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Don’t feel bad about your neck a dermatologist urges the importance of protecting ‘the forgotten skin’ – image.ie

According to my dermatologist, the neck starts to go at forty-three, and that's that..." writes Nora Ephron in I Feel Bad About My Neck. "The neck is a dead giveaway. Our faces are lies and our necks are the truth. You have to cut open a redwood tree to see how old it is, but you wouldn't have to if it had a neck. Here, Dr Rosemary Coleman, consultant dermatologist at Centre for Restorative Dermatology in Blackrock Clinic, Dublin, writes about the importance of protecting what she calls 'the forgotten skin'

From a very early age, we become conscious of our face yet neglect important other regions of skin until many decades later. If we paid them the same attention as our face, theyd remain in far better and more youthful condition. We can get away with it in the winter but not in the spring or summer, or in evening wear when theres a lovely, clear, plump-skinned face and pigmented, crinkly chest and neck to go with it.

Around mid-forties, we suddenly realise we have a neck and that its becoming somewhat crepey, pigmented or blotchy red. It takes another decade to suddenly observe, usually when trying on a summer or evening dress, that the chest skin has now become thinner, more translucent, has mottled pigmentation and broken blood vessels or developed crusty pre-cancerous lesions (actinic keratoses), soon to be skin cancers if not treated.

As for the hands, they are steadily losing their volume from our mid-40s, becoming crepey, developing liver spots and again pre-cancerous crusty areas. As we age further, they show the bruising of very thin old skin, Batemans purpura. Theres a reason why Madonna, Karl Largerfeld and many other celebrities never reveal their hands in public!

Finally, the lower legs are amongst the most common sites for skin cancers as we age. The skin here is very prone to drying out, getting crusty and pigmented and even developing leg ulcers if not cared for. People often forget SPF all the way down there, especially women wearing skirts.

Fret not, help is at hand using appropriate preventative/corrective skincare and restorative skin treatments. Heres how you can protect the forgotten skin.

The skin on these forgotten areas are highly environmentally exposed sites which get significantly sun-damaged and aged.

As with all anti-ageing approaches, prevention is better than cure. There is nothing cheaper and more effective than sun avoidance and protection from as early an age as possible. Society has become very aware of the importance of applying SPF to our face on a daily basis (and remember it should be 365 days a year) but it amazes me why people stop the application at their jawline! I believe that the face begins at the hairline and ends at the cleavage as far as SPF and skincare products are concerned. Even mens necks benefit from daily SPF rather than developing the blotchy red or brown discolouration we so frequently see.

To prevent pigment change and ageing on the neck, avoiding directly applying perfumes and aftershaves here. They interact with daylight and cause unsightly red-brown pigmentation, which can be extremely difficult to remove, so-called Berloque Dermatitis. Im amazed how many women have never heard of this and end up with discolouration on the sides of their necks below their ears.

Remember that 80% of ageing is photo-ageing and not just the passage of time. Clothes offer the best photoprotection for the forgotten skin, complemented of course by SPF underneath. Try wearing light summer scarves for the neck and chest, long skirts and sun protection gloves for driving and rash vests like the ones we put on our children to stop them burning in the swimming pool to protect the upper body while in the pool/sporting activities.

I often ask women if they put rash vests on their children on holidays in the sun and of course, they all do. However, when I ask if they wear them themselves they invariably say no, so I question at what age they decided they didnt need to protect their chest and shoulder skin anymore! Women also forget that if they are wearing a light, wispy fabric that they can see sun rays through, it can penetrate it and damage their skin.

Surprisingly, the skin of the neck and chest can be far less tolerant to stronger anti-ageing ingredients such as retinol and glycolic acid, than the face. However, it can usually tolerate vitamin C, peptides and resveratrol without a problem. If the skin here is pigmented, consider skincare products containing anti-pigment agents such as Skinceuticals Discolouration Defense, Skinceuticals Advanced Pigment Corrector and CE Ferulic Serum, Biologique Recherche Crme PIGM 400 and Lotion P50 PIGM 400, and products containing ingredients such as Kojic acid, Azelaic acid, Tranexamic acid and vitamin C.

Severe pigmentation disorders such as melasma will require prescription-grade products from your dermatologist.

For the hands, SPF is very hard to keep in place because of exposure and frequent hand washing, so consider protective gloves for activities such as golf, or if you do a lot of driving, flesh-coloured fingerless gloves are unnoticeable and easy to buy online. When applying retinol to the face, rub into the backs of the hands also. For lower legs, rich moisturisers containing urea and ceramides are particularly hydrating here, like Eucerin with urea and Cerave.

The face can tolerate stronger, active treatments than the neck or chest which are far more prone to keloid scarring and must be treated very cautiously when it comes to invasive treatments.

For the neck, combination treatments work best.In the early days when the jawline is softening, tightening treatments such as Ulthera will work well and tone everything back up for a few more years. If there is a pronounced double chin, CoolSculpt fat reduction by cryolipolysis might be beneficial in selected patients.

Fat-dissolving injections, not yet licensed in Ireland, can also tweak small fat bulges under the chin. Botulinum toxin injections can dramatically improve longitudinal platysmal bands, soften horizontal Venus lines, sharpen a slightly soft jawline and even improve the crepey appearance of the skin. For severe laxity, all of the above will be a complete waste of money and a little neck lift can be amazing, once you have thoroughly researched your surgeon.

With the hands, volume loss is a major issue for ageing hands. Radiesse, calcium hydroxyapatite, is the ideal volumiser here and results can last up to 2 years, after two 30 minute treatments a month apart.

For the chest, I often find that I cant convince women to mind the skin of their chests until they get their first skin cancer and then it takes a lot of work to try to restore it. Avoid filler injections here as volume loss is not the problem and lumps are almost inevitable.

With tone and texture, having firmer skin in all of these areas will still not look much better unless the tone and texture are also improved. They are all suitable for treatments such as Fractionated lasers, Intense Pulsed Light therapy, Yag laser, Platelet Rich Plasma injections, Sunekos, Profhilo, mesotherapy, micro-needling and skin peels.

These treatments stimulate collagen and elastic tissue production to thicken skin and many can also improve pigmentation and redness. The specific treatment needed must be chosen for the particular needs of the skin of the individual and be bespoke.

Finally, keratoses pre-cancerous lesions need to be treated by liquid nitrogen or chemotherapy creams from your dermatologist.

Dr Rosemary Coleman is a consultant dermatologist at Centre for Restorative Dermatology in Blackrock Clinic, Dublin.

Photography by Jason Lloyd Evans.

Read more:'Everyone should use a topical retinol' Dr Rosemary Coleman on the essential skincare routine

Read more:Maternal Mental Health: 'I was terrified they would take my children away if I admitted I was struggling'

Read more:#MetGalaChallenge: our favourite online efforts to recreate the First Monday in May

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Don't feel bad about your neck a dermatologist urges the importance of protecting 'the forgotten skin' - image.ie

Researchers discover stem cells’ ‘death-defying’ quality that aids healing – ETHealthworld.com

Washington D.C: Already known for their shape-shifting abilities, stem cells can now add "death-defying" to their list of remarkable qualities, suggests a novel study.

The new study shows how stem cells, which can contribute to creating many parts of the body, not just one organ or body part, are able to postpone their own death in order to respond to an injury that needs their attention.

The study was done in planarians, which are tiny worms used as model organisms to study regeneration because of their ability to recover from any injury using stem cells.

"Planarian stem cells, even when challenged and under a lot of duress, will still respond to an injury by delaying death," said Divya Shiroor, first author and a graduate student in Dr Carolyn Adler's lab, in the College of Veterinary Medicine.

This could have important implications for cancer research and therapies, particularly when examining chemotherapy and surgery options for patients.

"By understanding how injury prompts planarian stem cells to withstand radiation. We hope to identify genes that, if shared with mammals, could perhaps help hone existing therapies," Shiroor said.

Planarians are commonly used in basic research because of their similarities to humans. Like humans, planarians have stem cells, similar organs and similar genes, but are much more adept at responding to injury, thanks to their higher volume of stem cells and lack of a developed immune system, which in humans complicates the healing process.

"This really simplifies the process of understanding the effects of both injury and radiation on stem cells, and allows us to study it directly without being hampered by parallel processes integral to wound healing, such as inflammation, that get simultaneously triggered in mammals," Shiroor said.

By uncovering the mechanisms that govern stem cells after wounding in a system like planarians, researchers could also apply this knowledge when engineering stem cells to respond similarly in the human body.

Labs have many ways to understand how planarians use stem cells to successfully recover and regenerate, but the Adler lab's combination of radiation and injury to identify a novel stem cell response is unique. The researchers plan on digging deeper to understand how the stressed stem cells know that there is an injury and what role other cells may play in their response.

"We have identified a key gene that is required for stem cell persistence after radiation and injury. and we plan on using this as a stepping stone for further exploration," Shiroor said.

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Researchers discover stem cells' 'death-defying' quality that aids healing - ETHealthworld.com

FTC Letters Warn Marketers to Stop Making Unsupported Claims That Their Products and Therapies Can Effectively Prevent or Treat COVID-19 – New…

May 10, 2020 - The Federal Trade Commission announced it has sent 45 more letters warning marketers nationwide to stop making unsubstantiated claims that their products and therapies can treat or prevent COVID-19, the disease caused by coronavirus. This is the fourth set of warning letters the FTC has announced to sellers of such products as part of its ongoing efforts to protect consumers from COVID-19 related scams. In all, the Commission has sentsimilar letters to almost 100 companies and individuals.

The FTCpreviously sent warning lettersto sellers of vitamins, herbs, colloidal silver, teas, essential oils, and other products pitched as scientifically proven coronavirus treatments or preventatives.intravenous (IV) therapies with high doses of Vitamin C, ozone therapy, and purported stem cell treatments.

Several of the letters announced today target other treatments, including Chinese herbal medications, music therapy, homeopathic treatments, and even shields claimed to boost the immune system by protecting the wearer from electromagnetic fields. However, there is currently no scientific evidence that these, or any, products or services can treat or cure coronavirus.

The FTC sent the letters announced today to the companies and individuals listed below. The recipients are grouped based on the type of therapy, product, or service they pitched to supposedly prevent or treat COVID-19.

General Therapy Products, Supplements, Drugs, and Chinese Herbal Treatments:

IV Therapy and Vitamin C Therapy:

Air Purifiers/Sanitizers and Water Filters:

ChiropracticTherapy:

EMF Radiation Protection:

Homeopathic Treatments:

Music Therapy:

Ozone Therapy:

In the letters, the FTC states that one or more of the efficacy claims made by the marketers are unsubstantiated because they are not supported by scientific evidence, and therefore violate the FTC Act. The letters advise the recipients to immediately stop making all claims that their products can treat or cure COVID-19, and to notify the Commission within 48 hours about the specific actions they have taken to address the agencys concerns.

The letters also note that if the false claims do not cease, the Commission may seek a federal court injunction and an order requiring money to be refunded to consumers. Last week, the FTC announced itsfirst case against a marketer of such products, Marc Ching, doing business as Whole Leaf Organics.

The Commission also has sentletters to several Voice over Internet Protocol (VoIP) service providers, warning them that it is illegal to aid or facilitate the transmission of pre-recorded telemarketing robocalls pitching supposed coronavirus-related products or services, as well as tomulti-level marketers business opportunities with unsupported earnings claimsand unsubstantiated claims that their products or services can treat or cure coronavirus.

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Autolus Therapeutics Plc (AUTL) Q1 2020 Earnings Call Transcript – The Motley Fool

Image source: The Motley Fool.

Autolus Therapeutics Plc(NASDAQ:AUTL)Q12020 Earnings CallMay 07, 2020, 8:30 a.m. ET

Operator

Ladies and gentlemen, thank you for standing by, and welcome to the Autolus Therapeutics first-quarter 2020 financial results and operation highlights conference call. [Operator instructions] Please be advised that today's conference is being recorded. [Operator instructions] I would now like to hand your conference over to your speaker today, Mr. -- excuse me, Dr.

Lucinda Crabtree, vice president of investor relations. Thank you. Please go ahead, ma'am.

Lucinda Crabtree -- Vice President of Investor Relations

Thank you, Carrie. Good morning, and -- or good afternoon, everyone, and thank you for taking part in today's call on the financial results and operational highlights for the first quarter of 2020. I am Lucinda Crabtree, vice president of investor relations. With me today are Dr.

