Item
2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS
You
should read the following discussion and analysis of our financial condition and results of operations together with our condensed consolidated
financial statements and the related notes included elsewhere in this Quarterly Report on Form 10-Q, as well as our audited consolidated
financial statements and related notes for the year ended December 31, 2022, as filed in our Annual Report on Form 10-K for the year ended
December 31, 2022 (the “2022 Annual Report”). Some of the information contained in this discussion and analysis, particularly
with respect to our plans and strategy for our business and related financing, includes forward-looking statements that involve risks
and uncertainties. You should read “Risk Factors” in Item 1A of our 2022 Annual Report for a discussion of important factors
that could cause actual results to differ materially from the results described in or implied by the forward-looking statements contained
in the following discussion and analysis.
Overview
We
are a clinical-stage biotechnology company focused on the discovery and development of innovative therapeutics for fibrotic and inflammatory
diseases with high unmet needs. Based on the unique and pivotal role of the soluble protein CCL24 in promoting fibrosis and inflammation,
We developed CM-101, a monoclonal antibody designed to bind and block CCL24 activity. We believe CM-101 has demonstrated the potential
to treat multiple severe and life-threatening fibrotic and inflammatory diseases.
We
have pioneered the therapeutic targeting of CCL24, a chemokine that promotes various types of cellular processes that regulate inflammatory
and fibrotic activities through the CCR3 receptor. CCL24 is expressed in various types of cells, including immune cells, endothelial cells
and epithelial cells. We have developed a novel CCL24-inhibiting product candidate with dual anti-fibrotic and anti-inflammatory activity
that modulates the complex interplay of both of these inflammatory and fibrotic mechanisms, which drives abnormal states of fibrosis and
clinical fibrotic diseases. This innovative approach is being developed for difficult-to-treat rare diseases, also known as orphan indications
or diseases, such as primary sclerosing cholangitis, or PSC, and systemic sclerosis, or SSc, for which patients have no established disease
modifying standard of care treatment options. We estimate that there are approximately 77 thousand patients suffering from PSC in the
U.S., EU and Japan, representing an estimated $1 billion market opportunity, and approximately 170 thousand patients suffering from SSc
in those same markets, representing an estimated $1.5 billion market opportunity.
CM-101,
our lead clinical product candidate, is a first-in-class humanized monoclonal antibody that attenuates the basic function of CCL24, also
known as eotaxin-2, as a regulator of major inflammatory and fibrotic pathways. We have demonstrated that CM-101 interferes with the underlying
biology of inflammation and fibrosis through a novel and differentiated mechanism of action. Based on these findings, we are actively
advancing CM-101 in Phase 2 clinical studies directed toward two distinct clinical indications that include patients with liver or skin,
and/or lung fibrosis. We are currently conducting a Phase 2 clinical study in PSC, a rare obstructive and cholestatic liver disease. The
study is actively recruiting patients in the U.S., Europe and Israel and includes two dose arms (10 and 20mg/kg) as well as an open label
extension.
We
are also planning to open a Phase 2 clinical trial in SSc about midyear 2023. The trial in SSc, a rare autoimmune rheumatic disease characterized
by fibrosis in the skin and lung and other organs, will focus on establishing biological and clinical proof of concept in this patient
population. Although our primary focus is on these two rare indications, as we noted, an additional Phase 2 clinical study in patients
with liver fibrosis due to non-alcoholic steatohepatitis, or NASH was completed late last year. This trial provided safety and pharmacokinetic
(PK) data on CM-101 in this patient population and was informative for determining whether the company advances the development of its
current subcutaneous formulation of CM-101. Additionally, the trial measured a number of biomarkers that may be relevant to the potential
activity of CM-101 in NASH and in other fibro-inflammatory conditions. We reported results from this trial in January 2023 that showed
that the trial met its primary endpoint of safety and tolerability, and that CM-101 demonstrated encouraging activity in secondary endpoints
that include a range of liver fibrosis biomarkers and physiologic assessments.
