, but there exists some uncertainty regarding whether the SCCs
will remain a valid mechanism. Additionally, the SCCs impose additional compliance burdens, such as conducting transfer impact assessments
to determine whether additional security measures are necessary to protect the at-issue personal data. In addition, Switzerland and the
UK similarly restrict personal data transfers outside of those jurisdictions to countries, such as the United States, that do not provide
an adequate level of personal data protection, and certain countries outside Europe (e.g., Israel) have also passed or are considering
laws requiring local data residency or otherwise impeding the transfer of personal data across borders, any of which could increase the
cost and complexity of doing business.
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If
we cannot implement a valid compliance mechanism for cross-border data transfers, we may face increased exposure to regulatory actions,
substantial fines, and injunctions against processing or transferring personal data from Europe or other foreign jurisdictions. The inability
to import personal data to the United States could significantly and negatively impact our business operations; limiting our ability
to collaborate with parties that are subject to such cross-border data transfer or localization laws; or requiring us to increase our
personal data processing capabilities and infrastructure in foreign jurisdictions at significant expense.
Our
obligations related to data privacy and security are quickly changing in an increasingly stringent fashion, creating some uncertainty
as to the effective future legal framework. Additionally, these obligations may be subject to differing applications and interpretations,
which may be inconsistent or conflict among jurisdictions. Preparing for and complying with these obligations requires significant resources
and may necessitate changes to our information technologies, systems, and practices and to those of any third parties that process personal
data on our behalf. Although we endeavor to comply with all applicable data privacy and security obligations, we may at times fail (or
be perceived to have failed) to do so. Moreover, despite our efforts, our personnel or third parties upon whom we rely may fail to comply
with such obligations, which could negatively impact our business operations and compliance posture. For example, any failure by a third-party
processor to comply with applicable law, regulations, or contractual obligations could result in adverse effects, including inability
to or interruption in our ability to operate our business and proceedings against us by governmental entities or others.
If
we fail, or are perceived to have failed, to address or comply with data privacy and security obligations, we could face significant
consequences. These consequences may include, but are not limited to, government enforcement actions (e.g., investigations, fines, penalties,
audits, inspections, and similar); litigation (including class-related claims); additional reporting requirements and/or oversight; bans
on processing personal data; and orders to destroy or not use personal data.
Any
of these events could have a material adverse effect on our reputation, business, or financial condition, including but not limited to:
loss of customers; interruptions in our business operations (including, as relevant, clinical trials); inability to process personal
data or to operate in certain jurisdictions; limited ability to develop or commercialize our products; expenditure of time and resources
to defend any claim or inquiry; adverse publicity; or revision or restructuring of our operations.
If
our information technology systems or data, or those of third parties upon which we rely, are or were compromised, we could experience
adverse consequences resulting from such compromise, including but not limited to regulatory investigations or actions; litigation; fines
and penalties; disruptions of our business operations; reputational harm; loss of revenue or profits; loss of customers or sales; and
other adverse consequences.
We
are increasingly dependent on information technology systems and infrastructure to operate our business. In the ordinary course of our
business, we may process confidential, and sensitive, including personal data (such as health-related data), intellectual
property, and proprietary business information (collectively, sensitive information). It is critical that we do so in a
secure manner to maintain the confidentiality, integrity and availability of such information. We have also outsourced some of our operations
(including parts of our information technology infrastructure) to a number of third-party service providers who may have, or could
gain, access to sensitive information. In addition, many of those third parties, in turn, subcontract or outsource some of their
responsibilities to third parties.
Cyberattacks,
malicious internet-based activity, and online and offline fraud are increasing in frequency, persistence, sophistication and intensity.
These threats come from a variety of sources, including traditional computer “hackers,” threat actors, personnel (such as
through theft or misuse), sophisticated nation states, and nation-state-supported actors. Some actors now engage and are expected to
continue to engage in cyber-attacks, including, without limitation, nation-state actors for geopolitical reasons and in conjunction with
military conflicts and defense activities. During times of war and other major conflicts, we and the third parties upon which we
rely may be vulnerable to a heightened risk of these attacks, including cyber-attacks that could materially disrupt our systems and operations,
supply chain, and ability to produce, sell and distribute our products. We and the third parties upon which we rely may be subject to
a variety of evolving threats, including, but not limited to, malware (including as a result of persistent threat intrusions), malicious
code (such as viruses and worms), ransomware attacks, denial-of-service attacks (such as credential stuffing), social engineering attacks
(including phishing attacks), personnel misconduct or error, supply-chain attacks, software bugs, server malfunctions, software or hardware
failures, loss of data or other technology assets, adware, telecommunication failures, earthquakes, fires, floods, and other similar
threats. Although the aggregate impact on our operations and financial condition has not been material to date, we have been the target
of events of this nature and expect them to continue.
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Ransomware
attacks, including by organized criminal threat actors, nation-states, and nation-state-supported actors, are becoming increasingly prevalent
and severe and can lead to significant interruptions in our operations, loss of data and income, reputational harm, and diversion of
funds. Extortion payments may alleviate the negative impact of a ransomware attack, but we may be unwilling or unable to make such payments
due to, for example, applicable laws or regulations prohibiting such payments. Similarly, supply-chain attacks have increased in
frequency and severity, and we cannot guarantee that third parties and infrastructure in our supply chain or our third-party partners’
supply chains have not been compromised or that they do not contain exploitable defects or bugs that could result in a breach of or disruption
to our information technology systems or the third-party information technology systems that support us and our services. Additionally,
the COVID-19 pandemic and our remote workforce poses increased risks to our information technology systems and data, as more of our employees
work from home, utilizing network connections outside our premises. Moreover, the prevalent use of mobile devices to access confidential
information increase the risk to our information technology systems and data. Future or past business transactions (such as acquisitions
or integrations) could also expose us to additional cybersecurity risks and vulnerabilities, as our systems could be negatively affected
by vulnerabilities present in acquired or integrated entities’ systems and technologies.
Any
of the previously identified or similar threats could cause a security incident or other interruption. A security incident or other interruption
could result in unauthorized, unlawful, or accidental acquisition, modification, destruction, loss, alteration, encryption, disclosure
of, or access to our sensitive information. A security incident or other interruption could disrupt our ability (and that of third parties
upon whom we rely) to conduct our business operations.
We
may expend significant resources or modify our business activities to try to protect against security incidents. Certain data privacy
and security obligations may require us to implement and maintain specific security measures, industry-standard or reasonable security
measures to protect our information technology systems and sensitive information.
While
we have implemented security measures to protect our information technology systems and infrastructure, there can be no assurance that
such measures will prevent security incidents that could adversely affect our business. We may be unable in the future to detect
vulnerabilities in our information technology systems because such threats and techniques change frequently, are often sophisticated
in nature, and may not be detected until after a security incident has occurred. Despite our efforts to identify and remediate vulnerabilities,
if any, in our information technology systems, our efforts may not be successful. Further, we may experience delays in developing and
deploying remedial measures designed to address any such identified vulnerabilities. In addition, failure to maintain effective internal
accounting controls related to security incidents and cybersecurity in general could impact our ability to produce timely and
accurate financial statements and subject us to regulatory scrutiny.
Applicable
data privacy and security obligations may require us to notify relevant stakeholders of security incidents. Such disclosures are costly,
and the disclosures or the failure to comply with such requirements could lead to adverse consequences. If we (or a third party upon
whom we rely) experience a security incident or are perceived to have experienced a security incident, we may experience adverse consequences.
These consequences may include: government enforcement actions (for example, investigations, fines, penalties, audits, and inspections);
additional reporting requirements and/or oversight; restrictions on processing sensitive information (including personal data); litigation
(including class claims); indemnification obligations; negative publicity; reputational harm; monetary fund diversions; interruptions
in our operations (including availability of data); financial loss; and other similar harms. Security incidents and attendant consequences
may cause interruptions in our operations and could result in a material disruption of our programs. For example, the loss of clinical
trial data for our product candidates could result in delays in our regulatory approval efforts and significantly increase our costs
to recover or reproduce the data.
Our
contracts may not contain limitations of liability, and even where they do, there can be no assurance that limitations of liability in
our contracts are sufficient to protect us from liabilities, damages, or claims related to our data privacy and security obligations.
We cannot be sure that our insurance coverage will be adequate or sufficient to protect us from or to mitigate liabilities arising out
of our privacy and security practices, that such coverage will continue to be available on commercially reasonable terms or at all, or
that such coverage will pay future claims.
63 | P a g e
Failure
of our internal control over financial reporting could harm our business and financial results.
Our
management is responsible for establishing and maintaining adequate internal control over financial reporting. Because of its inherent
limitations, internal control over financial reporting is not intended to provide absolute assurance that a misstatement of our financial
statements would be prevented or detected. Our growth and entry into new products, technologies and markets will place significant additional
pressure on our system of internal control over financial reporting. Any failure to maintain an effective system of internal control
over financial reporting could limit our ability to report our financial results accurately and timely or to detect and prevent fraud.
Operating our business through subsidiaries, some of which are located in foreign countries, also adds to the complexity of our internal
control over financial reporting and adds to the risk of a system failure, an undetected improper use or expenditure of funds or other
resources by a subsidiary, or a failure to properly report a transaction or financial results of a subsidiary. We allocate certain expenses
among Lineage itself and one or more of our subsidiaries, which creates a risk that the allocations we make may not accurately reflect
the benefit of an expenditure or use of financial or other resources by Lineage as the parent company and the subsidiaries among which
the allocations are made. An inaccurate allocation may impact our consolidated financial results, particularly in the case of subsidiaries
that we do not wholly own since our financial statements include adjustments to reflect the minority ownership interests in our subsidiaries
held by others.
If
we identify material weaknesses in our internal control over financial reporting, if we are unable to comply with the requirements of
Section 404 of the Sarbanes-Oxley Act in a timely manner or assert that our internal control over financial reporting is effective, or
if our independent registered public accounting firm is unable to express an opinion or expresses a qualified or adverse opinion about
the effectiveness of our internal control over financial reporting, investors may lose confidence in the accuracy and completeness of
our financial reports and the market price of our common shares could be negatively affected. In addition, we could become subject to
investigations by the NYSE American, the Securities and Exchange Commission, and other regulatory authorities, which could require additional
financial and management resources.
Current
economic and stock market conditions may adversely affect the price of our common shares.
The
stock market has been experiencing extreme price and volume fluctuations which have affected the market price of the equity securities
without regard to the operating performance of the issuing companies. Broad market fluctuations, as well as general economic, political
and other conditions (such as the recent coronavirus outbreak), may adversely affect the market price of our common shares.
Our
business could be negatively affected as a result of actions of activist shareholders, and such activism could affect the trading value
of our securities.
Shareholders
may, from time to time, engage in proxy solicitations or advance stockholder proposals, or otherwise attempt to effect changes and assert
influence on our board of directors and management. Activist campaigns that contest or conflict with our strategic direction or seek
changes in the composition of our board of directors could have an adverse effect on our operating results and financial condition. A
proxy contest would require us to incur significant legal and advisory fees, proxy solicitation expenses and administrative and associated
costs and require significant time and attention by our board of directors and management, diverting their attention from the pursuit
of our business strategy. Any perceived uncertainties as to our future direction and control, our ability to execute on our strategy,
or changes to the composition of our board of directors or senior management team arising from a proxy contest could lead to the perception
of a change in the direction of our business or instability which may result in the loss of potential business opportunities, make it
more difficult to pursue our strategic initiatives, or limit our ability to attract and retain qualified personnel and business partners,
any of which could adversely affect our business and operating results. If individuals are ultimately elected to our board of directors
with a specific agenda, it may adversely affect our ability to effectively implement our business strategy and create additional value
for our stockholders. We may choose to initiate, or may become subject to, litigation as a result of the proxy contest or matters arising
from the proxy contest, which would serve as a further distraction to our board of directors and management and would require us to incur
significant additional costs. In addition, actions such as those described above could cause significant fluctuations in our stock price
based upon temporary or speculative market perceptions or other factors that do not necessarily reflect the underlying fundamentals and
prospects of our business.
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Securities
analysts may not initiate coverage or continue to cover our common shares, and this may have a negative impact on the market price of
our common shares.
The
trading market for our common shares depends, in part, on the research and reports that securities analysts publish about our business
and our common shares. We do not have any control over these analysts. There is no guarantee that securities analysts will cover our
common shares. If securities analysts do not cover our common shares, the lack of research coverage may adversely affect the market price
of those shares. If securities analysts do cover our common shares, they could issue reports or recommendations that are unfavorable
to the price of our common shares, and they could downgrade a previously favorable report or recommendation, and in either case our share
prices could decline as a result of the report. If one or more of these analysts does not initiate coverage, ceases to cover our common
shares or fails to publish regular reports on our business, we could lose visibility in the financial markets, which could cause our
share prices or trading volume to decline.
