
Cautionary Note Regarding Forward-Looking Statements
This Quarterly Report on Form 10-Q (Report) includes forward-looking statements. All statements contained in this Report other than statements of historical fact, including statements regarding our future results of operations and financial position, our business strategy and plans, and our objectives for future operations, are forward-looking statements. The words "believe," "may," "estimate," "continue," "anticipate," "intend," "expect" and similar expressions are intended to identify forward-looking statements. We have based these forward-looking statements largely on our current expectations and projections about future events and trends that we believe may affect our financial condition, results of operations, business strategy, short-term and long-term business operations and objectives and financial needs. These forward-looking statements are subject to a number of risks, uncertainties and assumptions. Our business is subject to significant risks including, but not limited to, our ability to obtain substantial additional financing, the results of our research and development efforts, the results of nonclinical and clinical testing, the effect of regulation by theU.S. Food and Drug Administration (FDA) and other domestic and foreign regulatory agencies, the impact of competitive products, product development, commercialization and technological difficulties, the effect of our accounting policies, and other risks as detailed in the section entitled "Risk Factors" in this Report. Further, even if our product candidates appear promising at various stages of development, our share price may decrease such that we are unable to raise additional capital without significant dilution or other terms that may be unacceptable to our management, Board of Directors (Board) and stockholders. Moreover, we operate in a very competitive and rapidly changing environment. New risks emerge from time to time. It is not possible for our management or Board to predict all risks, nor can we assess the impact of all factors on our business or the extent to which any factor, or combination of factors, may cause actual results to differ materially from those contained in any forward-looking statements we may make. In light of these risks, uncertainties and assumptions, the future events and trends discussed in this Report may not occur and actual results could differ materially and adversely from those anticipated or implied in the forward-looking statements. You should not rely upon forward-looking statements as predictions of future events. The events and circumstances reflected in the forward-looking statements may not be achieved or occur. Although we believe that the expectations reflected in the forward-looking statements are reasonable, we cannot guarantee future results, levels of activity, performance or achievements. We are under no duty to update any of these forward-looking statements after the date of this Report or to conform these statements to actual results or revised expectations. If we do update one or more forward-looking statements, no inference should be drawn that we will make additional updates with respect to those or other forward-looking statements. Business Overview We are advancing therapeutics with the potential to be faster-acting, and with fewer side effects and safety concerns, than those that are currently available. Our most advanced clinical-stage candidates, PH94B and PH10, are targeting multiple forms of anxiety and depression. They belong to a new class of drugs known as pherines. At microgram level doses, these investigational neuroactive steroids are formulated as nasal sprays designed to achieve rapid-onset anti-anxiety (PH94B) or antidepressant (PH10) effects by directly activating chemosensory neurons located in the nasal passages, which neurons then impact olfactory amygdala "fear off" (anti-anxiety) and "fear on" (antidepressant) neural circuits in the brain, without requiring systemic uptake or direct activity on central nervous system (CNS) neurons in the brain. Our goal is to become a biopharmaceutical company that develops and commercializes innovative therapies for highly prevalent CNS indications where current treatment options are inadequate to meet the needs of millions of patients in theU.S. and worldwide. We are passionate about transforming mental health care and redefining what is possible in the treatment of anxiety and depression - one mind at a time. Our Product Candidates PH94B Nasal Spray PH94B is a first-in-class synthetic investigational pherine nasal spray designed with a novel rapid-onset mechanism of action (MOA) that regulates the neural circuits of fear and anxiety and attenuates the tone of the sympathetic autonomic nervous system. PH94B is administered intranasally in microgram doses directly onto receptors for chemosensory neurons located in the nasal passages, which neurons then impact olfactory amygdala "fear off" neural circuits in the brain. The proposed MOA of PH94B is fundamentally differentiated from all currently approved anti-anxiety medications, including the antidepressants approved by the FDA for the treatment of SAD, as well as all benzodiazepines and beta blockers prescribed for treatment of SAD on an off-label basis. The proposed MOA for PH94B does not involve systemic uptake, direct activation of GABA-A receptors in the brain, or direct activation of CNS neurons in the brain. Rather, when administered intranasally, PH94B activates chemosensory neurons in the nose that activate neural circuits involving olfactory bulb neurons and the limbic amygdala, a region in the brain that is involved in the pathophysiology of SAD and potentially several other anxiety and mood disorders. We are currently evaluating PH94B for the potential treatment of multiple anxiety disorders, including for adults with SAD and for adults experiencing Adjustment Disorder with Anxiety (AjDA). Both pre-clinical and Phase 2 clinical data to date suggest that PH94B has the potential to achieve rapid-onset anti-anxiety effects without systemic uptake or transport into the brain, significantly reducing the risk of side effects and other safety concerns such as potential abuse, misuse and addiction associated with certain other pharmaceuticals that act directly on the CNS and are sometimes prescribed for anxiety disorders. -19-
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We are currently evaluating PH94B for the potential treatment of multiple anxiety disorders, including for adults with SAD and for adults experiencing Adjustment Disorder with Anxiety (AjDA). Both pre-clinical and Phase 2 clinical data to date suggest that PH94B has the potential to achieve rapid-onset anti-anxiety effects without systemic uptake or transport into the brain, significantly reducing the risk of side effects and other safety concerns such as potential abuse, misuse and addiction associated with certain other pharmaceuticals that act directly on the CNS and are sometimes prescribed for anxiety disorders. SAD Phase 1 Studies