Christian Itin, our chairman and chief executive officer; and Andrew Oakley, our chief financial officer. Before we begin, I would like to remind you that during this call, we will be making forward-looking statements. All statements other than statements of historical facts contained in this presentation are forward-looking statements. Our actual results, performance or achievements may be materially different from those expressed or implied by the forward-looking statements.

For a discussion of the risks and uncertainties related to our business and other important factors, any of which could cause our actual results to differ from those contained in the forward-looking statements, please see the section titled Risk Factors in our annual report on Form 20-F filed on March 3, 2020, as well as discussions of potential risks, uncertainties and other important factors in our other periodic filings with the SEC. The forward-looking statements contained in this presentation reflect the company's views as of the date of this presentation regarding future events, and the company does not assume any obligation to update any forward-looking statements. You should, therefore, not rely on these forward-looking statements as representing the company's views as of any date subsequent to the date of this presentation. So with that, on Slide 3, you will see the agenda for today, and it is as follows: Christian will provide a brief introduction, and that will be followed by our operational highlights for the first quarter of 2020.

Andrew will next discuss the company's financial results, and then Christian will conclude with upcoming milestones and other concluding comments and, of course, we welcome your questions following our remarks. So with that, I'd like to now turn the call over to Christian. Thank you.

Christian Itin -- Chairman and Chief Executive Officer

Thank you, Lucinda, and welcome to all of you, and thank you for joining us. I'm pleased to review our progress for the first quarter in 2020. First, on Slide 5, we are pleased to report on a very productive first quarter. We remain on track with our clinical programs, despite the challenges of COVID-19.

As an organization, we have quickly adapted to this very challenging environment, ensuring business continuity. Our focus has been on ensuring our clinical B-cell programs, AUTO1 and AUTO3, continue to progress, and we remain on track with recruitment ongoing and manufacturing operations uninterrupted. As such, we expect to deliver data in the time lines that we have previously guided. While some of our participating clinical centers have been an infection hotspots and had to pause enrollment for a few weeks, others could continue to work unimpacted.

We expect infections will continue throughout the year with flare-ups in places that were hit by the first wave of infections, while the areas spared for now may see a rise in infections at some point in the upcoming months. However, what is important to remember is that the patients we enroll in our trials have a very high medical need, no different from a severe COVID-19 patient and the drive for centers to continue to treat these cancer patients is very high. Typically, if a center gets under heavy pressure from COVID-19 infections, stem cell transplants and CAR-T therapy are among the last procedures to be stopped and are among the first to resume the post-peak infection. As many of you have analyzed, the tie from establishing social distancing and stronger measures to reaching the other side of the first infection peak has in all impacted areas taken approximately eight weeks, irrespective of whether the measures were taken early or late relative to the rise of infections.

The consistency of this infection pattern is helpful to anticipate the time of impact on a given center and catchment area. Finally, we expect the increasing levels of preparedness and adjustments under way in the various healthcare systems, and the continued implementation of social distancing measures that will allow for continued treatment of these severely ill patients throughout the year. We expect that the adjustments we made for clinical trial operations and in our supply chain will remain relevant and in place for the duration of this infection cycle, plus the wider operational adjustments we made to minimize risk of infection and exposure as well as increased resilience toward the risk of business interruptions will also remain in place and, if necessary, will be adjusted. With regards to our earlier-stage programs, we are monitoring potential impact.

At this point, we may see up to a quarter of delay depending on the program and the impact COVID-19 had on our respective academic or business partners. With that, and remaining on Slide 5, let me give you an overview of our corporate highlights. We announced in April that the FDA accepted the IND application for AUTO1, our lead CAR-T product candidate, for the treatment of adult patients with acute lymphoblastic leukemia, which allows us to initiate clinical sites in the company's first pivotal study, AUTO1-AL1 in the U.S. This followed up the opening of the first site in the U.K.

in March of this year, having received approval of the clinical trial applications by the MHRA earlier in the quarter. We expect to initiate dosing of our first patient in this study this quarter, and remain on track to provide full data by the end of 2021. With regards to our lead product candidate for the treatment of DLBCL AUTO3, the Phase 1/2 ALEXANDER study is ongoing. The timing of the program remains on track, and we will update on the decision for Phase II in mid-2020, as previously guided.

We're excited about our DLBCL program and its broader market potential, following the positive data update we provided at the EHA-EBMT CAR-T Cell Meeting in February 2020. Our Chief Scientific Officer, Dr. Martin Pule, presented early encouraging signs of sustained complete responses we've achieved with low toxicity and minimal patient management required. We're now planning to add a 20-patient cohort to the ongoing ALEXANDER study in second half of this year, with patients treated in an outpatient setting, which I will explain -- expand on a little later in this call.

The last item I wish to touch on in this slide is our forthcoming clinical data updates expected through May and June. For AUTO1 in adult ALL, we plan to present updated data at the virtual EHA Meeting in June with approximately six months of additional follow-up post our ASH 2019 data cut. For AUTO3, we are planning to present these updated data at ASCO in an oral session. We will also follow up with a similar presentation at the EHA Meeting two weeks later.

We plan to present both sets of data to investors in calls shortly following these virtual conferences. Moving to Slide 6, in addition to our two lead clinical candidates, we're planning a series of preclinical data updates on some of our pipeline programs at AACR II in late June. We have been invited to make an oral presentation in our prostate cancer program AUTO7 and and also have poster presentations planned for both AUTO6NG in small cell lung cancer as well as AUTO5 assisted program to the AUTO4 in T-cell lymphoma. Much like ASCO and DHA, we're planning an investor call that will shortly follow these presentations at AACR II.

Finally, I would like to thank our partners at the cell therapy, Catapult, and the GSK site organization in Stevenage for their continued support that enabled us to maintain operations throughout the peak of infection and support the critically ill patients in our trials. Moving to Slide 7, I wanted to spend a brief moment recapping on our lead program AUTO1 in adult ALL. Relapsed/refractory adult ALL is a challenging disease and often impacted in elderly patients. A lot of these patients have significant comorbidities, making them a fragile patient group to treat.

The indication is approximately three times the size of relapsed/refractory pediatric ALL and represents an attractive market opportunity. Within the U.S. and the top five European countries, approximately 3,000 patients every year are at an end stage of treatment, having failed chemo and transplant and, therefore, requiring other options. At this point, there's no CAR-T therapy approved for adult ALL.

Obviously, there are a number of programs that are being tested. However, all of them have experienced significant challenges with the management of the toxicities. And what we created with AUTO1 is a product that is designed to behave physiologically and engages target cells like a normal T-cell would. First generation CAR-T products share the identical binder to CD19, this is true for Kymriah to start to analyze the cell.

This binder has a slow off-rate from the CD19 target. And as a consequence, once the CAR-T cell binds to the leukemia cell and has delivered the cytotoxic payload, it has difficulty letting go from the target cell and get stuck. When you have a CAR-T cells -- when you have CAR-T cells getting stuck to target cells, they continue to be activated, which drives cytokine release and thus adverse events. In addition to leading to cytokine release syndrome, this continued activation of the CAR-T cells can drive exhaustion, which negatively impacts persistence.

So there's a real fundamental challenge with that type of engagement. In contrast, what we created with AUTO1 is a CAR-T product that mimics the behavior and the binding kinetics of a physiological T-cell with a very fast off-rate and an ability to disengage relatively rapidly after delivering the kill. The result is reduced cytokine release and also an increase in target cell killing as the CAR-T cells are freed up more quickly and can reengage new leukemia cells. In addition, CAR-T cells can expand more readily, that's leading to more active CAR-T cells in the patient's body capable of fighting the leukemia.

Now turning to Slide 8, what we show on the left-hand side is the data for blinatumomab, or Blincyto, which is also the current standard of care in this disease setting. What is important to understand is that the patients that we have treated on our trial that we highlighted and what we highlighted at ASH is that the patients have mostly undergone and failed stem cell transplant. In addition, approximately 60% of patients have been on inotuzumab or blinatumomab and failed. So our data is based on a patient population with more advanced disease compared to the data shown for blinatumomab.

However, what you see in the blinatumomab results is that our CR rate in that population is about 40% with an event-free survival of about 30% at six months. And in fact, most patients relapse within less than a year. When we look at the safety profile, Blincyto shows a good safety profile overall. And in fact, the product is typically delivered in an outpatient setting.

Now when we look at our own data for AUTO1, if you look at the total data set of 16 patients, we have an overall CR rate of 87%, and they have an event-free survival of 68% at six-month level. So in a simple way, we have around twice the activity that was reported with blinatumomab with a comparable safety profile. We have had no patients with high-grade cytokine release syndrome. We have 19% of the patients with high-grade neurotoxicity.

All patients with high-grade neurotoxicity had a very high tumor burden in the marrow of more than 50%. Going forward, we will manage these patients when the neurotoxicity starts to build to minimize high-grade adverse events. Finally, I just wanted to touch on the subset of patients that were treated with the closed commercial manufacturing process. You can see that the data, if anything, looks somewhat better than the total of overall, which includes patients that were treated with product that was manufactured by hand with a conventional manufacturing process.

So based on this data, I'm turning to Slide 9, we decided to move the program forward into a pivotal study. The CTA was filed in the U.K. and cleared in Q1, and we're enrolling currently in the U.K. The U.S.

IND also is now open, and we're opening up these centers in the U.S. with the aim of enrolling patients in the second quarter. As a reminder, this is a single-arm 100-patient study of relapsed/refractory patients. The primary endpoint is CR rate, and secondary endpoints include molecular CRS event-free survival and duration of response.

We remain on track to complete enrollment in the first half of next year. To what extent we may be impacted by the COVID-19 situation going forward, we'll have to see, but we currently expect the impact to be limited. Our plans to deliver data by the end of 2021 remain on track. Let's now turn to Slide 10, where I would now like to switch gears and talk about AUTO3, a program that is designed for the treatment of patients with diffuse large B-cell lymphoma.

Third line DLBCL is about four times bigger an indication than relapsed/refractory adult ALL and a setting with already two approved CAR-T therapy products with Yescarta and Kymriah plus liso-cel, or JCAR-17, expected to be approved later this year or beginning of next year. We know this is a large opportunity with approximately 10,000 patients in the back end of the disease, which is a sizable population with a very significant medical need. In terms of the outlook for those patients, they have typically run through a series of chemotherapy combinations often with a monoclonal antibody, and they also have received the transplant if they were eligible for it. If not, they go directly to salvage therapy.

CAR-T therapies are approved in the third line of salvage therapy setting in trials ongoing in patients in second-line setting. There are two things that we see as being really important for successful treatment and commercial uptake in DLBCL. First, you have to induce complete remissions that are lasting. This is a disease setting where you aim for cure.

Second is that you actually have to have a therapy that can be administered where our patients are situated. Today, in the U.S., approximately 80% of the patients are treated outside of university hospitals and only about 10% of the patients are treated as university hospital in-patients. It is this population that is primarily treated with CAR-T therapies. The key challenge for treatment centers is the need for intense patient management, which has the limited use of CAR-T outside of the university hospital in-patient setting.

What we're looking for in AUTO3 is a high level of sustained complete remissions. In addition, we're looking for a safety profile that can be managed in nonacademic outpatient settings to reach the majority of patients. Moving to Slide 11, across the CAR-T populate -- programs in DLBCL, we observed a fairly high overall response rate, yet the sustained complete response rate is limited. It is somewhere between 30% and 40%, depending on the program and the subset of indications that were treated or included in the respective trials.

Roughly 1/3 of the complete responses are lost early on, typically within the first three to six months. There are two key mechanisms reported that are likely driving relapse. Loss of CD19 antigen in about 30% to 50% of the patients at time of relapse and PD-L1 checkpoint upregulation in about two-thirds of our patients at time of relapse. Looking at safety.

With the commercial CD19 CARs, there's a significant amount of management of those patients required to address severe cytokine release syndrome and, in particular, as well as the severe neurotoxicity. Typically, these toxicities have an early onset and require intense patient management and monitoring, meaning patients are largely confined to a classical hospital in-patient setting. We designed a program with a dual targeting approach having two independent receptors in each CAR-T cells, individually designed and optimized for the respective target antigen to minimize the impact of CD19 antigen loss. We also gained at the PD-L1 upregulation and checkpoint based scope of lymphoma cells with a single dose of pembrolizumab on the day before infusion of AUTO3, providing the cover to achieve a CR and sustain it.