Fibrosis
is the abnormal and excessive accumulation of collagen and extracellular matrix, the non-cellular component in all tissues and organs,
which provides structural and biochemical support to surrounding cells. When present in excessive amounts, collagen and extracellular
matrix lead to scarring and thickening of connective tissues, affecting tissue properties and potentially leading to organ dysfunction
and failure. Fibrosis can occur in many different tissues, including lung, liver, kidney, muscle, skin, and the gastrointestinal tract,
resulting in a wide array of progressive fibrotic conditions. Fibrosis and inflammation are intrinsically linked. While a healthy inflammatory
response is necessary for efficient tissue repair; after disease or injury, an excessive, uncontrolled inflammatory response can lead
to tissue fibrosis that in turn can further stimulate inflammatory processes in a fibro-inflammatory vicious cycle.
Recent
Developments
FDA
Clearance of our IND Application to Study CM-101 in a Phase 2 Trial in SSc Patients
On
February 21, 2023, we reported U.S. Food and Drug Administration (FDA) clearance of our Investigational New Drug (IND) Application to
evaluate CM-101 in a Phase 2 trial in adults with systemic sclerosis (SSc). The Phase 2 ABATE trial is a multicenter, randomized, double-blind,
proof-of-biology study to evaluate the sAfety, toleraBility, and Activity of CM-101 in patients with sysTEmic sclerosis. It expects to
enroll 45 patients with clinically active dermatologic, vascular or pulmonary SSc. The study population is expected to be roughly split
between patients with diffuse SSc and patients with limited SSc. The primary outcome measure is safety. Secondary endpoints include multiple
serum-based biological markers and a variety of exploratory biological and clinical outcomes, including the American College of Rheumatology
Composite Response Index in Systemic Sclerosis (ACR-CRISS) score and its revisions (rCRISS). The trial includes a 24-week double blind
period during which active treatment patients will receive 10 mg/kg of CM-101 by intravenous infusion every three weeks, followed by a
24-week open label extension, where all patients will receive a 10 mg/kg dose. The trial includes multiple clinical assessments of the
skin, vasculature and pulmonary function. It is expected to generate additional information about disease mechanisms, provide data relevant
to future patient stratification strategies and inform the selection of appropriate endpoints for future studies. The trial is expected
to begin enrolling patients around midyear 2023. A data read-out is targeted for the second half of 2024.
Report
Topline Results from CM-101 Phase 2a Liver Fibrosis Biomarker Trial in NASH Patients
On
January 3, 2023, we reported positive topline results from our Phase 2a liver fibrosis biomarker trial of CM-101 in NASH patients. This
trial was primarily designed to assess a subcutaneous formulation of CM-101 and to evaluate the drug’s impact on liver fibrosis
biomarkers relevant to both NASH and the fibro-inflammatory conditions that represent the focus for the company, such as PSC and SSc.
The trial met its primary endpoint of safety and tolerability, and CM-101 demonstrated encouraging activity in secondary endpoints that
include a range of liver fibrosis biomarkers and physiologic assessments measured at baseline and at week 20.
The
randomized, placebo-controlled trial enrolled 23 NASH patients with stage F1c, F2 and F3 disease who were randomized to receive either
CM-101 or placebo. Patients received a dose of 5 mg/kg of study drug administered by subcutaneous (SC) injection once every two weeks,
for a treatment period of 16 weeks. Key findings of the CM-101 Phase 2a trial included the following.
|
• |
CM-101
appeared to be safe when administered subcutaneously. Most reported adverse events observed were mild, with one unrelated serious adverse
event reported. No significant injection site reactions were reported and no anti-drug antibodies were detected. |
|
• |
CM-101
administered subcutaneously demonstrated favorable pharmacokinetics and target engagement profiles as expected, and were similar to what
the company has previously reported. |
|
• |
CM-101-treated
patients showed greater improvements than the placebo group in a number of liver fibrosis-related biomarkers, including ProC-3, ProC-4,
ProC-18, TIMP-1 and ELF. |
|
• |
A
majority of CM-101-treated patients showed improvements in multiple liver fibrosis-related biomarkers—almost 60% of CM-101 patients
were “multiple responders”, responding in at least three biomarkers at week 20, compared to no patients in the placebo group. |
|
• |
CM-101-treated
patients with higher CCL24 levels at baseline showed greater reductions in fibrosis-related biomarkers than patients with lower levels
of CCL24 at baseline. More CM-101-treated patients with higher CCL24 levels also were “multiple responders”, responding in
three or more of the fibrosis-related biomarkers, compared to patients with lower CCL24 levels at baseline. These findings further add
to the growing body of evidence validating the role of CCL24 in the pathophysiology of fibrotic liver disease. |
|
• |
A
higher proportion of patients in the CM-101-treated group showed improvement in a physiologic measure of liver stiffness as compared to
placebo (reduction of at least one grade of fibrosis score as assessed by the non-invasive elastography method known as FibroScan®). |
|
• |
After
completion of the study, the unblinded data showed that patients in the CM-101-treated group had higher baseline levels of fibrosis compared
to placebo patients. The impact of this difference on the results, if any, is unknown. |
We
believe that the data from this trial provide important insights in support of the CM-101 development program, including the favorable
safety and tolerability of CM-101 in patients with serious liver disease, confirmation of early signs of biomarker activity that are relevant
for a number of fibro-inflammatory disorders, and support for the tolerability and pharmacokinetic data needed to assess next steps in
the development of our SC formulation.
