By John Vandermosten, CFA
NASDAQ:TLSA
READ THE FULL TLSA RESEARCH REPORT
First Half 2021 Results
Tiziana Life Sciences (NASDAQ:TLSA) updated on first half 2021 financial and operational results in a press release and SEC-filed Form 6-K. In the update, Tiziana reviewed recent clinical milestones for its candidates, new appointments, and financial results including plans to restructure as a Bermuda-incorporated company. We highlight major events year-to-date.
Highlights for the first half ended June 30th and to-date include:
➣ Completion of Brazil Phase I foralumab in COVID-19 - January 2021
➣ Appointment of Neil Graham MBBS, MD, MPH as CMO - January 2021
➣ Uplisting to LSE market, AIM delisting - January 2021
➣ Safety results from Phase I foralumab in COVID-19 - February 2021
➣ Thomas Adams, Ph.D. appointed Head of Drug Development - February 2021
➣ Phase II foralumab in COVID-19 planned - March 2021
➣ SPMS patient access granted - March 2021
➣ Strategic initiative with Takanawa Japan K.K. - May 2021
➣ Immunomodulation evidence in Phase I - May 2021
➣ UK-CTAP grant application - June 2021
➣ Kevin Schutz, Pharm.D. appointed VP of Regulatory Affairs - June 2021
➣ Phase II trial with foralumab in severe COVID-19 patients - June 2021
➣ Result of Annual General Meeting - June 2021
➣ Article publication on foralumab in COVID-19 patients - August 2021
➣ Files scheme for corporate reorganization - August 2021
➣ License Agreement to evaluate foralumab with CAR T & conference call - September 2021
Financial Results
Tiziana generated no revenue in first half 2021 and incurred operating expense of (£12.6) million which after adjusting for some minor non-operational items yielded comprehensive loss attributable to equity holders of (£12.6) million or (£0.074)1 per share.
For the first half ending June 30, 2021 and versus the same period ending June 30, 2020:
➣ Research & development expense grew 473% to £4.4 million from £0.76 million, driven by expenses related to advancing TZLS-401 and TZLS-501;
➣ Operating expense grew 159% to £8.2 million from £3.2 million;
➣ Total comprehensive loss attributable to equity holders was (£12.6) million vs. (£3.9) million.
As of June 30, 2021, cash and equivalents totaled £38.6 million. This amount compares to a £48.2 million balance in cash and equivalents held at the end of 2020. Tiziana carries no debt on its balance sheet. Cash used in operations was (£9.4) million versus (£5.1) million for the six months ended 2021 and 2020, respectively.
Anti-CD3 and CAR T: Joining with Precision
On September 2, 2021, Tiziana announced that it had entered into an exclusive licensing agreement with Precision BioSciences (NASDAQ:DTIL) to evaluate Tiziana's foralumab in conjunction with Precision's allogeneic CAR T portfolio. In this arrangement, foralumab, an anti-CD3 fully human monoclonal antibody, is being investigated as a lymphodepletion agent, an agent that purposely destroys the patient's immune system, including T cells, to make way for CAR T cells. Lymphodepletion is performed before receiving adoptive cell therapy (ACT). The aim is to determine whether or not foralumab can improve the outcome of ACT. Lymphodepletion typically comprises short-course chemotherapy to destroy T, B and NK cells. This can have the effect of debulking the tumor, altering the tumor phenotype, modifying the tumor microenvironment, and modulating the cytokine profile.2 Common lymphodepletion agents include fludarabine and cyclophosphamide, typically used in combination. These agents have severe side effects and in the case of fludarabine, are associated with neurotoxicity. Foralumab has the potential to either replace or reduce the chemotherapy regimen, thereby improving the side effect profile for patients.
Foralumab may induce tolerance of allogeneic CAR T, or CAR T cells not from the patient's own body, but from a donor, which may attack the patient (host) in what is known as graft-versus-host-disease (GVHD). Allogeneic CAR T has advantages over autologous approaches in that generation of autologous CAR T cells can be challenging, especially in patients of advanced disease due to the length of time needed to generate the cells.3
The Cluster of Differentiation 3 (CD3) is a receptor on effector T cells. Precision's processing of T cells uses ARCUS gene editing to knock out the TRAC gene and depletes CD3, producing allogeneic CAR T cells that are greater than 99.9% CD3-negative. Lymphodepletion has been shown to augment T cell adoptive immunotherapy through enhanced intratumoral proliferation. Management has noted the potential of its anti-IL-6 receptor monoclonal antibody (TZLS-501) to be included in CAR T therapy to address cytokine storm syndrome, although this was not discussed as part of the deal with Precision.