Phase 1 Autonomic System Biomarker Study
Pherines such as PH94B appear to modulate the activity of the limbic-hypothalamic autonomic nervous system. To evaluate the pharmacodynamic activity of PH94B, a single-blind, randomized study (n =16) was performed to compare the effect of PH94B and steroidal hormones (estradiol, progesterone, cortisol, and testosterone) on the electrogram recorded from the mucosal lining of the vomeronasal organ (VNO) nasal chemosensory epithelium (including the VNO pit area) and autonomic nervous system function in healthy male (n = 8) and female (n = 8) subjects. Intranasal administration of PH94B (400 ng 0.4 µg) significantly increased the amplitude of the electrogram, decreased cardiac and respiratory frequency rate (within physiologic range), and decreased the frequency of electrodermal activity (skin conductance) events. Local intranasal application of steroidal hormones estradiol, progesterone, cortisol, and testosterone (400 ng 0.4 µg each) had no significant effect on the electrical response of the mucosal lining of the nasal chemosensory epithelium (including the VNO pit area) or the measures of autonomic nervous system function. Volunteers felt calmer and less tense per self-report, suggesting an anxiolytic effect. We believe these results demonstrate the biological activity of PH94B and provide support for evaluating potential behavioral changes after intranasal PH94B administration. Phase 1 Dose Response Study In a Phase 1 dose response pharmacology study, the increased electrical activity of the nasal chemosensory epithelium electrogram of nasal receptors (EGNR) was shown to be dose dependent and similar in both male and female healthy volunteers after receiving ascending doses of PH94B. Maximal EGNR amplitude was achieved at the 3.2 ?g dose in both men (n=10) and women (n=10), and no significant increase was seen at higher doses (6.4 ?g and 12.8 ?g). SAD Phase 2 Studies
Positive Outcomes in Public Speaking and Social Interaction-Induced Stressors in a Clinical Setting
Phase 2 development of PH94B began with a two-part public speaking and social interaction challenge study. In this randomized, double-blind, placebo-controlled Phase 2 clinical trial (n=91) conducted at three clinical sites, 91 adult female subjects diagnosed with SAD underwent a placebo baseline period followed a week later by a randomized treatment period and intranasal administration of 1.6 ?g of PH94B. PH94B (1.6 ?g) was administered intranasally 15 minutes prior to both a performance challenge (public speaking) and a social interaction challenge simulation, which took place at the clinical sites. The two challenges were separated by a 30-minute rest period. The primary outcome measure was the Subjective Units of Distress Scale (SUDS). Peer-reviewed results published in theAmerican Journal of Psychiatry (Monti, et al., Am. J. Psychiatry (2014) 171:675-682) showed statistically significant results for reducing anxiety during a public speaking performance and during social interactions in a clinical setting. During the public speaking challenge, subjects randomized to treatment with PH94B (n = 45) showed a 26.7-point improvement in mean SUDS scores following the treatment visit with PH94B as compared to the SUDS scores during the baseline visit (placebo treatment). In comparison, subjects randomized to treatment with placebo (n = 46) showed an improvement of only 14.0 points in mean SUDS scores compared to baseline. The PH94B treatment group's improvement in the public speaking challenge significantly exceeded that of the placebo group's improvement (t = 3.16, p = 0.002).
Positive results in outpatients with SAD
PH94B is designed with the potential to lower anxiety acutely, on an as-needed basis, and to achieve cumulative functional improvement with continued use, such as less frequent avoidance of stressful or anxiety-provoking situations and reduced fear and anxiety about such situations. Accordingly, the protocol for a subsequent randomized, double-blind, placebo-controlled multiple administration assessment Phase 2 crossover study (n=22) involving both adult males (n =11) and females (n=11), required subjects to self-administer PH94B or placebo nasal spray in an outpatient setting (i.e., not in a clinical environment) acutely, on an as-needed basis, just prior to an anxiety-provoking situation, up to four times a day, for two weeks. The primary efficacy measure in the study was the SUDS and the secondary efficacy measure was the Liebowitz Social Anxiety Scale (LSAS). Dr.Michael Liebowitz , the innovator of the widely used LSAS, was the Principal Investigator of this study. -20-
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The change from baseline SUDS scores was significantly greater for all subjects while taking PH94B compared with the placebo group. The average change from baseline SUDS score was 15.6 points for all subjects while on PH94B and was 8.3 points while on placebo (paired t-test = 3.09; p = 0.006; effect size 0.658). During the first two weeks of treatment, subjectswho received PH94B first dropped an average of 23 points in LSAS score, while thosewho received placebo first dropped only eight points on average, showing a trend difference (p = 0.07) with a large effect size of 0.812. Looking at only the first two weeks of treatment, subjectswho received PH94B first had a significantly greater decrease in their avoidance score on the LSAS than thosewho received placebo first (p = 0.02, Cohen's d = 1.078). A large effect size (0.78) and trend to significance (p = 0.083) in favor of PH94B also was observed when comparing overall the Clinical Global Impression (CGI) score means for PH94B and placebo during the first two weeks of treatment. Patient Global Impression of Change (PGI-C) ratings also showed improvement for PH94B after two weeks of treatment (p = 0.024).
No drug-related serious adverse events (SAEs) were reported during the study. All adverse events (AEs) were mild or moderate and the frequencies of their occurrence did not differ significantly between active and placebo treatments.
We believe this multiple-administration assessment Phase 2 study conducted outside a clinical environment indicates the potential for cumulative functional improvement with longer use of PH94B, while still being used acutely, as-needed, as subjects are increasingly able to engage in previously difficult social and performance situations in their daily lives more frequently and with less fear and anxiety.