Corporate
Information
We
were incorporated on September 22, 2011, under the laws of the State of Israel. In March 2021, in connection with the Merger, we changed
our name from Anchiano Therapeutics Ltd. to Chemomab Therapeutics Ltd. Our principal executive offices are located at Kiryat Atidim, Building
7, Tel Aviv, Israel 6158002, and our phone number is +972-77-331-0156. Our website is: www.chemomab.com. The information contained on,
or that can be accessed through, our website is not incorporated by reference into this Quarterly Report on Form 10-Q. We have included
our website address as an inactive textual reference only.
Components
of Operating Results
References
to “we,” “us,” “our” and “Chemomab” in this “Components of Operating Results”
and in the “Results of Operations” below refer to the Company after the Merger, and, with respect to historical periods preceding
the Merger, refer to Chemomab Ltd., whose business became the business of the Company upon consummation of the Merger.
Revenues
To
date, we have not generated any revenue. We do not expect to generate revenue unless and until we obtain regulatory approval and commercialize
a product candidate, or until we receive revenue from a collaboration such as a co-development or out-licensing agreement. There can be
no assurance that we will receive such regulatory approvals, and if any product candidate is approved, that we will be successful in commercializing
it.
Research
and Development Expenses
Research
and development expenses consist primarily of costs incurred in connection with the development of our product candidates. These expenses
include:
|
• |
expenses
incurred under agreements with contract research organizations or contract manufacturing organizations, as well as investigative sites
and consultants that conduct our clinical trials, preclinical studies and other scientific development services; |
|
• |
manufacturing
scale-up expenses and the cost of acquiring and manufacturing preclinical and clinical trial materials; |
|
• |
employee-related
expenses, including salaries, related benefits, travel and share-based compensation expenses for employees engaged in research and development
functions, as well as external costs, such as fees paid to outside consultants engaged in such activities; |
|
• |
license
maintenance fees and milestone fees incurred in connection with various license agreements; |
|
• |
costs
related to compliance with regulatory requirements; and |
|
• |
depreciation
and other expenses. |
We
recognize external development costs based on an evaluation of the progress to completion of specific tasks using information provided
to us by our service providers.
We
do not allocate employee costs or facility expenses, including depreciation or other indirect costs, to specific programs because these
costs are deployed across multiple programs and, as such, are not separately classified. We use our internal resources primarily to oversee
research, as well as for managing our preclinical development, process development, manufacturing and clinical development activities.
Our employees work across multiple programs and, therefore, we do not track costs by program.
Research
and development activities are fundamental to our business. Product candidates in later stages of clinical development generally have
higher development costs than those in earlier stages of clinical development, primarily due to the increased size and duration of later-stage
clinical trials. As a result, we expect that our research and development expenses will increase substantially over the next several quarters
and years as we continue to advance the development of our product candidates. We also expect to incur additional expenses related to
milestone and royalty payments payable to third parties with whom we have entered into license agreements to acquire the rights to its
product candidates.
General
and Administrative Expenses
General
and administrative expenses consist primarily of salaries, related benefits and share-based compensation expenses for personnel in executive
and administrative functions. General and administrative expenses also include professional fees for legal, consulting, accounting and
audit services.