Under the terms of the agreement, Precision gained exclusive license to use foralumab as a lymphodepletion agent to complement its CAR T portfolio in the treatment of cancers. Precision will be responsible for development, commercialization, and costs associated with its use of foralumab in exchange for upfront payment, certain milestone payments and royalties to Tiziana. Amounts for upfronts, milestones and royalties were not disclosed; however, some of the milestones are payable upon start of a Phase II and Phase III study and upfront payments will be received shortly after execution of the deal.
Tiziana Update Call with Analysts and Investors
On September 8, 2021 following the market close, Tiziana hosted a web conference addressing its recent exclusive license agreement with Precision BioSciences for foralumab lymphodepletion support of allogeneic chimeric antigen receptor T cell (CAR T) therapy in cancer. Precision specializes in allogeneic CAR T therapy which provides advantages over autologous CAR T. More broadly, Precision is a genome editing company offering its ARCUS genome editing program. Its primary clinical programs are in blood cancers including Non-Hodgkin lymphoma (NHL) and B cell acute lymphoblastic leukemia (B-ALL).
One of the key benefits of Precision's CAR T offering is that it can be administered off the shelf. Precision's CAR T cells are specially engineered not to express Cluster of Differentiation 3 (CD3), a receptor that is normally found on effector T cells. Foralumab is an anti-CD3 fully human monoclonal antibody (mAb) and is expected to bind to T cell CD3 receptors, thereby preventing them from clearing the allogeneic CAR T cells. The use of foralumab can replace other conditioning agents such as cyclophosphamide, which is associated with neurotoxicity. Thus, adding foralumab to the therapy is expected to spare Precision's T cells while suppressing the patient's T cells, improving the side effect profile and the efficacy of Precision's T cells.
Tiziana CEO, Dr. Kunwar Shailubhai, began the call with a review of foralumab. Foralumab is the only fully human anti-CD3 mAb. Much clinical development has been performed on anti-CD3 mAb, in particular the earlier generation OKT-3, a fully mouse anti-CD3 antibody developed by Johnson & Johnson and approved by the FDA. However, because it is a mouse antibody, it elicited a strong, negative immune reaction and formation of anti-drug antibodies and stimulated cytokine release syndrome. OKT-3 was withdrawn from the market as a result; however, it presented favorable clinical efficacy. Thus, it was worth investigating the development of a fully human anti-CD3 antibody, especially for renal transplant or graft-versus-host-disease (GVHD). Visilizumab and teplizumab are follow-on humanized anti-CD3 antibodies previously developed by PDL Biopharma. Efficacy for these iterations was satisfactory, but long-term treatment was limited by formation of anti-drug antibodies. To sidestep the immune response to the mouse elements, Tiziana's foralumab was designed as a fully human anti-CD3 mAb, and has not produced anti-drug antibodies in clinical work thus far and has not triggered the immune reactions observed in previous anti-CD3 candidates.
Precision's CAR T cells do not express CD3 and foralumab will not bind to them, providing an appropriate candidate for lymphodepletion. Proper lymphodepletion can extend the durability of the CAR T cell therapy and lower the risk of cancer recurrence. Cyclophosphamide and fludarabine chemotherapies are often used for lymphodepletion conditioning; however, their use has been limited by neurotoxicity. Foralumab could replace other lymphodepleting agents, or even function by itself as a solution. Together, the allogeneic non-CD3-expressing CAR T with foralumab could provide better efficacy in currently unmanaged cancers.
Clinical Trials and Analyst Questions
Dr. Shailubhai updated on Tiziana's clinical progress. In the last year and a half, four trials were completed including Phase I trials for oral and nasal foralumab which laid the foundation for Phase II, as well as oral foralumab in Crohn's and nasal foralumab in multiple sclerosis. Tiziana also completed a preliminary trial in Brazil for COVID-19 and is currently targeting a Phase II for hospitalized COVID-19 patients.
