Sangamo Therapeutics Inc (SGMO) 2021 Q3 法說會逐字稿

Thank you all for standing by, and welcome to the Sangamo Third Quarter 2021 Teleconference Call. (Operator Instructions) Please also note that today's call is being recorded.

I'll now turn the call over to your host, Aron Feingold, Head of Corporate Communications. Ma'am, you may now begin.

Good morning, and thank you for joining us today. With me this morning on this call are several members of the Sangamo executive leadership team, including Sandy Macrae, Chief Executive Officer; Mark McClung, Chief Operating Officer; Prathyusha Duraibabu, Chief Financial Officer; Jason Fontenot, Chief Scientific Officer; Rob Schott, Head of Development; and Bettina Cockroft, Chief Medical Officer. Slides from our corporate presentation can be found on our website, sangamo.com, under the Investors & Media section under the Events and Presentations page.

This call includes forward-looking statements regarding Sangamo's current expectations. These statements include, but are not limited to, statements relating to therapeutic and commercial potential of our product candidate; the anticipated plans and time lines of Sangamo and our collaborators for conducting clinical trials and presenting clinical data; execution of our corporate strategy; advancement of our product candidates; our revised 2021 financial guidance and other statements that are not historical facts. Actual results may differ materially from what we discuss today. These statements are subject to certain risks and uncertainties that are discussed in our filings with the SEC. Specifically, our annual report on Form 10-K for the fiscal year ended December 31, 2020, are supplemented by our quarterly report on Form 10-Q for the fiscal quarter ended September 30, 2021.

The forward-looking statements stated today are made as of this date, and we undertake no duty to update such information, except as required by law. On this call, we discuss our non-GAAP operating expenses. Reconciliation of this measure to our GAAP operating expenses can be found in today's press release, which is available on our website.

Now I'd like to turn the call over to our CEO, Sandy Macrae.

Thank you, Aron, and good morning to everyone on the call. This is such an important moment for Sangamo as we share clinical data and business updates across several programs, demonstrating that we have 3 important assets in or progressing towards late-stage development.

Our gene therapy portfolio is advancing with accumulating safety and efficacy data in our Fabry and hemophilia A programs. Additionally, we are delighted with the preliminary proof-of-concept data demonstrated the clinical potential of our genome engineering zinc finger technology in sickle cell disease.

This morning, we announced preliminary clinical data from our Phase I/II STAAR study, evaluating isaralgagene civaparvovec, or ST-920, our Fabry disease gene therapy product candidate. Data from this important study were evaluated from the 4 patients in the first 2 cohorts, dose cycles 0.5e13 and 1e13 vg per kg as of the cutoff date, September 17 of this year. These encouraging results showed that for the first 4 patients, ST-920 was generally well tolerated. There were no treatment-related adverse events higher than grade 1 and no treatment-related serious adverse events. No patients experienced liver enzyme elevations or required steroid treatment. All 4 patients exhibited above-normal alpha-Gal A activity which were maintained for up to 1 year for the first patient treated and through 14 weeks from most recently treated patients.

Levels range from 2- to 15-fold above normal levels at last measurement as of the cutoff date. Interestingly, the first 3 patients dose reported improvements in ability to select a primary and common Fabry  disease symptom that limits exercise tolerance for the patient. ERT withdrawal is now complete for 1 patient and is planned for the other patient on ERT based on the stability of their alpha-Gal A activity following treatment.

Based on these data, we have initiated Phase III planning. The fifth patient in the study, who is the first patient in the third dose cohort had 3e13 was recently dosed. The sixth patient is currently in screening also for the third dose cohort, and we expect to provide updated results throughout 2022 and present these data at a medical meeting.