ITEM
1B.
UNRESOLVED
STAFF COMMENTS
None.
ITEM
2.
PROPERTIES
General
In
general, we believe that our properties are well-maintained, adequate and suitable for their current requirements and for our operations
in the foreseeable future. See Note 14 to our consolidated financial statements included elsewhere in this Report.
Lineage
Facilities
Our
corporate headquarters comprise 8,841 square feet of rentable space in an office park in Carlsbad, California. We also sublease 2,432
square feet of space in Alameda, California.
Cell
Cure Facilities
Cell
Cure leases 728.5 square meters (approximately 7,842 square feet) of office and laboratory space in the Bio Park on the campus of the
Hadassah University Hospital in Jerusalem, Israel under a lease that expires on December 31, 2025. We have an option to extend the term
for an additional 5 years.
In
January 2018, Cell Cure entered into another lease for an additional 934 square meters (approximately 10,054 square feet) of office space
in the same facility in Jerusalem, Israel under a lease that expires on December 31, 2025, with two five-year extension options. The
term of this lease commenced on April 1, 2018 and includes a leasehold improvement construction allowance of up to NIS 4,000,000 (approximately
up to $1.1 million) from the landlord. The leasehold improvements were substantially completed by December 31, 2018 and the construction
allowance was fully utilized.
In
November 2021, Cell Cure entered into a lease agreement for an additional 133 square meters (approximately 1,432 square feet) of office
space in the same facility in Jerusalem, Israel under a lease that expires on December 31, 2025, with one five-year and one approximate
three-year extension options (the “November 2021 Lease”), the term of this lease commenced on December 1, 2021.
ITEM
3.
LEGAL
PROCEEDINGS
From
time to time, we are subject to legal proceedings and claims in the ordinary course of business. While management presently believes
that the ultimate outcome of these proceedings, individually and in the aggregate, will not materially harm our financial position, cash
flows, or overall trends in results of operations, legal proceedings are subject to inherent uncertainties, and unfavorable rulings or
outcomes could occur that have individually or in aggregate, a material adverse effect on our business, financial condition or operating
results. Except as described below, we are not currently subject to any pending material litigation, other than ordinary routine litigation
incidental to our business, as described above.
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On
October 14, 2019, a putative class action lawsuit was filed challenging the Asterias Merger. This action (captioned Ross v. Lineage
Cell Therapeutics, Inc., et al. , C.A. No. 2019-0822) was filed in Delaware Chancery Court and names Lineage, the Asterias board of
directors, one member of Lineage’s board of directors, and certain stockholders of both Lineage and Asterias as defendants. The
action was brought by a purported stockholder of Asterias, on behalf of a putative class of Asterias stockholders, and asserts breach
of fiduciary duty and aiding and abetting claims under Delaware law. The complaint alleges, among other things, that the process leading
up to the Asterias Merger was conflicted, that the Asterias Merger consideration was inadequate, and that the proxy statement filed by
Asterias with the Commission omitted certain material information, which allegedly rendered the information disclosed materially misleading.
The complaint seeks, among other things, that a class be certified, the recovery of monetary damages, and attorneys’ fees and costs.
On December 20, 2019, the defendants moved to dismiss the complaint. On February 10, 2020, the plaintiff filed an opposition. Defendants
filed their replies on March 13, 2020. On June 23, 2020, a hearing on the motions to dismiss occurred. On September 21, 2020, the Chancery
Court denied the motion to dismiss as to Lineage and certain members of the Asterias board of directors, and it granted the motion to
dismiss as to all other defendants. On October 30, 2020, the remaining defendants filed an answer to the complaint. The parties are currently
engaged in discovery. A five-day trial before the Chancery Court is currently scheduled for October 17-21, 2022.
Lineage
believes the allegations in the action lack merit and intends to vigorously defend the claims asserted. It is impossible at this time
to assess whether the outcome of this proceeding will have a material adverse effect on Lineage’s consolidated results of operations,
cash flows or financial position.
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
Market
Information
Our
common shares trade on the NYSE American and on the Tel Aviv Stock Exchange under the ticker symbol LCTX.
Holders
As
of March 1, 2022, there were 375 record holders of our common shares. The number of beneficial owners is substantially greater than the
number of record holders because a large portion of our common shares is held of record through brokerage firms in “street name”.
Dividend
Policy
We
have not paid dividends on our common shares. We currently intend to retain any earnings for use in the operations of our business. We,
therefore, do not anticipate paying cash dividends on our common shares in the foreseeable future.
Recent
Sales of Unregistered Securities
Except
as previously reported in our quarterly reports on Form 10-Q and current reports on Form 8-K filed with the Securities and Exchange Commission,
during the year ended December 31, 2021, there were no unregistered sales of equity securities by us during the year ended December 31,
2021.
ITEM
6.
RESERVED
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ITEM
7.
MANAGEMENT’S
DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS
The
following Management’s Discussion and Analysis of Financial Condition and Results of Operations is intended to provide information
necessary to understand our audited consolidated financial statements for the two-year period ended December 31, 2021, and highlight
certain other information which, in the opinion of management, will enhance a reader’s understanding of our financial condition,
changes in financial condition and results of operations. In particular, the discussion is intended to provide an analysis of significant
trends and material changes in our financial position and the operating results of our business during the year ended December 31, 2021
as compared to the year ended December 31, 2020. This discussion should be read in conjunction with our consolidated financial statements
and related notes included elsewhere in this Report. These historical financial statements may not be indicative of our future performance.
This Management’s Discussion and Analysis of Financial Condition and Results of Operations contains a number of forward-looking
statements, all of which are based on our current expectations and could be affected by the uncertainties and risks described throughout
this Report, particularly in “Item 1A. Risk Factors.”
Company
and Business Overview
Lineage Cell Therapeutics,
Inc. (“Lineage,” “we,” “us,” or “our”) is a clinical-stage biotechnology company developing
novel cell therapies to address unmet medical needs. Our programs are based on our proprietary cell-based technology and associated development
and manufacturing capabilities. From this platform, we design, develop, and manufacture specialized human cells with anatomical and physiological
functions which are similar or identical to cells found naturally in the human body. These cells which we manufacture are created by
developmental differentiation protocols applied to established and well-characterized, pluripotent, and self-renewing cell lines. These
functional cells are transplanted into patients to either replace or support cells that are dysfunctional or absent due to degenerative
disease or traumatic injury, or are administered as a means of helping the body mount a more robust and effective immune response to
cancer or infectious diseases.
Our
strategy is to efficiently leverage our technology platform and manufacturing capabilities to develop and advance our programs internally
or in conjunction with strategic partners to further enhance their value. As one example, on December 17, 2021, we entered into a Collaboration
and License Agreement with F. Hoffmann-La Roche Ltd and Genentech, Inc., a member of the Roche Group (collectively, “Roche”),
wherein Lineage granted to Roche exclusive worldwide rights to develop and commercialize retinal pigment epithelium cell therapies, including its proprietary cell therapy known as OpRegen®, for the treatment of ocular disorders, including advanced
dry age-related macular degeneration with geographic atrophy. Roche has paid Lineage a $50.0 million upfront payment under this alliance
and Lineage is eligible to receive up to an additional $620.0 million in certain developmental, regulatory, and commercialization milestone
payments. Lineage also is eligible for tiered double-digit percentage royalties on net sales of OpRegen.
Currently,
Lineage is working with Roche in support of the dry age-related macular degeneration (OpRegen) program and is clinically testing
therapies to treat spinal cord injuries and non-small cell lung cancer, as well as conducting research and preclinical development activities
intended to advance our pipeline into other therapeutic indications and target tissues or organs.
Product
Candidates & Other Programs
We
have several allogeneic, or “off-the-shelf,” cell therapy programs in development:
●
OpRegen ® ,
a retinal pigment epithelium (“RPE”) cell replacement therapy currently in a Phase 1/2a multicenter clinical trial for
the treatment of advanced dry age-related macular degeneration (“AMD”) with geographic atrophy (“GA”) (also
known as atrophic AMD). There are currently no therapies approved by the U.S. Food and Drug Administration (“FDA”) for
dry AMD. As of December 17, 2021 this program has been partnered with Roche for further clinical development and commercialization.
●
OPC1 ,
an oligodendrocyte progenitor cell therapy currently in long-term follow-up for a Phase 1/2a multicenter clinical trial for spinal
cord injuries (“SCI”). This clinical trial has been partially funded by the California Institute for Regenerative Medicine
(“CIRM”).
●
VAC ,
an allogeneic cancer immunotherapy of antigen-presenting dendritic cells. One of the VAC
product candidates, VAC2, is currently in a Phase 1 clinical trial in non-small cell lung
cancer (NSCLC). This clinical trial is being funded and conducted by Cancer Research UK,
one of the world’s largest independent cancer research charities. We also have another
VAC-based product candidate in preclinical development with our partner, Immunomic Therapeutics,
Inc. (“ITI”), for the treatment of glioblastoma multiforme (“GBM”).
●
Other.
We have other product candidates in preclinical
development covering a range of therapeutic areas and target tissues or organs. Generally, these candidates are based on the same
pluripotent platform technology and employ a similar guided cell differentiation and transplant approach as our current clinical-stage
products.
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In
addition to seeking to create value for shareholders by developing product candidates and other technologies through our clinical development
programs, we also seek to create value from our technologies through partnering and strategic transactions. We founded two companies
that later became publicly traded companies: OncoCyte Corporation (“OncoCyte”) and AgeX Therapeutics, Inc. (“AgeX”).
We continue to hold common stock in OncoCyte as of December 31, 2021.
During
the year ended December 31, 2021, we received approximately $10.1 million in gross proceeds in connection with our sale of shares of
OncoCyte. In August 2020, we also received $24.6 million from Juvenescence Limited (“Juvenescence”), representing principal
and accrued interest under a promissory note we received in connection with our sale of AgeX shares to Juvenescence in August 2018.
Critical
Accounting Estimates
The
preparation of consolidated financial statements in conformity with accounting principles generally accepted in the United States (“GAAP”)
requires management to make estimates and assumptions that affect the reported amounts in our consolidated financial statements and related
notes. Our significant accounting policies are described in Note 2 to our consolidated financial statements included elsewhere in this
Report. We have identified below our critical accounting policies and estimates that we believe require the greatest amount of judgment.
On an ongoing basis, we evaluate estimates which are subject to significant judgment, including those related to going concern assessment
of our consolidated financial statements, useful lives associated with long-lived assets, including evaluation of asset impairment, allowances
for uncollectible accounts and financing receivables, v aluing shares owned in nonconsolidated companies
using the equity method of accounting, loss contingencies, deferred income taxes and tax reserves, including valuation allowances
related to deferred income taxes, and assumptions used to value stock-based awards, debt or other equity instruments. Actual results
could differ materially from those estimates. On an ongoing basis, we evaluate our estimates compared to historical experience and trends
which form the basis for making judgments about the carrying value of assets and liabilities. To the extent that there are material differences
between our estimates and our actual results, our future financial statement presentation, financial condition, results of operations
and cash flows will be affected.
We
believe the assumptions and estimates associated with the following have the greatest potential impact on our consolidated financial
statements.
Goodwill
and IPR&D – Goodwill is calculated as the difference between the acquisition date fair value of the consideration transferred
and the values assigned to the assets acquired and liabilities assumed. Goodwill is tested for impairment in accordance with Accounting
Standards Update (“ASU”) 2017-04, Intangibles—Goodwill and Other (Topic 350): Simplifying the Test for Goodwill
Impairment . In-process research and development (“IPR&D”) assets are indefinite-lived intangible assets until the
completion or abandonment of the associated research and development (“R&D”) efforts. Once the R&D efforts are completed
or abandoned, the IPR&D will either be amortized over the asset’s estimated life as a finite-lived intangible asset or be impaired,
respectively, in accordance with ASC 350, Intangibles – Goodwill and Other (“ASC 350”). In accordance with ASC
350, goodwill and acquired IPR&D are determined to have indefinite lives and, therefore, are not amortized. Instead, they are tested
for impairment at least annually and between annual tests if we become aware of an event or a change in circumstances that would indicate
the asset may be impaired.
Leases
– We account for leases in accordance with ASC 842, Leases . We determine if an arrangement is a lease at inception.