During the Q&A session, topics began with teplizumab's (sponsored by Provention Bio) recent BLA Complete Response Letter (CRL). Teplizumab is a humanized anti-CD3 antibody being developed for prevention of Type 1 diabetes that recently received a CRL from the FDA for its candidate teplizumab. Shailubhai cited deficiencies with CMC and issues related to pharmacokinetic comparability.4 Tiziana management has not seen anti-drug antibody response thus far in clinical evaluation nor has immunotoxicity been observed. Autoimmune disorders could be another area where a fully-humanized anti-CD3 antibody could become useful.
Other topics discussed during the call reviewed the mechanism of lymphodepletion. When allogeneic (foreign) therapeutic CAR T cells are injected into the body, the patient's immune cells may attack the CAR T cells that are intended to treat the patient. Thus, cancer progression is an issue especially if CAR T therapy is terminated prematurely by the patient's own immune system. Lymphodepletion drugs are used to attenuate the patient's immune system, thereby enhancing clinical outcomes. However, neurotoxicity is an issue for lymphodepletion agents. Foralumab binds to CD3, depleting the cells expressing it (patient's non-CAR T cells), allowing the CAR T cells that were engineered and administered to work. Precision's CAR T cells lack CD3 and can be used for long periods of time avoiding systemic immunosuppression and toxicity.
Analyst questions then shifted direction towards Tiziana's clinical progress and expectations for upcoming milestones. Tiziana completed a Phase I study with nasal foralumab in COVID-19 with positive results. Foralumab was given once daily for ten consecutive days. Post-study analysis provided evidence that T regs were upregulated which is a favorable finding in light of a study conducted by Johns Hopkins where researchers found that T regs are depleted in COVID-19. By restoring T reg balance, foralumab may be able to provide clinical benefit for these patients.
Next steps for foralumab in Crohn's Disease include a Phase II multicenter trial in the US and Europe. Management anticipates the Crohn's study starting by end of this year or early next year. The nasal foralumab for secondary progressive multiple sclerosis (SPMS) program is underway and under the individual access program, one patient has completed three months of treatment. Management believes the data generated so far is favorable and nasal administration during the three months of therapy has shown no signs of toxicity. When complete, the data will be reviewed and will guide further efforts in conjunction with FDA guidance. Tiziana is also now considering a similar program in Europe.
Building on preliminary work in Brazil, Tiziana plans to target a total of 80 patients in multiple sites for its next trial of nasal foralumab in hospitalized COVID-19 patients. Tiziana must wait for the Agência Nacional de Vigilância Sanitária (ANVISA) or in English the Brazilian Health Regulatory Agency to grant approval to initiate the trial. Following approval, the trial should be able to begin a few weeks later.
Dr. Shailubhai concluded the call highlighting the recent additions to clinical leadership, Dr. Neil Graham, Dr. Kevin Schutz, as Tiziana continues its venture deeper into the clinic.
Corporate Reorganization
On August 20, Tiziana announced the official commencement of its strategic plan to change its corporate structure by establishing Tiziana Life Sciences as the Bermuda-incorporated, NASDAQ-traded parent of the Tiziana Group, subject to legal and shareholder approval. Existing shareholders, including American Depositary Share (ADS) holders, will have their shares exchanged, two-for-one, for the new parent company and the current company will then become a wholly-owned subsidiary. The new shares are expected to be listed while old shares are delisted from the London Stock Exchange and ADSs are delisted from the NASDAQ. The reorganization is intended to structure Tiziana in a manner more fitting to its US-centric operations, including enhanced trading and coverage characteristics, and reduce cost to shareholders. All outstanding options and warrants pursuant to the 2014 and 2016 Share Option Plans are intended to continue on the same basis but deliver the new shares. Likewise, holders of loan notes are intended to be converted as well.
Intranasal Foralumab in Hospitalized, Severe COVID-19
On June 23, 2021, Tiziana announced that it had entered into a collaboration with FHI Clinical to conduct a Phase II trial for intranasal foralumab in hospitalized, severe COVID-19. The Phase II study will be conducted in Brazil, and is intended as a proof-of-concept effort, as well as to evaluate safety, tolerability and efficacy of the candidate in severe COVID-19 and pulmonary inflammation. In the trial, foralumab will be delivered intranasally through a metered atomizing device. The trial will be randomized, placebo-controlled and double-blind. It will expand on the findings of intranasal foralumab in mild to moderate, non-hospitalized COVID-19 patients announced in February and will examine attenuation of pulmonary pathology characteristic of severe COVID-19 patients. Up to seven sites in Brazil will participate in the study, targeting enrollment of 80 patients with CT-confirmed pulmonary involvement. The study will also evaluate foralumab's effect on resolution of symptoms via chest CT, inflammatory biomarkers, T cell subpopulations, safety and mucosal inflammatory response following 14 days of intranasal administration.