AUTO3 has shown a high level of CRs in the dose escalation phase of the current study, and we will present a further update at ASCO. It is worthwhile noting that the high level of complete remissions were obtained without inducing high-grade CRS, or cytokine release syndrome, and no neurotoxicity of any grade in the patients dosed at 150 million to 450 million cell doses, and this is a very unusual finding. When you compare this profile with Yescarta, Kymriah and JCAR-17 data, the contrast is remarkable. What is also important to note is that with AUTO3, we have not managed the patients actively for adverse events.

Now to talk about the extent of the total addressable market, this profile enables us to potentially reach, let's continue to Slide 12. Currently, our approved products are only tapping into a proportion of substantially less than 20% of the market opportunity, which is managed by the academic centers. There's very little to no penetration to the remaining 80% of the market, which comprises settings that we cannot deal with the intensity of patient management required for the current CAR-T products. We believe this creates an enormous opportunity for the profile of a product that we're seeing with AUTO3.

And as such, we believe that the program has a unique potential going forward. We expect to provide an updated ASCO on the clinical profile of the program. So let us turn to Slide 13, where I would like to outline how we continue to build on this potential patient profile. Given the highly differentiated clinical and safety profile we have reported so far, we see an attractive opportunity for AUTO3 as an in and outpatient solution for patients with DLBCL, therefore, maximizing that commercial potential of CAR-T products all across the settings of care in this disease.

As such, we're planning to add a 20-patient cohort to our ongoing Phase 1/2 ALEXANDER study in the second half of this year, with patients treated in an outpatient setting in order to broaden our understanding of the feasibility of outpatient administration. With that, I will turn over the call to Andrew for our first-quarter 2020 financial update. Andrew?

Andrew Oakley -- Chief Financial Officer

Thanks, Christian, and good morning or good afternoon to everyone. If we move to Slide 15, it's my pleasure to review our financial results for the first quarter of 2020. Net total operating expenses for the three months ending March 31, 2020 were $38.6 million. That was net of grant income of $300,000.

And that compares to net operating expenses of $30.2 million, net of grant income of $2 million for the same period in 2019. The increase was due, in general, to our continued increase in clinical trial activity which is expected to deliver on key milestones throughout the rest of 2020; also increased headcount; and an increase in public company costs, primarily related to insurance. Research and development expenses increased to $31.3 million for the three months ended March 31, 2020, and that's up from $22.6 million for the same period in 2019. Cash costs, which also exclude depreciation and amortization as well as share-based compensation, increased to $25.6 million from $17.5 million.

The increase in R&D cash costs, that's $8.1 million, consisted primarily of an increase in some compensation-related costs of $2.2 million due to an increase in employee headcount that supports the advancement of our product candidates as well as an increase of $3.7 million in project expenses associated with a clinical activity. And that includes the research, process development, manufacturing activities necessary to conduct the studies. Plus an increase of $1.8 million in licenses, legal fees and consulting services, which -- some of which is related to an option to negotiate a future license as well as the IT infrastructure and support. The remainder was attributable to other additional costs in the amount of about $400,000.

General and administrative expenses decreased to $7.6 million for the three months ending March 31st, and that's down from $9.6 million for the same period in 2019. Cash costs, again, which exclude depreciation as well as share-based compensation, decreased to $5.9 million from $6.3 million. Compensation-related expenses decreased by $300,000 and IT, communication -- telecommunication and general office costs decreased by the same amount and a decrease also of the same amount in commercial costs, but -- that was all offset by an increase in public company costs of around $0.5 million, which primarily relates to insurance, as I have previously mentioned. Net noncash costs within the G&A area decreased to $1.7 million for the three months ending March 31, and that compares to $3.3 million for the same period in 2019.

The decrease here is attributed to basically share-based compensation expense, which decreased by $1.6 million as a result of the lower value of the stock options that were recognized during the period. The net loss attributable to ordinary shareholders was $29.9 million for the three months ending March 31, 2020, and that compares to $27.2 million for the comparable period in 2019. Cash and cash equivalents at the end of the quarter totaled $243.3 million, and that compares with $210.6 million that we had at the end of December 2019. As such, we anticipate that, that cash on hand provides us with a runway into 2022.

And with that, I will now hand the call back to Christian to give you a brief outlook on expected milestones. Christian?

Christian Itin -- Chairman and Chief Executive Officer

Thanks, Andrew. Let me conclude this part of the management discussion with a review of the upcoming milestones and news flow through 2020. Let's move to Slide 17. The upcoming eight months will be an end full period for us with multiple clinical milestones and opportunities for value creation.

Our chief and most imminent operational focus is to conduct these, obviously, our pivotal trial for AUTO1 in adult ALL. We expect to report clinical data across multiple programs, including updated AUTO3 ALEXANDER data at the forthcoming ASCO Meeting and updated AUTO1 or CAR19 data as well as AUTO3 data at EHA, as previously mentioned. We will look to progress a number of our other preclinical candidates through the second half of 2020 and are looking forward to providing preclinical data updates in our solid tumor programs AUTO6NG and AUTO7 at AACR as well as our T-cell lymphoma program with AUTO5. Finally, toward the end of the year, and we look forward to providing further data updates on both AUTO1 and AUTO3, as we expect for the end of the year.

In conclusion, on Slide 18, I'd like to recap the major message raised from today's call. First AUTO1 is our first Autolus' program to move into pivotal stage. Given the positive safety and efficacy profile today, we believe that AUTO1 has the potential to be a best-in-class CD19 CAR-T program in adult ALL, a disease setting with a very high unmet medical need. Secondly, with regards to AUTO3 and DLBCL, which is expected and slated for additional clinical data updates at the ASCO and EHA.

We plan to conduct an outpatient cohort in the second half of this year. The company is in an excellent position, combined with a strong balance sheet, which provides us a run rate into 2022. We feel we're in a good position. I think are looking forward to an exciting second half of the year.

We're now happy to take questions. Thank you.

Operator

[Operator instructions] Your first question comes from the line of Chad Messer with Needham & Company.

Unknown speaker

Hi, everyone. This is Joe on for Chad. And congratulations on the progress in a difficult environment. So just a couple of questions from me.

You discussed kind of the challenges that are related to DLBCL. And hypothetically, what would you consider more important, patient accessibility or the duration of and deepness of response?

Christian Itin -- Chairman and Chief Executive Officer

Well, thanks a lot for joining, really appreciate it. The -- I think with regards to DLBCL, you want -- you need both aspects actually to be addressed. You need a high level of sustained CRs and you need an excellent safety profile to reach the population. Both aspects are important, and we believe that we have an ability to make a significant improvement on both sides of the program.

Unknown speaker

So you do not consider one more important than the other in this instance?

Christian Itin -- Chairman and Chief Executive Officer

Well, there's -- it is -- it's a life-threatening disease. The first thing you have to make sure is you -- the patient survives. So getting to a long-term remission is what the ultimate goal is, but then you also have to make sure that the patient has access to the therapy. And right now, in the U.S., there are only about 10% of the patients in that disease setting that has access to CAR-T therapy because it is confined to the inpatient segment of the centers of excellence.

And that has actually created a situation where while there is a big demand for these types of therapies, the actual access that can be realized is very, very small. And that is all on the actual intensity of the management of these patients during the adverse events that occur in the -- at the onset of the therapy. And that is sort of the key reason for the confinement to this relatively small number of centers. So you have to make fundamentally have the impact on the disease.

That is what the sustained CR rates give you, but then you actually have to have a safety profile that allows you to further expand the delivery of this type of therapy to centers beyond the relatively small numbers of academic centers of excellence.

Unknown speaker

All right. All right. Thank you.And we are very much looking forward to seeing some of the preclinical data at the second half of AACR. I noted that it looks like the AUTO6NG data would be presented in small cell lung cancer.

So that's a very interesting indication, not just because of the target, but also because of the lack of immunogenicity that's seen in a lot of these cells. Kind of maybe you could kind of orient us what kind of data we should be expecting at AACR?

Christian Itin -- Chairman and Chief Executive Officer

So at AACR, what we're going to be presenting are obviously a preclinical data on these -- from these programs. As you may remember, the way we designed the programs is actually to include a set of cell programming modules that enable the cells to have a higher resilience and higher ability to cope with the challenging microenvironments that we find in these particular sets of tumors. I believe that is going to be a key part of the data that we're going to be presenting is the use of those modules in those settings and the impact the modules have to actually give us an appropriate level of activity in these, as you point out, very challenging tumor environments.

Unknown speaker

Excellent. Then -- and just some kind of a last clarification. You're expecting to complete enrollment in the pivotal study by year-end '21 or [Inaudible]

Christian Itin -- Chairman and Chief Executive Officer

First half next year.

Unknown speaker

First half next year?

Christian Itin -- Chairman and Chief Executive Officer

First half next year with data at the year-end, next year.

Unknown speaker

OK. Thank you. That's what I thought. Thank you for taking my questions, and congratulations on your progress.

Christian Itin -- Chairman and Chief Executive Officer

Thanks a lot. Thanks for joining.

Operator

Your next question comes from the line with Mara Goldstein with Mizuho Securities.

Mara Goldstein -- Mizuho Securities -- Analyst

Thanks very much for taking the question. If I could just ask on the AUTO3 outpatient program, can you just talk a little bit about what the profile of that patient would look like relative to inpatient within to the content -- to the extent that you can discuss protocol on that basis? And then just also if I could drill in a little bit on the sort of go, no-go decision as well expected later in this year and the decision tree that will help you get to making that decision, if you could discuss that?

Christian Itin -- Chairman and Chief Executive Officer

Yes. Hi, Mara, thanks for joining. So in terms of the patients, the patients actually, we don't expect to look different from the patients that we've treated so far. The reason why you treat the patients in an inpatient setting with the current CAR-T programs is not because of the state the patient is in, but it is the consequences of the toxicity induced at the onset of the therapy that you're providing.

So there is not a -- and we don't expect to see a difference in the patients. And in fact, as you can imagine, with the majority of the patients treated outside of the academic centers, the patients are in a reasonable condition and can obviously normally manage -- be managed in oncology clinics and networks, et cetera, much more in the periphery of the healthcare system. So we expect the same patients, but obviously, we're treating them in a slightly different setting than what the inpatient setting is. So this is not a difference of the patients, it's a difference on the level of patient management that's required to actually get these patients safely through the therapy.

And that is what the profile of AUTO3 is actually enabling us to explore.

Mara Goldstein -- Mizuho Securities -- Analyst

OK. Thank you.

Christian Itin -- Chairman and Chief Executive Officer

And then with regards to decision points, obviously, we're going to provide an update of where we are with the program at ASCO. That gives us a very good view on the response rate level. We will have additional follow-up that we'd like to see, which gets us into -- slightly into the second half of the year that, at which point, we'll understand what the sustained CR rate looks like. And that will be the key piece of information that will inform us on the path forward.

And as you can imagine, getting the data from the outpatient cohort would also enable us to actually design a pivotal study somewhat differently, including outpatients -- an outpatient setting in the pivotal study as well, which we believe it would actually be a very important component of the pivotal program. So that data will be very informative in terms of the design of the study as well.

Mara Goldstein -- Mizuho Securities -- Analyst

OK. Thank you. I appreciate it.

See the original post here:
Autolus Therapeutics Plc (AUTL) Q1 2020 Earnings Call Transcript - The Motley Fool

Combating coronavirus: UAE announces its highest ever recoveries in a day – Khaleej Times

Dr Amna Al Dahak Al Shamsi, official spokesperson of the UAE Government, said 25 per cent of all Covid-positive patients have now recovered.

The UAE has recorded 458 Covid-19 recoveries in a single day - its highest ever. This brings the total number of recoveries in the country to 4,295.

Dr Amna Al Dahak Al Shamsi, official spokesperson of the UAE Government, said 25 per cent of all Covid-positive patients have now recovered. The UAE has 12,937 Covid-19 active cases.

The official announced 624 new infections after 33,155 more tests were carried out. She also announced 11 deaths, taking the toll to 185.

Dr Al Shamsi attributed the increase in recovery cases to the proactive measures being taken in the country. "We call on the public to cooperate with the health authorities and to continue adhering to all precautionary measures, including staying at home, social distancing protocols and wearing of face masks."

Meanwhile, on Friday, His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi and Deputy Supreme Commander of the UAE Armed Forces, ordered payment of all costs related to treatment of critical cases of coronavirus through stem-cell therapy. The initiative comes after the Abu Dhabi Stem Cell Center (ADSCC) announced development of an innovative and promising treatment for Covid-19 infections using stem cells.

ismail@khaleejtimes.com

Ismail Sebugwaawo

Read the original:
Combating coronavirus: UAE announces its highest ever recoveries in a day - Khaleej Times

Orchard Therapeutics (ORTX) Q1 2020 Earnings Call Transcript – Motley Fool

Image source: The Motley Fool.