Leases are classified as either financing or operating, with classification affecting the pattern of expense recognition in the consolidated
statements of operations. Under the available practical expedients for the adoption of ASC 842, we account for the lease and non-lease
components as a single lease component. We recognize right-of-use (“ROU”) assets and lease liabilities for leases with terms
greater than twelve months in the consolidated balance sheet. ROU assets represent our right to use an underlying asset during the lease
term and lease liabilities represent our obligation to make lease payments arising from the lease. Operating and finance lease ROU assets
and liabilities are recognized at commencement date based on the present value of lease payments over the lease term. As most of our
leases do not provide an implicit rate, we use our incremental borrowing rate based on the information available at commencement date
in determining the present value of lease payments. We use the implicit rate when readily determinable. The operating and finance lease
ROU assets also includes any lease payments made and excludes lease incentives. Our lease terms may include options to extend or terminate
the lease when it is reasonably certain that we will exercise that option. Lease expense for operating lease payments is recognized on
a straight-line basis over the lease term. Lease expense for finance lease payments is recognized as amortization of ROU assets
and related interest. Operating and finance leases are included as right-of-use assets in property and equipment, and ROU lease liabilities,
current and long-term, in the consolidated balance sheets. We disclose the amortization of our ROU assets and operating lease
payments as a net amount, “Amortization of ROU assets”, on the consolidated statement of cash flows.
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Going
concern assessment – In accordance with Accounting Standards Update 2014-15, Presentation of Financial Statements –
Going Concern , we assess going concern uncertainty in our consolidated financial statements to determine if we have sufficient cash
and cash equivalents on hand and working capital to operate for a period of at least one year from the date our consolidated financial
statements are issued or are available to be issued, which is referred to as the “look-forward period” as defined by ASU
No. 2014-15. As part of this assessment, based on conditions that are known and reasonably knowable to us, we will consider various scenarios,
forecasts, projections, and estimates, and we will make certain key assumptions, including the timing and nature of projected cash expenditures
or programs, and our ability to delay or curtail those expenditures or programs, if necessary, among other factors. Based on this assessment,
as necessary or applicable, we make certain assumptions concerning our ability to curtail or delay research and development programs
and expenditures to the extent we deem probable those implementations can be achieved and we have the proper authority to execute them
within the look-forward period in accordance with ASU 2014-15.
Revenue
recognition - Lineage recognizes revenue in accordance with Financial Accounting Standards Board (“FASB”) ASU 2014-09 ,
Revenues from Contracts with Customers (Topic 606) , and in a manner that depicts the transfer of control of a product or a service
to a customer and reflects the amount of the consideration it is entitled to receive in exchange for such product or service. In doing
so, Lineage follows a five-step approach: (i) identify the contract with a customer; (ii) identify the performance obligations in the
contract; (iii) determine the transaction price; (iv) allocate the transaction price to the performance obligations; and (v) recognize
revenue when (or as) the customer obtains control of the product or service. Lineage considers the terms of a contract and all relevant
facts and circumstances when applying the revenue recognition standard. Lineage applies the revenue recognition standard, including the
use of any practical expedients, consistently to contracts with similar characteristics and in similar circumstances. As part of the
accounting treatment for these contracts, we must develop estimates and assumptions that require judgement to determine the underlying
stand-alone selling price for each performance obligation which determines how the transaction price is allocated among the performance
obligations.
Royalties
from product sales and license fees – For agreements that include sales-based royalties, including commercial milestone
payments based on the level of sales, and the license is deemed to be the predominant item to which the royalties relate, Lineage
recognizes revenue at the later of (i) when the related sales occur, or (ii) when the performance obligation to which some or all of
the royalty has been allocated has been satisfied (or partially satisfied). Lineage estimates and recognizes royalty revenues based
on all available information, including estimates provided by the customer or licensee from which Lineage obtains such estimates
directly for each reporting period. Actual revenues ultimately received may differ from those estimates recorded and are adjusted in
the period when information to actuals is available to Lineage.
Collaborative
agreements - We review collaborative agreements to determine if the accounting treatment falls under Accounting Standards Codification,
Topic 606 , Revenue from Contracts with Customers (“ASC 606”) , or Accounting Standards Codification Topic
808, Collaborative Arrangements (“ASC 808”). While these agreements may be within the scope of ASC 808, we may analogize
to ASC 606 for some aspects of the agreements.
The
terms of our collaborative agreements typically include one or more of the following: (i) upfront fees; (ii) milestone payments related
to achievement of development or commercial goals; (iii) royalties on net sales of licensed products; and (iv) reimbursement of cost-sharing
of R&D expenses. Each of these payments eventually result in collaboration revenues. When a portion of non-refundable upfront fees
or other payments received are allocated to continuing performance obligations under the terms of a collaborative arrangement, they are
recorded as deferred revenue and recognized as collaboration revenue when (or as) the underlying performance obligation is satisfied.
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To
identify the performance obligations within the collaboration agreements, we first identify all the promises in the contract (i.e.,
explicit and implicit), which may include a customer option to acquire additional goods or services for free or at a discount. We
exclude any immaterial promises from the assessment of identifying performance obligations. When an option is identified as providing
a customer with a material right, the option is identified as a performance obligation. A portion of the transaction price is then allocated
to the option and recognized when (or as) the future goods or services related to the option are provided or when the option expires.
As
part of the accounting treatment for these agreements, we must develop estimates and assumptions that require judgement to determine
the underlying stand-alone selling price for each performance obligation which determines how the transaction price is allocated among
the performance obligations. The following items are estimated in the calculation of the stand-alone selling price: forecasted revenues
and development costs, development timelines, discount rates and probabilities of technical and regulatory success. We evaluate each
performance obligation to determine if they can be satisfied at a point in time or over time, and we measure the services delivered to
our collaboration partners each reporting period, which is based on the progress of the related program. If necessary, we adjust the
measure of performance and related revenue recognition. Any such adjustments are recorded on a cumulative catch-up basis which would
affect revenue and net income (loss) in the period of adjustment. In addition, variable consideration (e.g., milestone payments) must
be evaluated to determine if it is constrained and, therefore, excluded from the transaction price.
Upfront
fees - If a license to our intellectual property is determined to be distinct from the other performance obligations identified in
the arrangement, we recognize collaboration revenues from the transaction price allocated to the license when the license is transferred
to the licensee, and the licensee is able to use and benefit from the license. When the license is determined to be non-distinct, we
utilize judgment to assess the nature of the combined performance obligation to determine whether the combined performance obligation
is satisfied over time or at a point in time, and, if over time, the appropriate method of measuring progress for purposes of recognizing
collaboration revenue from the allocated transaction price. For example, when we receive upfront fees for the performance of research
and development services, or when research and development services are not considered to be distinct from a license, we recognize collaboration
revenue for those units of account over time using a measure of progress. We evaluate the measure of progress at each reporting period
and, if necessary, adjust the measure of performance and related revenue as a change in estimate.
Milestone
payments - At the inception of each collaboration agreement that includes milestone payments (variable consideration), we evaluate
whether the milestones are considered probable of being reached and estimate the amount to be included in the transaction price using
the most likely amount method. If it is probable that a significant revenue reversal would not occur, the associated milestone value
is included in the transaction price. Milestone payments that are not within our or the collaboration partner’s control, such as
non-operational developmental and regulatory approvals, are generally not considered probable of being achieved until those approvals
are received. At the end of each reporting period, we re-evaluate the probability of achievement of milestones that are within our or
the collaboration partner’s control, such as operational developmental milestones and any related constraint, and if necessary,
adjust our estimate of the overall transaction price. Any such adjustments are recorded on a cumulative catch-up basis, which would affect
collaboration revenues and net income (loss) in the period of adjustment. Revisions to our estimate of the transaction price may also
result in negative collaboration revenues and net income (loss) in the period of adjustment.
Royalties
- For collaboration agreements that include sales-based royalties, including commercial milestone payments based on the level of
sales, and the license is deemed to be the predominant item to which the royalties relate, we recognize revenue at the later of (i) when
the related sales occur, or (ii) when the performance obligation to which some or all of the royalty has been allocated has been satisfied
(or partially satisfied).
Reimbursement,
cost-sharing payments - Under certain collaborative agreements, we will receive reimbursement for a portion of our R&D expenses.
Such reimbursements are reviewed for gross versus net reporting considerations and reflected either as a reduction of R&D expense
or as reimbursement revenue in our condensed consolidated statements of operations.
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Long-lived
intangible assets – Long-lived intangible assets, consisting primarily of acquired patents, patent applications, and licenses
to use certain patents are stated at acquired cost, less accumulated amortization. Amortization expense is computed using the straight-line
method over the estimated useful lives of the assets, generally over five to ten years.
Impairment
of long-lived assets – Our long-lived assets, including long-lived intangible assets, are reviewed for impairment whenever
events or changes in circumstances indicate that the carrying amount of an asset may not be fully recoverable. If an impairment indicator
is present, we evaluate recoverability by a comparison of the carrying amount of the assets to future undiscounted net cash flows expected
to be generated by the assets. If the assets are impaired, the impairment recognized is measured by the amount by which the carrying
amount exceeds the estimated fair value of the assets.
Research
and development – Research and development expenses consist of costs incurred for company-sponsored, collaborative and contracted
research and development activities. These costs include direct and research-related overhead expenses including compensation and related
benefits, stock-based compensation, consulting fees, research and laboratory fees, rent of research facilities, amortization of intangible
assets, and license fees paid to third parties to acquire patents or licenses to use patents and other technology. Research and development
costs which have an alternative future use will be capitalized as tangible assets, and costs with no future benefit or alternative use
will be expensed as incurred. Research and development expenses incurred and reimbursed by grants from third parties approximate the
grant income recognized in the consolidated statements of operations. Royalty expenses or sublicensing fees are recorded as research
and development costs, unless these costs are associated with royalties from product sales, which we classify as cost of sales on our
consolidated statements of operations. We estimate preclinical, clinical, and other research related expenses based on services performed,
pursuant to arrangements with contract research organizations, that conduct studies and research on our behalf. We
estimate these expenses based on regular reviews with internal management personnel and external service providers as to the progress
or stage of completion of services and the contracted fees to be paid for such services. Based upon the combined inputs of internal and
external resources, if the actual timing of the performance of services or the level of effort varies from the original estimates, we
will adjust the accrual accordingly.
Stock-based
compensation – We follow accounting standards governing share-based payments, which require the measurement and recognition
of compensation expense for all share-based compensation awards made to directors and employees, including employee stock options, based
on estimated fair values. We utilize the Black-Scholes option pricing model. Our determination of fair value of share-based payment awards
on the date of grant using an option-pricing model is affected by our stock price as well as assumptions regarding a number of complex
and subjective variables. These variables include, but are not limited to, expected stock price volatility over the term of the awards,
and the expected term of options granted, which is derived using the simplified method, which is an average of the contractual term of
the option and its vesting period, as we do not have sufficient historical exercise data. The risk-free rate is based on the U.S. Treasury
yield in effect at the time of grant for zero coupon U.S. Treasury notes with maturities similar to the expected term of the awards.
Forfeitures are accounted for as they occur.
Although
the fair value of employee stock options is determined in accordance with FASB guidance, changes in the assumptions can materially affect
the estimated value and therefore the amount of compensation expense recognized in the consolidated financial statements.
In
management’s opinion, the existing valuation models may not provide an accurate measure of the fair value of employee stock options
because the option-pricing model value may not be indicative of the fair value that would be established in a willing buyer/willing seller
market transaction.
Income
taxes – We account for income taxes in accordance with ASC 740, Income Taxes , which prescribe the use of the asset and
liability method, whereby deferred tax asset or liability account balances are calculated at the balance sheet date using current tax
laws and rates in effect. Valuation allowances are established when necessary to reduce deferred tax assets when it is more likely than
not that a portion or all of the deferred tax assets will not be realized. ASC 740 guidance also prescribes a recognition threshold and
a measurement attribute for the financial statement recognition and measurement of tax positions taken or expected to be taken in a tax
return. For benefits to be recognized, a tax position must be more-likely-than-not sustainable upon examination by taxing authorities.
We file a U.S. federal income tax return as well as various state and foreign income tax returns. Our judgments regarding future taxable
income may change over time due to changes in market conditions, changes in tax laws, tax planning strategies or other factors. If our
assumptions, and consequently the estimates, change in the future with respect to our own deferred tax assets and liabilities, the valuation
allowance may be increased or decreased, which may have a material impact on our consolidated financial statements. We
recognize accrued interest and penalties related to unrecognized tax benefits, if any, as income tax expense, however, no amounts were
accrued for the payment of interest and penalties as of December 31, 2021 and 2020.
72 | P a g e
Principles
of consolidation – Our consolidated financial statements include the accounts of our wholly owned and majority-owned subsidiaries.
All material intercompany accounts and transactions have been eliminated in consolidation. The consolidated financial statements are
presented in accordance with accounting principles generally accepted in the U.S. and with the accounting and reporting requirements
of SEC Regulation S-X.
Results
of Operations
Comparison
of Years Ended December 31, 2021 and 2020
Revenues
The
following table shows our revenues for the years ended December 31, 2021 and 2020 (amounts in thousands except percentages).