This morning, we also announced that preliminary proof-of-concept results from the Phase I/II PRECIZN study of SAR445136, an investigational zinc finger nuclease gene edited cell therapy, in patients with sickle cell disease will be presented at ASH. This program is partnered with our friends at Sanofi. The data in the abstract shows that as of June 25, 2021, cutoff date, none of the 4 patients treated require blood transfusion post-engraftment through 65 weeks of follow-up for the longest treated patients.

The Board treated patients all experienced increases in total hemoglobin, fetal hemoglobin and percent F cells. No adverse events or serious adverse events related to treatment were reported as the cutoff date. Further data will be provided in a poster presentation attached on December 12.

Sangamo and Sanofi are continue to advance the sickle cell disease program. The company's recently obtained manufacturing requirements guidance from the FDA in preparation for potential further clinical studies. Separately, we and Sanofi made the business decision to cease development for the beta thalassemia indication and allowing us to focus resources on the sickle cell disease program.

Moving now on to our hemophilia A program partnered with Pfizer. We announced this morning the updated follow-up results from the Phase /II Alta study of giroctocogene fitelparvovec will be presented at ASH. For the 4 patients in the highest dose cohort who have been followed for at least 104 weeks as of May 19, 2021 cutoff, mean factor VIII activity was 30.9% at week 104, as measured by chromogenic assay. In this cohort, annualized bleeding rate was 0 for the first year after treatment and 0.9% throughout total duration of follow-up. As demonstrated in this study, the gene therapy was generally well tolerated in patients with severe hemophilia A. Further data will be provided in a poster presentation at ASH on December 12, 2021.

We and Pfizer also announced that some of the patients treated to date in the Phase III AFFINE trial experienced Factor VIII levels greater than 150% following treatment. To date, none of these patients have experienced thrombotic events, and some have been treated with direct oral anticoagulants to reduce thrombotic risk. Out of an abundance of caution, Pfizer voluntary pause screening and dosing of patients in the trial in order to implement a protocol amendment, which will provide guidelines for clinical management of elevated Factor VIII levels.

On November 3, Pfizer was informed that the FDA has put this trial on clinical hold. Pfizer and Sangamo are committed to resuming patient dosing as soon as possible. We continue to believe that this gene therapy will represent an important treatment option for patients with hemophilia A. The next step is to share the proposed protocol amendment with health authorities and respond to the clinical hold, after which the companies will be able to provide updated timing for the trial.

Turning now to our kidney transplant program. We have now enrolled the first patient in our Phase I/II STEADFAST study evaluating TX200, our wholly owned autologous CAR-Treg cell therapy candidate. We believe that this is the first in-human CAR-Treg study and that this field is going with much excitement as a promising approach for challenging autoimmune conditions. In this study, similar to other genetically engineered cell therapy approaches, patients will undergo a procedure from which their Treg cells will be isolated, engineered and then cryopreserved. The HLA-A2 negative patient will subsequently undergo kidney transplant and following a recovery period, will receive their personalized TX200 therapy. We expect to dose the first 2 patients in the study by the middle of 2022, following their kidney transplants.

We continue to open sites and screen patients. We believe this proof-of-concept study may represent an important treatment for patients undergoing renal transplant and will help us understand CAR-Treg biology in humans as well as advanced process development knowledge. We hope that this study establishes the foundation for a portfolio of wholly owned CAR-Treg therapies for autoimmune indications.

Finally, I'm delighted to share that Mark McClung has been appointed as Sangamo's Chief Operating Officer effective November 1. Mark's expanded role as COO, is an important organizational step for Sangamo, which will support the multiple advancing wholly-owned and partnered programs. We look forward to Mark's continued leadership as we continue to build the capabilities to bring genomic medicines to patients and to the marketplace.

Everyone at Sangamo is thrilled with this clinical momentum, and we look forward to presenting updated Fabry results throughout 2022 as well as working with our collaboration partners and investigators to present the ASH data in December. And with that, I'll turn the call over to Prathyusha for a financial update. Prathyusha?

Thank you, Sandy, and good morning. Our financial results for this quarter are available in the press release issued this morning, which can also be found on our website.