Orchard Therapeutics(NASDAQ:ORTX)Q12020 Earnings CallMay 9, 2020, 8:30 p.m. ET

Operator

Ladies and gentlemen, thank you for standing by, and welcome to the Orchard Therapeutics First Quarter 2020 Investor Conference Call. [Operator Instructions]

I would now like to hand off the conference over to your speaker today, Renee Leck, Director of Investor Relations. Please go ahead, ma'am.

Renee T. Leck -- Director, Investor Relations

Thanks, Sonia. Good morning, everyone, and welcome to Orchard's First Quarter 2020 Investor Call. You can access the slides for today's call by going to the Investors section of our website, orchardtx.com.

Before we get started, I'd like to remind everyone that statements we make on this call will include forward-looking statements. Actual events and results could differ materially from those expressed or implied by any forward-looking statements as a result of various risk factors and uncertainties, and including those set forth in our annual 10-K filed with the SEC and any other filings we may make. In addition, any forward-looking statements made on this call represent our views only as of today and should not be relied upon as representing our views as of any subsequent date. We specifically disclaim any obligation to update or revise any forward-looking statements.

And with that, I'll turn the call over to our CEO, Bobby Gaspar.

Bobby Gaspar, M.D., Ph.D. -- Chief Executive Officer

Thanks, Renee. Hello, everyone, and welcome. I'd like to start by first acknowledging the tremendous efforts of our organization and our partners in the healthcare field to ensure patients in need continue to receive care during this difficult time. Thank you, everyone. The last few weeks have been an important period for Orchard. Since taking on the leadership, Frank and I, together with the executive team, have thought very carefully about what the new Orchard can become, how we can ensure that Orchard can fulfill its true potential and what we need to do to make that happen.

When we think about our strategic vision as a company, it's really all based on the potential of the hematopoietic stem cell gene therapy platform, where it can take us and the benefit it can provide for many patient populations even beyond our current portfolio of ultra-rare diseases. We have taken some bold and decisive actions that we believe will allow Orchard to achieve long-term growth and focus the company on sustainable value creation. This vision is supported by a new strategic plan that we have developed and which is built around four pillars. Each of these forms a chapter in our remarks this morning.

First, operating efficiencies. We have made a series of important changes to our operations that will enable us to sharpen our focus and more efficiently execute our strategy, which I will detail in a moment. Second is our commercial build. We are focused on establishing the right model for the diagnosis and treatment of patients undergoing HSC gene therapy, and see the true value of this approach over a series of ultra-rare products. Third, one of the most exciting areas in gene therapy right now is the innovation taking place in manufacturing technologies that have the potential to deliver economies of scale. We want to be leaders and invest in this space, knowing that our near-term capacity needs are covered by our experienced CDMO network.

Finally, central to this strategy is prioritizing our portfolio to enable the expansion of Orchard's pipeline beyond ultra-rare to less-rare indications. We are disclosing two new research programs for the first time today, and these are a genetic subset of frontotemporal dementia or FTD, and a genetic subset of Crohn's disease. We believe that the biological and clinical validation that has already been shown in our ultra-rare indications allow us to expand with confidence to these larger indications.

Turning to the first chapter in our new strategic plan. We are focused on improving the operational efficiency throughout the organization. This started with an extensive evaluation over the past six weeks of each program in our portfolio using several criteria that are shown here on the left-hand side of slide five. We undertook an objective analysis that involved both financial metrics and strategic considerations in identifying those programs where there was high need for patients and high-value creation for shareholders. As you can imagine, these were difficult decisions given the potentially transformative nature of many of these programs. Each has value, and we intend to realize that in different ways and over different time horizons.

Today, however, we believe our resources are best focused on Metachromatic Leukodystrophy, Wiskott-Aldrich syndrome, the MPS programs and our research programs. This also means that we have a balanced portfolio with late, mid and early stage programs. The programs I haven't mentioned such as OTL-101 and ADA-SCID and the transfusion-dependent, beta-thalassemia program, OTL-300, will have a reduced investment moving forward. We will look for alternative ways to realize value with those programs, including through partnerships.

So slide six brings together a summary of the operational changes that we've announced today. We believe these changes were important and necessary to enable Orchard to execute its mission and objectives at the highest level by matching our attention and resources to a set of core imperatives for the business. As summarized here, we expect to realize cash savings of approximately $15 million from the prioritization of our portfolio. Another $60 million in savings results from the decision to consolidate our R&D teams to one site and defer the investment in the manufacturing facility. Finally, the more staged approach to the commercial build-out and 25% reduction to our existing workforce and future headcount planning will each yield another $25 million in savings.

All of these cash savings are expected to be realized over 2020 and 2021, and result in total expected savings of $125 million over that period. With the revised plan, we now have cash runway into 2022 and no near term need to finance. It's worth briefly mentioning that this $125 million savings is after making investments in the following key areas to support our new strategy, shown on slide seven. In commercial, diagnostic and screening initiatives, including no-charge testing programs to help identify patients with MLD and other neurodegenerative conditions in time for treatment. In manufacturing, the technology, process innovations and efficiencies to drive scalability.

In R&D, initiatives in less-rare diseases that have the potential to fuel the company's future growth in a substantial way. This wasn't just an exercise to reduce expenses, but important decision-making to ensure our capital is deployed in a disciplined manner, while building a pipeline that can leverage our success across all phases of our business.

Now let me turn the call over to Frank to discuss additional key elements of the new plan.

Frank Thomas -- President and Chief Operating Officer

Thanks, Bobby, and good morning, everyone. As you can tell from this morning's press release, we have carefully examined each aspect of our business. You heard that a moment ago from Bobby, with the way we are creating operational efficiencies, and I think you will see additional evidence in the next two sections as we summarize our latest thinking around commercial deployment and manufacturing. Starting with commercial. We understand the importance of developing a commercial model that will demonstrate our ability to execute and bring these therapies to the market successfully. This model and the infrastructure that we build will also be leveraged for any future product launches.

As you'll note from the bottom of slide nine, each rare disease has certain dynamics that will impact the launch trajectory and speed with which we can penetrate the market. In fact, we anticipate our first two potential launches in WAS and MLD having distinct but complementary launch curves, as you can see from the illustrative diagrams. Let me start with MLD on the left, where we expect to launch first in the EU, followed by the U.S. and then other countries around the world. We think an important inflection point on the revenue curve with MLD will come later when newborn screening is established, providing an opportunity for an acceleration in growth rate. Disease progression is a second important dynamic that will affect market penetration. Because MLD advances so rapidly, it will be important to diagnose patients early and get them treated.

For Wiskott-Aldrich syndrome, the dynamics are very different, and it's reflected in the shape of the curve on the right. Unlike MLD, this disease is slower progressing and more readily diagnosed. We believe that WAS will provide an opportunity to treat a number of prevalent patients from the outset and also give us additional long-term revenue stream. This program, the BLA and MAA filings are on track for 2021. Turning back to MLD for an update on the regulatory time line. We are on track to get a decision from the European Medicines Agency later this year, and if approved, launch in the EU in the first half of 2021.

In the U.S., we recently engaged with the FDA on our planned BLA submission of OTL-200 for the treatment of MLD. The FDA has provided written feedback on the sufficiency of the company's data package, including the clinical endpoint, the natural history comparator and the CMC data package. As a result of this feedback, we intend to file an IND later this year and also seek RMAT designation, both of which we believe will facilitate a more comprehensive dialogue to discuss the data more fully and resolve the open matters before submitting a BLA. We are committed to working closely with the agency, and we'll provide updated guidance on the new filing time lines for the BLA after further regulatory interaction.

On slide 10, you can see that we're tracking nicely for the launch of OTL-200 in the EU in the first half of 2021, if approved, with Germany being the first country where we expect to treat commercial patients. Many of the prelaunch activities are under way, and the team has been able to keep up momentum during the pandemic to work with key centers and progress with site qualifications. We intend to set up a network of treatment centers where MLD patients are often referred and who also have transplant expertise. These same centers can be leveraged in future launches, especially for programs in the neurometabolic franchise.

I previously mentioned the importance of diagnosis in MLD to identify patients at early stages of disease, and we are taking the necessary steps to achieve long-term success. Beyond typical disease awareness efforts, we are also looking at initiatives such as no-charge diagnostic testing with partners such as Invitae, and we are looking to facilitate newborn screening for MLD with funding of upcoming pilots in New York State and Italy that are designed to validate the assay and provide the data for wider implementation. Success in these key initiatives will support early MLD patient identification.

Coming up quickly behind MLD and the neurometabolic franchise, our two proof-of-concept programs in MPS disorders, where we have made recent progress even during this challenging period with COVID-19. For MPS-I, over the past year, we've shown promising preliminary proof-of-concept data with positive engraftment, biomarker correction and encouraging early clinical outcomes, and we are excited to announce our plan to begin a registrational trial next year, bringing this program one step closer to commercialization.

For MPS-IIIA, we announced late last month that the first patient was treated in a proof-of-concept trial at Royal Manchester Children's Hospital, with enrollment planned to continue this year and interim data to be released in 2021. You can see graphically on slide 12 how the aggregation of these commercial markets lead to sustainable revenue growth. In addition, the infrastructure build is designed to provide the necessary commercial capabilities to realize the potential of the portfolio. On this slide, we've included the incidence figures for MLD and the incidence and prevalence figures for WAS to help you understand each opportunity as we see it today.

Given the dynamics at play for MLD that I described on slide nine, we believe this opportunity should largely be tied to the incident patient population, which we believe ranges from 200 to 600 patients per year in countries where rare diseases are often reimbursed. We've taken a more conservative view than previously on the addressable patient and market opportunity in countries such as those in the Middle East and Turkey, where the literature has a wide range of differing incident figures. Also, over time, with improved disease awareness, there may be prevalent patients identified who also could benefit from therapy. Our commercial strategy has always been and continues to be based not only on one product, but rather the aggregation of multiple potential products launching off one HSC gene therapy platform and infrastructure.

Turning to manufacturing. We've also made some key changes to our approach in manufacturing and how we allocate capital in the short and mid-term. On slide 14, you'll see the main tenets of our new manufacturing strategy. First, in the near term, we plan to focus on innovative technologies to enable commercial scalability.

Second, to ensure the appropriate focus on those technologies, we've made a decision to consolidate R&D to a single site in London, which brings together our organization in a more efficient way. This will allow efforts made to improve our manufacturing processes to be quickly and easily shared and then scaled commercially to transfer to our third party manufacturers, all of whom are currently located in Europe. As part of this consolidation, we will close our California site, including the termination of the Fremont project and associated capital spend.

Third, we have strong relationships with CDMOs that will ensure supply of clinical and commercial product to satisfy near-term requirements. And longer term, we intend to identify a new site in the U.S. to eventually bring manufacturing capabilities in-house with a facility that is appropriately sized and fitted for future techniques and operations.

Slide 15 shows the three phases of our approach in manufacturing: invest, partner and build. Today, we are investing, and we'll continue to invest in technologies such as transduction enhancers, stable producer cell line and closed automated processing of the drug product. This will potentially reduce the amount of vector needed, drive down COGS and potentially change the way products are manufactured, making it less labor-intensive, less expensive and more consistent. In the near and mid-term, we will continue to rely on our manufacturing partners for the early planned launches in MLD and WAS. For example, MolMed has been with these programs since the beginning, and they've been a reliable commercial partner with Strimvelis.

In addition to our existing CDMO network, we have begun to search for a drug product partner in the U.S. to complete a tech transfer and serve the U.S. market, thereby reducing scheduling challenges and creating some redundancy. And finally, over time, we plan to build in-house manufacturing capabilities closer to when there is a need for additional capacity. This enables us to explore options that are more aligned with our business in terms of scale and timing.

And with that, I'll turn the call back over to Bobby.

Bobby Gaspar, M.D., Ph.D. -- Chief Executive Officer

Thanks, Frank. In this section, I'm going to briefly highlight the potential of HSC gene therapy to correct not only blood lineage cells, but also how through natural mechanisms, specific cell types may allow correction of disease in specific organ systems and enable expansion of our portfolio into new research indications. As many of you know, and as shown on slide 17, through HSC gene therapy, we are able to insert a working copy of the gene permanently into the genome of HSCs, and these genetically modified cells can lead to multiple corrected cell types in the bloodstream, including immune cells, red blood cells and platelets.