FHI Clinical is a subsidiary of FHI 360, specializing in clinical development of drugs for infectious diseases. FHI Clinical is involved with COVID-19 trials in all phases for vaccines and therapeutics, as well as observational studies to characterize SARS-CoV-2 infection. FHI Clinical has a network of clinical sites across 16 countries and 43 states in the US.
On August 17th, Tiziana informed investors via press release that a peer-reviewed article had been published featuring data from the foralumab trial in mild to moderate COVID-19 patients in Brazil, which was conducted in February. The article was published in Frontiers in Immunology titled "Nasal Administration of Anti-CD3 Monoclonal Antibody (foralumab) Reduces Lung Inflammation and Blood Inflammatory Biomarkers in Mild to Moderate COVID-19 Patients: A Pilot Study." The study was a collaboration with teams from Harvard Medical School and INTRIALS, a CRO based in São Paulo. The aim of the study was to assess safety of intranasal foralumab and its potential efficacy in treating immune hyperactivity and lung inflammation associated with mild/moderate COVID-19 patients. 39 patients were randomized into three cohorts: control, 100 µg foralumab + dexamethasone, and foralumab monotherapy.
Foralumab was well tolerated and all patients completed the study. No serious adverse events (SAEs) were observed. 11 patients experienced an adverse event including headache (n=4), burning in the nostril (n=1), retrosternal pain (n=2), pustular lesions and itching in cervical area (n=1), dysuria (n=1), tachycardia associated with anxiety (n=1), and insomnia (n=1). On the efficacy front, foralumab treatment resulted in significant reduction in lung inflammation, as observed with CT scans, which revealed improvement in clearance of lung infiltrates versus baseline. The CT data were correlated by reduction in levels of inflammatory markers such as IL-6 levels (69%; p=0.03) and CRP6 (85%; p=0.03) at day 10. Management anticipates initiation of Phase II proof-of-concept study in Brazil to further evaluate
Summary
Tiziana Life updated on first half 2021 financial and operational results. We've highlighted major milestones year to date including a partnership with Precision BioSciences to evaluate foralumab as a lymphodepletion agent with allogeneic CAR T, Tiziana's intent to reorganize as a Bermuda-incorporated company and progress on the intranasal foralumab COVID-19 program. Additional highlights year-to-date included the appointment of multiple key positions in the firm, as well as preliminary work with Takanawa to survey for Japanese partners, as well as grant application submission to UK-CTAP proposing intranasal foralumab as a potential take-home therapy for COVID-19.
As Tiziana updates investors with its financial performance, our focus turns to the two Phase II trials in Crohn's Disease and Multiple Sclerosis. These programs drive the majority of the value in our assessment and address unmet needs in important indications.
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1. As calculated by the company. Our calculation using the reported 150.2 million basic and diluted average number of shares outstanding yielded a loss per share of (£0.084).
2. Lymphodepletion optimization for CAR T-cell therapy (multiplemyelomahub.com)
3. McCreedy BJ, Senyukov VV, Nguyen KT. Off the shelf T cell therapies for hematologic malignancies. Best Pract Res Clin Haematol. 2018 Jun;31(2):166-175. doi: 10.1016/j.beha.2018.03.001. Epub 2018 Mar 28. PMID: 29909917.