I want to reiterate that this is an exciting moment for us as a company. And this quarter, we continue to invest in the advancement of our clinical programs, including Fabry and TX200, our preclinical research pipeline and our in-house manufacturing capabilities. With approximately $519 million in cash, cash equivalents and marketable securities at the end of the quarter, we believe that our balance sheet remains strong.

Turning to 2021 full year guidance. We expect non-GAAP operating expenses to be between $265 million to $275 million for the year, which is within the range of the guidance that we have previously provided. This range excludes estimated non-cash stock-based compensation expense of approximately $35 million.

I will now turn the call back to Sandy for closing remarks.

Thank you, Prathyusha. We are very excited about these clinical data readouts. We show the advancement of our first-generation genomic medicine pipeline with traditional gene therapy and autologous cell therapy. These programs potentially pave the way for our next generation focus on genome regulation and allogeneic CAR-Treg cell therapy, where we have a robust preclinical pipeline in neurological and autoimmune diseases, respectively.

We're delighted with the positive momentum and look forward to updating you in the near-term about several potential catalysts, including presentation at ASH of 4 patient sickle cell disease Phase I/II data, presentation at ASH of 2-year Phase I/II hemophilia A data. And additionally, we'll provide a timing update for the Phase III trial once the proposed protocol amendment in response to the hold is shared with health authorities. Dosing of the 6 patients and updated Fabry Phase I/II data presentations throughout 2022, including at a medical meeting, dosing of the first 2 patients in the STEADFAST Phase I/II study by the middle of 2022 and completion of our in-house cell therapy manufacturing facility in our Valbonne France location following the completion of our in-house manufacturing facility in our Brisbane California headquarters this past quarter. So we'll now turn it over to the operator to open the line for questions.

(Operator Instructions) Speakers first question is from the line of Aspen Mori of Bank of America.

So on Fabry, I think you previously hadn't expected to share some of the enzyme replacement therapy withdrawal data in this year-end release. It's good to see that time frame seems to have maybe a bit faster than expected. But with that in mind, I guess, is there any patterns you're seeing in the time frame it takes from getting from the dose of ST-920 to removal of that therapy? And it also appears that maybe the patient for kind of got to that milestone a little quicker than Patient 1, who had a longer follow-up. Just want to see if there's anything you're seeing there to explain that?

So thank you for your question. I think what I'm hearing -- you're asking about is about ERT withdrawal. So we thought it was important to see -- to truly understand the effect duration. And we've been very pleased that over the course of a year in the longest treated patients, there's been a consistency of effect. And we then have discussions with the investigators. And at the appropriate point for them and for their patient, they will withdraw treatment and the first patient was only withdrawn very recently, and the second one is planned to be withdrawn this year. And so we will share that data at an appropriate time.

Okay. And then I have one more on the -- on Fabry. Are there any trends you're seeing among patients 1 and 4 for that signal maybe what's driving better alpha-Gal A response than you're seeing with patients 2 and 3? I think 2 and 3 might have had lower baseline Gb3, but if there's anything you could point to that would help out there?

Well, so there's only 4 patients, so it's very difficult to say anything specific. It is notable though that patients 1 and 4 are on ERT and patients 2 and 3 are not. And it may be that there is some additional effect from the ERT that is leading to that effect. But I think that is only speculation, and we need to dose more patients to understand it.

Next question is from Yanan Zhu of Wells Fargo.

I have a question on Fabry and maybe also additional questions on other updates. But Fabry, could you, Sandy, comment on the dose response here? And also, I think for patient 2, there was a increase in enzyme levels above normal, but the substrate levels seems to be flat. So could you shed some light on that finding?

So it's a good question. And I think this has been something that's been consistently seen across all of the research into Fabry disease, if the substrate levels are low, they don't change in the treatment period. But Bettina, do you have thoughts on this on the dose response that we've seen?

