Vericel Corp (VCEL) 2013 Q1 法說會逐字稿

Ladies and gentlemen, thank you for standing by. Welcome to the Aastrom Bioscience's First Quarter 2013 Earnings Conference Call. (Operator Instructions). I would like to also remind you that this call is being recorded for replay.

I will now turn the conference call over to Brian Gibson, Aastrom's Vice President of Finance.

Thank you, Tyrone and good afternoon, everyone. Welcome to our First Quarter 2013 Conference Call to discuss our most recent financial results and the progress of our development programs. Before we begin, let me remind you that on today's call, we will be making forward-looking statements covered under the Private Securities Litigation Reform Act of 1995. And all of our projections and forward-looking statements represent our judgment as of today.

These statements may involve risks and uncertainties that are described more fully in our filings with the SEC, which are also available on our website. In addition, any forward-looking statements represent our views only as of today and should not be relied upon as representing our views as of any subsequent date. With us on today's call are Aastrom's President and Chief Executive Officer, Nick Colangelo; our Chief Scientific Officer, Dr. Ronnda Bartel, and our Chief Business Officer, Dan Orlando. We are also pleased to have a special guest speaker with us, Dr. Nabil Dib, a world-renowned interventional cardiologist and Director of Cardiovascular Research at Mercy Gilbert and Chandler Medical Centers in Phoenix who will discuss his participation in Aastrom's Phase 2b ixCELL-DCM clinical trial. Following our prepared remarks, we will open the call to your questions.

I will now turn the call over to Nick.

Thank you, Brian and good afternoon, everyone. Since our fourth-quarter conference call in March, we've taken several important actions to advance our company in the development of our lead product candidate, ixmyelocel-T. First, we implemented an R&D strategy focusing our clinical efforts and resources on our dilated cardiomyopathy or DCM orphan disease program which we believe provides a streamlined path to commercialization for ixmyelocel-T and represents a substantial commercial opportunity for Aastrom.

Second, we enrolled and treated the first patients in the ixCELL-DCM study which is now well underway at a number of U.S. clinical sites. The objective of this study is to evaluate the efficacy and safety of ixmyelocel-T in the treatment of patients with advanced heart failure due to ischemic DCM. Dr. Dib will share his perspective on the urgent medical need for these heart failure patients and the potential use of ixmyelocel-T in this indication in a few minutes.

Third, we filed an S1 registration statement to sell $25 million of common stock in a fully marketed follow on offering to support the Phase 2b DCM clinical program and other corporate activities. We believe that this is the most appropriate structure and timing for the financing as its successful offering with provide the capital required to complete the ixCELL-DCM study and obtain the data to support advancing the program into Phase 3 clinical testing.

In focusing on the development of ixmyelocel-T to treat advanced heart failure due to ischemic DCM, we're targeting an area of major unmet medical need and a highly compelling commercial opportunity for ixmyelocel-T.

Heart failure remains a leading global health issue. Approximately 5.5 million people in the U.S. suffer from heart failure and there are an estimated 550,000 new cases in the U.S. each year. Medical costs to treat these patients now total more than $25 billion annually and this figure is expected to more than triple over the next 20 years.

DCM, which is characterized by weakening of the heart muscle, enlargement of the heart chambers, and an ability to sufficiently pump blood throughout the body, is the third-leading cause of heart failure and the leading cause of heart transplantation. A majority of the advanced heart failure patients who are refractory to medical therapy, which is more than a quarter of a million patients in the United States, have DCM. And approximately 60% of these cases are of ischemic origin due to atherosclerotic cardiovascular disease. These patients typically have maximized their use of prescription and device therapies and are no longer candidates for further revascularization procedures such as angioplasty and bypass surgery. At this stage of the disease, they have very limited treatment options, including placement of left ventricular assist devices or LVADs and heart transplantation.

This is a well-defined patient population at a well-defined point in disease progression, which makes these patients optimal candidates for treatment with ixmyelocel-T.

There's also a strong pre-clinical and clinical rationale for developing ixmyelocel-T in this indication. Pre-clinical results have demonstrated that ixmyelocel-T significantly and reproducibly reduced cardiac tissue damage and had additional cardio protective effects in relevant disease models.

Further, our Phase 2a clinical results demonstrated that ixmyelocel-T was well-tolerated in patients with DCM and that consistent positive efficacy trends were observed in ischemic DCM patients treated with ixmyelocel-T.