Year Ended December 31,
$ Increase/
% Increase/
2021
2020
(Decrease)
(Decrease)
Royalties
$ 2,776
$ 773
$ 2,003
259 %
Collaboration revenues
1,120
-
1,120
100 %
Grant revenues
445
1,053
(608 )
(58 )%
Total revenues
4,341
1,826
2,515
138 %
Cost of sales
(1,426 )
(385 )
(1,041 )
270 %
Gross profit
$ 2,915
$ 1,441
$ 1,474
102 %
Total
revenues for the year ended December 31, 2021 were $4.3 million compared to $1.8 million for the year ended December 31, 2020. The
increase of $2.5 million is primarily due to a $2.0 million increase in royalties, a $1.1 million increase in collaboration revenues
from our collaboration agreements with Roche and ITI, offset by a $0.6 million decrease in grant revenues due to less grant-related activities
during the year.
Our
royalties are derived from product sales and license fees. For the year ended December 31, 2021 royalties were $2.0 million higher compared
to the prior year, primarily due to additional royalty revenues of $1.8 million from a certain royalty customer, based on the customer’s
updated communication to us regarding royalties due. Consequently, Lineage also recorded 50% of these additional royalties in cost of
sales during the year.
Grant
revenues are generated primarily by our subsidiary Cell Cure Neurosciences Ltd (“Cell Cure”) from the Israel Innovation Authority
(“IIA”) for the development of OpRegen and our bio retina program, and previously from a Small Business Innovation Research
grant from the National Institutes of Health for our vision restoration program (the “NIH Grant”). The decreases in our grant
revenues for the year ended December 31, 2021 as compared to the year ended December 31, 2020, were primarily due to less grant-related
activities. Grant revenues generated by Cell Cure from the IIA for the development of OpRegen and our bio retina program amounted to
$0.4 million and $0.7 million for the years ended December 31, 2021 and 2020, respectively, and grant revenues generated by the NIH Grant
amounted to $0.4 million for the year ended December 31, 2020.
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Operating
Expenses
The
following table shows our operating expenses for the years ended December 31, 2021 and 2020 (amounts in thousands, except percentages).
Year Ended December 31,
$
%
2021
2020
Increase
Increase
Research and development expenses
$ 33,914 (1)
$ 12,317
$ 21,597
175 %
General and administrative expenses
18,212
15,571
2,641
17 %
(1)
Includes $21.0 million of royalty and redemption fee expense to Hadasit Medical Research and Development Ltd. (“Hadasit”)
and the IIA, respectively, pursuant to Lineage’s financial obligations related to the Roche Agreement (see Note 14), in connection
with the receipt of the $50.0 million upfront payment received from Roche .
Research
and development expenses
Research
and development expenses consist of costs incurred for company-sponsored, collaborative and contracted research and development activities.
These costs include direct and research-related overhead expenses including compensation and related benefits, stock-based compensation,
consulting fees, research and laboratory fees, rent of research facilities, amortization of intangible assets, and license fees paid
to third parties to acquire patents or licenses to use patents and other technology. Research and development costs which have an alternative
future use will be capitalized as tangible assets, and costs with no future benefit or alternative use will be expensed as incurred.
Research and development expenses incurred and reimbursed by grants from third parties approximate the grant income recognized in the
consolidated statements of operations. Royalty expenses or sublicensing fees are recorded as research and development costs, unless these
costs are associated with royalties from product sales, which we classify as cost of sales on our consolidated statements of operations.
The
following table shows the amount of our total research and development expenses allocated to our primary research and development projects
for the periods presented (amounts in thousands, except percentages).
Year Ended December 31,
(unaudited)
Amount
Percent of Total
Program
2021
2020
2021
2020
OpRegen ® and other ophthalmic applications
$ 25,507
$ 5,569
75 %
45 %
OPC1
6,145
3,958
18 %
32 %
VAC platform
2,178
2,472
6 %
20 %
All other programs
84
318
1 %
3 %
Total research and development expenses
$ 33,914
$ 12,317
100 %
100 %
Research
and development expenses for the year ended December 31, 2021 were $33.9 million as compared to $12.3 million for the year ended December
31, 2020. The increase of $21.6 million is mainly attributable
to the following:
●
an
increase of $19.9 million in OpRegen, attributable primarily to a $12.1 million redemption fee to the IIA and a royalty expense of
$8.9 million to Hadasit, related to Lineage’s financial obligations related to the Roche Agreement (see Note 14), in connection
with receipt of the $50.0 million upfront payment received from Roche.
●
an increase of $2.2 million
in OPC1 related expenses, primarily related to an increase in manufacturing and development activities for this program, and a return
of unspent project funds of approximately $0.8 million in the prior year from a former Asterias service provider,
●
a net decrease of $0.3 million in the VAC program expenses,
primarily driven by the prior year signature fee accrual of $1.6 million to Cancer Research UK related to our license agreement,
substantially offset with increased manufacturing activities in the current year, as well as activities to support the ITI collaboration
agreement, and
●
a net decrease of $0.2
million in Renevia and related expenses due to a reduction in research activities.
74 | P a g e
General
and administrative expenses
General
and administrative expenses include employee and director compensation allocated to general and administrative expenses, consulting fees
other than those paid for science-related consulting, facilities and equipment rent and maintenance related expenses, insurance costs
allocated to general and administrative expenses, costs of patent applications, prosecution and maintenance, stock
exchange-related costs, depreciation expense, marketing costs, board fees, legal and accounting costs, and other miscellaneous expenses
which are allocated to general and administrative expense.
General
and administrative expenses for the year ended December 31, 2021 were $18.2 million as compared to $15.6 million for the year ended December
31, 2020. The total net increase of $2.6 million was
primarily attributable to a $0.9 million increase in share-based compensation expense, a $0.7 million increase in litigation and other
expenses related to Lineage’s merger with Asterias, a $0.6 million increase in legal and patent expenses, a $0.3 million increase
in payroll and related benefits, a $0.3 million increase in investor relations expenses, a $0.2 million increase in consulting expense,
partially offset with a $0.4 million reduction in rent and utilities.
Other
income and expenses, net
The
following table shows the amount of other income, net, during the year ended December 31, 2021 and 2020 (in thousands):
Year Ended December 31,
2021
2020
Other income, net
Interest income, net
$ 2
$ 1,039
Gain on sale of marketable equity securities
6,024
4,560
Gain on extinguishment of debt
523
-
Unrealized loss on marketable equity securities
(2,299 )
(3,782 )
Unrealized gain (loss) on warrant liability
205
(174 )
Other income, net
1,486
2,880
Total other income, net
$ 5,941
$ 4,523
Interest
income and expense, net - During the year ended December 31, 2020, we earned $1.0 million of interest income from our promissory
note with Juvenescence.
Marketable
equity securities - As of December 31, 2021, Lineage owned 1.1 million shares of OncoCyte common stock. These shares had a fair value
of $2.4 million, based on the closing price of OncoCyte common stock of $2.17 per share on December 31, 2021. As of December 31, 2020,
Lineage owned 3.6 million shares of OncoCyte common stock. These shares had a fair value of $8.7 million, based on the closing price
of OncoCyte common stock of $2.39 per share on December 31, 2020.
For
the year ended December 31, 2021, Lineage recorded a realized gain of $6.0 million due to sales of OncoCyte shares in the year. Lineage
recorded a net unrealized loss on marketable equity securities of $2.2 million related to changes in fair market value of OncoCyte’s
common stock price during the year. For the year ended December 31, 2020, Lineage recorded a realized gain of $3.1 million due to sales
of OncoCyte shares in the period. Lineage also recorded an unrealized loss on marketable equity securities of $2.5 million related to
changes in fair market value of OncoCyte’s common stock price during the year. All share prices are determined based on the closing
price of OncoCyte common stock on the NYSE American on the applicable dates, or the last day of trading of the applicable quarter, if
the last day of a quarter fell on a weekend.
We
expect our other income and expenses, net, to continue to fluctuate each reporting period based on the changes in the market price of
our OncoCyte shares, which could significantly impact our net income or loss reported in our condensed consolidated statements of operations
for each period.
75 | P a g e
We
account for the shares we hold in Hadasit Bio-Holdings Ltd (“HBL”) as marketable equity securities as of December 31, 2021.
These securities were carried at fair market value on our consolidated balance sheets, and the accounting transactions for the year ended
December 31, 2021, were not material. For the year ended December 31, 2021, we did not hold any marketable securities related to AgeX.
For
the year ended December 31, 2020, Lineage recorded realized gains of $0.8 million and $0.6 million due to sales of AgeX shares and HBL
shares, respectively, in the period. For the year ended December 31, 2020, we recorded unrealized losses of $1.3 million, due to changes
in fair market value of AgeX’s common stock price during the period.
Gain
on extinguishment of debt – For the year ended December 31, 2021, Lineage recognized a gain of $0.5 million on extinguishment
of debt related to the Paycheck Protection Program (“PPP”) loan from Axos Bank. Lineage applied for forgiveness on the PPP
loan on September 30, 2020, and on May 13, 2021, received notice that the PPP loan was forgiven in full.
Other
income, net – Other income, net, in 2021 and 2020 consist primarily of net foreign currency transaction gains recognized by
Cell Cure and ESI, and changes in the fair value of the Cell Cure liability classified warrants. Foreign currency transaction gains for
the periods presented are principally related to the remeasurement of the U.S. dollar denominated notes payable by Cell Cure to Lineage.
Income
Taxes
The
market value of the shares of OncoCyte common stock we hold creates a deferred tax liability based on the closing prices of the shares,
less our tax basis in the shares. The deferred tax liability generated by the OncoCyte shares that we hold as of December 31, 2021, is
a source of future taxable income to us, as prescribed by ASC 740-10-30-17, that will more likely than not result in the realization
of our deferred tax assets to the extent of the deferred tax liability. This deferred tax liability is determined based on the closing
prices of the OncoCyte shares as of December 31, 2021. Due to the inherent unpredictability of future prices of those shares, we cannot
reliably estimate or project those deferred tax liabilities on an annual basis. Therefore, the deferred tax liability pertaining to OncoCyte
shares, determined based on the actual closing prices on the last stock market trading day of the applicable accounting period, and the
related impacts to the valuation allowance and deferred tax asset changes, are recorded in the accounting period in which they occur.
In
connection with the Asterias Merger, a deferred tax liability of $10.8 million was recorded as part of the acquisition accounting. The
deferred tax liability (“DTL”) is related to fair value adjustments for the assets and liabilities acquired in the Asterias
Merger, principally consisting of IPR&D. This estimate of deferred taxes was determined based on the excess of the estimated fair
values of the acquired assets and liabilities over the tax basis of the assets and liabilities acquired. The statutory tax rate was applied,
as appropriate, to the adjustment based on the jurisdiction in which the adjustment is expected to occur. Because the IPR&D (prior
to completion or abandonment of the R&D) is considered an indefinite-lived asset for accounting purposes, the fair value of the IPR&D
on the acquisition date creates a deferred income tax liability in accordance with ASC 740. This DTL is computed using the fair value
of the IPR&D assets on the acquisition date multiplied by Lineage’s respective federal and state income tax rates. While this
DTL would reverse on impairment or sale or commencement of amortization of the related intangible assets, those events are not anticipated
under ASC 740 for purposes of predicting reversal of a temporary difference to support the realization of deferred tax assets, except
for certain deferred tax assets and credit carryforwards that are also indefinite in nature as of the Asterias Merger date, which may
be considered for reversal under ASC 740 as further discussed below.
We
have concluded that an ownership change did occur after the Asterias Merger, and the acquired net operating loss carryforwards are subject
to limitation under Section 382 of the Internal Revenue Service Code; Lineage will only be able to utilize $52.8 million and $41.9 million
of their federal and California net operating losses, respectively, as of December 31, 2021.
A
valuation allowance is provided when it is more likely than not that some portion of the deferred tax assets will not be realized. Lineage
established a full valuation allowance as of December 31, 2018 due to the uncertainty of realizing future tax benefits from its net operating
loss carryforwards and other deferred tax assets, including foreign net operating losses generated by its subsidiaries. For the year
ended December 31, 2021, Lineage did not record a tax provision or deferred tax benefit.
76 | P a g e
For
the year ended December 31, 2020, Lineage recorded a $1.2 million deferred tax benefit for income taxes.
We
expect that deferred income tax expense or benefit we record each reporting period, if any, will vary depending on the change in the
closing stock prices of OncoCyte shares from period to period and the related changes in those deferred tax liabilities and our deferred
tax assets and other credits, including changes in the valuation allowance, for each period.
Liquidity
and Capital Resources
At
December 31, 2021, we had $58.4 million of cash, cash equivalents and marketable equity securities on hand, which includes our investments
in OncoCyte and HBL. We may use our marketable equity securities for liquidity, as necessary, and as market conditions allow. The market
value may not represent the amount that could be realized in a sale of investment shares due to various market and regulatory factors,
including trading volume or market depth factors and volume and manner of sale restrictions under Federal securities laws, prevailing
market conditions and prices at the time of any sale, and subsequent sales of securities by the entities. In addition, the value of our
marketable equity securities may be significantly and adversely impacted by deteriorating global economic conditions and the recent disruptions
to and volatility in the credit and financial markets in the United States and worldwide resulting from the ongoing COVID-19 pandemic.