Thank you, Sandy. So as Sandy mentioned, we have now dosed 2 patients in cohort 1 and 2 patients in cohort 2. This is still a small sample size. This needs to be emphasized at this point in time. But regarding the levels of life of Gb3, for sure, in 3 of the 4 patients, those are Gb3 levels started off low and as Sandy mentioned, across programs, it has been seen that these remain stable if they are low to start with. If you look at patient 3, this patient like Gb3 level start-off high and the levels of lyso-Gb3 were reduced by about 40% within 10 weeks after dosing, and this reduction was maintained through 32 weeks.

So at this point in time, with such a small sample size, it is really difficult to talk about those relationships. I would say that throughout 2022, we anticipate to share more data and that data will also be shared at a medical meeting. So there will be more granularity and data to come.

But what I want you to take away is how excited we are by this because all 4 patients are above the normal physiological level. All 4 patients have shown consistency of response in the time that they've been observed. And 3 of the 4 patients are already reporting patient effects are very encouraging about the effect of the drug, and we are already into the next higher cohort. And as Bettina says, we'll talk about this next year.

Great. And on the clinical hold, for the hemophilia A collaborated hemophilia A program, I was wondering how high is the Factor VIII level? I thought we had seen like 200% from other studies. So could you shed some light on the rationale for that clinical hold? And lastly, a question on BIVV003, a very quick one that is at ASH, would we see VOC data for the treated patients?

So I'm going to pass the question on hemophilia to Rob. Rob, can you talk to this?

Yes. We have seen elevations of Factor VIII greater than 150% in some patients. This is an ongoing Phase III trial. So we're not getting very specific with the data around this. There were no these thrombotic events associated with these elevated levels and the decision to voluntarily pause the trial was out of an abundance of caution. And as anticipated, the FDA followed through with a clinical hold that was -- we were notified of that late yesterday. It's our plan to -- with Pfizer to submit a protocol amendment and have a discussion with the agency and resume the trial when it is appropriate to do so.

And regarding sickle cell disease, we have -- we'll show the full data set at ASH in December.

Next question is from Luca Issi of RBC Capital.

Congrats on the progress. Maybe on Fabry disease exciting early proof-of-concept. I'm wondering if you can comment on how you're thinking about the Phase III study design? On hemophilia A, maybe if you can provide any additional color on the protocol amendment that you're thinking about to minimize the risk going forward? And then maybe on, beta thal can you just expand a little bit more on the rationale behind the decision to terminate a program?

Goodness. So it's so exciting to be talking about Phase III design because we are very pleased with the results. But we need to see the results of the third cohort to really be able to understand which dose we're taking forward. And have we design the study. But I can reassure you that planning and the full energy behind the Phase III has already started on these programs. Let me then pass the hemophilia A question to Rob and the beta thalassemia to Mark.

Yes. With regard to the protocol amendment, we're not disclosing any of the specifics of the protocol amendment at this time. But the protocol amendment is being considered and will be submitted promptly and in discussion with the agency in response to the clinical...

And the current plan is to find the best way to guide management of any patient that has a higher level.

Yes. So it will be monitoring and management of the patients with levels of Factor VIII that are greater than 150%.

But we feel it important to restate every time that conversation comes up that no patient has come to harm, there have been no adverse events related to this. And this is an abundance of caution, and I think a correct abundance of caution because this is a gene therapy that we need to take very seriously and do the best for the patients. Mark?

Yes. So in terms of the beta thal decision, it was really a business decision that we took alongside our partners at Sanofi just due to the timing and relative to where the competitive set lies in terms of their development. We felt that it is important to really focus our effort and our resources solely on sickle cell disease.

And driving forward together.

Next question is from Maury Raycroft of Jefferies.

Congrats on the update today. For Fabry, just wondering if you can talk more about the alpha-Gal data being 2- to 15-fold higher than normal. It seems higher than competitor data at month 12 that showed about 5- to 6-fold higher. I guess what's the best way to contextualize your data versus competitors? And how could this translate to kidney substrate reduction.