Finally, we believe that the refractory ischemic DCM market represents a significant commercial opportunity for Aastrom for several reasons. In addition to a growing patient population, we have a leading position in this indication and an opportunity to make ixmyelocel-T the first approved product for the treatment of ischemic DCM.

We also have a potentially streamlined regulatory pathway based upon ixmyelocel-T's U.S. orphan drug designation for this indication, and a strong pharmaco economic rationale to support premium pricing based on the limited availability and high cost of treatment involving LVADs and heart transplantation for these patients.

To tell us more about the treatment of these patients with advanced heart failure due to ischemic DCM, and the rationale for testing ixmyelocel-T in this indication, I'm pleased to introduce Dr. Nabil Dib, Director of Cardiovascular Research at Mercy Gilbert & Chandler Medical Centers in Phoenix, Associate Professor of Medicine and Director of Clinical Cardiovascular Cell Therapy at the University of California, San Diego and Founder and Editor and Chief of the Journal of Cardiovascular Translational Research.

Dr. Dib is a world-renowned interventional cardiologist and a principle investigator in the ixCELL DCM study. Dr. Dib?

Well, thank you Nick for your nice introduction. As an interventional cardiologist with more than 15 years of clinical trial experience in the treatment of advanced cardiovascular disease and as an investigator in the ixCELL DCM trial, I am very pleased to share my perspective on the unmet medical need in the treatment of patients with advanced heart failure and the therapeutic potential of ixmyelocel-T to treat these patients.

As Nick indicated, there are currently very limited treatment options for patients with advanced heart failure due to ischemic cardiomyopathy; we call this DCM, which is extremely frustrating for patients, family and their healthcare professional. The biggest challenge for these patients is a marked loss in what's called exercise capacity, which really refers to daily living activities such as shopping for groceries or walking from car to the stands to watch a grandchild ballgame and so on.

As Nick mentioned, for patients who can no longer benefit from medical therapy, devices such as pacemaker or further revascularization procedure such as angioplasty; the only remaining current treatment options are left ventricular assist devices or heart transplants. And as you know, the heart donors are so scarce, even in the United States alone, there are only about 2800 transplants per year.

Fortunately for these patients, early study results from promising cell therapy like ixmyelocel-T indicates strongly that we may be able to fill this gap and restore living capacity for many of these patients.

I choose to be an investigator and I'm honored to be an investigator in this clinical trial of the ixCELL-DCM trial because I have done a significant amount of research on the use of cell therapy to treat advanced heart failure. And I find that ixmyelocel-T, which is comprised of multiple key effecter cells such as mesenchymal stromal, cell and M2-like macrophage has tremendous therapeutic potential and makes a unique product in the market of cell therapy.

The data from Aastrom's Phase 2 study suggests that ixmyelocel-T can deliver benefits in patients who have very few treatment alternatives. I am compelled to help these patients as a physician. And as a researcher, I am committed to the advancing science in the area of the great unmet medical need.

Which will bring me to my final reason for participation in this study; I like the trial design of the Phase 2b trial. The ixCELL-DCM study is well-designed to demonstrate definitive and meaningful clinical results. The primary outcome of mortality, hospitalization and heart failure, ER visits- emergency room visits, plus the secondary clinical functional and symptomatic efficacy measures are the type of meaningful clinical endpoints that the regulatory agency- FDA and medical community are looking for.

I only choose to be part of the trials that I feel are well-designed, have the opportunity to make a significant contribution to medical practice and benefit patients.

Thank you Dr. Dib, for sharing your insights and perspective. We greatly appreciate your comments and we'd ask that you remain on the call for any questions from our listeners at the conclusion of our prepared remarks.

As we reported last month, enrollment in our Phase 2b ixCELL-DCM study has begun and we've treated our first patients in the study. The ixCELL-DCM study is a multi-center, randomized, double-blind, placebo-controlled Phase 2b study designed to evaluate the efficacy and safety of ixmyelocel-T in patients with advanced heart failure to ischemic DCM. This study is designed to enroll 108 patients with advanced heart failure at approximately 30 clinical sites in the U.S. and Canada, with the primary end point being the number of all caused deaths and hospitalizations and unplanned emergency room visits for IB treatment of acute worsening heart failure over 12 months.