4. Provention Bio Receives Complete Response Letter (CRL) to Biologics License Application (BLA) for Teplizumab for the Delay of Clinical Type 1 Diabetes (T1D) in At-risk Individuals - Jul 6, 2021
5. https://doi.org/10.3389/fimmu.2021.709861
6. C-reactive protein
約翰·範德莫斯滕(John Vandermosten),CFA
納斯達克:TLSA
閲讀完整的TLSA研究報告
2021年上半年業績
Tiziana生命科學公司(納斯達克市場代碼:TLSA)在一份新聞稿和SEC提交的Form 6-K中更新了2021年上半年的財務和運營業績。在更新中,Tiziana回顧了其候選人最近的臨牀里程碑、新的任命和財務結果,包括重組為一家百慕大註冊公司的計劃。我們重點介紹今年到目前為止的重大事件。
截至6月30日的上半年要聞到目前為止,包括:
➣在新冠肺炎完成巴西校友一期工程-2021年1月
➣任命尼爾·格雷厄姆·MBBS,醫學博士,公共衞生碩士為首席營銷官-2021年1月
➣提升至倫敦證交所市場,AIM退市-2021年1月
新冠肺炎校友第一階段的➣安全結果-2021年2月
➣Thomas Adams,博士被任命為藥物開發負責人--2021年2月
新冠肺炎校友➣第二階段計劃-2021年3月
批准➣自發性骨質疏鬆症患者進入-2021年3月
➣與高川日本K.K.的戰略倡議-2021年5月
➣免疫調節證據在第一階段-2021年5月
➣UK-CTAP贈款申請-2021年6月
➣凱文·舒茨,藥學博士被任命為監管事務副總裁-2021年6月
福拉單抗用於重症新冠肺炎患者的➣II期試驗-2021年6月
➣年度股東大會結果-2021年6月
➣關於新冠肺炎患者使用Foralab的文章發表-2021年8月
➣企業重組文件計劃-2021年8月
➣許可協議通過CAR T和電話會議評估Alumab-2021年9月
財務業績
蒂齊亞納在2021年上半年沒有產生收入,發生了1260萬英鎊的運營費用,扣除一些次要的非運營項目後,股權持有人的綜合虧損為1260萬英鎊或0.074英鎊。1每股。
截至2021年6月30日的上半年與截至2020年6月30日的同期比較:
➣的研發費用從76萬GB增長到440萬GB,增長了473%,這主要是由於與推進TZLS401和TZLS501相關的費用;
➣運營費用從320萬GB增長到820萬GB,增幅為159%;
➣股東應佔的全面虧損總額為(1,260萬英鎊),而不是(390萬英鎊)。
截至2021年6月30日,現金及現金等價物共計3860萬GB。這一數額與2020年底持有的4820萬GB現金和等價物餘額形成對比。Tiziana的資產負債表上沒有債務。截至2021年和2020年的6個月,運營中使用的現金分別為(GB 940萬)和(GB 510萬)。
抗CD3抗體與CAR T:與Precision結合
2021年9月2日,Tiziana宣佈與Precision BioSciences(納斯達克股票代碼:DTIL)達成獨家許可協議,與Precision的同種異體汽車T組合一起評估Tiziana的Alumab。在這一安排中,一種完全抗CD3的人類單克隆抗體foralab正在被作為淋巴清除劑進行研究,這種試劑故意破壞患者的免疫系統,包括T細胞,為CAR T細胞讓路。在這種安排中,foralab被作為淋巴清除劑進行研究,這種試劑故意破壞患者的免疫系統,包括T細胞,為CAR T細胞讓路。在接受過繼細胞治療(ACT)之前要進行淋巴濾除。目的是確定Foralab是否可以改善ACT的結果。淋巴枯竭通常包括短程化療以破壞T、B和NK細胞。這可以起到清除腫瘤、改變腫瘤表型、改變腫瘤微環境和調節細胞因子分佈的作用。2常見的淋巴清除劑包括氟達拉濱和環磷酰胺,通常聯合使用。這些藥物有嚴重的副作用,在氟達拉濱的情況下,與神經毒性有關。Foralab有可能取代或減少化療方案,從而改善患者的副作用情況。