Thank you, Maury. Bettina, do you want to talk about Fabry?

Sure. Thank you, Sandy. So in terms of the alpha-Gal data, we're obviously very excited to see the super physiologic alpha-Gal expression that we are seeing with all 4 patients. I think at this point, it is early to compare and probably not the right place to do comparisons across programs. We look forward to sharing more granularity on this data at an upcoming meeting in 2022. So that also goes to any additional data related to kidney substrate.

You can imagine, though, that having seen efficacy at the 2 initial cohorts and moving into a third higher cohort, it gives us enormous energy that this is going to be a medicine that will be useful for patients with Fabry. It really is compelling data early as it is, we find a compelling data.

And I would add that our priority, we had targeted super physiologic expressions of alpha-Gal A and plasma to drive clearance from tissue. So this is a desired effect of what we're seeing.

Got it. That's all helpful. And maybe just one follow-up. If you can compare and contrast the Fabry observations and gene expression and dose with your hemophilia gene therapy program? Maybe if you can talk more about that?

That's a good question. I mean we are fortunate that we used AAV6 now in several programs, and we understand the safety of it. And across all of the programs, we've had very few adverse events. In addition, if you look at the point at which there's an inflection of efficacy, it's about the 1 to 3.e13 in hemophilia. And it's even earlier than that in the Fabry disease program. Other than that, we're very pleased with the safety and efficacy we've now seen in our 2 gene therapy programs.

Next question is from the Nicole Germino, Truist Securities.

Congrats on the progress. So I dialed in a little bit late, and I might have missed some of the opening remarks, so I apologize if my questions were already addressed. But for Fabry, can you talk about how the primary symptoms have improved over time from baseline? And any color on cardiac function? And for hem A, how long some infusion did these excursions happen? And how long are (inaudible) going forward to monitor?

So your line isn't -- is a little unclear. So let me see -- read back to see the -- I understood your question, it's about the patient symptoms in Fabry and it's about how we manage the patients in hemophilia, is that correct?

Yes. And how long -- for hemophilia, how long from the infusion did these persons happen?

So Bettina, can you say what we know about the patient-reported symptoms in Fabry, please?

Yes, of course. So as a reminder, again, I'd like to emphasize this is the early data that we're sharing -- early preliminary data. The patients in cohort 2, 3 of the 4 patients had an hidrosis, reported at baseline. And some of these patients -- these 3 patients have reported improvement in sweating or perspiration, which is a favorable outcome for patients in the time period over the course of the study that we have seen so far. One of the patients also had seen stabilization of target structure on serial assessment on imaging. So these are preliminary reports that we are gathering. And as I mentioned before, we will be sharing more information over the course of next year of some of these details.

I'd like to add that if you look at the totality of the data, including the patient observations that were related to the investigators, the alpha Gal expression, the adverse events that all of the data are all pointing in a favorable direction. So we would like you to look at the data in its totality, not just each individual component.

Great. And then for heme A, how long from the infusion did the excursions happen?

This is an ongoing Phase III trial. So we aren't disclosing the specifics around the data. We want to keep that Phase III trial protected because it's a potential registration trial.

Next question is from Gena Wang of Barclays.

This Tom for Gina. So for the Fabry, just one question with the dosing and the alpha-Gal enzyme level. Do you plan to dose higher, depending on the data radar? And what is the out-and-go of that outgo level in the serum? Is the current (inaudible) physiological level enough in your thought? And how about the alpha-Gal enzyme level changed after the patient who withdraw from the ERT? And -- for the hemo A.