SAD PALISADE Phase 3 Program (PALISADE-1, PALISADE-2 and PALISADE Open Study)
InMay 2021 , we initiated our PALISADE Phase 3Program for PH94B in SAD with PALISADE-1, our single-administration assessment Phase 3 clinical study of PH94B for the acute treatment of anxiety in adults with SAD. Following discussions with the FDA in mid-2020 during the early phase of the COVID-19 pandemic, we agreed to design PALISADE-1 in a manner substantially similar to the single-administration Phase 2 public speaking challenge study of PH94B in SAD, which study involved self-administration of a single dose of PH94B by subjects randomized to the treatment arm of the study prior to a public speaking challenge conducted only in a clinical setting. InJuly 2022 , we announced that PALISADE-1 did not achieve its primary efficacy endpoint, as measured by change from baseline using the SUDS as compared to placebo. Although PALISADE-1 did not meet its primary efficacy endpoint, the safety and tolerability of PH94B in PALISADE-1 were favorable and consistent with previously reported results from previous clinical trials. InOctober 2021 , we initiated PALISADE-2, which involves the same study design as PALISADE-1 but primarily involves different clinical sites. InJuly 2022 , after receiving top line results from PALISADE-1, we paused recruitment and enrollment in PALISADE-2 to allow independent third-party biostatisticians to conduct an interim analysis of available data from subjects randomized in PALISADE-2 up to the date we paused the study. InSeptember 2022 , based on their review of unblinded data from the 140 subjectswho had completed PALISADE-2, the independent third-party biostatisticians recommended that we continue PALISADE-2 as planned. Although we did not and do not have access to any unblinded data from PALISADE-2, based on the outcome of the interim analysis and the recommendation from the independent biostatisticians, we are preparing to restart PALISADE-2 as soon as practicable and plan to continue the study to the targeted enrollment of 208 adult subjects. We initiated the PALISADE Open Label Study (PALISADE OLS) inOctober 2021 to evaluate the safety and tolerability of PH94B in adult subjects with SAD taken as needed prior to acute anxiety-provoking social and performance situations in daily life, up to four times per day, over a period of up to 12 months. In addition to assessing safety and tolerability, we also included several exploratory objectives, including assessment of PH94B's potential to achieve overall symptom reduction and improvement in severity of SAD, as measured by the LSAS, the efficacy endpoint required by the FDA for prior SAD approvals. InAugust 2022 , we closed recruitment and enrollment in the PALISADE OLS. Preliminary analysis of nearly 400 subjects in the final data set for the PALISADE OLS demonstrate robust functional improvement in anxiety-provoking social and performance situations in daily life, as measured by the LSAS. We now have two data sets supporting PH94B's ability to improve LSAS scores - the PALISADE OLS over a period of one month and beyond, and a published double-blind, placebo-controlled Phase 2 cross-over study after two weeks of use. These two studies combined demonstrate the potential for PH94B to achieve robust overall reduction in symptoms of SAD and improvement in severity over time as measured by the LSAS. We believe LSAS measurements over time may be well suited for a Phase 3 trial to demonstrate efficacy and the true impact of PH94B on patients' lives given that it measures overall improvement in disease severity by capturing the reduction in fear and anxiety as well as the avoidance of social and performance situations. These studies reinforce our belief in the potential of PH94B, used acutely as-needed in daily life, to provide rapid-onset, clinically meaningful, and sustained response with a favorable safety and tolerability profile. Taking into consideration the results of PALISADE-1, we believe the combination of data from two positive Phase 2 clinical studies of PH94B in SAD, the results of the interim analysis of PALISADE-2, preliminary LSAS-related data from our PALISADE OLS study and the overall safety profile of PH94B in all studies to date support our confidence in PH94B's therapeutic potential in SAD and several other anxiety-related indications. Accordingly, in parallel, we are currently preparing to restart PALISADE-2 and to meet with the FDA to reach consensus with the FDA on a clearly-defined plan for the next Phase 3 study of PH94B in SAD, taking into account multiple potential outcomes of PALISADE-2. -21-
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Exploratory phase 2A development for AjDA and future development opportunities
We are currently conducting an exploratory Phase 2A clinical study of PH94B to assess its therapeutic potential in adults experiencing Adjustment Disorder with Anxiety (AjDA). We recently completed enrollment in the study and anticipate top line results in the first calendar quarter of 2023. Adjustment Disorder (AjD) refers to a maladaptive emotional or behavioral response to an identifiable stressor. AjD occurs within three months of exposure to the stressor as evidenced by marked distress that is out of proportion to the socially or culturally expected reactions to the stressor, or that represents significant impairment in social, occupational or other important areas of daily functioning. Current pharmacological treatments for AjDA vary widely and include antidepressants (SSRIs and SNRIs), benzodiazepines, buspirone and natural products such as cannabidiol. Our randomized, double-blind, placebo-controlled exploratory Phase 2A study in AjDA involves daily use of PH94B administered four times per day in a real-world outpatient setting for 28 days.
We plan to evaluate additional potential development opportunities involving PH94B, both for potential acute and ongoing use in the treatment of other anxiety-related disorders, including procedural anxiety, post-traumatic stress disorder, postpartum anxiety, and panic disorder.
PH10 Nasal Spray PH10 is an investigational pherine nasal spray with a potential rapid-onset MOA that is fundamentally differentiated from the MOA of all currently approved treatments for depression disorders. PH10, which is administered at microgram-level doses, engages and activates chemosensory neurons in the nasal passages, connected to neural circuits in the brain that produce antidepressant effects. Specifically, PH10's proposed MOA involves binding to receptors for chemosensory neurons in the nasal passages to regulate the olfactory amygdala "fear on" neural circuits believed to increase activity of the limbic-hypothalamic sympathetic nervous system and increase the release of catecholamines. Importantly, unlike all currently approved oral antidepressants (Ads) and rapid-onset ketamine-based therapy (KBT), including both intravenous ketamine and intranasal ketamine (esketamine), we believe PH10 does not require systemic uptake to produce rapid-onset of antidepressant effects and does not cause the side effects and safety concerns potentially associated with KBT. In a small (n=30) exploratory randomized, double-blind, placebo-controlled parallel design Phase 2A study in major depressive disorder (MDD) conducted inMexico , at a 6.4 ?g dose administered intranasally twice daily for 8 weeks, PH10 significantly reduced depressive symptoms as early as one week based on the 17-item Hamilton Depression Scale (HAM-D-17) scores compared to placebo (p = 0.022). PH10 was well-tolerated and did not cause psychological side effects (such as dissociation and hallucinations) or other safety concerns that may be associated with KBT. We recently submitted ourU.S. Investigational New Drug (IND) application to enable us to initiate a small and brief Phase 1 study of PH10 in theU.S. in healthy volunteers. Subject to receiving confirmation from the FDA that the study may proceed, we plan to initiate the study before the end of calendar 2022. Given the prior Phase 1 and Phase 2A studies of PH10 in MDD, this small and brief Phase 1 study is primarily intended to facilitate potential Phase 2B development of PH10 in theU.S. , on our own or with a collaborator, for treatment of MDD. We may also have potential opportunities to develop PH10 for other depression-related disorders. AV-101 AV-101 is an oral prodrug of 7-chloro-kynurenic acid (7-Cl-KYNA), which is a potent and selective antagonist of the glycine co-agonist site of the NMDAR that inhibits the function of the NMDAR. Unlike ketamine and many other NMDAR antagonists, 7-Cl-KYNA is not an ion channel blocker. At doses administered in the Company's studies completed to date, AV-101 has been observed to be well tolerated and has not exhibited dissociative or hallucinogenic psychological side effects or safety concerns, unlike other modulators of the NMDAR. Based on observations and findings from preclinical studies, we believe that AV-101, in combination with FDA-approved oral probenecid, has the potential to become a new oral treatment alternative for certain CNS indications involving the NMDAR. We are presently conducting an exploratory Phase 1B drug-drug interaction clinical study of AV-101 in combination with probenecid.