Foralab可能會誘導同種異體CAR T或CAR T細胞的耐受,這些細胞不是來自患者自己的身體,而是來自捐贈者,這可能會攻擊患者(宿主),這就是眾所周知的移植物抗宿主病(GVHD)。與自體方法相比,異體CAR T的優勢在於,自體CAR T細胞的生成可能具有挑戰性,特別是在晚期疾病患者中,因為生成細胞所需的時間很長。3
分化簇3(CD3)是效應性T細胞上的受體。Precision對T細胞的處理使用Arcus基因編輯來敲除TRAC基因並耗盡CD3,產生大於99.9%CD3陰性的同種異體CAR T細胞。淋巴耗竭已被證明通過增強腫瘤內增殖來增強T細胞過繼免疫治療。管理層已經注意到,其抗IL-6受體單克隆抗體(TZLS-501)有可能被納入CAR T療法,以應對細胞因子風暴綜合徵,儘管這並未作為與Precision交易的一部分進行討論。
根據協議條款,Precision獲得了使用foralumab作為淋巴清除劑的獨家許可,以補充其治療癌症的CAR T產品組合。Precision將負責其開發、商業化以及使用ForAlumab的相關成本,以換取向Tiziana支付的預付款、某些里程碑付款和特許權使用費。預付款、里程碑和特許權使用費的金額沒有披露;不過,一些里程碑在第二階段和第三階段研究開始時支付,並將在交易執行後不久收到預付款。
Tiziana Update與分析師和投資者的電話會議
2021年9月8日,市場收盤後,Tiziana主持了一次網絡會議,就其最近與Precision BioSciences就用於治療癌症的同種異體嵌合抗原受體T細胞(CAR T)療法的單抗淋巴耗竭支持達成的獨家許可協議發表講話。Precision專門從事同種異體CAR T療法,這提供了比自體CAR T更廣泛的優勢。更廣泛地説,Precision是一家提供Arcus基因組編輯程序的基因組編輯公司。它的主要臨牀項目是血癌,包括非霍奇金淋巴瘤(NHL)和B細胞急性淋巴細胞白血病(B-ALL)。
Precision提供的Car T的主要好處之一是,它可以現成管理。Precision的CAR T細胞經過特殊設計,不表達分化簇3(CD3),這是一種通常在效應器T細胞上發現的受體。Foralab是一種抗CD3的全人單克隆抗體(MAb),有望與T細胞CD3受體結合,從而阻止它們清除同種異體CAR T細胞。使用foralab可以替代其他調節劑,如環磷酰胺,這與神經毒性有關。因此,在治療中加入foralab有望節省Precision的T細胞,同時抑制患者的T細胞,改善副作用和Precision的T細胞的療效。
Tiziana首席執行官昆瓦爾·沙魯拜博士首先對foralab進行了回顧。Foralab是唯一一種完全人源性抗CD3單抗。針對抗CD3mAb,特別是早期的OKT-3,已經進行了大量的臨牀研究,OKT-3是由強生研製並獲得美國食品和藥物管理局批准的全鼠型抗CD3mAb。但是,由於它是一種小鼠抗體,它會引起強烈的陰性免疫反應,形成抗藥物抗體,並刺激細胞因子釋放綜合徵。OKT-3因此退出市場,但表現出良好的臨牀療效。因此,開發一種完全人源性的抗CD3抗體,特別是用於腎移植或移植物抗宿主病(GVHD),是值得研究的。Visilizumab和teplizumab是PDL Biophma以前開發的後續人源化抗CD3抗體。這些迭代的療效令人滿意,但長期治療受到抗藥抗體形成的限制。為了避開對小鼠成分的免疫反應,Tiziana的foralab被設計成一種完全人源性的抗CD3單抗,到目前為止還沒有在臨牀工作中產生抗藥抗體,也沒有引發以前的抗CD3候選抗體中觀察到的免疫反應。
Precision的CAR T細胞不表達CD3,單抗也不會與其結合,為淋巴枯竭提供了合適的候選細胞。適當的淋巴淨化可以延長CAR T細胞治療的耐受性,降低癌症復發的風險。環磷酰胺和氟達拉濱化療常用於淋巴枯竭調節,然而,它們的使用受到神經毒性的限制。Foralab可以替代其他淋巴清除劑,甚至可以單獨作為一種解決方案。總之,非CD3表達的同種異體CAR T與foralab聯合使用可以在目前未經治療的癌症中提供更好的療效。