Since inception,
we have incurred significant operating losses and have funded our operations primarily through the issuance of equity securities, the
sale of common stock of our former subsidiaries, AgeX and OncoCyte, payments from research grants, royalties from product sales and sales
of research products and services. At December 31, 2021, we had an accumulated deficit of approximately $337.1 million, working capital
of $64.4 million and shareholders’ equity of $90.9 million. We evaluated the projected cash flows for Lineage and our subsidiaries,
and we believe that our $58.4 million in cash, cash equivalents and marketable equity securities at December 31, 2021, provide sufficient
cash, cash equivalents, and liquidity to carry out our current planned operations through at least twelve months from the issuance date
of our consolidated financial statements included elsewhere in this Report. We believe we will meet the longer-term expected future cash
requirements and obligations, through our current cash and cash equivalents, milestone and other payments under our collaborative
agreements, and our available capacity on the At-the-Market (“ATM”) program (see Note 11). We may, in the future, sell marketable
securities, including additional equity, to fund additional working capital, capital expenditures, or for other general
purposes. Our cash flows are dependent on a number of factors in addition to our operational results, including our contractual obligations.
We are obligated to make the following material rent payments under the terms of our operating leases at our Cell Cure facilities. We
have three leases which aggregate to 1,796 rentable square meters (approximately 19,328 square feet) of office and laboratory space in
Jerusalem, Israel, the leases all expire in December 2025. Total remaining rent payments due are $2.4 million, of which $0.5 million
is due in 2022. See Note 14, for additional details on our contractual obligations.
In
January 2022, Lineage received a $50.0 million upfront payment related to the Roche Agreement. Lineage made a subsequent payment of $12.1
million to the IIA, pursuant to Lineage’s obligations under the Innovation Law. Additionally, Lineage made a subsequent
payment of $8.9 million to Hadasit, pursuant to Lineage’s obligations under the Second Amended and Restated License Agreement.
See Note 14 for a description of the Roche Agreement and related payment obligations.
The
COVID-19 pandemic previously impacted patient enrollment in our OpRegen Phase 1/2a multicenter clinical trial and is currently affecting
the VAC2 Phase 1 multicenter clinical trial. In particular, we saw sites pause enrollment to focus on, and direct resources to, the COVID-19
pandemic or adhere to national or local guidelines. Additionally, currently enrolled patients may decide not to enroll or continue participating
in follow-up visits as part of the ongoing clinical trials, as a result of the pandemic. At this point in time, the majority of our sites
are back to normal daily operations. However, we are unable to predict with confidence if there will be future patient enrollment delays
or missed study visits as the COVID-19 pandemic continues or gets worse. If patient enrollment or study follow-up is delayed for an extended
period of time, our clinical trials could be delayed or otherwise adversely affected. Additionally, an inability to enroll or follow
a sufficient number of patients for any of our current or future clinical trials could result in significant delays.
77 | P a g e
Our
projected cash flows are subject to various risks and uncertainties, and the unavailability or inadequacy of financing to meet future
capital needs could force us to modify, curtail, delay, or suspend some or all aspects of our current planned operations. Our determination
as to when we will seek new financing and the amount of financing that we will need will be based on our evaluation of the progress we
make in our research and development programs, any changes to the scope and focus of those programs, any changes in grant funding for
certain of those programs, and projection of future costs, revenues, and rates of expenditure. Our ability to raise additional funds
may be adversely impacted by deteriorating global economic conditions and the disruptions to and volatility in the credit and financial
markets in the United States and worldwide resulting from the ongoing COVID-19 pandemic. We may be required to delay, postpone, or cancel
our clinical trials or limit the number of clinical trial sites, unless we are able to obtain adequate financing. We cannot assure that
adequate financing will be available on favorable terms, if at all. Sales of additional equity securities by us or our subsidiaries and
affiliates could result in the dilution of the interests of our current shareholders.
Cash
used in operating activities
Net
cash used in operating activities of $23.6 million for the year ended December 31, 2021 primarily reflects the loss from operations of
$49.2 million adjusted for the changes in assets and liabilities of $21.1 million. These items were offset primarily by non-cash expenses
of $3.5 million for stock-based compensation and $0.9 million of depreciation and amortization. The unrealized loss on marketable securities,
and foreign currency remeasurement are non-cash items that had no effect on cash flows.
Net
cash used in operating activities of $19.8 million for the year ended December 31, 2020 primarily reflects the loss from operations of
$26.4 million adjusted for the changes in assets and liabilities of $1.3 million. These items were offset primarily by non-cash expenses
of $2.2 million for stock-based compensation and $2.1 million of depreciation and amortization. The unrealized loss on marketable securities,
foreign currency remeasurement and deferred tax benefit are non-cash items that had no effect on cash flows.
Cash
used in investing activities
Cash
provided by investing activities of $9.7 million for the year ended December 31, 2021 was associated primarily with receipts of $10.1
million from sales of a portion of our OncoCyte holdings, offset with the purchase of equipment for $0.4 million.
Cash
provided by investing activities of $13.0 million for the year ended December 31, 2020 was associated primarily with receipts of $10.9
million from sales of a portion of our OncoCyte holdings, $1.3 million in sales of our AgeX holdings and $0.8 million in sales of a portion
of our HBL holdings.
Cash
provided by financing activities
Cash
provided by financing activities of $36.9 million for the year ended December 31, 2021 was associated primarily with proceeds net of
financing costs of $29.8 million from the sale of common shares in at-the-market offerings under our Controlled Equity Offering SM
Sales Agreement with Cantor Fitzgerald & Co. and proceeds of $7.2 million from the exercise of employee stock options.
Cash
provided by financing activities of $29.9 million for the year ended December 31, 2020 was associated primarily with proceeds of $24.6
million from payment of the Juvenescence promissory note, gross proceeds of $5.1 million from sales of our common shares (which excludes
$0.3 million of cash in transit related to 2020 sales that settled in 2021), and proceeds of $0.5 million from a PPP loan under the Coronavirus
Aid, Relief, and Economic Security Act, all offset by $0.4 million in financing costs.
ITEM 7A.
QUANTITATIVE AND QUALITATIVE
DISCLOSURES ABOUT MARKET RISK
Under
rules and regulations of the Securities and Exchange Commission, as a smaller reporting company, we are not required to provide the information
required by this item.
78 | P a g e
ITEM 8.
FINANCIAL STATEMENTS
AND SUPPLEMENTARY DATA
Index
to consolidated financial statements
Independent
Registered Public Accounting Firm - Audit Opinion
80
Financial Statements:
Consolidated Balance Sheets
83
Consolidated Statements of Operations
84
Consolidated Statements of Comprehensive Loss
85
Consolidated Statements of Shareholders Equity
86
Consolidated Statements of Cash Flows
87
See
accompanying notes to consolidated financial statements.
79 | P a g e
Report of Independent Registered Public Accounting
Firm
To
the Shareholders and Board of Directors
Lineage
Cell Therapeutics, Inc.
Opinion
on the Financial Statements
We
have audited the accompanying consolidated balance sheet of Lineage Cell Therapeutics, Inc. and Subsidiaries (collectively, the “Company”)
as of December 31, 2021, the related consolidated statements of operations, comprehensive loss, changes in shareholders’ equity,
and cash flows for the year ended December 31, 2021, and the related notes (collectively referred to as the “consolidated financial
statements”). In our opinion, the consolidated financial statements present fairly, in all material respects, the financial position
of the Company at December 31, 2021, and the results of its operations and its cash flows for the year ended December 31, 2021, in conformity
with accounting principles generally accepted in the United States of America.
The
consolidated financial statements of the Company as of and for the year ended December 31, 2020 were audited by OUM & Co. LLP, who
joined WithumSmith+Brown, PC on July 15, 2021, and rendered their opinion on such statements on March 11, 2021.
Basis
for Opinion
These
consolidated financial statements are the responsibility of the Company’s management. Our responsibility is to express an opinion
on the Company’s consolidated financial statements based on our audit. 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 audit in accordance with the standards of the PCAOB. Those standards require that we plan and perform the audit to obtain
reasonable assurance about whether the consolidated financial statements are free of material misstatement, whether due to error or fraud.
The Company is not required to have, nor were we engaged to perform, an audit of its internal control over financial reporting. As part
of our audit, 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
audit included performing procedures to assess the risks of material misstatement of the consolidated financial statements, whether due
to error or fraud, and performing procedures that respond to those risks. Such procedures included examining, on a test basis, evidence
regarding the amounts and disclosures in the consolidated financial statements. Our audit also included evaluating the accounting principles
used and significant estimates made by management, as well as evaluating the overall presentation of the consolidated financial statements.
We believe that our audit provides a reasonable basis for our opinion.
Critical
Audit Matter
The
critical audit matter communicated below is a matter arising from the current period audit of the consolidated financial statements that
was communicated or required to be communicated to the Audit Committee and that: (1) relates to accounts or disclosures that are material
to the consolidated financial statements; and (2) involved our especially challenging, subjective, or complex judgments. The communication
of a critical audit matter does not alter in any way our opinion on the consolidated financial statements, taken as a whole, and we are
not, by communicating the critical audit matter below, providing a separate opinion on the critical audit matter or on the accounts or
disclosures to which it relates.
Accounting
for revenue and collaboration agreements
80 | P a g e
Description
of the Matter
The
Company recorded deferred revenue and revenue from collaboration agreements of $50.4 million and $1.1 million, respectively, as of and
for the year ended December 31, 2021. As described in Note 2, the terms of the Company’s collaboration agreements may include licenses
for the Company’s technology or programs, research and development services, and services or obligations in connection with participation
in research or steering committees. Amounts received under these arrangements typically include nonrefundable upfront payments and license
fees, research funding, milestone and other contingent payments for the achievement of defined collaboration objectives and certain preclinical,
clinical, regulatory and sales-based events, as well as royalties on sales of any commercialized products.
Auditing
the Company’s accounting for revenues from collaboration arrangements was complex and required significant judgments primarily
in identifying which elements represent revenue producing performance obligations, determining the measurement and allocation of arrangement
consideration, and evaluating estimates of the total expected inputs under the input method for revenue recognized over time.
How
We Addressed the Matter in Our Audit
To
test the accounting treatment for revenue from collaboration arrangements, we evaluated, among other things, whether the identified performance
obligations were properly determined, and the transaction price was properly measured and allocated to the identified performance obligations.
To test the measurement of efforts toward satisfying the performance obligation, our audit procedures included, among others, reviewing
management’s analysis for accuracy and completeness by agreeing data to the underlying contract, inspecting communications with
the collaborative partner, evaluating the application of the input method for the recognition of revenue and testing the estimated total
inputs and actual inputs incurred.
/s/
WithumSmith+Brown, PC
We
have served as the Company’s auditor since 2014.
San
Francisco, California
March
10, 2022
PCAOB
ID Number 100
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Report
of Independent Registered Public Accounting Firm
Shareholders
and Board of Directors
Lineage
Cell Therapeutics, Inc.
Carlsbad,
California
Opinion
on the Consolidated Financial Statements
We
have audited the consolidated balance sheet of Lineage Cell Therapeutics, Inc. and Subsidiaries (collectively, the “Company”)
as of December 31, 2020, and the related consolidated statements of operations, comprehensive loss, changes in shareholders’ equity,
and cash flows for the year ended December 31, 2020, and the related notes (collectively referred to as the “consolidated financial
statements”). In our opinion, the consolidated financial statements present fairly, in all material respects, the financial position
of the Company at December 31, 2020, and the results of their operations and their cash flows for the year ended December 31, 2020 ,
in conformity with accounting principles generally accepted in the United States of America.
Basis
for Opinion
These
consolidated financial statements are the responsibility of the Company’s management. Our responsibility is to express an opinion
on the Company’s consolidated financial statements based on our audit. We are a public accounting firm registered with the 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 audit in accordance with the standards of the PCAOB. Those standards require that we plan and perform the audit to obtain
reasonable assurance about whether the consolidated financial statements are free of material misstatement, whether due to error or fraud.
Our
audit included performing procedures to assess the risks of material misstatement of the consolidated financial statements, whether due
to error or fraud, and performing procedures that respond to those risks. Such procedures included examining, on a test basis, evidence
regarding the amounts and disclosures in the consolidated financial statements. Our audit also included evaluating the accounting principles
used and significant estimates made by management, as well as evaluating the overall presentation of the consolidated financial statements.
We believe that our audit provides a reasonable basis for our opinion.
/s/
OUM & CO. LLP
San
Francisco, California
March
11, 2021
We served as the Company’s auditor since 2014.