The FDA has granted Fast Track designation for the development of AV-101 as a potential adjunctive treatment for MDD and as a non-opioid treatment for neuropathic pain.
SubsidiariesVistaGen Therapeutics, Inc. , aCalifornia corporation d/b/a VistaStem (VistaStem), is our wholly owned subsidiary. For the relevant periods, our Consolidated Financial Statements in this Quarterly Report on Form 10-Q (Report) also include the accounts of VistaStem's two wholly owned inactive subsidiaries,Artemis Neuroscience, Inc. , aMaryland corporation which was dissolved inApril 2022 , andVistaStem Canada, Inc. , a corporation organized under the laws ofOntario, Canada which was dissolved inJune 2022 . -22-
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Summary of financial operations and results of operations
Our critical accounting policies and estimates and recent accounting pronouncements are disclosed in our Annual Report on Form 10-K for the fiscal year endedMarch 31, 2022 , as filed with theSEC onJune 23, 2022 , and in Note 3 to the accompanying unaudited Condensed Consolidated Financial Statements included in Part 1, Item 1 of this Report. Summary Net Loss We have not yet achieved recurring revenue-generating status from any of our product candidates or technologies in amounts sufficient to sustain our operations and enable our strategic business plans. Since acquiring our exclusive worldwide licenses to PH94B and PH10 in 2018, we have devoted substantial resources to advance initiatives related to research, development, and contract manufacturing of our intranasal investigational product candidates, PH94B and PH10, including initiatives related to manufacturing processes, analytical methods and production programs for drug substance and finished drug product, as well as for preclinical studies and clinical studies focused on potential commercialization of these product candidates for neuropsychiatry indications. During calendar 2021 and to date in calendar 2022, we have allocated significant resources to our PALISADE Phase 3 Program evaluating PH94B for the acute treatment of anxiety in adults with SAD. We conducted, and are continuing to conduct, various preclinical studies and manufacturing activities that enabled submission of ourU.S. IND for PH10 in MDD in lateSeptember 2022 and our planned initiation of a small Phase 1 clinical study of PH10 later this calendar year to facilitate potential Phase 2B clinical development of PH10 in theU.S. as a stand-alone treatment for MDD. With respect to AV-101, our current focus is evaluating AV-101 in combination with probenecid which may provide opportunities to explore the therapeutic potential of the combination for certain CNS indications involving the NMDAR. We have on-going initiatives for creating, protecting and patenting intellectual property (IP) related to our product candidates and technologies and raising sufficient working capital to fund these studies, initiatives and other activities. AtSeptember 30, 2022 , we had an accumulated deficit of approximately$304.9 million . Our net loss for the six months endedSeptember 30, 2022 and 2021 was approximately$37.3 million and$21.3 million , respectively, and was approximately$47.8 million and$17.9 million for the fiscal years endedMarch 31, 2022 (Fiscal 2022) and 2021 (Fiscal 2021), respectively. We expect losses to continue for the foreseeable future as we engage in further research, development and regulatory activities related to PH94B, PH10 and AV-101.
Summary of the six months ended
Throughout Fiscal 2022 and through the date of this Report, we have continued to advance our nonclinical and clinical development, manufacturing, and regulatory activities necessary for (i) Phase 3 clinical development of PH94B as a potential acute treatment of anxiety in adults with SAD, (ii) advancing our Phase 2A clinical study of PH94B in adults experiencing AjDA, (iii) submitting our PH10 IND and initiating a small Phase 1 study of PH10 in theU.S. to facilitate potential Phase 2B development as a stand-alone treatment of MDD and (iv) exploratory Phase 1B development of AV-101 in combination with probenecid to assess potential opportunities to develop the combination for treatment of certain CNS indications. We initiated our PALISADE Phase 3Program for PH94B in SAD with PALISADE-1 inMay 2021 and PALISADE-2 inAugust 2021 . During Fiscal 2022, we also initiated the PALISADE OLS and advanced our Phase 2A clinical study of PH94B in adults experiencing AjDA. We achieved last patient out of PALISADE-1 inJune 2022 and commenced analysis of the data generated throughout the study. As noted above, inJuly 2022 we determined that PALISADE-1 did not achieve its primary efficacy endpoint. Accordingly, we have actively investigated, on multiple fronts, potential contributors to that outcome and will apply our learnings to the restart and completion of PALISADE-2 and to future clinical studies of PH94B in SAD and/or other anxiety indications. As noted above, inJuly 2022 we paused recruitment and enrollment of PALISADE-2 while we engaged independent third-party biostatisticians to conduct an interim assessment of data then available from randomized subjects in that study. We received the results of that interim assessment inSeptember 2022 and, as a result, we are preparing to resume recruitment and enrollment of subjects in PALISADE-2 as soon as practicable. In addition to pausing enrollment in PALISADE-2, we ended recruitment and enrollment in our PALISADE OLS inAugust 2022 and are assessing preliminary data from the study that we believe supports continued late-stage clinical development of PH94B as a potential treatment for SAD in a manner consistent with both data observed in Phase 2 development of PH94B in SAD, i.e., with multiple assessments of PH94B's potential efficacy, as compared to placebo, when used acutely, as-needed, over an extended period of time in an outpatient setting, rather than a single administration assessment in an anxiety-provoking public speaking challenge conducted in a clinical setting. -23-