臨牀試驗和分析師問題
Shailubhai醫生更新了Tiziana的臨牀進展。在過去的一年半里,完成了四項試驗,包括為第二階段奠定基礎的口服和鼻用福爾馬單抗的第一階段試驗,以及用於克羅恩病的口服福爾馬單抗和用於多發性硬化症的鼻福爾馬單抗。Tiziana還完成了新冠肺炎在巴西的初步試驗,目前目標是住院的新冠肺炎患者的第二階段試驗。
在問答環節,話題從替普利珠單抗(由Provention Bio贊助)最近的BLA完全回覆信(CRL)開始。Teplizumab是一種人源化的抗CD3抗體,正在開發用於預防1型糖尿病,最近獲得了FDA對其候選teplizumab的CRL。沙魯拜列舉了CMC的不足之處以及與藥代動力學可比性相關的問題。4到目前為止,Tiziana治療在臨牀評估中沒有看到抗藥抗體反應,也沒有觀察到免疫毒性。自身免疫性疾病可能是另一個完全人源化的抗CD3抗體可能有用的領域。
電話會議期間討論的其他話題回顧了淋巴枯竭的機制。當異基因(外來)治療性CAR T細胞被注射到體內時,患者的免疫細胞可能會攻擊原本用於治療患者的CAR T細胞。因此,癌症進展是一個問題,特別是如果CAR T治療被患者自身的免疫系統提前終止的話。淋巴耗竭藥物用於減弱患者的免疫系統,從而提高臨牀療效。然而,對於淋巴清除劑來説,神經毒性是一個問題。Foralab與CD3結合,耗盡表達CD3的細胞(患者的非CAR T細胞),允許設計和使用的CAR T細胞工作。Precision的CAR T細胞缺乏CD3,可以長期使用,避免全身免疫抑制和毒性。
分析師的問題隨後轉向了Tiziana的臨牀進展和對即將到來的里程碑的期望。Tiziana在新冠肺炎完成了鼻用Foralab的I期研究,結果呈陽性。Foralab每日一次,連續服用10天。研究後的分析提供了T基因上調的證據,考慮到約翰·霍普金斯大學進行的一項研究,研究人員發現新冠肺炎中的T基因缺失,這是一個有利的發現。通過恢復T-reg平衡,foralab可能會為這些患者提供臨牀益處。
下一步用於治療克羅恩病的單抗包括在美國和歐洲進行的第二階段多中心試驗。管理層預計克羅恩的研究將於今年年底或明年初開始。針對繼發性進行性多發性硬化症(SPMS)的鼻孔治療計劃正在進行中,在個人准入計劃下,一名患者已經完成了三個月的治療。管理層認為,到目前為止產生的數據是有利的,在三個月的治療期間,鼻腔給藥沒有顯示出毒性的跡象。完成後,數據將被審查,並將結合FDA的指導意見指導進一步的工作。Tiziana現在也在考慮在歐洲推出類似的計劃。
在巴西前期工作的基礎上,Tiziana計劃在多個地點針對總共80名患者進行下一次在住院新冠肺炎患者中進行鼻用Foralab的試驗。Tiziana必須等待巴西國家衞生監督管理局(ANVISA)或巴西衞生管理署批准啟動試驗。在獲得批准後,審判應該可以在幾周後開始。
Shailubhai博士在電話會議結束時強調,隨着Tiziana繼續深入臨牀,尼爾·格雷厄姆(Neil Graham)博士和凱文·舒茨(Kevin Schutz)博士最近加入了臨牀領導層。
企業重組
8月20日,Tiziana宣佈正式開始其改變公司結構的戰略計劃,將Tiziana生命科學公司設立為Tiziana集團在百慕大註冊、在納斯達克上市的母公司,這還有待法律和股東的批准。包括ADS(American Depositary Share)持有者在內的現有股東將以二比一的方式換取新母公司的股份,目前的公司隨後將成為全資子公司。新股預計將上市,而舊股將從倫敦證券交易所(London Stock Exchange)退市,美國存託憑證(ADS)將從納斯達克(NASDAQ)退市。重組的目的是以一種更適合其以美國為中心的業務的方式構建Tiziana,包括增強交易和覆蓋特點,並降低股東的成本。根據2014年和2016年購股權計劃,所有已發行的期權和認股權證都打算在相同的基礎上繼續,但會交付新股。同樣,借款票據的持有者也打算進行轉換。
重症新冠肺炎住院患者鼻腔內應用Foralab