Well, let -- can we just (inaudible) first, so as we make sure we cover all your questions. We've never said it must be this for alpha-Gal because this is the first time that people have really done gene therapy in Fabry disease. And so there isn't a definitive level. We've always thought it had to be better-than-normal physiological levels. And we're pleased to the patients both on ERT and off ERT are at that level. And now what we're doing is withdrawing the ERT and seeing were the levels provided by the gene therapy in the liver level out. And until we do that experiment, we really won't understand this fully.

We are also dosing at 3.e13, which is 3x higher than the current dose. And once we see that data in its totality, we will be able to decide which dose to take forward into Phase III. But we felt that the first 2 cohorts were so compelling, as Rob says, with the alpha-Gal with the patient safety with the patient-related outcomes that came spontaneously from patients talking to the investigator about things that have been -- that are important to them, like ability to exercise consequent no sweat that we felt that this data was exciting and compelling and wanted to share it with the broader community.

Okay. Great. That's very helpful. And maybe just a quick follow-up on the Fabry that you comment that you will share additional data, including the pre-made function data in the 2022 medical meeting? And will that be included like Gb3 kidney inclusion or it will be EGFR like the filtration function measurement? Can you set a -- help us to set an expectation for that?

It's unlikely that we'll be sharing renal biopsy data in '22. There's a -- the patient would undergo an initial biopsy and then some months later, a second one. So that data is unlikely to be available in 2022.

Okay. Okay. And for the hemo A, so we know that there will be protocol amendment. And other than that, do you expect any additional steps that require in order to remove the clinical hold? Or the implementation of the oral anticoagulate will be on only one that will be required?

I have enormous confidence in our colleagues at Pfizer. They're putting together an amendment that puts patients first and make sure that the patients always remains safe and then they will discuss that and present it to the agency. And hopefully, we'll be able to move forward with this trial. As Pfizer have said, over 50% of the patients have been involved now and they had pre-study to collect the patients to have them ready to go into the trial. So we think this will move forward and are sure that Pfizer is doing the right thing.

Next question is from Ritu Baral of Cowen.

As part of this Phase III/II, what other clinical, I guess, a clinical quality of life or patient-reported symptomatology are you capturing? Sandy, you mentioned improvement in sweating. Are there other things that are being proactively asked clinical symptomatology wise? And then can you talk at all about sort of the curve of expression that you're seeing, like for patient 1, that 15-fold at week 52. Can you confirm that that's like the top expression that you've seen and for patient 4 that you're sort of continuing on your way up and anything you can say about the curve?

Okay. So we measure a whole slew of things, including formal patient-related outcomes. We want to be very clear. This was spontaneous -- patient spontaneously talking to the investigator to tell them of their -- of the changes that they've known and the investigator felt compelled to tell us because it was important. We will measure this going on in the Phase III and because it's not just about the enzyme what's important is what's important to the patient is things like the neuropathic like pain that they have, it's about the sweating, it's about the quality of their life and their energy. And so we want to capture all these things.

The second question, I think, that you're asking us about duration. That's very pleasing to us because this is a solution we want for as long as possible for those patients. And in all of the patients, after -- once it gets to its plateau level, it has remained at that level throughout the duration of the study. And we will continue to follow these patients and report how the -- hopefully, the continued duration of effect.

Got it. And just given the change in the, I guess, the regulatory landscape in Fabry  over the last 12 months or so, are there any plans to potentially add a biopsy to this study? Or are you -- is that going to be reserved for the next study? Kidney biopsy I mean.

We have plans for biopsy in this study. It's just that the results will not be available within the 2022 phase. We've always said that we would not do the biopsy in their initial patients until we saw that the medicine was effective. And now we see the medicine is affected biopsies will be part of the routine of the study.

Got it. Okay. So maybe not the biopsy from these patients that maybe the fifth and sixth patients of highest dose, is that the plan?

So the first 4 patients did not have renal biopsy and future patients will, as part of the study protocol.

Next question is from Ben Burnett of Stifel.