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Table of Contents Since the fourth quarter of Fiscal 2021, we have expanded our employee infrastructure with experienced personnel additions across multiple functional areas, including clinical operations, clinical research, data management, chemistry, manufacturing and controls (CMC) and quality assurance, biostatistics and clinical analytics, regulatory affairs, medical affairs, translational medicine, commercial operations, legal, contracts and corporate affairs, development operations, and investor and public relations. We have paused further additions to our employee base pending results from the completion of our PALISADE-2 clinical trial of PH94B. Throughout Fiscal 2021 and Fiscal 2022 and through the date of this Report, strains of SARS-CoV-2, commonly referred to as COVID-19 and multiple variants of the virus, have spread globally and the outbreak has been declared a pandemic by theWorld Health Organization and a public health emergency in theU.S. by theU.S. Secretary ofHealth and Human Services . Operations at our headquarters inSouth San Francisco were significantly curtailed during Fiscal 2021 and the first half of Fiscal 2022, and, to some extent, periodically thereafter, while state and local restrictions required remote working conditions. Most of our employee additions since Fiscal 2021 are geographically located away from our headquarters facility inSouth San Francisco and routinely work remotely. Our employees have worked efficiently and productively while remotely-located and working from home whether as a result of the COVID-19 pandemic or otherwise. From time to time during the COVID-19 pandemic, however, the efficiency and productivity of certain preclinical and clinical development programs and our third-party collaborators, including, among others, contract research and development organizations (CROs), contract manufacturing organizations (CMOs) and other third-party service providers have been, and may be in the future, impacted by prevailing surges in the spread of variants of COVID-19, such as spreads induced by the Delta and Omicron variants and their sub-variants during Fiscal 2021, Fiscal 2022 and thereafter, shelter-in-place orders, social distancing measures, travel bans and restrictions, and certain business and government closures or reductions in service. From time to time since the beginning of the COVID-19 pandemic, we have experienced delays in the delivery of supplies of active pharmaceutical product (API) or other key materials required to continue development of PH94B and PH10, as well as temporary disruptions in the availability of third-party personnel and others involved in the conduct of our preclinical and clinical programs. Future unexpected delays may result in a significant, material delay or disruption to our current clinical and nonclinical development plans, programs, and operations. We have not completed any capital-raising or other significant financing activities during the six months endedSeptember 30, 2022 . InMay 2021 , we entered into an Open Market Sale Agreement SM (the Sales Agreement) withJefferies LLC (Jefferies) as sales agent, with respect to an at-the-market offering program (the ATM) under which we may, at our option, offer and sell, from time to time, shares of our common stock having an aggregate offering price of up to$75.0 million through Jefferies as our sales agent. During September and earlyOctober 2021 , we sold an aggregate of 1,517,798 shares of our common stock and received gross cash proceeds of approximately$4.45 million under the ATM. We have not sold any shares under the ATM fromOctober 2, 2021 through the date of this Report. Given the results of PALISADE-1, we are carefully monitoring our cash resources and critically evaluating our internal and external research and development and general and administrative expenditures, which includes (i) resuming recruitment and enrollment in PALISADE-2 following the independent third-party interim analysis of data from subjects randomized in PALISADE-2 to date, (ii) terminating the PALISADE OLS study of PH94B, (iii) continuing our Phase 2A clinical study of PH94B in adults experiencing AjDA and (iv) preparing for a Phase 1 clinical study of PH10 as a treatment for adults suffering from MDD. Results of Operations
Comparison of three months ended
The following table summarizes our results of operations for the three months ended
Three Months Ended September 30, 2022 2021 Sublicense revenue $ (892 ) $ 358 Operating expenses: Research and development 12,895 9,937 General and administrative 3,702 3,221 Total operating expenses 16,597 13,158 Loss from operations (17,489 ) (12,800 ) Interest income, net 6 5 Loss before income taxes (17,483 ) (12,795 ) Income taxes - - Net loss (17,483 ) (12,795 ) Accrued dividends on Series B Preferred Stock - (375 ) Net loss attributable to common stockholders$ (17,483 ) $ (13,170 ) -24-
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Table of Contents Revenue We derecognized$582,500 in sublicense revenue pursuant to the AffaMed Agreement during the six months endedSeptember 30, 2022 , compared to recognizing revenue of$712,100 during the six months endedSeptember 30, 2021 . As described more completely in Note 3 and Note 11 to our Condensed Consolidated Financial Statements in Part I of this Report, onJune 24, 2020 , we entered into the AffaMed Agreement, pursuant to which we received a non-refundable upfront license fee payment of$5.0 million onAugust 3, 2020 , which payment permitted the commencement of our revenue recognition under the AffaMed Agreement. We recognize revenue on a straight-line basis over the period in which we expect to perform our obligation under the AffaMed Agreement. Revenue related to our performance obligation, which is satisfied over time, could be materially impacted as a result of changes in our estimates of the time or effort necessary to satisfy the performance obligation. Due to the failure of PALISADE-1 to meet its primary efficacy endpoints and the resulting anticipated delay in subsequent clinical and regulatory processes for PH94B in SAD, atSeptember 30, 2022 , we estimated that we would complete our performance obligation under the AffaMed Agreement during mid-calendar 2027. As described in Note 3, as a result of the change in our estimate of the time required to complete our performance obligation under the AffaMed Agreement, we recorded a cumulative catch-up adjustment atSeptember 30, 2022 pursuant to which we derecognized previously recorded revenue, resulting in negative revenue of$582,500 in the six months endedSeptember 30, 2022 , including$310,000 of revenue that had been recognized in the quarter endedJune 30, 2022 . Following the cumulative catch-up adjustment, throughSeptember 30, 2022 , we have recognized an aggregate of$1,615,900 as revenue under the AffaMed Agreement and expect to recognize the remaining$3,384,100 as revenue over the estimated performance period as our obligation is completed. We will adjust our estimates, as necessary, in subsequent periods should more definitive information on which to base our projections become available. While we may potentially receive additional cash payments and royalties in the future under the AffaMed Agreement in the event certain performance-based milestones and commercial sales are achieved, there can be no assurance that the AffaMed Agreement will provide any additional revenue beyond that noted or cash payments to us in the near term, or at all.