PCAOB
ID Number 252
82 | P a g e
LINEAGE
CELL THERAPEUTICS, INC. AND SUBSIDIARIES
CONSOLIDATED
BALANCE SHEETS
(IN
THOUSANDS)
December 31, 2021
December 31, 2020
ASSETS
CURRENT ASSETS
Cash and cash equivalents
$ 55,742
$ 32,585
Marketable equity securities
2,616
8,977
Accounts and grants receivable, net (Note 3)
50,840
4
Prepaid expenses and other current assets
2,351
2,433
Total current assets
111,549
43,999
NONCURRENT ASSETS
Property and equipment, net (Notes 6 and 14)
4,872
5,630
Deposits and other long-term assets
630
616
Goodwill
10,672
10,672
Intangible assets, net
46,822
47,032
TOTAL ASSETS
$ 174,545
$ 107,949
LIABILITIES AND SHAREHOLDERS’ EQUITY
CURRENT LIABILITIES
Accounts payable and accrued liabilities
$ 27,969
$ 6,813
Lease liabilities, current portion (Note 14)
801
746
Financing lease, current portion (Note 14)
30
16
Deferred revenues (Note 3)
18,119
193
Liability classified warrants, current portion
197
1
Total current liabilities
47,116
7,769
LONG-TERM LIABILITIES
Deferred tax liability
2,076
2,076
Deferred revenues, net of current portion (Note 3)
32,454
-
Lease liability, net of current portion (Note 14)
1,941
2,514
Financing lease, net of current portion
30
26
Liability classified warrants and other long-term liabilities
30
437
TOTAL LIABILITIES
83,647
12,822
Commitments and contingencies (Note 14)
SHAREHOLDERS’ EQUITY
Preferred shares, no par value, authorized 2,000 shares; none issued and outstanding as of December 31, 2021 and 2020, respectively
-
-
Common shares, no par value, authorized 250,000 shares; 169,477 and 153,096 shares issued and outstanding as of December 31, 2021 and 2020, respectively
434,529
393,944
Accumulated other comprehensive loss
( 5,211 )
( 3,667 )
Accumulated deficit
( 337,097 )
( 294,078 )
Lineage Cell Therapeutics, Inc. shareholders’ equity
92,221
96,199
Noncontrolling (deficit)
( 1,323 )
( 1,072 )
Total shareholders’ equity
90,898
95,127
TOTAL LIABILITIES AND SHAREHOLDERS’ EQUITY
$ 174,545
$ 107,949
See
accompanying notes to the consolidated financial statements.
83 | P a g e
LINEAGE
CELL THERAPEUTICS, INC. AND SUBSIDIARIES
CONSOLIDATED
STATEMENTS OF OPERATIONS
(IN
THOUSANDS, EXCEPT PER SHARE DATA)
2021
2020
Year Ended December 31,
2021
2020
REVENUES:
Royalties
$ 2,776
$ 773
Collaboration revenues
1,120
-
Grant revenues
445
1,053
Total revenues
4,341
1,826
Cost of sales
( 1,426 )
( 385 )
Gross profit
2,915
1,441
OPERATING EXPENSES:
Research and development
33,914
12,317
General and administrative
18,212
15,571
Total operating expenses
52,126
27,888
Loss from operations
( 49,211 )
( 26,447 )
OTHER INCOME, NET:
Interest income, net
2
1,039
Gain on sale of marketable securities
6,024
4,560
Unrealized loss on marketable equity securities
( 2,299 )
( 3,782 )
Gain on extinguishment of debt
523
-
Unrealized gain (loss) on warrant liability
205
( 174 )
Other income, net
1,486
2,880
Total other income, net
5,941
4,523
LOSS BEFORE INCOME TAXES
( 43,270 )
( 21,924 )
Income tax benefit
-
1,239
NET LOSS
( 43,270 )
( 20,685 )
Net loss attributable to noncontrolling interest
251
36
NET LOSS ATTRIBUTABLE TO LINEAGE
$ ( 43,019 )
$ ( 20,649 )
NET LOSS PER COMMON SHARE:
BASIC AND DILUTED
$ ( 0.26 )
$ ( 0.14 )
WEIGHTED AVERAGE NUMBER OF COMMON SHARES OUTSTANDING:
BASIC AND DILUTED
164,502
150,044
See
accompanying notes to the consolidated financial statements.
84 | P a g e
LINEAGE
CELL THERAPEUTICS, INC. AND SUBSIDIARIES
CONSOLIDATED
STATEMENTS OF COMPREHENSIVE LOSS
(IN
THOUSANDS)
2021
2020
Year Ended December 31,
2021
2020
NET LOSS
$ ( 43,270 )
$ ( 20,685 )
Other comprehensive loss, net of tax:
Foreign currency translation adjustments, net of tax
( 1,544 )
( 2,986 )
COMPREHENSIVE LOSS
( 44,814 )
( 23,671 )
Less: comprehensive loss attributable to noncontrolling interest
251
36
COMPREHENSIVE LOSS ATTRIBUTABLE TO LINEAGE COMMON SHAREHOLDERS
$ ( 44,563 )
$ ( 23,635 )
See
accompanying notes to the consolidated financial statements.
85 | P a g e
LINEAGE
CELL THERAPEUTICS, INC. AND SUBSIDIARIES
CONSOLIDATED
STATEMENTS OF CHANGES IN SHAREHOLDERS’ EQUITY
(IN
THOUSANDS)
Number
of
Shares
Amount
Number
of
Shares
Amount
Accumulated Deficit
Interest/
(Deficit)
Comprehensive
Income/(Loss)
Shareholders’
Equity
Preferred
Shares
Common
Shares
Noncontrolling
Accumulated
Other
Total
Number
of
Shares
Amount
Number
of
Shares
Amount
Accumulated Deficit
Interest/
(Deficit)
Comprehensive
Income/(Loss)
Shareholders’
Equity
BALANCE AT DECEMBER
31, 2019
-
$ -
149,804
$ 387,062
$ ( 273,422 )
$ ( 1,712 )
$ ( 681 )
$ 111,247
Shares issued through ATM
-
-
3,095
5,404
-
-
-
5,404
Shares issued upon vesting
of restricted stock units, net of shares retired to pay employees’ taxes
-
-
47
( 27 )
-
-
-
( 27 )
Shares issued for services
-
-
150
119
-
-
-
119
Stock-based compensation
-
-
-
2,227
-
-
-
2,227
Shares issued
upon exercise of stock options
Shares issued
upon exercise of stock options, shares
Financing related fees
-
-
-
( 209 )
-
-
-
( 209 )
Dissolution of BioTime Asia
-
-
-
( 676 )
( 7 )
676
-
( 7 )
Hadasit non-cash warrant exercise
-
-
-
44
-
-
-
44
Shares issued upon exercise
of stock options
Shares issued upon exercise
of stock options, shares
Foreign currency translation
gain (loss)
-
-
-
-
-
-
( 2,986 )
( 2,986 )
NET
LOSS
-
-
-
-
( 20,649 )
( 36 )
-
( 20,685 )
BALANCE AT DECEMBER 31, 2020
-
$ -
153,096
$ 393,944
$ ( 294,078 )
$ ( 1,072 )
$ ( 3,667 )
$ 95,127
Shares issued through ATM
-
-
11,923
29,817
-
-
-
29,817
Shares issued upon vesting
of restricted stock units, net of shares retired to pay employees’ taxes
-
-
40
( 54 )
-
-
-
( 54 )
Shares issued for services
-
-
78
202
-
-
-
202
Stock-based compensation
-
-
-
3,519
-
-
-
3,519
Shares issued upon exercise of stock options
-
-
4,320
7,429
-
-
-
7,429
Financing related fees
-
-
-
( 330 )
-
-
-
( 330 )
Shares issued upon exercise of stock options
-
-
20
2
-
-
-
2
Foreign currency translation
gain (loss)
-
-
-
-
-
-
( 1,544 )
( 1,544 )
NET
LOSS
-
-
-
-
( 43,019 )
( 251 )
-
( 43,270 )
BALANCE
AT DECEMBER 31, 2021
-
$ -
169,477
$ 434,529
$ ( 337,097 )
$ ( 1,323 )
$ ( 5,211 )
$ 90,898
See
accompanying notes to the consolidated financial statements.
86 | P a g e
LINEAGE
CELL THERAPEUTICS, INC. AND SUBSIDIARIES
CONSOLIDATED
STATEMENTS OF CASH FLOWS
(IN
THOUSANDS)
2021
2020
Year Ended December 31,
2021
2020
CASH FLOWS FROM OPERATING ACTIVITIES:
Net loss attributable to Lineage
$ ( 43,019 )
$ ( 20,649 )
Net loss attributable to noncontrolling interest
( 251 )
( 36 )
Adjustments to reconcile net loss attributable to Lineage to net cash used in operating activities:
Gain on sale of marketable equity securities
( 6,024 )
( 4,560 )
Unrealized loss on marketable equity securities
2,299
3,782
Deferred tax benefit
-
( 1,239 )
Depreciation expense, including amortization of leasehold improvements
663
823
Amortization of right-of-use assets
14
72
Amortization of intangible assets
210
1,216
Stock-based compensation
3,519
2,227
Common stock issued for services
202
119
Change in unrealized (gain) loss on warrant liability
( 205 )
174
Write-off of security deposit
-
150
Amortization of deferred license fee
-
( 200 )
Foreign currency remeasurement and other (gain)
( 1,566 )
( 2,957 )
Loss (gain) on sale of assets
24
( 20 )
Realized loss on warrant exercise
-
44
Gain on extinguishment of debt
( 523 )
-
Changes in operating assets and liabilities:
Accounts and grants receivable
( 857 )
287
Accrued interest receivable
-
( 1,008 )
Receivables from affiliates, net of payables
-
7
Prepaid expenses and other current assets
( 72 )
1,575
Accounts payable and accrued liabilities
21,645
308
Deferred revenue and other liabilities
380
132
Net cash used in operating activities
( 23,561 )
( 19,753 )
CASH FLOWS FROM INVESTING ACTIVITIES:
Proceeds from sale of OncoCyte common shares
10,064
10,941
Proceeds from the sale of AgeX common shares
-
1,290
Proceeds from the sale of HBL common shares
21
830
Purchase of property and equipment
( 354 )
( 64 )
Proceeds from sale of assets
14
23
Security deposit paid and other
-
18
Net cash provided by investing activities
9,745
13,038
CASH FLOWS FROM FINANCING ACTIVITIES:
Proceeds from employee options exercised
7,240
-
Proceeds from payment of Juvenescence promissory note
-
24,624
Common shares received and retired for employee taxes paid
( 54 )
( 27 )
Proceeds from sale of common shares
30,865
5,127
Payments for offering costs
( 1,101 )
( 356 )
Repayment of financing lease liabilities
( 20 )
( 26 )
Proceeds from Paycheck Protection Program (“PPP”) Loan (Note 8)
-
523
Net cash provided by financing activities
36,930
29,865
Effect of exchange rate changes on cash, cash equivalents and restricted cash
( 20 )
( 63 )
NET INCREASE (DECREASE) IN CASH, CASH EQUIVALENTS AND RESTRICTED CASH
23,094
23,087
At beginning of year
33,183
10,096
At end of year
$ 56,277
$ 33,183
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION:
Cash paid during year for interest
$ 13
$ 20
SUPPLEMENTAL SCHEDULE OF NON-CASH FINANCING AND INVESTING ACTIVITIES:
Receivable from sale of common shares in at the market offering
$ 147
$ 269
Receivable from exercise of stock options
$ 189
$ -
See
accompanying notes to the consolidated financial statements.
87 | P a g e
LINEAGE
CELL THERAPEUTICS, INC.
NOTES
TO THE CONSOLIDATED FINANCIAL STATEMENTS
1.
Organization, Basis of Presentation and Liquidity
Lineage Cell Therapeutics,
Inc. (“Lineage,” “we,” “us,” or “our”) is a clinical-stage biotechnology company developing
novel cell therapies to address unmet medical needs. Our programs are based on our proprietary cell-based technology and associated development
and manufacturing capabilities. From this platform, we design, develop, and manufacture specialized human cells with anatomical and physiological
functions which are similar or identical to cells found naturally in the human body. These cells which we manufacture are created by
developmental differentiation protocols applied to established and well-characterized, pluripotent, and self-renewing cell lines. These
functional cells are transplanted into patients to either replace or support cells that are dysfunctional or absent due to degenerative
disease or traumatic injury, or are administered as a means of helping the body mount a more robust and effective immune response to
cancer or infectious diseases.