In addition, HSCs can differentiate into cells of the monocyte macrophage lineage that naturally migrate into various organ systems, and thus gives us an opportunity to deliver genes and proteins directly to those organs, including the brain and the GI tract. Within the neurometabolic space, in particular, we have understood through our preclinical and clinical programs in MLD, MPS-I and MPS-IIIA how HSC gene therapy can deliver genes and proteins to the CNS to correct neurodegeneration. Here is an example of this natural mechanism at work in slide 18.

Data shows that there are a population of gene-modified HSCs that can naturally cross the blood-brain barrier, distribute throughout the brain, engraft as microglia and express enzyme that is taken up by neurons. We have seen this approach results in clinical benefits for patients with MLD, and we are also using the same approach for MPS-I and MPS-IIIA. Beyond this, we see that the HSC gene therapy approach could be used to deliver specific genes and proteins for other larger neurodegenerative conditions which have high unmet need.

One of the conditions we are disclosing today, and shown on slide 19, is a specific genetic subset of frontotemporal dementia, where the underlying pathogenesis has a number of parallels with the neurometabolic conditions that we are already addressing. This program involves a broad strategic alliance with Dr. Alessandra Biffi, Boston Children's Hospital and Padua University in Italy, to further explore the potential of ex vivo HSC gene therapy in neurometabolic and neurodegenerative conditions. In other organ systems, such as the GI tract, there are similar mechanisms at work which are illustrated on slide 20. Tissue resident macrophages in the gut wall are required to respond to bacterial invasion from the gut lumen and prevent infection. In certain disorders, such as X-linked chronic granulomatous disease or XCGD, defects in macrophage function results in an abnormal immune response and severe colitis.

Moving on to slide 21. We have already seen in our XCGD program the modification of HSCs and migration of gene-modified cells into the gut can lead to resolution of colitis through presumed reconstitution of the immune response. Certain subsets of Crohn's disease are also associated with mutations in genes that affect the response of macrophages to infection, and so our clinical observations that HSC gene therapy for XCGD suggest that the same approach may be applicable to this genetic subset of Crohn's disease. This preclinical work is ongoing in our Orchard research laboratories.

As we advance our work in FTD and Crohn's disease, and assuming we show preclinical proof-of-concept, these will become exciting opportunities for us to expand and address larger patient populations, either alone or in partnership. We believe we have truly just begun to explore the potential for HSC gene therapy in diseases such as these and others, and are excited to share more about the preclinical development of these programs later this year.

So to summarize our path forward on slide 22, the next 12 to 18 months offers many important milestones as we continue our evolution to a commercial stage company and advance our next wave of clinical stage therapies. We anticipate approval and launch of OTL-200 for MLD in the EU, additional regulatory filings in Wiskott-Aldrich syndrome and MLD, a new registrational study next year in MPS-I, multiple clinical data readouts from our neurometabolic franchise and further detail and progress on our research programs in FTD and Crohn's disease.

To wrap up our prepared remarks, we are confident that our new strategic plan and operational decisions announced today will set us on the right path to achieve long-term growth, build sustainable value and serve an even larger number of patients who could benefit from hematopoietic stem cell gene therapy.

Thank you very much. And now we'll use the rest of the time to answer your questions. So let's have the operator open up the line.

Operator

Thank you. [Operator Instructions] And our first question comes from Whitney Ijem from Guggenheim. Your line is now open. Please go ahead.

Whitney Ijem -- Guggenheim -- Analyst

Hey guys, thanks for the question. So first, just wondering, can you give us some more color maybe on the discussions you're having with the FDA in MLD? Kind of what are they looking for? And I guess is the IND just sort of a tool to get RMAT? Or is there additional kind of clinical work you plan you think you'll need to do?

Bobby Gaspar, M.D., Ph.D. -- Chief Executive Officer

Hi. Whitney, Bobby here. Thanks for that. In general, we can't go into all of the details, obviously, of the discussions with the FDA. But I think in the release and in the script, we've talked about the fact that they've commented on certain endpoints, the natural history, the CMC package, etc. Now I think I'd just like to say this is a and obviously, a very complex disease, a very ultra-rare population, we have extensive data set, and we have already filed with the EMA. Now for historical reasons, there hasn't been an IND in the U.S., and so we haven't had the opportunity to discuss that data in full with the FDA.

What I can say is that we do have an extensive body of data. We want to be able to talk to the FDA and have a comprehensive dialogue to be able to explain that full data set. We feel confident that we have the endpoints that they are looking for and the data that they are asking for. But we need to have that conversation with them in order to be explain to be able to do that fully. So that's why we're filing an IND filing, filing the RMAT, so we can have that dialogue. And once we can clarify those issues, then we can go ahead with submission of the BLA.

Whitney Ijem -- Guggenheim -- Analyst

Okay. Got it. And then just one quick follow-up on MLD. Can you remind us where you are with newborn screening, I guess, both in Europe and then in the U.S.?

Bobby Gaspar, M.D., Ph.D. -- Chief Executive Officer

Yes, sure. So newborn screening for MLD, I think, is an important, a very important issue, because, obviously, that means that we'll be able to get earlier diagnosis and have more patients be able to access therapy. So it's a very important part of our kind of diagnostic initiatives in this disease. What we have so far is that we have worked with a key scientist, where an assay has been developed, that's been published to show that there is an assay that we've done on a dry blood spot to understand the decrease in the enzyme activity and also the increase in the sulfur-type levels.

And that assay is now going to be put into pilots, and we are funding a pilot in New York State, and that will start later this year. And we're also looking at pilots in other states as well. We're also transferring that assay to Italy and that and we're funding a program in Tuscany and in Italy where that will be rolled out. And we're also looking for opportunities in other EU states as well. So I'd say, there are already two that are going to start, we are looking to fund other pilots as well.

And together, that data will allow us to validate the assay but also allow wider implementation of newborn screening, and also for nomination, for example, onto the WAS panel for implementation in states in the U.S. So I say there's a lot of work going on in order to make sure that happens.

Whitney Ijem -- Guggenheim -- Analyst

Great, thanks.

Bobby Gaspar, M.D., Ph.D. -- Chief Executive Officer

Thank you.

Operator

And your next question comes from Esther Rajavelu from Oppenheimer. Your line is now open. Please go ahead.

Esther Rajavelu -- Oppenheimer -- Analyst

Hey guys. Congrats on all the changes. I guess, my first question again on MLD is I'm trying to understand the duration between EU approval and NBS. I don't know if that math or if that graph was drawn to scale, but it looks like it's almost a four-year lag from first approval to newborn screening. Can you help us understand the time line there?

Frank Thomas -- President and Chief Operating Officer

You mean between EU and U.S. or around newborn screening or both?

Esther Rajavelu -- Oppenheimer -- Analyst

Around newborn screening, generally, between EU approval and newborn screening.

Frank Thomas -- President and Chief Operating Officer

Yes, sure. As Bobby mentioned, there's a pretty active program planned around newborn screening that I think we will expect will come over time in order to even apply for the Ross Panel, there are certain requirements that need to be met in terms of the number of patients or a number of children that have to be screened, identifying the positive patients and then you can apply on the Ross Panel. And then from there, there's a process that you go through in the U.S., at least, on a state-by-state basis to get it added.

So I think there are a number of steps along the way. We haven't guided specifically on the time line, but I think there are other precedents out there that suggest that this could take years. Once we screen the once we apply for the Ross Panel to get sort of full reimbursement, but obviously, we'll focus on states initially after that approval that have the largest populations.

Esther Rajavelu -- Oppenheimer -- Analyst

And my Yes, go ahead.

Bobby Gaspar, M.D., Ph.D. -- Chief Executive Officer

Esther for I was just going to say for the EU, obviously, we're looking for approval for MLD later this year. As far as people screening in the EU is concerned, that's on a country-by-country basis, and sometimes it's even certain states. But I've worked on newborn screening for SCID, for example, in the EU. And now there are numerous countries in the EU that are screening for SCID with a number of pilots also in the pipeline as well. And so with that kind of experience, and we would be looking to kind of really facilitate that uptake in the EU and as in and in the U.S., as Frank has already mentioned.

Esther Rajavelu -- Oppenheimer -- Analyst

Understood. And then the decision to defer capex, is that related to some of the time lines for U.S. versus EU approvals and the newborn screening? Or what really kind of went into that delay, given you already have some cost into that facility?

Frank Thomas -- President and Chief Operating Officer

Yes. I can start, and Bobby can add on that again. I think, obviously, we continue to believe in-house manufacturing is an important capability that we're going to want to have over some period of time. It really comes down to sort of when is the need for that capacity and capability relative to the various programs we have. Working with the CDMOs that we have today, we know that we have capacity for the MLD and WAS launches and for a period beyond the launch. So there's not an imminent need to secure the capacity today, and we think that deferring it makes the most sense. We'll continue to work with CDMOs on those launches.

We will look at bringing on a U.S. supplier for drug product to be able to more easily service the U.S. market. And then longer term, look at, potentially, in-house manufacturing at a site and location that we think is more fitted to what the capacity needs will be. So I wouldn't say it's tied to any sort of launch time lines because the plan always was to utilize CDMOs for WAS and MLD. But certainly, as those launches roll out and demand grows, our capacity needs will grow and that will be the appropriate time, we think, to make the investment.

Esther Rajavelu -- Oppenheimer -- Analyst

Understood. Thank you very much.

Bobby Gaspar, M.D., Ph.D. -- Chief Executive Officer

Thank you.

Operator

And your next question comes from Anupam Rama from JPMorgan. Your line is now open. Please go ahead.

Tessa Romero -- JPMorgan -- Analyst

Good morning, guys. This is Tessa on the call this morning for Anupam. You pointed out that updated interim data from the proof-of-concept trial for OTL-203 and MPS-I is expected at ASGCT upcoming here next week. Can you remind us of what will be the size and scope of data that we will see at the conference? And maybe can you just clarify if there is any other newly updated clinical data we should be thinking about for other programs at ASGCT?

Bobby Gaspar, M.D., Ph.D. -- Chief Executive Officer

Okay, fine. Bobby here, and I'll take this question. On MPS-I, so just to remind you, the proof-of-concept study has enrolled all eight patients, so that's been fully recruited into. What we've shared with you previously is biochemical data showing the overexpression of IDUA activity, the decrease in the heparan and dermatan sulfate, the engraftment of gene-modified cells and some early clinical data on patients who have got beyond the one-year time frame after gene therapy. There was only previously one patient who had reached that time point.

So there's been further follow-up on those eight patients. We'll be able to show you longer-term engraftment of the gene-modified cells, more consistent overexpression of enzymatic activity, longer follow-up, decrease in GAG levels and also more clinical data on patients who have got to longer endpoints as well. So we'll be able to show data assay on clinical data on patients after longer follow-up. And this will be both on their cognitive outcome, but we also will have data on, for example, growth parameters as well, which is again a big issue in MPS-I. So that is for MPS-I.

We will also be sharing data on OTL-101 as well for ADA-SCID. There will be further follow-up on patients who have undergone treatment for transfusion-dependent beta-thalassemia, so longer follow-up on the patients who have been treated so far. So there's really quite, as well as other programs. So there's really quite an extensive body of data, and it just showcases the potential of Orchard's platform across a number of different diseases and how HSC gene therapy can correct the underlying defects in immune deficiencies, neurometabolic deficiencies and hemoglobin opportunities as well. And obviously, we'll give you more detail on those different abstracts next week.

Tessa Romero -- JPMorgan -- Analyst

Great, thank you.

Bobby Gaspar, M.D., Ph.D. -- Chief Executive Officer

Thank you.

Operator

Read more:
Orchard Therapeutics (ORTX) Q1 2020 Earnings Call Transcript - Motley Fool

Edited Transcript of FLXN earnings conference call or presentation 7-May-20 8:30pm GMT – Yahoo Finance

BURLINGTON May 8, 2020 (Thomson StreetEvents) -- Edited Transcript of Flexion Therapeutics Inc earnings conference call or presentation Thursday, May 7, 2020 at 8:30:00pm GMT

* David A. Arkowitz

Flexion Therapeutics, Inc. - CFO

Flexion Therapeutics, Inc. - Chief Commercial Officer

* Michael D. Clayman

Flexion Therapeutics, Inc. - Co-Founder, President, CEO & Director

Flexion Therapeutics, Inc. - VP of Corporate Communications & IR

* Randall S. Stanicky

RBC Capital Markets, Research Division - MD of Global Equity Research & Lead Analyst

Scott Young, Flexion Therapeutics, Inc. - VP of Corporate Communications & IR [1]

Good afternoon. This is Scott Young, Vice President of Corporate Communications and Investor Relations.