Research and development expenses
Research and development (R&D) expense increased by approximately$12.8 million , from$15.4 million for the six months endedSeptember 30, 2021 to$28.2 million for the six months endedSeptember 30, 2022 . Activities related to conducting our PALISADE Phase 3Program for PH94B , including PALISADE-1, PALISADE-2 and the PALISADE OLS study, and the PH94B Phase 2 Study in AjDA, as well as nonclinical development, outsourced manufacturing and regulatory activities for both PH94B and PH10, accounted for increased expenses of approximately$11.8 million during the six months endedSeptember 30, 2022 in comparison to the activities conducted during the six months endedSeptember 30, 2021 . We expect R&D project expense for the remainder of Fiscal 2023 to decrease for PH94B due to completing the PALISADE-1 study, concluding the PALISADE OLS study and deferring certain previously projected NDA-enabling nonclinical and clinical development of PH94B, to be somewhat offset by anticipated costs for commencing the Phase 1 clinical trial of PH10 in MDD. Salaries and benefits expense for the six months endedSeptember 30, 2022 increased compared to those of the six months endedSeptember 2021 due to the hiring of additional regulatory, clinical, CMC and data management personnel during calendar 2021 and earlier in calendar 2022, partially offset by a reduction in the accrual for estimated additional compensation expense attributable to calendar 2022 corporate objectives compared to the estimated achievement of certain corporate objectives during the 2021 calendar year. Noncash research and development expense, primarily stock-based compensation and depreciation in both periods, accounted for approximately$851,000 and$606,000 for the six months endedSeptember 30, 2022 and 2021, respectively. The following table indicates the primary components of research and development expense for each of the periods (amounts in thousands): Three Months Ended September 30, 2022 2021 Salaries and benefits $ 1,744 $ 1,897 Stock-based compensation 466 314 Consulting and other professional services 174 165 Clinical and nonclinical studies and development expenses: PH94B and PH10 9,815 7,191 AV-101 484 91 All other 18 10 10,317 7,292 Rent 139 143 Depreciation 27 22 All other 28 104Total Research and Development Expense $ 12,895 $ 9,937 -25-
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Table of Contents The decrease in salaries and benefits expense for the quarter endedSeptember 30, 2022 primarily reflects the addition of ten additional management and staff positions across multiple functional disciplines, including biostatistics and clinical analytics, clinical operations, chemistry, manufacturing and controls, and regulatory affairs subsequent toSeptember 30, 2021 , as well as the impact of salary increases effective inJanuary 2022 granted to our R&D management and staff. These increases are offset by the elimination during the quarter endedSeptember 30, 2022 of the accrual for estimated additional compensation expense for R&D officers and employees as a result of the outcome of the PALISADE-1 study and delay or termination of other clinical trials and nonclinical activities related to calendar year 2022 corporate operational objectives compared to the accrual of approximately$705,000 atSeptember 30, 2021 for estimated achievement of calendar 2021 objectives. As a result of voluntary resignations of certain R&D employees subsequent toSeptember 30, 2022 , we expect R&D salaries and benefit expense to further decrease in future periods. Stock-based compensation expense for the quarter endedSeptember 30, 2022 reflects the amortization of option grants made to our R&D staff and certain clinical and scientific consultants sinceAugust 2020 , in addition to grants to new employees as indicated above. All outstanding options granted to R&D employees and consultants prior toAugust 2020 have become fully vested and amortized prior to the quarter endedSeptember 30, 2022 . Grants awarded afterSeptember 30, 2021 , including those granted to new employees, account for approximately$179,000 of expense in the quarter endedSeptember 30, 2022 , offset by an expense reduction of approximately$73,000 attributable to options that became fully vested and amortized prior to or during the quarter endedSeptember 30, 2022 . The impact of option forfeitures related to Fiscal 2023 terminations reduced expense by approximately$57,000 compared to expense for the quarter endedSeptember 30, 2021 and the extension of option exercisability by 90 days for a terminated employee accounted for approximately$109,000 of additional expense in the quarter endedSeptember 30, 2022 . 2019 ESPP expense for the quarter endedSeptember 30, 2022 was$9,500 compared to$14,400 in the quarter ended September, 2021.
Consulting and other professional services in both periods reflect fees incurred, generally as needed, for scientific, non-clinical and clinical development and project-based regulatory advisory and analytical services provided to us by third parties primarily in support of of our PH94B and PH10 development initiatives.