Our
strategy is to efficiently leverage our technology platform and manufacturing capabilities to develop and advance our programs internally
or in conjunction with strategic partners to further enhance their value. As one example, on December 17, 2021, we entered into a Collaboration
and License Agreement with F. Hoffmann-La Roche Ltd and Genentech, Inc., a member of the Roche Group (collectively, “Roche”),
wherein Lineage granted to Roche exclusive worldwide rights to develop and commercialize retinal pigment epithelium cell therapies, including its proprietary cell therapy known as OpRegen®, for the treatment of ocular disorders, including advanced
dry age-related macular degeneration with geographic atrophy. Roche has paid Lineage a $ 50.0 million upfront payment under this alliance
and Lineage is eligible to receive up to an additional $ 620.0 million in certain developmental, regulatory, and commercialization milestone
payments. Lineage also is eligible for tiered double-digit percentage royalties on net sales of OpRegen.
Currently,
Lineage is working with Roche in support of the dry age-related macular degeneration (OpRegen) program and is clinically testing
therapies to treat spinal cord injuries and non-small cell lung cancer, as well as conducting research and preclinical development activities
intended to advance our pipeline into other therapeutic indications and target tissues or organs.
Product
Candidates & Other Programs
We
have several allogeneic, or “off-the-shelf,” cell therapy programs in development:
●
OpRegen ® ,
a retinal pigment epithelium (“RPE”) cell replacement therapy currently in a Phase 1/2a multicenter clinical trial for
the treatment of advanced dry age-related macular degeneration (“AMD”) with geographic atrophy (“GA”) (also
known as atrophic AMD). There are currently no therapies approved by the U.S. Food and Drug Administration (“FDA”) for
dry AMD. As of December 17, 2021 this program has been partnered with Roche for further clinical development and commercialization.
●
OPC1 ,
an oligodendrocyte progenitor cell therapy currently in long-term follow-up for a Phase 1/2a multicenter clinical trial for spinal
cord injuries (“SCI”). This clinical trial has been partially funded by the California Institute for Regenerative Medicine
(“CIRM”).
●
VAC ,
an allogeneic cancer immunotherapy of antigen-presenting dendritic cells. One of the VAC product candidates, VAC2, is currently in
a Phase 1 clinical trial in non-small cell lung cancer (“NSCLC”). This clinical trial is being funded and conducted by
Cancer Research UK, one of the world’s largest independent cancer research charities. We also have another VAC-based product
candidate in preclinical development with our partner, Immunomic Therapeutics, Inc. (“ITI”), for the treatment of glioblastoma
multiforme (“GBM”).
●
Other.
We have other product candidates
in preclinical development covering a range of therapeutic areas and target tissues or organs. Generally, these
candidates are based on the same pluripotent platform technology and employ a similar guided cell differentiation and transplant
approach as our current clinical-stage products.
In
addition to seeking to create value for shareholders by developing product candidates and other technologies through our clinical development
programs, we also seek to create value from our technologies through partnering and strategic transactions. We founded two companies
that later became publicly traded companies: OncoCyte Corporation (“OncoCyte”) and AgeX Therapeutics, Inc. (“AgeX”).
We continue to hold common stock in OncoCyte as of December 31, 2021.
During
the year ended December 31, 2021, we received approximately $ 10.1 million in gross proceeds in connection with our sale of shares of
OncoCyte. In August 2020, we also received $ 24.6 million from Juvenescence Limited (“Juvenescence”), representing principal
and accrued interest under a promissory note we received in connection with our sale of AgeX shares to Juvenescence in August 2018.
88 | P a g e
Asterias
Merger
On
November 7, 2018, Lineage, Asterias Biotherapeutics, Inc. (“Asterias”) and Patrick Merger Sub, Inc., a wholly owned subsidiary
of Lineage, entered into an Agreement and Plan of Merger (the “Merger Agreement”) whereby Lineage agreed to acquire all of
the outstanding common stock of Asterias in a stock-for-stock transaction (the “Asterias Merger”).
On
March 7, 2019, the shareholders of each of Lineage and Asterias approved the Merger Agreement. Prior to the Asterias Merger, Lineage
owned approximately 38 % of Asterias’ issued and outstanding common stock and accounted for Asterias as an equity method investment.
On
March 8, 2019, the Asterias Merger closed with Asterias surviving as a wholly owned subsidiary of Lineage. The former stockholders of
Asterias (other than Lineage) received 0.71 common shares of Lineage for every share of Asterias common stock they owned. Lineage issued
24,695,898 common shares, including 58,085 shares issued in respect of restricted stock units issued by Asterias that immediately vested
in connection with the closing of the Asterias Merger. The aggregate dollar value of such shares, based on the closing price of Lineage
common shares on March 8, 2019, was $ 32.4 million. The total purchase price was $ 52.6 million. Lineage also assumed warrants to purchase
shares of Asterias common stock.
The
Asterias Merger was accounted for using the acquisition method of accounting in accordance with Accounting Standards Codification (“ASC”)
Topic 805, Business Combinations , which requires, among other things, that the assets and liabilities assumed be recognized at
their fair values as of the acquisition date.
Use
of estimates
The
preparation of consolidated financial statements in conformity with accounting principles generally accepted in the U.S. (“GAAP”)
requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent
assets and liabilities at the date of the consolidated financial statements and the reported amounts of revenues and expenses during
the reporting period with consideration given to materiality. Significant estimates and assumptions which are subject to significant
judgment include those related to going concern assessment of consolidated financial statements, useful lives associated with long-lived
assets, including evaluation of asset impairment, allowances for uncollectible accounts receivables, loss contingencies, deferred income
taxes and tax reserves, including valuation allowances related to deferred income taxes, and assumptions used to value stock-based awards,
debt or other equity instruments. Actual results could differ materially from those estimates.
Principles
of consolidation
Lineage’s
consolidated financial statements include the accounts of its subsidiaries. The following table reflects Lineage’s ownership, directly
or through one or more subsidiaries, of the outstanding shares of its operating subsidiaries as of December 31, 2021.
89 | P a g e
Schedule
of Lineage’s Ownership of Outstanding Shares of its Subsidiaries
Subsidiary
Field of Business
Lineage
Ownership
Country
Asterias BioTherapeutics, Inc. (1)
Cell
based therapeutics to treat neurological conditions and cancer
100 %
USA
Cell Cure Neurosciences Ltd (“Cell Cure”)
Manufacturing
of Lineage’s cell replacement platform technology
99 % (2)
Israel
ES Cell International Pte. Ltd. (“ESI”) (3)
Research
and clinical grade cell lines
100 %
Singapore
OrthoCyte Corporation (“OrthoCyte”)
Research
in orthopedic diseases and injuries
99.8 %
USA
(1)
Asterias
was acquired by Lineage in March 2019.
(2)
Includes shares
owned by Lineage and ESI.
(3)
The operating activities and fields of business listed
under these subsidiaries are conducted primarily by Lineage as the parent company.
All
material intercompany accounts and transactions have been eliminated in consolidation. As of December 31, 2021, Lineage consolidated
its direct and indirect wholly owned or majority-owned subsidiaries because Lineage has the ability to control their operating and financial
decisions and policies through its ownership, and the noncontrolling interest is reflected as a separate element of shareholders’
equity on Lineage’s consolidated balance sheets.
Liquidity
Lineage
has incurred significant operating losses and in recent years has funded its operations primarily through sale of common stock of AgeX
and OncoCyte, both former subsidiaries, sale of common stock of Hadasit Bio-Holdings Ltd (“HBL”), receipt of research grants,
royalties from product sales, license revenues, sales of research products and issuance of equity securities.
On
May 1, 2020, Lineage entered into a Controlled Equity Offering SM Sales Agreement (the “Sales Agreement”) with
Cantor Fitzgerald & Co., as sales agent (“Cantor Fitzgerald”), pursuant to which Lineage may offer and sell, from time
to time, through Cantor Fitzgerald, common shares of Lineage (“ATM Shares”) having an aggregate offering price of up to $ 25.0
million. Lineage is not obligated to sell any ATM Shares. Subject to the terms and conditions of the Sales Agreement, Cantor Fitzgerald
will use commercially reasonable efforts, consistent with its normal trading and sales practices, applicable state and federal law, rules
and regulations, and the rules of the NYSE American, to sell the ATM Shares from time to time based upon Lineage’s instructions,
including any price, time or size limits specified by Lineage. Under the Sales Agreement, Cantor Fitzgerald may sell the ATM Shares by
any method deemed to be an “at-the-market” offering as defined in Rule 415(a)(4) under the Securities Act of 1933, as amended,
or by any other method permitted by law, including in privately negotiated transactions. Cantor Fitzgerald’s obligations to sell
the ATM Shares are subject to satisfaction of certain conditions, including the continued effectiveness of Lineage’s Registration
Statement on Form S-3 (File No. 333-237975), which was filed with the Commission on May 1, 2020 and was declared effective on May 8,
2020. The Sales Agreement replaced the previous sales agreement with Cantor that had been entered into in April 2017.
On
March 5, 2021, Lineage filed a prospectus supplement with the SEC in connection with the offer and sale of an additional $ 25.0 million
of common shares under the Sales Agreement increasing the total offering to $ 50.0 million. As of December 21, 2021, $ 14.1 million remained
available for sale under the Sales Agreement. On December 21, 2021, Lineage filed a prospectus supplement with the SEC in connection
with the offering and sale of up to $ 64.1 million of common shares (the “New Sales Agreement”), with Cantor Fitzgerald as
the sales agent, no additional sales will be made under the Sales Agreement. The $ 64.1 million under the New Sales Agreement which may
be issued are registered pursuant to Lineage’s effective shelf registration on Form S-3 (File
No. 333-237975), as filed with the SEC on May 1, 2020 and declared effective on May 8, 2020 (the “May 2020 Registration Statement”),
and Lineage’s effective shelf registration statement on Form S-3 (File No. 333-254167), which was filed with the SEC on March 5,
2021 and declared effective on March 19, 2021. As of December 31, 2021, under the Sales Agreement, Lineage had issued 14,908,735 common
shares at a weighted average price per share of $ 2.41 for gross proceeds of $ 35.9 million. As of December 31, 2021, under the New Sales
Agreement, Lineage had issued 108,200 common shares at a weighted average price per share of $ 2.55 for gross proceeds of $ 0.3 million
(which includes $ 0.2 million of cash in transit related to a 2021 transaction that settled in early 2022). As a result, as of December
31, 2021, $ 63.9 million remained available for sale under the New Sales Agreement.
90 | P a g e
As
of December 31, 2021, Lineage had an accumulated deficit of approximately $ 337.1 million, working capital of $ 64.4 million and shareholders’
equity of $ 90.9 million. Lineage has evaluated its projected cash flows and believes that its $ 58.4 million of cash, cash equivalents
and marketable equity securities are sufficient to fund Lineage’s planned operations for at least the next twelve months from the
issuance date of the consolidated financial statements included herein. If Lineage needs near term working capital or liquidity to supplement
its cash and cash equivalents for its operations, Lineage may sell some, or all, of its marketable equity securities, as necessary.
In
January 2022, Lineage received a $ 50.0 million upfront payment related to the Roche Agreement. Lineage made a subsequent payment of $ 12.1
million to the IIA, pursuant to Lineage’s obligations under the Innovation Law. Additionally, Lineage made a subsequent
payment of $ 8.9 million to Hadasit, pursuant to Lineage’s obligations under the Second Amended and Restated License Agreement.
See Note 14 for a description of the Roche Agreement and related payment obligations.
Lineage’s
projected cash flows are subject to various risks and uncertainties, and the unavailability or inadequacy of financing to meet future
capital needs could force Lineage to modify, curtail, delay, or suspend some or all aspects of its planned operations. Lineage’s
determination as to when it will seek new financing and the amount of financing that it will need will be based on Lineage’s evaluation
of the progress it makes in its research and development programs, any changes to the scope and focus of those programs, any changes
in grant funding for certain of those programs, and projection of future costs, revenues, and rates of expenditure. Lineage’s ability
to raise additional funds may be adversely impacted by deteriorating global economic conditions and the disruptions to and volatility
in the credit and financial markets in the United States and worldwide resulting from the ongoing COVID-19 pandemic. Lineage may be required
to delay, postpone, or cancel clinical trials or limit the number of clinical trial sites, unless it is able to obtain adequate financing.
Lineage cannot assure that adequate financing will be available on favorable terms, if at all. Sales of additional equity securities
by Lineage or its subsidiaries and affiliates could result in the dilution of the interests of current shareholders.
2.
Summary of Significant Accounting Policies
Marketable
equity securities -
Lineage accounts for the shares it holds in OncoCyte and HBL as marketable equity securities in accordance with ASC 320-10-25, Investments
– Debt and Equity Securities , as amended by Accounting Standards Update (“ASU”) 2016-01, Financial Instruments–Overall:
Recognition and Measurement of Financial Assets and Financial Liabilities, further discussed below.