Before we begin, I'd call your attention to the metrics slides that we will discuss in today's presentation. Those slides can be viewed directly via the webcast or under the Investors tab on flexiontherapeutics.com. In addition, the press release we issued this afternoon and an archive of this conference call can also be found there.

Today's conference call will be led by Flexion's Chief Executive Officer, Dr. Michael Clayman; and he is joined by David Arkowitz, Chief Financial Officer; and Melissa Layman, Chief Commercial Officer.

On today's call, we will be making forward-looking statements that include commercial, financial, clinical and regulatory projections. Statements relating to future financial or business performance, conditions or strategies and other business matters, including expectations regarding net sales, operating expenses, cash utilization, clinical, regulatory and commercial developments and anticipated milestones are forward-looking statements within the meaning of the Private Securities Litigation Reform Act. Flexion cautions that these forward-looking statements are subject to various assumptions, risks and uncertainties which change over time. Additional information on the factors and risks that could affect Flexion's business, financial conditions and results of operations are contained in Flexion's Form 10-Q for the quarter ended March 31, 2020, filed with the SEC today and other filings which are available at http://www.sec.gov as well as Flexion's website. These forward-looking statements speak only as of the date of this call and Flexion assumes no duty to update such statements.

I will now turn the call over to Flexion's CEO, Mike Clayman.

Michael D. Clayman, Flexion Therapeutics, Inc. - Co-Founder, President, CEO & Director [2]

Thank you, Scott, and thank you all for joining us today.

It is clear that in the only 8 weeks since our fourth quarter earnings call, the world has changed dramatically as a result of COVID-19. On today's call, we'll talk about what we've been seeing in doing both commercially and operationally during the unprecedented public health crisis, but we'll begin with a focus on our first quarter performance and provide color on why we remain enthusiastically bullish about ZILRETTA's future.

Today, we reported net ZILRETTA sales of $20.1 million for the first quarter of 2020. We had previously indicated that we believed our Q1 sales would be roughly flat versus Q4 sales of $23.7 million, and we were on track to deliver sales in this range prior to the COVID-19 outbreak. We also said that at that point, it was simply impossible to predict how the outbreak would evolve or what the effects of more aggressive social distancing or other containment efforts might have on patients or practices. Since then, the picture has become much clearer, and we can speak now to the effects of the pandemic on ZILRETTA sales and later in the call, on our development activities.

Beginning in late Q1, we saw most practices substantially reduce patient visits or even suspend these altogether. And as a result, utilization of ZILRETTA dropped significantly. We believe it will take time to get to the new normal and the cadence of the recovery will vary practice by practice, region by region and even person by person. Thus far, we have seen decreased demand for ZILRETTA in the second quarter and believe COVID-19 will adversely impact ZILRETTA revenue for the remainder of the year.

That said, we do take note of a number of external circumstances that have the potential to increase demand for ZILRETTA over time. These all relate to the delay, postponement or cancellation of total knee arthroplasties or TKAs, and the intense medical need to provide rapid, substantial, durable non-opioid analgesia for patients whose knee pain drove them to consider TKA in the first place. Three factors contribute to this dynamic and these were all brought to our attention by orthopedic key opinion leaders.

First, while elective surgeries are beginning to happen around the country, in most cases, there will be a gradual return to full capacity, and many TKAs will be further delayed. Second, particularly for those of Medicare age, who are all considered in the vulnerable COVID-19 population, there may be reluctance to enter a hospital to have surgery until these patients have greater confidence they can avoid infectious risk. Finally, for those who are younger than 65 and were previously employed, many may prioritize income generation over surgery and rehab.

Recent survey data indicate that almost 50% of orthopedic surgeons expect that procedure volume will not be back to normal until some time in 2021 and 63% expect anywhere between 25% and 75% of their patients will continue to delay their surgery for fear of COVID-19.

Of course, Flexion is adapting, too. Since instructing our employees to work from home in mid-March, our MBMs have adopted various technologies to engage in meaningful conversations with prescribing physicians. Melissa can provide more color on what we are seeing in the field, but since health care practitioners have more time on their hands, our MBMs have experienced greater access to prescribers who have historically been very difficult to see, and their response to the ZILRETTA clinical data has been highly encouraging. And even with COVID-19, we continue to hear stories of patients who have received unprecedented OA knee pain relief from ZILRETTA.

The bottom line is that our confidence in ZILRETTA's clinical performance and long-term potential is undiminished. We are not the only company to believe that ZILRETTA holds tremendous potential for millions of patients with OA knee pain. In April, in the midst of the pandemic, we announced that we entered into an exclusive license agreement with HK Tainuo and Jiangsu Tainuo, a subsidiary of CSPC, a leading Chinese biopharmaceutical company. Under the terms of the agreement, we are entitled to receive an upfront payment of $10 million and up to $32.5 million in development, regulatory and commercial sales milestone payments. And Flexion will be solely responsible for the manufacturing and supply of ZILRETTA for all clinical and commercial activities.

While our confidence in ZILRETTA is resolute, it is impossible for us to predict how long the pandemic will affect sales. And as we announced in our press release this afternoon, we have taken meaningful actions to reduce our operating expenses in the near term. David will discuss these steps in more detail, but we are committed to ensuring that we come out of the pandemic in a strong financial position.

Regarding clinical development, recognizing that many clinical trial sites had shut down, wanting to ensure the safety of our research participants and in consideration of guidance issued by the FDA, in early April we announced that we would temporarily suspend our Phase II clinical trial evaluating the efficacy of ZILRETTA in patients with shoulder OA or adhesive capsulitis and also our Phase I clinical trial evaluating the safety and tolerability of FX201, our intra-articular gene therapy candidate for OA.

Subsequently, we made the strategic decision to discontinue our Phase II trial investigating ZILRETTA in shoulder OA and in adhesive capsulitis. Given the small number of patients enrolled in that trial, the uncertainty of when we would be able to restart it, as well as the costs required to maintain the study in an inactive status, we believe terminating the trial is the most responsible action at this time. Moving forward, we will look to leverage our learnings from the study and potentially use these to refine the trial design to advance ZILRETTA in these indications.

We also aim to reinitiate the FX201 single ascending dose trial and recommence enrollment when conditions and staffing at our trial sites safely permit the return of patients.

Turning to FX301, our NaV1.7 inhibitor formulated within a thermosensitive hydrogel for administration as a peripheral nerve block for controlled postoperative pain, we continue to advance this product candidate. FX301 is a liquid at room temperature and gels following injection at body temperature to create a controlled release depot that can provide persistent therapeutic concentrations of drug locally at the selected nerve. We recently unveiled new preclinical data in a virtual poster presentation now available on the American Society of Regional Anesthesia and Acute Pain Medicine website. These data show that compared to liposomal bupivacaine and placebo, FX301 provided sustained postoperative analgesic effect with no impairment in motor function. In addition, high local concentrations of funapide, the active ingredient in FX301, were measured at the site of administration for the duration of the study, consistent with the creation of the depot providing controlled drug release.

While it is still early days for the program, these findings support our belief that unlike typical local anesthetics, the selective pharmacology of FX301 has the potential to deliver substantial and persistent pain relief while preserving motor function which could enable earlier rehabilitation following musculoskeletal surgery and potentially more rapid discharge from the hospital. We are completing GLP tox studies for FX301, and we remain on track to initiate clinical trials in 2021.

Before I turn it over to Melissa, I would like to make just a few final comments. While there are many uncertainties about the shape and pace of the recovery, there are some key facts we know right now. We know that there are millions of patients for whom ZILRETTA can provide substantial and extended relief from OA knee pain. We know that at least many tens of thousands of elective knee replacements have been deferred due to COVID-19 and those patients will need effective pain relief while they wait for surgery. We know that our commercial organization is poised for the recovery at whatever pace or shape it takes. Finally, we know that everyone at Flexion stands ready to adapt to any circumstances we face, and we remain confident in our future prospects.

At this point, I would like to turn it over to Melissa to discuss our commercial operations.

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Melissa Layman, Flexion Therapeutics, Inc. - Chief Commercial Officer [3]

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Thank you, Mike.

I've been with Flexion now for just under 2 months, my first day marked by our Q4 earnings call and my second day by the work-from-home directive resulting from the rise of the COVID-19 pandemic. Despite having yet to set foot in the field, I've met virtually with dozens of physicians and members of our sales organization. Each of these meetings has only confirmed what I believed about ZILRETTA before joining the team and bolstered my perceptions of the Flexion organization, particularly in light of our response to COVID-19 and the enhanced role I know ZILRETTA can play in effective, durable pain management for patients all along the OA knee pain treatment continuum.

Mike discussed some of what we have experienced in the field during recent weeks. I'll provide some additional color on how we've been engaging with prescribers during the crisis and how we plan to emerge from the crisis, restore ZILRETTA's prior sales trajectory and continue to grow from there. Before I talk about what we are seeing now, I'd like to start by walking through the commercial metrics for the first quarter.

As Mike mentioned, we were pleased with the way the first quarter was progressing prior to the onset of COVID-19 and believe ZILRETTA was tracking to meet our expectations. You can see in Slide 2 that we recorded ZILRETTA net sales of $20.1 million, reflecting the pandemic's material impact on March sales. We expanded our list of target accounts in the fourth quarter to 5,000 and by March 31, 2020, our reach had extended to almost all of them. And by the end of the first quarter, 3,672 accounts had purchased ZILRETTA, which was an increase of 184 purchasing accounts compared to the fourth quarter of 2019. As of the end of March, 2,832 or 77% of accounts had reordered ZILRETTA. Notably, this increase in purchasers occurred off a customer base that continued to grow even in light of the pandemic.

On Slide 3, you can see how our sales have progressed since launch. And as we've mentioned, we were pleased with the performance in the first part of Q1 prior to the onset of COVID-19, when we were on track to deliver sales in line with fourth quarter of last year, consistent with our previous guidance.

The next 3 slides reflect ZILRETTA purchasing patterns across our growing account base comprised of practices, clinics and hospitals of various sizes and potential.

Slide 4 describes the cumulative number of accounts that have purchased ZILRETTA since launch as well as the distribution of quarterly purchase volumes across our account base. In Q1, the trend continued with a growing number of accounts purchasing within and across the purchase break of 1 to 10 units, 11 to 50 units and 51 or more units with significant growth to 916 accounts in the 51-plus category.

Slide 5 flips the perspective, looking at the cumulative distribution of ZILRETTA purchases by accounts. For example, those 916 accounts in the 51-plus purchase group shown on the previous slide have been responsible for 177,664 of the total units purchased since launch and roughly 35,000 more units than were purchased from this purchase volume group in Q4 2019. This clearly illustrates that purchasing accounts continue to move through the ZILRETTA utilization continuum described on previous calls.

As we've also previously highlighted, even our largest accounts remain underpenetrated, and we continue to believe that there is tremendous opportunity to increase ZILRETTA utilization within and across each of these groups.

It is also important to point out that while total ZILRETTA purchases in the first quarter were approximately 36,500 units, which is slightly lower than the 37,500 units purchased in the fourth quarter, through the middle of March, we were pleased with our progress and believe we were well on track to meet or exceed the fourth quarter purchase volume until the effects of COVID-19 began to impact our business and ZILRETTA purchases dropped precipitously.

In our final slide, #6, we break out ZILRETTA purchasing by new and existing accounts. In Q1, new accounts purchased 12,504 units, which further illustrates our strong start to 2020 prior to the onset of COVID-19 across the U.S.

As Mike mentioned, COVID-19 has had significant impact on our customers. Throughout the COVID-19 impacted window, overall clinician access to ZILRETTA-eligible patients has been limited, variable and practice dependent. Some practices have shut down in-person patient visits altogether, while others are open to high priority critical or acute cases while implementing social distancing measures. While the circumstances vary, one common denominator has been the presence and tenacity of our sales force. While not a replacement for in-person exchanges, our reps have been successful in targeted remote detailing, in some cases gaining access to prescribers that exceeds pre-COVID-19 levels. They have effectively employed various audiovisual technologies to engage with both existing and new accounts to discuss the important role ZILRETTA can play in the OA treatment paradigm, including for those patients who are awaiting or opt to decline surgery once COVID-19 restrictions are lifted.