We
anticipate that our general and administrative expenses will increase in the future as we increase headcount and general activities to
support our continued research activities and development of our product candidates as well as expanding our presence in the United States.
We also anticipate that we will incur increased headcount, accounting, audit, legal, regulatory, compliance, director and officer insurance
costs, as well as investor and public relations expenses associated with being a public company. We expect that the additional costs for
these services will substantially increase our general and administrative expenses. Additionally, if and when we believe that regulatory
approval of a product candidate appears likely, we expect to incur an increase in payroll and related expenses as a result of our preparation
for commercial operations, especially as it relates to the sales and marketing of any product candidate.
Results
of Operations
Three
Months Ended March 31, 2023 Compared to the Three Months Ended March 31, 2022
Below
is a summary of our results of operations for the periods indicated:
|
|
Three
months ended |
|
|
|
|
|
|
|
|
|
March
31, |
|
|
Increase/(decrease) |
|
|
|
2023 |
|
|
2022 |
|
|
$ |
|
|
% |
|
|
|
(in
thousands) |
|
|
|
|
|
|
|
|
Operating
expenses: |
|
|
|
|
|
|
|
|
|
|
|
|
|
Research
and development |
|
|
6,887 |
|
|
|
2,745 |
|
|
|
4,142 |
|
|
|
151 |
% |
General
and administrative |
|
|
2,162 |
|
|
|
2,575 |
|
|
|
(413 |
) |
|
|
(16 |
)% |
Operating
loss |
|
|
9,049 |
|
|
|
5,320 |
|
|
|
3,729 |
|
|
|
70 |
% |
Financing
income, net |
|
|
(317 |
) |
|
|
(216 |
) |
|
|
(101 |
) |
|
|
47 |
% |
Loss
before taxes |
|
|
8,732 |
|
|
|
5,104 |
|
|
|
3,628 |
|
|
|
71 |
% |
Taxes
on income |
|
|
21 |
|
|
|
- |
|
|
|
21 |
|
|
|
100 |
% |
Net
loss |
|
$ |
8,753 |
|
|
$ |
5,104 |
|
|
$ |
3,649 |
|
|
|
71 |
% |
Our
results of operations have varied in the past and can be expected to vary in the future due to numerous factors. We believe that period-to-period
comparisons of our operating results are not necessarily meaningful and should not be relied upon as indications of future performance.
Research
and development expenses
Research
and development expenses increased by approximately $4.1 million, or 151%, for the three months ended March 31, 2023, as compared to the
same period of 2022. The increase was primarily due to increased clinical and preclinical activities.
General
and administrative expenses
General
and administrative expenses decreased by approximately $0.4 million, or 16%, for the three months ended March 31, 2023, as compared to
the same period of 2022. The decrease was primarily due to a decrease in non-cash share-based expenses and decrease in insurance expenses.
Financing
income, net
Financing
income, net for the three months ended March 31, 2023 was $317 thousand. Financing income, net for the three months ended March 31, 2022
was $216 thousand. This reflects an increase in finance income, net of $101 thousand, or 47%, for the three months ended March 31, 2023
from the comparable period of 2022. The increase was primarily related to interest earned on bank deposits and to foreign currency exchange
rate gains.
Liquidity
and Capital Resources
Since
inception, we have not generated any revenue and have incurred significant operating losses and negative cash flows from our operations,
resulting in an accumulated deficit at March 31, 2023 of $73.0 million. We have funded our operations to date primarily with proceeds
from the sale of our ADSs, and, prior to the Merger, other equity securities. Cash in excess of immediate requirements is invested primarily
in bank deposits with a view to liquidity and capital preservation.
On
April 30, 2021, the Company entered into an At the Market
Offering Agreement (the "ATM Agreement") with Cantor Fitzgerald & Co., ("Cantor"). Pursuant to the ATM Agreement, the Company may
offer and sell, from time to time, its ADSs having an aggregate offering price of up to $75 million through Cantor or the ATM Agreement.
From April 30, 2021, through December 31, 2022 the Company issued 699,806 ADSs at an average price of $22.75 per ADS under the ATM Agreement,
resulting in gross proceeds of $15,917 thousand.