PH94B expense for the quarter endedSeptember 30, 2022 reflects (i) the costs associated with completing PALISADE-1, including data analysis and root cause investigations, (ii) costs associated with the PALISADE-2 study prior to its pause and for the interim analysis of data available from PALISADE-2, (iii) costs associated with the PALISADE OLS study prior to its termination, and (iv) on-going costs for the Phase 2A study of PH94B in AjDA, as well as various other clinical, nonclinical, regulatory and manufacturing activities. The PALISADE OLS study commenced inJuly 2021 , PALISADE-2 commenced inAugust 2021 and the PH94B AjDA study commenced inmid-June 2021 . During the quarters endedSeptember 30, 2022 and 2021, manufacturing, formulation, process validation and analysis of sufficient quantities of drug substance and drug product for clinical trials and other developmental requirements were significant initiatives for advancing both PH94B and PH10. Additionally, there was significant regulatory activity during the quarter endedSeptember 30, 2022 leading to thelate-September 2022 submission to the FDA of the IND for PH10 in MDD. Due to its later stage of development, costs for PH94B initiatives have significantly exceeded those for PH10 during both Fiscal 2023 and Fiscal 2022. However, as a result of pausing of PALISADE-2 inJuly 2022 and terminating the PALISADE OLS study inAugust 2022 , we expect costs associated with our continued PH94B-related initiatives, including our Phase 2 AjDA study and other nonclinical studies of PH94B, to substantially decrease in the near-term and then increase once again as we resume recruitment and enrollment in PALISADE-2 in the first quarter of calendar 2023. We anticipate increased clinical development expense associated with PH10 in the near term as we anticipate aU.S. Phase 1 clinical trial of PH10 to facilitate potentialU.S. Phase 2B development of PH10 for treatment of MDD. In both periods, AV-101 project expense includes costs for certain preclinical studies related to the use of AV-101 with adjunctive probenecid and certain AV-101 manufacturing stability studies. Expense for the quarter endedSeptember 30, 2022 also includes the impact of our ongoing exploratory Phase 1B AV-101 and probenecid clinical trial. Rent expense for both periods reflects our implementation of ASC 842 and the requirement to recognize, as an operating lease related to ourSouth San Francisco office and laboratory facility, a right-of-use asset and a lease liability, both of which must be amortized over the expected lease term. The underlying lease reflects commercial property rents prevalent in theSouth San Francisco real estate market at the time of ourNovember 2016 lease amendment extending the lease of our headquarters facilities inSouth San Francisco by five years fromJuly 31, 2017 toJuly 31, 2022 . As disclosed in Note 10, Commitments and Contingencies, in the Condensed Consolidated Financial Statements in Part I of this Report, inOctober 2021 , we entered into an amendment to this lease, pursuant to which the term of the lease was extended fromAugust 1, 2022 toJuly 31, 2027 and the base rent under the lease for the five-year extension period was specified. We allocate total rent expense for ourSouth San Francisco facility between R&D expense and G&A expense based generally on square footage dedicated to each function. In both periods reported, rent expense includes charges for such items as common area maintenance fees, taxes and insurance which are generally assessed to us by our landlord. -26-
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Table of Contents
General and adminsitrative expenses
General and administrative (G&A) expense increased by approximately$0.5 million to approximately$3.7 million for the quarter endedSeptember 30, 2022 , compared to approximately$3.2 million for the quarter endedSeptember 30, 2021 . Primary components of the increase include:
Yo. Professional services expenses incurred in anticipation of a possible
line of credit offer that we choose to waive as a result of the
PALISADE-1 result;
ii. Insurance coverage limits increased and new coverages added to our insurance
briefcase;
iii. An increase in stock-based compensation expense related to the recent option
subsidies;
IV. Increased public and investor relations and corporate awareness initiatives;
Y
v. The impact of new G&A employees hired since
elimination during the fourth ended
for estimated additional compensation expense for G&A officers and employees
as a result of the outcome of PALISADE-1 and delay or conclusion of other clinical trials and nonclinical activities related to calendar year 2022
corporate operating objectives compared to the accumulation in
2021 for estimated achievement of calendar 2021 objectives. Noncash general and administrative expense, approximately$491,000 and$501,000 in the quarters endedSeptember 30, 2022 and 2021, respectively, primarily reflects stock-based compensation and depreciation in both periods and an adjustment to contract acquisition amortization expense in the quarter endedSeptember 30, 2022 . The following table indicates the primary components of general and administrative expense for each of the periods (amounts in thousands): Three Months Ended September 30, 2022 2021 Salaries and benefits $ 1,010 $ 1,235 Stock-based compensation 566 451 Board fees and other consulting services 167 135 Legal, accounting and other professional fees 777 430 Investor and public relations 295 152 Pre-launch marketing studies and analyses 426 475 Insurance 352 144 Travel expenses 41 2 Sublicense contract amortized acquisition expense (84 ) 34 Rent and utilities 101 102 All other expenses 51 61 $ 3,702 $ 3,221 The decrease in salaries and benefits expense for the quarter endedSeptember 30, 2022 primarily reflects the addition of six additional management and staff positions including our Vice President, Medical Affairs inOctober 2021 , our Vice President, Strategic Insights and Analytics inNovember 2021 , our Vice President, Human Resources inJanuary 2022 , our Chief Legal Officer inMay 2022 , our Vice President, Associate General Counsel inAugust 2022 and one additional administrative employee inJune 2022 , as well as the impact of salary increases effective inJanuary 2022 granted to our G&A management and staff. These increases are offset by the elimination during the quarter endedSeptember 30, 2022 of the accrual for estimated additional compensation expense for G&A officers and employees as a result of the outcome of PALISADE-1 and delay or termination of other clinical trials and nonclinical activities related to calendar year 2022 corporate operational objectives compared to the accrual of approximately$537,000 atSeptember 30, 2021 for estimated achievement of calendar 2021 objectives. As a result of voluntary resignations of certain G&A employees subsequent toSeptember 30, 2022 , including our Chief Commercial Officer, we expect G&A salaries and benefit expense to further decrease in future periods. Stock-based compensation expense for the quarter endedSeptember 30, 2022 reflects the amortization of option grants made to our G&A officers and staff and certain consultants sinceSeptember 2019 , in addition to grants to new employees as indicated above. With the exception of options granted inSeptember 2019 , which became fully-vested and amortized inSeptember 2022 , all outstanding options granted to G&A employees and consultants prior toOctober 2020 have become fully vested and amortized prior to the quarter endedSeptember 30, 2022 . Grants awarded afterSeptember 30, 2021 , including those granted to new employees, account for approximately$286,000 of expense in the quarter endedSeptember 30, 2022 , offset by an expense reduction of approximately$260,000 attributable to certain options granted betweenSeptember 2019 andJune 2020 that became fully vested and amortized prior to or during the quarter endedSeptember 30, 2022 . Grants made during the quarter endedSeptember 30, 2021 reflected a full quarter of expense during the quarter endedSeptember 30, 2022 , increasing expense by approximately$69,000 compared to the prior year. 2019 ESPP expense for the quarter endedSeptember 30, 2022 was approximately$4,100 compared to$6,000 for the quarter endedSeptember 30, 2021 . -27-