To better understand the current impact of COVID-19 on orthopedic practice and what the recovery might look like, we held a series of focus groups with specialists from across the nation. The insight from those exchanges support our assumptions that the return to new normalized practice patient flow will be gradual and driven by ongoing social distancing requirements and safety requirements as well as patients' comfort in returning to their doctors' offices. However, we also see the potential for increased use of ZILRETTA in a wider variety of patient types as both existing and new prescribers look to manage the growing backlog of surgical candidates, including those previously scheduled for TKR who, for various COVID-19-related reasons, choose to defer treatment in favor of less invasive options like ZILRETTA.

As Mike aptly described, we cannot predict the timing or shape of the recovery. But as it occurs, our commercial team will be there to support prescribers and ensure they understand the even more important role ZILRETTA can play in effectively managing their patients' OA knee pain prior to or in avoidance of surgery.

With that, I'll now turn it over to David for the financial update.

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David A. Arkowitz, Flexion Therapeutics, Inc. - CFO [4]

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Thank you, Melissa.

Before I provide an overview of our financial performance in the first quarter, I'd like to share some details on our fiscal response to the economic and business disruption caused by COVID-19.

As Mike mentioned and as we described in our first quarter earnings press release, we undertook a series of prudent and disciplined steps to reduce expenses across the organization in order to enhance our financial flexibility and liquidity. In total, we believe these steps will deliver between $43 million and $53 million in savings this year. As a result, our full year 2020 total operating expenses, which include the cost of sales, research and development, and selling, general and administrative expenses, are expected to be in the range of $167 million to $177 million.

We undertook cost savings initiatives across every area of the business, but the majority of the savings will be realized through the following: hiring and travel freezes, suspension and/or termination of active clinical trials, elimination of live presence at medical and industry conferences, reductions in in-person physician speaker programs and reductions in market research and select marketing programs and materials as well as elimination of nonessential operating expenses.

In addition, given the impact of COVID-19 and the uncertainty surrounding ZILRETTA sales for the remainder of this year, we are temporarily suspending manufacturing activities for ZILRETTA to avoid excessive inventory buildup and to reduce costs. We believe our current inventory of finished goods will be sufficient to meet demand for ZILRETTA through at least the remainder of this year. And unlike typical contract manufacturing agreements, our condominium model at Patheon provides us with the ability to scale up production based on market dynamics. And once we determine that additional supply will be needed, we can reinitiate manufacturing.

With respect to our first quarter financial performance, we reported a net loss of $36.8 million for the first quarter of 2020 compared to a net loss of $41.5 million for the same period of 2019.

Net sales of ZILRETTA were $20.1 million and $10.6 million for the 3 months ended March 31, 2020 and 2019, respectively. Cost of sales were $2.3 million and $1.8 million for the 3 months ended March 31, 2020 and 2019, respectively. The first quarter 2020 net sales reflect a gross to net reduction of 11%. The gross to net reduction is primarily comprised of distributor and service fees, returns reserve, health care provider rebates and mandatory government discounts and rebates, such as Medicaid, 340B institutions, Veterans Administration and Department of Defense. The rebates to health care providers are variable based on the volume of product purchased and contribute 2% of the first quarter total gross to net reduction of 11%.

As Melissa mentioned, starting in the middle of March, purchases of ZILRETTA by accounts, meaning physician practices, clinics and hospitals, dropped materially due to COVID-19. As a result, the inventory levels held by our distributors at the end of the first quarter were higher than our target level of 1 to 3 weeks. While purchases of ZILRETTA by accounts continue at a decreased rate, it will take time for our distributors to work through their current inventory. Since we recognize revenue upon sales to our distributors, a combination of reduced purchases in the second quarter by account and higher-than-normal distributor inventory levels have the potential to particularly impact our second quarter revenue negatively.

Research and development expenses were $21.1 million and $15.4 million for the 3 months ended March 31, 2020 and 2019, respectively. The increase in research and development expenses of $5.7 million was primarily due to an increase of $2.2 million in salary and other employee-related costs for additional headcount and stock compensation expense; an increase in expenses related to FX201, including the $2.5 million milestone to GeneQuine for dosing the first human patient in the Phase I clinical trial; and an increase in other portfolio expenses primarily related to a $0.5 million milestone to Xenon Pharmaceuticals, offset by a decrease of $0.5 million in development expenses for ZILRETTA due to lower clinical trial expenses during the period.

Selling, general and administrative expenses were $29.3 million and $32.2 million for the 3 months ended March 31, 2020 and 2019, respectively. Selling expenses were $20.5 million and $23.8 million for the 3 months ended March 31, 2020 and 2019, respectively. The year-over-year decrease in selling expenses of $3.3 million was primarily due to a reduction in physician and patient marketing activities. General and administrative expenses were $8.8 million and $8.4 million for the 3 months ended March 31, 2020 and 2019, respectively, which represents an increase of $0.4 million.

Interest expense was $0.4 million and $1 million for the 3 months ended March 31, 2020 and 2019, respectively. Interest expense was $4.7 million and $3.9 million for the 3 months ended March 31, 2020 and 2019, respectively.

As of March 31, 2020, we had approximately $125.2 million in cash, cash equivalents and marketable securities compared with $136.7 million as of December 31, 2019.

At this point in time, we cannot forecast with any precision the duration of the pandemic or its full impact on purchasing patterns or utilization of ZILRETTA. Therefore, it would be imprudent for us to provide specific guidance with respect to our future sales of ZILRETTA or our cash runway. We will continue to review and reassess our assumptions and provide additional color when possible. As Mike mentioned, our confidence in ZILRETTA is as strong as ever, and we will take the steps necessary to ensure we are well positioned from a financial perspective to maximize ZILRETTA's value in a post-COVID-19 environment.

At this point, I would ask the operator to please open the line for questions.

================================================================================

Questions and Answers

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Operator [1]

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(Operator Instructions) Our first question or comment comes from the line of Randall Stanicky from RBC Capital Markets.

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Randall S. Stanicky, RBC Capital Markets, Research Division - MD of Global Equity Research & Lead Analyst [2]

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Great. Do you have a sense from any of the regions or the large practices that have reopened as to what their ordering patterns look like? Because presumably, that would give you a sense for at least physician or practice thinking around any pent-up demand and then where they intend to focus on from a procedure perspective kind of channel inventory aside. And then I have a follow-up.

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Michael D. Clayman, Flexion Therapeutics, Inc. - Co-Founder, President, CEO & Director [3]

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Melissa, do you want to take that?

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Melissa Layman, Flexion Therapeutics, Inc. - Chief Commercial Officer [4]

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Yes. I think that's me. We have been sort of following the basis for which practices have been reopening and it is not geographically specific. We believe that the return to normal patient volume is going to vary by region, by practice and even by patient. And the impact to existing office-based patient flow that we've seen don't necessarily correlate to the areas where COVID-19 has been more prevalent.

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Michael D. Clayman, Flexion Therapeutics, Inc. - Co-Founder, President, CEO & Director [5]

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And just building on Melissa. I mean, Randall, I just think it's too early for us to declare that we're seeing patterns. We're seeing some accounts order substantial quantities, other accounts ordering lesser amounts, but it's far from us having an update and then say, we have clarity on ordering pattern.

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Randall S. Stanicky, RBC Capital Markets, Research Division - MD of Global Equity Research & Lead Analyst [6]

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Let me ask a follow-up. I mean, during this shutdown period, which in some regions, regions like New York is probably going to continue, have you guys been able to alter your outreach via DTC? I mean, you have captive patients who are homebound, who are probably in pain, maybe thinking about the timing of elective surgeries. Have you figured out a way to access those patients to get ZILRETTA as an option in front of them?

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Melissa Layman, Flexion Therapeutics, Inc. - Chief Commercial Officer [7]

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So with regard to accessing patients specifically, our efforts haven't been focused there during this period. They have been focused specifically with our health care providers. Our sales force has been working from home since the middle of March, and they have been fully audiovisual equipped to continue to engage physicians remotely. And in fact, many of their conversations with our users and some of our nonusers have focused around that very point, which is that with surgeries having been rescheduled, postponed, canceled altogether, the wait times to get to those surgeries are mounting and that ZILRETTA offers an alternative to managing the intractable pain that these patients are continuing to suffer with and therefore is being more widely considered by our customers as that bridging tool that they can use until those patients are able to be put back on to the surgical schedule.

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Operator [8]

See the article here:
Edited Transcript of FLXN earnings conference call or presentation 7-May-20 8:30pm GMT - Yahoo Finance

The medicine of music: Tim Vallillee turns to song as therapy for cystic fibrosis and for life – TheChronicleHerald.ca

YARMOUTH, N.S.

For Tim Vallillee, music is medicine.

Something he can reach out to when hes hurting and when hes not. Something he can tap into for his physical health and his soul.

Something, most importantly,he can share with others.

Ive always felt that the fact I sing so much has been added therapy for me, says Vallillee, 52, who has cystic fibrosis.

Vallillee grew up in Yarmouth and lives in the Valley with his wife Agatha and son Isaiah. When COVID-19 came into play, he lost his gigs as venues were no longer open to the public.

When theyre taken away your musical brain says, this really sucks. But my CF brain says I cant do my thing, how am I going to tell how Im feeling?

Singing is a barometer that I use for the level of my health, he explains, likening it to an early warning device that lets him know how hes feeling inside especially when hes reaching for those high notes.

Ive got a pretty powerful voice but you cant do that without air in your lungs, he says. If that air is not in there it shows in my voice. It can be very subtle, but I notice it. I know something is brewing.

But where theres a will, theres a way.

Vallillee has been performing and sharing music Thursday evenings via Facebook live on his personal social media page. For his first session he put his iPhone in a tripod, sat on his bed and played for a couple of hours. Its now a highlight of his week.

Its great because I get to do what I like to do and its all part of my life therapy to have music in my life.

And hes happy to have that connection with others again.

In addition to Facebook you can also hear his music on YouTube. He also has a website to connect with others http://www.timothyv.ca.

Vallillee learned to play the guitar when he was 18. But it was something that happened when he was 16 that chartered his musical course.

My dad had a massive heart attack and when he was in the hospital . . . I promised my dad that if he wouldnt die I would learn to play an instrument, he says. He always wanted one of his four kids to learn an instrument. He always joked the best thing we could play was the record player.

His father recovered and a couple of years later reminded Vallillee of his promise. So the son grabbed a guitar and taught himself to play.

He ended up playing in many bands with friends. One of his first gigs was a variety show during Yarmouth high schools winter carnival in the 1980s.

Vallillee turns to music to express himself when hes feeling happy, sad, joyful, fearful sometimes bored and, more recently, heartbroken. His most recent original song is called Home To Me.

Its a song he wrote about what a special place Nova Scotia is. He wrote the song following the April mass shooting tragedy in the province. In the lyrics he picked out places and experiences in Nova Scotiathat he connects with and hopes others will as well.

I tried to encompass as many people as I could from Yarmouth to Cape Breton, he says.

Vallillee didnt want the song to just be about healing right now but a song people can listen to at any point in their life, whether next week, next month, or next year, and it will make them feel good.

Folks from this part of the country, are different from all the rest. We've got a special something deep down in our chest.

Nova Scotia is where I roam...Nova Scotia, that's my home. Nova Scotia is where I'll be ... Nova Scotia, is home to me.

Vallillee'swife, Agatha Bourassa, says not only is music where her husband shines, its a gift he gives to others.

This great song idea came about like every one of Tims songs have over the past two decades. Nobody really knows how he writes but he sparks an idea. Sometimes he pulls off on the side of the road and all of a sudden he regurgitates a song, she says. We just lived through this horrific tragedy in Nova Scotia and maybe no one feels like celebrating but Tim truly wrote that song to try and uplift every Nova Scotian. Lets celebrate life because every breath is worth it.

Indeed. Breaths are something those with cystic fibrosis cant take for granted. Which makes life challenging during the COVID-19 pandemic. People with immune deficiencies and underlying health issues are especially at risk.

Still, Vallillee isnt doing anything drastically different now than he does in normal times. Thats because, in a sense, hes always living in a COVID reality.

I used to say Im one bug away from getting sick and ending up in the hospital and dying in a week Ive always lived that perspective, he says, adding those with CF are very used to avoiding germs.

He calls himself a germ ninja.

Its not like I normally go around in a mask, but I will in a hospital. And Im vigilantabout always trying to wash my hands and avoid germs.