OncoCyte
shares have readily determinable fair values quoted on the NYSE American under trading symbol “OCX”. The HBL shares have
a readily determinable fair value quoted on the Tel Aviv Stock Exchange (“TASE”) under the trading symbol “HDST”
where share prices are denominated in New Israeli Shekels (NIS).
Revenue
recognition - Lineage recognizes revenue in accordance with Financial Accounting Standards Board (“FASB”) ASU 2014-09 ,
Revenues from Contracts with Customers (Topic 606) , and in a manner that depicts the transfer of control of a product or a service
to a customer and reflects the amount of the consideration it is entitled to receive in exchange for such product or service. In doing
so, Lineage follows a five-step approach: (i) identify the contract with a customer; (ii) identify the performance obligations in the
contract; (iii) determine the transaction price; (iv) allocate the transaction price to the performance obligations; and (v) recognize
revenue when (or as) the customer obtains control of the product or service. Lineage considers the terms of a contract and all relevant
facts and circumstances when applying the revenue recognition standard. Lineage applies the revenue recognition standard, including the
use of any practical expedients, consistently to contracts with similar characteristics and in similar circumstances.
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In
applying the provisions of ASU 2014-09, Lineage has determined that government grants are out of the scope of ASU 2014-09 because the
government entities do not meet the definition of a “customer,” as defined by ASU 2014-09, as there is not considered to
be a transfer of control of goods or services to the government entities funding the grant. In the absence of applicable guidance under
U.S. GAAP, the Company’s policy is to recognize grant revenue when the related costs are incurred and the right to payment is realized.
Costs incurred are recorded in research and development and general and administrative expenses on the accompanying statements of operations .
Deferred grant revenues represent grant funds received from the governmental funding agencies for which the allowable expenses have
not yet been incurred as of the balance sheet date reported.
Royalties
from product sales and license fees -
For agreements that include sales-based royalties, including commercial milestone payments based on the level of sales, and the license
is deemed to be the predominant item to which the royalties relate, Lineage recognizes revenue at the later of (i) when the related sales
occur, or (ii) when the performance obligation to which some or all of the royalty has been allocated has been satisfied (or partially
satisfied). Lineage estimates and recognizes royalty revenues based on all available information, including estimates provided by the
customer or licensee from which Lineage obtains such estimates directly for each reporting period. Actual revenues ultimately received
may differ from those estimates recorded and are adjusted in the period when information to actuals is available to Lineage.
Collaborative
agreements -
On April 16, 2021, Lineage entered a worldwide license and collaboration agreement with ITI for the development and commercialization
of the VAC platform. Under the terms of this agreement, Lineage is entitled to upfront licensing fees totaling $ 2.0
million paid over the first year, and up to $ 67.0
million in development and commercial milestones
across multiple indications. Lineage will also be eligible to receive royalties up to 10 %
on net sales of future products. On December 17, 2021, we entered into an exclusive worldwide collaboration and license agreement with
Roche, for the development and commercialization of OpRegen. Roche paid a $ 50.0
million upfront payment and we are eligible to
receive up to $ 620.0
million in additional development, approval,
and sales milestone payments, in addition to tiered double-digit royalties.
We
review collaborative agreements to determine if the accounting treatment falls under Accounting Standards Codification, Topic 606 ,
Revenue from Contracts with Customers (“ASC 606”) , or Accounting Standards Codification Topic 808, Collaborative
Arrangements (“ASC 808”). While these agreements may be within the scope of ASC 808, we may analogize to ASC 606 for
some aspects of the agreements.
The
terms of our collaborative agreements typically include one or more of the following: (i) upfront fees; (ii) milestone payments related
to achievement of development or commercial goals; (iii) royalties on net sales of licensed products; and (iv) reimbursement of cost-sharing
of research and development (“R&D”) expenses. Each of these payments eventually result in collaboration revenues. When
a portion of non-refundable upfront fees or other payments received are allocated to continuing performance obligations under the terms
of a collaborative arrangement, they are recorded as deferred revenue and recognized as collaboration revenue when (or as) the underlying
performance obligation is satisfied.
To
identify the performance obligations within the collaboration agreements, we first identify all the promises in the contract (i.e. explicit
and implicit), which may include a customer option to acquire additional goods or services for free or at a discount. We exclude any
immaterial promises from the assessment of identifying performance obligations. When an option is identified as providing a customer
with a material right, the option is identified as a performance obligation. A portion of the transaction price is then allocated to
the option and recognized when (or as) the future goods or services related to the option are provided, or when the option expires.
As
part of the accounting treatment for these agreements, we must develop estimates and assumptions that require judgement to determine
the underlying stand-alone selling price for each performance obligation which determines how the transaction price is allocated among
the performance obligations. The following items are estimated in the calculation of the stand-alone selling price: forecasted revenues
and development costs, development timelines, discount rates and probabilities of technical and regulatory success. We evaluate each
performance obligation to determine if they can be satisfied at a point in time or over time, and we measure the services delivered to
our collaboration partners each reporting period, which is based on the progress of the related program. If necessary, we adjust the
measure of performance and related revenue recognition. Any such adjustments are recorded on a cumulative catch-up basis which would
affect revenue and net income (loss) in the period of adjustment. In addition, variable consideration (e.g., milestone payments) must
be evaluated to determine if it is constrained and, therefore, excluded from the transaction price.
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Upfront
fees - If a license to our intellectual property is determined to be distinct from the other performance obligations identified in
the arrangement, we recognize collaboration revenues from the transaction price allocated to the license when the license is transferred
to the licensee, and the licensee is able to use and benefit from the license. When the license is determined to be non-distinct, we
utilize judgment to assess the nature of the combined performance obligation to determine whether the combined performance obligation
is satisfied over time or at a point in time, and, if over time, the appropriate method of measuring progress for purposes of recognizing
collaboration revenue from the allocated transaction price. For example, when we receive upfront fees for the performance of research
and development services, or when research and development services are not considered to be distinct from a license, we recognize collaboration
revenue for those units of account over time using a measure of progress. We evaluate the measure of progress at each reporting period
and, if necessary, adjust the measure of performance and related revenue as a change in estimate.
Milestone
payments - At the inception of each collaboration agreement that includes milestone payments (variable consideration), we evaluate
whether the milestones are considered probable of being reached and estimate the amount to be included in the transaction price using
the most likely amount method. If it is probable that a significant revenue reversal would not occur, the associated milestone value
is included in the transaction price. Milestone payments that are not within our or the collaboration partner’s control, such as
non-operational developmental and regulatory approvals, are generally not considered probable of being achieved until those approvals
are received. At the end of each reporting period, we re-evaluate the probability of achievement of milestones that are within our or
the collaboration partner’s control, such as operational developmental milestones and any related constraint, and if necessary,
adjust our estimate of the overall transaction price. Any such adjustments are recorded on a cumulative catch-up basis, which would affect
collaboration revenues and net income (loss) in the period of adjustment. Revisions to our estimate of the transaction price may also
result in negative collaboration revenues and net income (loss) in the period of adjustment.
Royalties
- For collaboration agreements that include sales-based royalties, including commercial milestone payments based on the level of
sales, and the license is deemed to be the predominant item to which the royalties relate, we recognize revenue at the later of (i) when
the related sales occur, or (ii) when the performance obligation to which some or all of the royalty has been allocated has been satisfied
(or partially satisfied).
Reimbursement,
cost-sharing payments - Under certain collaborative agreements, we will receive reimbursement for a portion of our R&D expenses.
Such reimbursements are reviewed for gross versus net reporting considerations and reflected either as a reduction of R&D expense
or as reimbursement revenue in our consolidated statements of operations.
As
of December 31, 2021, we recorded $ 49.7
million and $ 0.8
million of deferred revenue on the consolidated
balance sheet, related to the Roche and ITI collaboration agreements. For the year ended December 31, 2021, we recognized $ 0.3
million and $ 0.8
million of revenue on the statement of operations,
related to the Roche and ITI collaboration agreements, respectively.
Basic
and diluted net income (loss) per share attributable to common shareholders -
Basic earnings per share is calculated by dividing net
income or loss attributable to Lineage common shareholders by the weighted average number of common shares outstanding, net of unvested
restricted stock or restricted stock units, subject to repurchase by Lineage, if any, during the period. Diluted earnings per share is
calculated by dividing the net income or loss attributable to Lineage common shareholders by the weighted average number of common shares
outstanding, adjusted for the effects of potentially dilutive common shares issuable under outstanding stock options and warrants, using
the treasury-stock method, convertible preferred stock, if any, using the if-converted method, and treasury stock held by subsidiaries,
if any.
For
the years ended December 31, 2021 and 2020, respectively, Lineage reported a net loss attributable to common shareholders, and therefore,
all potentially dilutive common shares were considered antidilutive for those periods.
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The
following common share equivalents were excluded from the computation of diluted net income (loss) per common share for the periods presented
because including them would have been antidilutive (in thousands):
Schedule of Antidilutive Securities Excluded from Computation of Earnings Per Share
Years
Ended December 31,
2021
2020
Stock options
14,883
16,215
Lineage Warrants
-
1,090
Restricted stock units (1)
31
93
(1)
On February 11, 2022, the
Board of Directors of Lineage, approved restricted stock unit awards for an aggregate of 694,424 (see Note 12).
Restricted
cash -
In accordance with ASU 2016-18, Statement of Cash Flows (Topic 230): Restricted Cash , Lineage explains the change during the period
in the total of cash, cash equivalents and restricted cash, and includes restricted cash with cash and cash equivalents when reconciling
the beginning-of-period and end-of-period total amounts shown on the consolidated statements of cash flows.
The
following table provides a reconciliation of cash, cash equivalents, and restricted cash reported within the consolidated balance sheet
dates that comprise the total of the same such amounts shown in the consolidated statements of cash flows for all periods presented herein
(in thousands):
Schedule of Reconciliation of Cash, Cash Equivalents, and Restricted Cash
December
31, 2021
December
31, 2020
Cash and cash equivalents
$ 55,742
$ 32,585
Restricted cash included in deposits and other long-term assets (see Note 14)
535
520
Restricted cash included in prepaid expenses and other current assets (see Note 14)
-
78
Total cash, cash equivalents, and restricted cash as shown in the consolidated statements of cash flows
$ 56,277
$ 33,183
Accounts
and grants receivable, net – Net accounts receivables amounted to $ 50,640,000
and $ 4,000
and grants receivable amounted to $ 200,000
and $ 61,000
as of December 31, 2021 and 2020, respectively.
Net trade receivables include an allowance for doubtful accounts of approximately $ 74,000
and $ 44,000
as of December 31, 2021 and 2020, respectively,
for those amounts deemed uncollectible by Lineage. Lineage establishes an allowance for doubtful accounts based on the evaluation of
the collectability of its receivables on a variety of factors, including the length of time receivables are past due, significant events
that may impair the customer’s ability to pay, such as a bankruptcy filing or deterioration in the customers operating results
or financial position, and historical experience. If circumstances related to customers change, estimates of the recoverability of receivables
would be further adjusted.
Leases
- We account for leases in accordance with ASC 842, Leases . We determine if an arrangement is a lease at inception. Leases
are classified as either financing or operating, with classification affecting the pattern of expense recognition in the consolidated
statements of operations. Under the available practical expedients for the adoption of ASC 842, we account for the lease and non-lease
components as a single lease component. We recognize right-of-use (“ROU”) assets and lease liabilities for leases with terms
greater than twelve months in the condensed consolidated balance sheet. ROU assets represent our right to use an underlying asset during
the lease term and lease liabilities represent our obligation to make lease payments arising from the lease. Operating and finance lease
ROU assets and liabilities are recognized at commencement date based on the present value of lease payments over the lease term. As most
of our leases do not provide an implicit rate, we use our incremental borrowing rate based on the information available at commencement
date in determining the present value of lease payments. We use the implicit rate when readily determinable. The operating and finance
lease ROU assets also includes any lease payments made and excludes lease incentives. Our lease terms may include options to extend or
terminate the lease when it is reasonably certain that we will exercise that option. Lease expense for operating lease payments is recognized
on a straight-line basis over the lease term. Lease expense for finance lease payments is recognized as amortization of ROU assets and
related interest. Operating and finance leases are included as ROU assets in property and equipment, and ROU lease liabilities, current
and long-term, in the consolidated balance sheets.
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Goodwill
and IPR&D – Goodwill is calculated as the difference between the acquisition date fair value of the consideration transferred
and the values assigned to the assets acquired and liabilities assumed. Goodwill is tested for impairment in accordance with ASU 2017-04,
Intangibles—Goodwill and Other (Topic 350): Simplifying the Test for Goodwill Impairment . In-process research and development
(“IPR&D”) assets are indefinite-lived intangible assets until the completion or abandonment of the associated research
and development (“R&D”) efforts. Once the R&D efforts are completed or abandoned, the IPR&D will either be amortized
over the asset’s estimated life as a finite-lived intangible as
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