We will also be evaluating several secondary clinical functional and symptomatic efficacy measures at three, six and twelve months. As previously communicated, we expect to enroll the study by the end of Q1 2014 and have top line efficacy results from the study in Q2 of 2015.

We believe that Aastrom is well-positioned to execute the ixCELL-DCM study for several reasons. First, as I mentioned earlier, the target patient population for this study, advanced heart failure patients refractory to medical therapy is well defined and a distinct point in disease progression with limited treatment options.

Second, our targeted investigators, interventional cardiologists, routinely perform catheter-based procedures and coordinate with heart failure specialists in the management of patient care. Our study sites, which are concentrated in areas of high disease prevalence, are experienced in using the NOGA Myostar catheter system for cell therapy studies as that system is specifically designed for cell therapy delivery.

And finally, we believe that 30 study sites in the U.S. and Canada should be sufficient to enroll 108 patients, according to our current study timelines.

Turning to our R&D efforts, we mentioned on our last conference call that ongoing research by Aastrom's scientists and our collaborators continues to define the highly differentiated mechanism of action of ixmyelocel-T and the broad therapeutic potential for Aastrom's platform and products.

Results of some of this research has been presented at important international scientific meetings over the past few weeks, and I'd like to turn the call over to our Chief Scientific Officer, Dr. Ronnda Bartel, to briefly review some of these important findings. Ronnda?

Thank you, Nick. As mentioned, ixmyelocel-T stands out from other cell therapies because its effectory cells include not only mesenchymal stromal cells or MSCs but also M2-like macrophages, a cell type that plays a key role in tissue repair and regeneration that is not found in other cell therapies.

M2-like macrophages are known to play a beneficial role in atherosclerosis, providing clear support for our effort to investigate the impact of ixmyelocel-T on the underlying pathology of coronary artery disease.

As some of you may already know, atherosclerosis is characterized by both an accumulation of cholesterol and chronic inflammation of the vessel lining or endothelium, which together leads to the formation of plaque and vessel blockage.

To test the hypothesis that ixmyelocel-T could address these two hallmarks of atherosclerosis, we conducted animal studies and presented results over the past few weeks at the nineteenth annual International Society for Cell Therapy and the Atherosclerosis, Thrombosis and Vascular Biology 2013 Scientific Session.

The poster and presentation, which can be found on Aastrom's website, reports that ixmyelocel-T may help address the issue of cholesterol accumulation via the M2-like macrophages. These cells were shown to actively pick up modified cholesterol, acetylated at low-density lipo proteins or LDL and transfer this cholesterol to both apoA-1 and high-density lipo proteins or HDL, which is the first step in removing excess cholesterol

In addition, when cholesterol loaded ixmyelocel-T was administered to animals, the cholesterol was shown to accumulate in the serum and the liver of the animal and it was eventually excreted the normal route of elimination of cholesterol.

Other data presented focused on the impact of ixmyelocel-T on other aspects of atherosclerosis, namely the endothelial dysfunction caused by chronic inflammation. When added to endothelial cells, ixmyelocel-T increased nitric oxide production, an important basal dilator, and also endothelial nitric oxide synthase or eNOS, the enzyme responsible for making nitric oxide.

Ixmyelocel-T also reduced oxidized stress by reducing the levels of reactive oxygen species and increased the amount of the anti-oxidant enzyme superoxide mutates and activated endothelial cells.

In addition, ixmyelocel-T reduced endothelial cell inflammatory markers such as ICAM 1, ZCAM 1 and MCP 1, while increasing the very important anti-inflammatory cytokine, interleuken 10. These effects were also associated with the reduction in apoptosis or death or endothelial cells.

The combination of the M2 macrophage activity, with the cholesterol transport activity, positions ixmyelocel-T as a highly promising and appropriate investigational therapy for patients with advanced ischemic DCM.

Thank you, Ronnda. At this time, I will turn the call over to Brian Gibson, for his brief financial report before opening the call for questions.

Thanks, Nick. For the first quarter ended March 31, 2013, Aastrom had a net loss attributable to common shareholders of $6.8 million, or $0.15 per share, versus $9.7 million or $0.25 per share for the same period in 2012.

The change in net loss reflects the non-cash changes in the fair value of our warrants and the non-cash accretion of the convertible preferred stock. Our loss from operations for the quarter, which excludes the impact of the warrants and preferred stock, was $7.2 million or $0.16 per share compared to $8.6 million or $0.22 per share a year ago.