2021年6月23日,Tiziana宣佈它已經與FHI臨牀達成合作,在住院的重症新冠肺炎中進行鼻內Foralab的第二階段試驗。第二階段研究將在巴西進行,旨在作為一項概念驗證努力,以及評估候選藥物治療嚴重新冠肺炎和肺部炎症的安全性、耐受性和有效性。在試驗中,foralab將通過計量霧化裝置鼻腔給藥。這項試驗將是隨機、安慰劑對照和雙盲的。它將在2月份宣佈的輕中度非住院新冠肺炎患者中鼻內應用Foralab的研究結果基礎上進行擴展,並將檢查重度新冠肺炎患者的肺部病理特徵的減弱情況。巴西將有多達7個地點參與這項研究,目標是招募80名CT證實的肺部病變患者。這項研究還將通過胸部CT、炎症生物標誌物、T細胞亞羣、安全性和鼻腔給藥14天后的粘膜炎症反應來評估foralab在緩解症狀方面的效果。
FHI臨牀是FHI 360的子公司,專門從事傳染病藥物的臨牀開發。三菱重工臨牀公司參與了新冠肺炎所有階段的疫苗和治療試驗,以及表徵SARS-CoV-2感染特徵的觀察性研究。FHI臨牀擁有遍佈美國16個國家和43個州的臨牀站點網絡。
8月17日,Tiziana通過新聞稿通知投資者,已經發表了一篇同行評議的文章,文章內容是2月份在巴西對輕中度新冠肺炎患者進行的foralab試驗的數據。這篇文章發表在免疫學前沿一項名為“鼻腔給藥抗CD3單克隆抗體(Foralab)減少輕中度新冠肺炎患者fl中的肺和fl中的血液中的炎症生物標誌物:一項先導性研究”的研究。這項研究是與哈佛醫學院和總部設在聖保羅的CRO InTrials的團隊合作進行的。本研究的目的是評價鼻腔內應用Foralab的安全性及其對輕中度新冠肺炎患者免疫功能亢進和肺部炎症的潛在療效。39例患者被隨機分成3組:對照組、100µg阿莫單抗+地塞米松組和阿莫單抗單藥治療組。
Foralab耐受性良好,所有患者都完成了研究。未觀察到嚴重不良反應(SAE)。不良反應11例,頭痛4例,鼻孔灼熱1例,胸骨後疼痛2例,頸部膿皰、瘙癢1例,排尿困難1例,心動過速伴焦慮1例,失眠1例。在療效方面,正如CT掃描所觀察到的那樣,Foralab治療導致肺部炎症顯著減少,這表明肺浸潤的清除比基線有所改善。CT數據與炎症標記物,如IL-6水平(69%;p=0.03)和CRP水平降低相關6(85%;p=0.03)在第10天。管理層預計在巴西啟動第二階段概念驗證研究,以進一步評估
摘要
Tiziana Life更新了2021年上半年的財務和運營業績。我們重點介紹了今年到目前為止的主要里程碑事件,包括與精密生物科學公司合作評估Foralab作為同種異體CAR T淋巴去除劑的作用、Tiziana打算重組為百慕大註冊公司以及鼻腔Foralab新冠肺炎計劃的進展。今年到目前為止的其他亮點包括在公司任命了多個關鍵職位,以及與高川一起為日本合作伙伴進行調查的初步工作,以及向英國-CTAP提交的撥款申請,提議將foralab作為新冠肺炎的潛在帶回家療法。
隨着Tiziana向投資者介紹其最新的財務表現,我們的焦點轉向克羅恩病和多發性硬化症的兩個第二階段試驗。這些計劃推動了我們評估中的大部分價值,並解決了重要適應症中未得到滿足的需求。
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1.按公司計算。我們使用報告的150,200,000股基本和稀釋後的流通股平均數計算得出的每股虧損為(GB 0.084)。
2.CAR T細胞治療的淋巴耗竭優化(Multiemyelomahub.com)
3.McCreedy BJ,Senyukov VV,Nguyen KT.針對血液系統惡性腫瘤的現成T細胞療法。最佳實踐者克萊恩·海馬託爾(Clin Haematol)。2018年6月;31(2):166-175。Doi:10.1016/j.behavi.2018.03.001。EPub 2018年3月28日。29909917。
4.Proventive Bio收到針對Teplizumab用於延遲高危個人臨牀1型糖尿病(T1D)的生物製品許可證申請(BLA)的完整回覆信(CRL)-2021年7月6日
5.https://doi.org/10.3389/fimmu.2021.709861
6.C反應蛋白