I will echo my congratulations on the Fabry disease data. I did want to ask a couple of questions around this. The first one I would also agree with some of the others on the call. It seems like the enzyme activity is quite good, at least relative to competitors. But I guess just curious that the impact on lyso-Gb3 just wasn't more profound, specifically on patients 1, 2 and 4. I guess how -- what is your interpretation of those data? And how representative is lyso-Gb3 in the plasma to what's happening inside of cells?

(inaudible) question. And until we biopsy, we won't have that direct correlation. I'll say again, in all of the Fabry trials from each of our competitors and us, patients who have low lyso-Gb3 don't go lower. If it's already very low, it's hard to make it go lower and that's across all of the trials. And even in the trials that have done Gb3, even in the (inaudible) trial, for example, who showed a reduction in Gb3 in the kidney, they also showed that effect that it had to be a high lyso-Gb3 to show a reduction in the plasma. It's a very different system that we're producing here. And we think this is what patients want. They want a onetime injection that is safe, that is effective at producing alpha-Gal and is effective at producing over a long period of time. And that they notice a benefit, and we're already having indications that that's what we've seen.

Now we need to go to the next higher dose and hopefully show even more benefit. And then pull all that data together and decide on the full design of the study for Phase III and get this medicine to patients as soon as possible. But we are very pleased with the safety, the efficacy, the consistency and the patient benefit that we've seen so far.

Understood. Okay. That's helpful. And if I could just ask one sort of clarifying question on patient 4. Alpha-Gal activity at week 14, you show an assessment that looks, I think, really good. But was this assessment made after they were weaned off of enzyme replacement therapy? Or was that prior to that?

Bettina, can you just clarify please?

Absolutely. So patient number 4 has only been withdrawn from ERT therapy very recently and after the cutoff data for what you're seeing on these slides that we have posted on our corporate website. So the data you're seeing is with the patients still on ERT. And just to clarify, all the data points are at trough ERP level. So dosing was prior to the ERT infusion. So the ERT withdrawal will have been after this data cut.

It's part of the reason that this therapy is, I think, offers a better solution than ERT is -- ERT has a very rapid C-max and then it declines quickly. But we wanted to be particularly careful and therefore, we measure the trough level usually out day 14 after the ERT at the very last point before the patient had their next dose of ERT to make sure there was no residual enzyme in the plasma. And that's something I think we all -- in all the different studies from all the different companies need to be careful about is making sure that the trough is the trough.

Speakers, we have time for one more question from Andreas Argyrides of Wedbush Securities.

Let me also reiterate our congrats on this early encouraging data. Yes. So for Fabry, just a quick 1 on the pre-existing antibodies and your thoughts around any potential impact that may have? And then on the hemophilia A, does the protocol amendment restart the time for the ABR data?

So let me answer the second one and then pass the antibodies to Bettina. Why this had to be treated seriously? Was these are patients in gene therapy? So when they get the medicine, it stays in their body, even if the trial is paused. And so we and Pfizer will continue to collect data from the patients even though the recruitment into is paused, there's still information about prolongation of effect and safety of the medicine being collected by Pfizer. So it's unusual compared to a pause trial where the patient stops taking the medicine. The medicine is still there and continuing to have benefit for the patient, we hope. Bettina, the antibodies?

Yes. For the antibodies, so I think what is important to emphasize is this is early data on 4 patients, and it is early to make inferences as to whether antibodies and to what degree antibodies are having an effect on these patients. We need to bear in mind that 2 of these patients are on ERT, 2 are not. There is a lot of variability in the data at this point in time. So we look forward to seeing more data coming out from our next cohort, cohort 3, and being able to assess that impact in a better manner.

And -- but we haven't seen anything -- any correlation up to now.

At this point in time, that would be difficult to say.

Thank you, participants. I'll now turn the call back over to Aron Feingold, for closing remarks.

Thank you once again for joining us today and for your questions. We look forward to keep you -- keeping you updated on our future developments.

That concludes today's conference call. Thank you all for joining. You may now disconnect.