Research and development expenses for the quarter ending March 31, 2013 were $5.5 million versus $6.8 million for the same period a year ago. The decrease in R&D expense was primarily attributable to the reversal of nearly $900,000 of non-cash stock-based compensation expense, related options forfeited as a result of the corporate restructuring announced in March. The remainder of the decrease is primarily due to lower purchasing and manufacturing supplies to align inventory levels with the expected clinical production volume.

General and administrative expenses for the first quarter ending March 31, 2013 were $1.6 million versus $1.8 million for the same period in 2012. This decrease was primarily attributable to the reversal of non-cash stock-based compensation expense related to the corporate restructuring.

At the end of the quarter, Aastrom had $9.2 million in cash and cash equivalents, compared to $13.6 million at the end of 2012. Our cash use for operations of $6.8 million during the quarter was in line with our previous forecast of $6.5 million to $6.7. It was partially offset by nearly $2.4 million in net proceeds from our ATM during the quarter.

We expect our Q2 cash spend to be in the $4.5 million to $5 million as we ramp up enrollment in the ixCELL-DCM trial and continue to execute cost-cutting measures as part of the restructuring.

As for our financing plans and as Nick mentioned earlier, we filed a Form S1 registration statement with SEC last week to sell up to $25 million in stock. Earlier this week, the SEC informed us that the filing would not be reviewed, and therefore we are kicking off the formal offering process now.

I can't comment on the specific timing for closing on the transaction at this point, however we do expect to have the process completed by the end of the second quarter. We believe the proceeds from this financing will provide approximately two year of additional cash, funding the Company beyond ixCELL-DCM data in Q2 2015.

That completes my review of the financials and I'll now turn the call back to Nick.

Thanks, Brian. I believe we've taken the right steps to address our capital requirements and improve our financial position as we advance ixmyelocel-T for the treatment of advanced heart failure due to ischemic DCM. We're now in a much stronger position to execute our Phase 2b ixCELL-DCM study, prepare for Phase 3 testing and consider other potential indications for ixmyelocel-T. This concludes our prepared remarks. Now I'd like the Operator to open the call to your questions.

(Operator Instructions). Our first question is from Chad Messer of Needham & Company. Your line is open.

Thanks for taking my question. This one is for Dr. Dib. You mentioned that Phase 2 data, we guess the Phase 2a data on DCM and of course there's an early proof of concept trial. It was smaller and uncontrolled and didn't have the kind of functional outcome that we're going to get in the Phase 2b. But as you look at that data, I was wondering if you could just walk us through what in there was most encouraging to you and do you think is most predictive of the potential success in the current trial.

Yes, I'm sorry. I was on silence I guess. Can you hear me now?

Yes, we can hear you. Did you hear the question?

Yes, I do not have here exactly the slide in front of me. Do you have the slide? Are you asking about a specific question or just the result in general?

It's pretty open in general. I'm wondering what in that data you found-- that gave you-- you said the data was encouraging to you and I'm wondering if you could comment on specifically what you found most encouraging in it.

Now, in general, if you look at the 13 years of stem-cell therapy experience, the most important finding in the stem-cell therapy very modest improvement in the objective finding like ejection fraction and so on, it's very modest.

I think here the total benefit; this probably has the most value for the patient, from the patient point of view their improvement and their physical activity. Our realized goal here is to concentrate on the re-hospitalization which is probably one of the most beneficial for patient and for health care in terms of cost effectiveness as realized at clinical endpoint. If we look at all that they look for, in general, they do look at the hospitalization, quality of life and mortality. And all that exists in a positive direction in the Aastrom product.

Great. Thank you very much for your insight.

Thank you. Our next question is from Steve Brozak of Web Securities. Your line is open.

Yes, hi. This is actually Steve Brozak from WBB. But this question is for Dr. Dib as well. Your expertise is actually in trial design and outcome and based on that, can you walk us through, not so much in the past what you've seen, but how you see this trial design being differentiated basically in terms of what you look to see and what would be positive outcomes into the future.