On
April 25, 2022, the Company filed a prospectus supplement with the SEC for the issuance and sale of up to $18,125,000 of its ADSs in connection
with the reactivation of the ATM Facility and pursuant to General Instruction I.B.6 of Form S-3, which, subject to certain exceptions,
limits the amount of securities the Company is able to offer and sell under such registration statement to one-third of our unaffiliated
public float. During the year ended December 31, 2022, the Company issued 130,505 ADSs at an average price of $2.11 per ADS under the
ATM Agreement, resulting in gross proceeds of $275 thousand.
Developing
product candidates, conducting clinical trials and commercializing products are expensive, and we will need to raise substantial additional
funds to achieve our strategic objectives. We believe that our existing cash resources, including from the ADSs sold pursuant to the Sales
Agreement, will be sufficient to fund our projected cash requirements through June 30, 2024. Nevertheless, we will require significant
additional financing in the future to fund our operations, including if and when we progress into additional clinical trials, obtain regulatory
approval for any of our product candidates and commercialize the same. We believe that we will need to raise significant additional funds
before we have any cash flow from operations, if at all. Our future capital requirements will depend on many factors, including:
|
• |
the progress
and costs of our preclinical studies, clinical trials and other research and development activities; |
|
|
|
|
• |
the scope,
prioritization and number of our clinical trials and other research and development programs; |
|
|
|
|
• |
the amount
of revenues and contributions we receive under future licensing, development and commercialization arrangements with respect to our product
candidates; |
|
|
|
|
• |
the costs of
the development and expansion of our operational infrastructure; |
|
|
|
|
• |
the costs and
timing of obtaining regulatory approval for our product candidates; |
|
• |
the costs of
filing, prosecuting, enforcing and defending patent claims and other intellectual property rights; |
|
|
|
|
• |
the costs and
timing of securing manufacturing arrangements for clinical or commercial production; |
|
|
|
|
• |
the costs of
contracting with third parties to provide sales and marketing capabilities for us; |
|
|
|
|
• |
the costs of
acquiring or undertaking development and commercialization efforts for any future products, product candidates or platforms; |
|
|
|
|
• |
the magnitude
of our general and administrative expenses; and |
|
|
|
|
• |
any cost that
we may incur under future in- and out-licensing arrangements relating to our product candidates. |
We
currently do not have any commitments for future external funding. In the future, we will need to raise additional funds, and we may decide
to raise additional funds even before we need such funds if the conditions for raising capital are feasible. Until we can generate significant
recurring revenues, we expect to satisfy our future cash needs through debt or equity financings, credit facilities or by out-licensing
applications of our product candidates. The sale of equity or convertible debt securities may result in dilution to our existing shareholders.
The incurrence of indebtedness would result in increased fixed obligations and could also subject us to covenants that restrict our operations.
We cannot be certain that additional funding, whether through grants from the Israel Innovation Authority, financings, credit facilities
or out-licensing arrangements, will be available to us on acceptable terms, if at all. If sufficient funds are not available, we may be
required to delay, reduce the scope of or eliminate research or development plans for, or commercialization efforts with respect to, one
or more applications of our product candidates, or obtain funds through arrangements with collaborators or others that may require us
to relinquish rights to certain potential products that we might otherwise seek to develop or commercialize independently.
Cash
Flows
The
table below shows a summary of our cash flow activities for the periods indicated:
|
|
Three
months ended |
|
|
|
|
|
|
|
|
|
March
31, |
|
|
Change |
|
|
|
2023 |
|
|
2022 |
|
|
$ |
|
|
% |
|
|
|
(in
thousands) |
|
|
|
|
|
|
|
|
Net
cash used in operating activities |
|
$ |
(7,186 |
) |
|
$ |
(3,711 |
) |
|
$ |
(3,475 |
) |
|
|
(94 |
)% |
Net
cash provided by investing activities |
|
$ |
14,432 |
|
|
$ |
2,382 |
|
|
$ |
12,050 |
|
|
|
506 |
% |
Net
cash used in financing activities |
|
|
- |
|
|
$ |
- |
|
|
|
|
|
|
$ |
- |
% |
Net
increase (decrease) in cash, cash equivalents and restricted cash |
|
$ |
7,246 |
|
|
$ |
(1,329 |
) |
|
$ |
8,575 |
|
|
|
(645 |
)% |
Operating
activities
Net
cash used in operating activities increased by $3.5 million, or 94%, for the three months ended March 31, 2023, compared to the same period
of 2022. The increase is primarily related to the increase in net loss of $3.6 million.