My wife, God love her, if she hears anybody coughing or sneezing in my direction even if were sitting a movie theatre and she hears somebody cough behind or near us its like weve got to move, he says. Shes seen me knock on deaths door quite a number of times. Thankfully we survived that.

Fortunately for Vallillee and his family, his health has been good in recent years. He hasnt been in the hospital in abouteight years and he attributes this to Kalydeco, a new medication he received six years ago. Its been a game-changer.

It basically goes in and changes CF genes inside my body on a genetic level. Because of that my lung function jumped about 20 per cent when I first got on it, he says. It virtually saved my life. I havent been in the hospital since. Ive had a couple of rounds of being sick, but never to the point that I was hospitalized.

The health of others with cystic fibrosis is also never far from Vallillees thoughts. Hes been promoting an online House of Commons petition aimed at helping Canadians with cystic fibrosis, cancer and other life-threatening diseases to have access to medicines and clinical trials that could save, prolong and/or improve their lives.

And then there is fundraising that has always been a special cause for Vallillees family, especially during May, which is Cystic Fibrosis Month.

COVID-19 will have an impact in terms of preventing people from coming together physically in large numbers to fundraise. In some areas that held traditional walks each May, virtual walks are being held instead.

In other words, COVID wont silence efforts in more ways than one.

On Saturday, May 16, from noonto 12 a.m. he and others will take part in an event called the 12-Hour Sing-A-Thon for Cystic Fibrosis via Facebook live. Darrin Harvey of 89.3 K-Rock will the celebrity host for the kickoff that day and Vallillee and Eben Higgins (both living with CF) will perform and also present numerous East Coast musicians from the region. The goal is to entertain, raise awareness and fundraise. Information about 12-Hour Sing-A-Thon for Cystic Fibrosis can be found on Facebook.

Vallillee is the second oldest person that he knows of in Nova Scotia living with cystic fibrosis.

Every cystic has this timeline, but we dont know what the timeline is, its all dependent on how healthy we are, if we take care of ourselves, if we get exposed to some bug, he says.

But Vallillee doesnt focus on getting sick. Instead, his focus is always on staying well.

And thats where his songs help.

Its the medicine of music, he says.

And he hopes its contagious.

Cystic fibrosis (CF) is the most common fatal genetic disease affecting Canadian children and young adults. At present, there is no cure.

CF causes various effects on the body, but mainly affects the digestive system and lungs. The degree of CF severity differs from person to person, however, the persistence and ongoing infection in the lungs, with the destruction of lungs and loss of lung function, will eventually lead to death in the majority of people with CF.

Typical complications caused by cystic fibrosis are:

It is estimatedone in every 3,600 children born in Canada has CF. More than 4,300 Canadian children, adolescents, and adults with cystic fibrosis attend specialized CF clinics.

Visit the Cystic Fibrosis Canada website to learn more and to see how you can donate.

You can also visit the Cystic Fibrosis Atlantic Canada website

CF is a multi-system disorder that produces a variety of symptoms including:

CF is a genetic disease that occurs when a child inherits two defective copies of the gene responsible for cystic fibrosis, one from each parent. Approximately, one in 25 Canadians carry one defective copy of the CF gene. Carriers do not have CF, nor do they exhibit any of the related symptoms.

When two CF carriers have a child, there is a 25 percent chance that the child will be born with CF. There is also a 50 per cent chance that the child will be a carrier, and a 25 per cent chance that the child will not be a carrier, nor have CF.

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The medicine of music: Tim Vallillee turns to song as therapy for cystic fibrosis and for life - TheChronicleHerald.ca

COVID-19 Stem Cell Therapies Pipeline, 2020 Report – ResearchAndMarkets.com – Business Wire

DUBLIN--(BUSINESS WIRE)--The "COVID-19 Stem Cell Therapies Pipeline" report has been added to ResearchAndMarkets.com's offering.

Complementing the slew of vaccines in development are the upcoming stem cell therapies, aimed at boosting patients' immune systems and eliminating pathogens. The COVID-19 Stem Cell Therapies Pipeline report provides comprehensive data analysis of 22 organizations developing stem cell therapies for COVID-19 globally from the Americas, Europe, the Middle East and Africa (EMEA), and Asia-Pacific region (APAC).

Some report features include:

The report covers stem cell therapy market with detailed review of their cell therapy research and development including the stages of production (pre-clinical, clinical and commercial). In addition, it pulls together insights from interviews and surveys with key opinion leaders. It seeks to holistically inform the community on the current status of COVID-19 stem cell therapy development and discover future opportunities for collaboration, technology transfer and co-development.

Key Topics Covered

Section 1

Section 2: COVID-19 Stem Cell Therapies Pipeline in the Americas

Section 3: COVID-19 Stem Cell Therapies Pipeline in EMEA

Section 4: COVID-19 Stem Cell Therapies Pipeline in APAC

Companies Mentioned

For more information about this report visit https://www.researchandmarkets.com/r/kpp6tj

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COVID-19 Stem Cell Therapies Pipeline, 2020 Report - ResearchAndMarkets.com - Business Wire

Role of science highlighted in pandemic fight – Chinadaily.com.cn –

Members of the medical team from Beijing's China-Japan Friendship Hospital visit a novel coronavirus pneumonia patient in an ICU ward at Tongji Hospital in Wuhan, Central China's Hubei province, on March 25, 2020. [Photo by Zhu Xingxin/chinadaily.com.cn]

Experts exploring new, innovative approaches to tackle novel coronavirus

Science and technology have played, and will continue to play, a decisive role in mitigating the pandemic, whether it is by discovering new features about the novel coronavirus, looking for new treatment or vaccines or offering expertise in psychological services, experts said.

But science does not always proceed in an unambiguous straight line toward progress. These undertakings, especially those involve pushing boundaries deeper into the unknown, are time-consuming, complicated and unpredictable. So it is important for the public to understand the scientific process to fully respect and appreciate these efforts, they said.

As President Xi Jinping has said, the COVID-19 epidemic is the "fastest spreading, most infectious and most challenging public health emergency since the birth of New China". He has also stressed that epidemic control efforts require the support of science and technology and urged scientists who are working on treatment and a vaccine to accelerate their research while upholding rigorous scientific practices and ensuring their products are safe.

With the leadership of Xi and joint efforts by the whole of society, the epidemic is now under control in China, said Huai Jinpeng, executive vice-president of the China Association for Science and Technology.

"But the disease is still spreading across the globe, and there is a strong downward pressure for the world economy and a noticeable spike in instability and uncertainty," he said at a meeting with the nation's science officials on April 30.

During this critical juncture, Chinese scientists need to be even more hardworking and pragmatic, and make a greater contribution to the nation's post-epidemic socioeconomic recovery with science and innovation, Huai said.

At the same time, they also need to expand their network of cooperation at home and abroad. Science officials and workers should maintain high ethical and professional standards, and be a role model for society, he added.

Wan Gang, president of the China Association for Science and Technology, said the nation's science workers were immediately mobilized to tackle the epidemic when the outbreak began, and have provided crucial scientific support in controlling the disease and assisting the socioeconomic recovery.

Communication is also a key aspect of the overall disease prevention and control effort, he said, adding that the various COVID-19 related information platforms under the association have attracted over 7 billion views in the past few months.

When Chinese microbiologist Wang Jun volunteered to go to Wuhan, Hubei province, to help the city's hospitals research the novel coronavirus, he said he felt like he was heading into a "battlefield".

The motive behind his action was simple. "Our institute (the Institute of Microbiology of the Chinese Academy of Sciences) has been researching the virus since the outbreak began," Wang said on April 20.

"With Wuhan being the first place to have reported the disease, I had a gut feeling that there must have been many questions that our front-line medical staff didn't even know existed, so we had to go to the battlefront to learn about the situation and their needs," he said.

Since the outbreak began, the academy has sent dozens of researchers to Wuhan. Their work has played a major role in the overall epidemic control effort. Their five main objectives were viral research, creating new diagnostic tools, testing clinical treatments, health evaluation for recovered patients and psychological counseling.

Wang said his team had discovered that children, who were believed to be less susceptible to COVID-19, could still spread the disease even when their symptoms were mild, making them potential asymptomatic carriers that might float under the diagnostic radar.

The virus also has some very intricate immunological effects that would make case tracing via antibody tests more difficult, so "more research is definitely needed", he added.

Jin Qi, director of the Chinese Academy of Medical Sciences' Institute of Pathogen Biology, said that scientists' understanding of the novel coronavirus remains limited and is constantly expanding, and with new information unearthed, new questions would emerge.

For example, most researchers agreed that a 14-day quarantine is generally sufficient for a patient to show symptoms, but there are now rare cases in which patients experience the onset of symptoms well after the two-week period, Jin said.

Drugs and vaccines

Wang Guiqiang, head of Peking University First Hospital's department of infectious diseases, said at a seminar in late April that drugs and vaccines are crucial for stopping the pandemic for good, but this will require time and effort by scientists around the globe.

China has three vaccines, one vectorwhich uses just a gene from the coronavirusand two inactivated, currently in Phase II clinical trials. The vector vaccine is spearheaded by Chen Wei, a senior preventive medical expert, and the results for the Phase II trial are set to be published in May, according to official sources.

The two inactivated vaccines were developed respectively by the Wuhan Institute of Biological Products Co Ltd and Sinovac Research & Development Co Ltd.

Zhong Nanshan, a renowned respiratory expert, told People's Daily last month that although there has not been a wonder cure found for COVID-19, some drugs have proved to be effective to some extent.

"We're testing a variety of drugs, such as chloroquine, and experiment results have shown the drug is definitely effective," he said, adding that scientists are analyzing the data and would publish their findings soon.

Some traditional Chinese medicines, including Lianhua Qingwen Capsules, are also being studied. For the capsule, Zhong said although its anti-viral effect against COVID-19 isn't that pronounced, it does have a "remarkable anti-inflammatory effect" that can help patients recover quicker.

A major component of all scientific work is about testing available knowledge and methods, but not all tests can return positive results. Discovering what works, and, sometimes more importantly, what doesn't work and why, is crucial in expanding humanity's knowledge of the disease.

Cao Bin, vice-president of China-Japan Friendship Hospital, said at a seminar last month that they had found Lopinavir/Ritonavir, a combination of anti-HIV drugs that showed potential in treating COVID-19 in the early days of the outbreak, did not produce desirable results.

In late April, the Lancet medical journal published a study by Cao on his clinical trials on remdesivir in China. The study said the experimental drug from the United States did not significantly speed up the recovery of critically ill patients compared with the control group.

The authors warn that interpretation of their study is limited because it only recruited 237 adults, rather than the target of 453 patients, due to the rapid decline of COVID-19 cases in China. They concluded that more research is needed.

Pushing boundaries

Through strong government support and hard work, Chinese scientists are also exploring new and innovative ways to tackle the novel coronavirus.

Zhang Linqi, a professor at Tsinghua University School of Medicine in Beijing, said his team has been using antibodies to "drive a wedge" between the virus' spike proteinits "key" for entering cellsand the receptor that it binds to.

That would effectively block the virus from entry. It has been very effective in animal tests, and may serve to inspire new vaccine candidates, he said at an online seminar in late April.

Scientists have discovered that there is a small but potent section of the spike protein that does most of the work called the receptor-binding domain, or RBD.

Knowing that, Zhang's team, along with scientists from Shenzhen Third People's Hospital, found two antibodies that, together, can insert themselves at the junction of the RBD and the cell's receptor, blocking the virus from latching onto the cell.

Zhang said they are testing the blocking effect in possible vaccines, and early results are "really encouraging". But research is still in its early stages and more rigorous studies and tests are needed, he added.

Hu Baoyang, executive president of the Chinese Academy of Sciences' Institute of Stem Cell and Regenerative Medicine, said since arriving in Wuhan on March 1, his team had been busy testing stem cell therapy to calm the overreacting immune system and repair the lung tissue of severe and critically ill patients.

In the 46 days that followed, Hu and his team traveled to 13 hospitals and screened over 650 candidate patients for this innovative treatment. At a news briefing on April 16, Sun Yanrong, deputy director of the China National Center for Biotechnology Development, said over 200 patients in Wuhan had received stem cell therapy, and current results show the treatment can improve the recovery rate of severely ill patients and is generally safe.

However, stem cell therapy is far from perfect. Stem cells can differentiate into various types of cells, and some might turn cancerous, according to the University of Nebraska Medical Center. Some stem cells are also difficult to isolate and cultivate in large quantities, so more research and testing are also needed.

"Labs are our bastions, and our scientific research is the weapon against the epidemic," Hu said.

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