I can speak very highly for this design of the clinical trial; comparison to other trials that have been done. And the most powerful thing in this design of clinical trial in addition to the good design in terms of double-blind trial, in terms of randomization; but the clinical end point that this trial is looking for and this is really one of the most-- that's what differentiates this trials from other clinical trials we have done specifically for heart failure. In here, as you see, we are looking for a clinical end point that relates to the quality of life of the patient and more important to their re-hospitalization. This is a very critical and important clinical end point. For patients it is important, for the healthcare industry it is important. You can imagine if we decreased the re-hospitalization of patients. For sure we improve their quality of life and for sure we almost likely will affect their survival, but also very important for the healthcare in terms of cost effectiveness, you can imagine how much we can also improve on the cost effectiveness for healthcare. And that's why I think that will play a very important role in terms of the reimbursement in the future for cell therapy.

I'll end it with one last question. Given the fact that you did have training at Harvard on trial design, you also obviously are very capable of assessing wherewithal and finances on trials. Given the fact that obviously you've got to put together a trial, you're looking at a system now that the trial, the trial design and the resourcing for that trial is something that you now are comfortable with for Aastrom going forward. Would that be an accurate statement?

That would be a very accurate statement, yes.

Okay. Great, thank you.

You're very welcome.

Thank you. The next question is from Keay Nakae of Ascendiant Capital. Your line is open.

Yes, thank you. My question is for the Aastrom Scientist who was speaking earlier. You gave us some insight about the ability of the product as it relates to atherosclerosis. I'm wondering if you could give us any further insights about the product as it relates to ischemic tissue repair and that being any effect on angiogenesis or formulation of the right type of cardio cells that are needed to increase the functionality of the heart.

Okay. This is Ronnda. We have demonstrated in animal models that we do see an increase in tissue profusion with the treatment of ixmyelocel-T. We've seen cardiac remodeling; we've seen an increase wall thickness around the infarct areas. So we've aspects of all of that in our animal studies. So I'm not sure if that answers your question or not.

Well, I guess what I'm trying to get to is-- in terms of some of the improvements that we've seen with some of the other trials using stem-cell therapies for heart failure, the effects don't seem to be all the durable. So I'm wondering- is there anything specific that you believe about your science that could lead to better outcomes.

Yes, I think it's because the-- we've seen structural changes in the tissues and that tends not to be a transient issue. But the major thing for me is that differentiates us from the other studies that were done is the presence of the macrophages, because it really is a-- it's not just MSCs or bone marrow mononuclear cells. It incorporates those things as well as the M2 macrophages, so it's kind of a broader approach to treating the indication.

Okay. Thank you.

Thank you. The next question is from Jason Kolbert of Maxim Group.

So Ronnda, can we just pick where you left off? What is it about the M2 macrophages that they are producing that your run-of-the-mill or highly selected homogeneous population of MFCs wouldn't produce?

To me, I don't think there's a lot of factors that are necessarily different, but it's the cell-related activities. You've got phagocytosis, efferocytosis, the remodeling capabilities with extra cellular matrix that you don't see with the other cell types. Plus, it's in the context of the other bone marrow cells and the MSCs.

Okay, fair enough. And so I'd like to drop back a little bit and talk about ischemic DCMs. Dr. Dib, when a patient comes in, what's the entry criteria for this patient? How do you qualify them of an ischemic [utology] and how do you decide what level of DCM that they're actually experiencing. We're all familiar with CLI where we were trying to select the sweet spot between a Rutherford 4 and a Rutherford 5 patient. Is there a similar grading system in DCM that you're using to select patients that will get the most benefit, but that are not so far gone that maybe won't be able to be helped?

An extremely important question; extremely important question, and the way we select those patients-- depending on clinical symptoms number one, and number two, depending on objective finding-- testing that we do. For the clinical symptoms we have a classification depending on your heart class. So it will be class one, two, three and four. And four is the worst and one is the best. And usually those patients are in categories three and four which means on minimal activity; even if they are walking in a room they might have shortness of breath. Sometimes if they are sleeping they wake up with shortness of breath. That's the clinical symptom, usually; so minimal activity can induce their symptoms- fatigue, tiredness, shortness of breath- those are the complaints.

Now we go and we always look- ischemic versus non-ischemic is easy to differentiate. As patients have a heart attack in the past we call them ischemic or if they have significant blockages in the blood vessel of their heart, decreasing their blood flow to the heart; those are ischemic. Now we go farther and say if we cannot fix those arteries with a stint, everything is usually done for those patients. Already bypass can be done and should be done with angioplasty or a stint can be done and should be done. And usually those patients have those already done and some of them have pacemakers already in place and they are on optimal medical therapy which is beta blockers and inhibitors, etc.