Investing
activities
Net
cash provided in investing activities for the three months ended March 31, 2023 increased by approximately $12 million, as compared to
the same period of 2022. The increase is primarily related to withdrawal of bank deposits.
Contractual
Commitments
The
Company’s contractual commitments are as follows at March 31, 2023 (in thousands):
Remainder
of 2023 |
|
$ |
6,361 |
|
2024 |
|
|
1,676 |
|
2025 |
|
|
1,060 |
|
Total |
|
$ |
9,097 |
|
Critical
Accounting Estimates
The
Company’s financial statements are prepared in accordance with generally accepted accounting principles in the United States (“GAAP”).
The preparation of the Company’s financial statements and related disclosures in accordance with GAAP requires it to make estimates
and judgments that affect the reported amounts of assets, liabilities, revenue, costs and expenses, and the disclosure of contingent assets
and liabilities in the Company’s financial statements. The Company bases its estimates on historical experience, known trends and
events and various other factors that it believes are reasonable under the circumstances, the results of which form the basis for making
judgments about the carrying values of assets and liabilities that are not readily apparent from other sources. The Company evaluates
its estimates and assumptions on an ongoing basis. The Company’s actual results may differ from these estimates under different
assumptions or conditions.
While
the Company’s significant accounting policies are described in more detail in Note 2 to the Company’s consolidated financial
statements included in our 2022 Annual Report, the Company believes that the following accounting estimates are those that include a higher
degree of judgment or complexity and are reasonably likely to have a material impact on our financial condition or results of operations
and are therefore considered critical accounting estimates.
Share-Based
Compensation
We
apply Accounting Standard Codification (ASC) 718-10, “Share-Based Payment,” which requires the measurement and recognition
of compensation expenses for all share-based payment awards made to employees and directors, including employee options under the Company’s
option plans based on estimated fair values.
ASC
718-10 requires that we estimate the fair value of equity-based payment awards on the date of grant using an option-pricing model. The
fair value of the award is recognized as an expense over the requisite service periods in the Company’s statements of comprehensive
loss. The Company recognizes share-based award forfeitures as they occur, rather than estimate by applying a forfeiture rate.
In
June 2018, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2018-07,
“Compensation-Stock Compensation (Topic 718): Improvements to Nonemployee Share-Based Payment Accounting”, which simplifies
the accounting for nonemployee share-based payment transactions by aligning the measurement and classification guidance, with certain
exceptions, to that for share-based payment awards to employees. The amendments expand the scope of the accounting standard for share-based
payment awards to include share-based payment awards granted to non-employees in exchange for goods or services used or consumed in an
entity’s own operations and supersedes the guidance related to equity-based payments to non-employees. We adopted these amendments
on January 1, 2019.
We
recognize compensation expenses for the fair value of non-employee awards over the requisite service period of each award.
We
estimate the fair value of options granted as equity awards using a Black-Scholes options pricing model. The option-pricing model requires
a number of assumptions, of which the most significant are share price, expected volatility and the expected option term (the time from
the grant date until the options are exercised or expire). The Company determines the fair value per share of the underlying stock by
taking into consideration its most recent sales of stock, as well as additional factors that the Company deems relevant. The Company’s
board determined the fair value of ordinary shares based on valuations performed using the Option Pricing Method subject to relevant facts
and circumstances. The Company has historically been a private company and lacks company-specific historical and implied volatility information
of its stock. Expected volatility is estimated based on volatility of similar companies in the biotechnology sector. The Company has historically
not paid dividends and has no foreseeable plans to issue dividends. The risk-free interest rate is based on the yield from governmental
zero-coupon bonds with an equivalent term. The expected option term is calculated for options granted to employees and directors using
the “simplified” method. Grants to non-employees are based on the contractual term. Changes in the determination of each of
the inputs can affect the fair value of the options granted and the results of operations of the Company.
Recently-Issued
Accounting Pronouncements
Certain
recently-issued accounting pronouncements are discussed in Note 2, Summary of Significant Accounting Policies, to the audited consolidated
financial statements in our 2022 Annual Report.