But despite the standard of care and that's really the importance of the biologic and cell therapy in this field. So in addition to standard of care, all standard of care there are exhausted and the patient continues to suffer, those are the patients- and angiographically nothing can be done for them and the heart function is reduced to less than 30%, their function by echocardiography, and of course we'll look at some criteria just to make sure the procedure is safe which just means the aortic valve is okay. We cut across it; there is no clot in the heart and the ventricle. So those are the patients that really we would like to-- will be the ideal candidates for this.

And from my experience, I did the first stem-cell therapy in the United States with the myeloblast and it was a Class three and four population. And we don't want to cross a line to go to a very, very sick patient who is taking inotrope and his heart is very sick. He might not tolerate the procedure and we can increase the risk. We can have complication that can lead to a problem.

So yes there is a fine line and very important to recognize, a clinically and with objective testing to make sure that we can to the procedure safely and we can hopefully also benefit from the cell therapy at the same time.

And those are not a small number of patients, as you know in the United States alone there are 500,000 patients per year die of heart failure and actually two thirds of them are ischemic; between 65% to 70% those are ischemic because of a coronary artery disease. There's a 5 million admission per year from heart failure and two thirds of those as I said are ischemic.

So the market is huge, in terms of the market. But for us, for clinical trial we have to clearly train our investigator to do that safely, like what you said. There's a really good fine line between safety and efficacy.

And just remind me, how did you come to the decision to use NOGA mapping versus delivering to multiple arterial branches, via what may or may not be the infarct-related artery. It just seems like it would be a simpler, faster procedure. What's the benefit that you're getting in NOGA and how will that compare or comparatively compare across different DCM patients?

Another very important question and the cell-therapy world. And I was part of the NOGA mapping development since 1998 when I was at Harvard and after that I got the first stem-cell approval using the NOGA mapping for the gene in the year 2002 and then 2004 for the myeloblast- the stem cell myeloblast. So we work very hard on this.

Now what the rationale behind giving the cell direct injection versus intracoronary found in many studies that the retention rate of the cells are different in the chronic setting than in the acute setting. And when I say chronic setting I mean the heart failure population versus the acute myocardial infarction population. So when you talk about a recent heart attack or just somebody has a heart attack, you hear that they give the cell inside the artery.

But when you hear about heart failure, you see they did direct injection. Because the cytokine and the inflammatory process and the environment is different between patients with acute myocardial infarction versus heart failure patients; so we expect the retention rate to be better with direct injection versus getting intra-coronary.

Now if this product shows to be very beneficial in the acute myocardial setting, and I think they will expand in the future toward the acute myocardial setting, then that would be another-- that would be the clinical indication where you can deliver this therapy intra-arterially. As a matter of fact, I am designing a catheter myself for intra-coronary delivery just a catheter going (Inaudible) mark.

But again, here, specifically because of the heart failure, the inflammatory process is different and we think the retention of the cell to be better with a direct injection than with the NOGA mapping.

Perfect. Thank you so much; great answers. My last question comes back to Ronnda and it's just- can you remind us on the math of the Phase 2 clinical trial? How did you come of the patient number and have you talked at all about the powering, statistical powering assumptions are behind this trial as well as the monthly enrollment assumptions around the number of sites you've selected?

Yes, Jason I'll start there. First of all the trial is powered to show 80% to show a reduction in over 12 months from 1.7 events to 1.1 event in the drug-treated group. In terms of enrollment, at this point we've said that we expected to complete enrollment on the study by the end of Q1 2014. Obviously we're kind of in early days in the study, having just started treating patients. Generally, it's not standard practice for management teams to provide frequent interim updates on at-site activations and patient enrollments and so we don't plan to do that. We certainly will follow that practice and only provide updates on our projected enrollment completion timeline if and when it's warranted. But for now, as I mentioned, we expect to complete enrollment by the end of Q1 2014.

All right; thanks. That's very clear. Thanks for all the answers, guys; I appreciate it.

Thank you. There are no further questions at this time. I'd like to turn the call back over to Mr. Colangelo for any closing remarks.

Okay, well thank you Tyrone, and again I'd like to thank Dr. Dib for joining us today and thank our callers for your questions and continued interest in our company and I look forward to updating you on our next call. Thank you very much.

Ladies and gentlemen, thank you for your participation in today's conference. This concludes the program. You may now disconnect. Have a wonderful day.