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Table of Contents Board fees and other consulting services represents, in both periods, fees paid as consideration forBoard and Board Committee services to the independent members of our Board of Directors. We modified our cash compensation policy for our independent Board members at the beginning of Fiscal 2022, increasing payments to reflect current market conditions and we added one new independent Board member inApril 2021 and two additional independent members duringJuly 2021 . Expenses for the quarter endedSeptember 30, 2022 also include recruiting fees for certain administrative positions. Legal, accounting and other professional fees for both periods include expenses related to routine and project-based legal services as well as accounting services related to the audit of our annual financial statements. Expense for both periods includes the cost of certain outsourced financial and accounting services and our information technology service provider. Expense in both periods also includes legal counsel and other costs related to patent prosecution and protection pursuant to our stem cell technology license agreements, our AV-101 patents, or patents that we have elected to pursue for commercial purposes, recurring annual license fees, and costs we have incurred to advance various patent applications in theU.S. and numerous foreign countries, primarily with respect to AV-101 and our stem cell technology platform, but also nominally with respect to our PH94B and PH10 intellectual property portfolios. During the quarter endedSeptember 30, 2022 , we expensed approximately$301,000 of professional services fees incurred in anticipation of a potential credit facility offering that was terminated as a result of the outcome of PALISADE-1. Investor and public relations expense in both periods includes the fees of our various external service providers for a broad spectrum of investor relations, public relations and social media services, and, primarily in the quarter endedSeptember 30, 2022 , additional market awareness and strategic advisory and support functions and initiatives. During both periods, we conducted numerous virtual meetings and other communication activities focused on expanding global market awareness of the Company, our CNS product candidate pipeline and technologies and our research and development programs, including among registered investment professionals and investment advisors, individual and institutional investors, and prospective strategic collaborators for development and commercialization of our product candidates in major pharmaceutical markets worldwide. During both periods, we incurred expenses for a number of pre-commercialization studies, analyses, projections, strategic modeling and awareness services, primarily attributable to PH94B as a potential acute treatment of anxiety in adults with SAD. Given the results of PALISADE-1 and the resulting delay to our anticipated commercialization timeline for PH94B, we are evaluating the extent and timing of such future activities, and it is anticipated that such expenditures will not recur in the short term in excess of the level expended during the quarter endedSeptember 30, 2022 . The increase in insurance expense is primarily attributable to the increased coverage obtained under our directors' and officers' liability insurance upon renewal of our policy inMay 2022 and additional coverages, including cybersecurity and employment practices liability, added to our insurance program during Fiscal 2022. As a result of periodic shelter-in-place restrictions and travel and workplace precautions and restrictions associated with the COVID-19 pandemic continuing throughout both Fiscal 2021 and Fiscal 2022, management presentations and historically in-person meetings held in multipleU.S. markets and certain international markets with existing and potential individual and institutional investors, investment professionals and advisors, media, and securities analysts, as well as various investor relations, market awareness and corporate development and partnering initiatives, generally occurred remotely without requiring in-person business travel by our executives. We incurred nominal travel expense in the quarter endedSeptember 30, 2022 for attendance at seminars, clinical trial site visits and certain investor-focused events, as conditions have permitted. Rent expense for both periods reflects our implementation of ASC 842 and the requirement to recognize, as an operating lease related to ourSouth San Francisco office and laboratory facility, a right-of-use asset and a lease liability, both of which must be amortized over the expected lease term. The underlying lease reflects commercial property rents prevalent in theSouth San Francisco real estate market at the time of ourNovember 2016 lease amendment extending the lease of our headquarters facilities inSouth San Francisco by five years fromJuly 31, 2017 toJuly 31, 2022 . As disclosed in Note 10, Commitments and Contingencies, in the Condensed Consolidated Financial Statements in Part I of this Report, inOctober 2021 , we entered into an amendment to this lease, pursuant to which the term of the lease was extended fromAugust 1, 2022 toJuly 31, 2027 and the base rent under the lease for the five-year extension period was specified. We allocate total rent expense for ourSouth San Francisco facility between R&D expense and G&A expense based generally on square footage dedicated to each function. In both periods reported, rent expense includes charges for such items as common area maintenance fees, taxes and insurance which are generally assessed to us by our landlord. Beginning in the quarter endedSeptember 30, 2020 , we began to amortize the deferred contract acquisition costs related to our acquisition of the AffaMed Agreement, composed of the cash payment of$220,000 for sublicense fees which we were obligated to make pursuant to our PH94B license from Pherin, and the$125,000 cash payment and$125,000 fair value of common stock issued for consulting services, in each case exclusively related to our acquisition of the AffaMed Agreement. The contract acquisition costs are amortized over the expected term of our performance obligation to be provided under the AffaMed Agreement. As described above in the section entitled Revenue, the outcome of the PALISADE-1 study resulted in an estimated extension of the period over which we will recognize both revenue under the AffaMed Agreement and the period over which we will amortize the deferred contract acquisition costs. Our extended estimate of the time required to satisfy our performance obligation required a cumulative catch-up adjustment to amortization of the contract acquisition costs. During the quarter endedSeptember 30, 2022 , we reversed previously recorded expense of$83,900 , including$29,100 which had been expensed in the quarter endedJune 30, 2022 . During the quarter endedSeptember 30, 2021 , we amortized$33,600 of contract acquisition costs. -28-
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Table of Contents Interest and Other Expense Interest income, net totaled$6,100 for the quarter endedSeptember 30, 2022 , compared to$5,100 for the quarter endedSeptember 30, 2021 . The following table indicates the primary components of interest income and expense for each of the periods (amounts in thousands): Three Months Ended September 30, 2022 2021 Interest income $ 15 $ 5 Interest expense on financing lease and insurance premium financing note (9 ) - Interest income, net $ 6 $ 5 For the quarters endedSeptember 30, 2022 and 2021, interest income relates to cash deposits in interest-bearing cash equivalent accounts. Interest expense for the quarter endedSeptember 30, 2022 relates to interest paid on the insurance premium financing note executed inMay 2022 and in both periods on our financing lease of office equipment subject to ASC 842. We did not finance insurance premiums for policies that renewed inFebruary 2021 ,February 2022 orMay 2021 . We recognized approximately$375,200 during the quarter endedSeptember 30, 2021 attributable to the 10% cumulative dividend accrued on then-outstanding shares of our Series B 10% Convertible Preferred Stock (Series B Preferred) as an additional deduction in arriving at net loss attributable to common stockholders in the Condensed Consolidated Financial Statements. InNovember 2021 , the custodial holder of 1,131,669 outstanding shares of our Series B Preferred exercised its rights for conversion into common stock under the terms of the Certificate of Designation of the Relative Rights and Preferences of the Series B 10% Convertible Preferred Stock (Series B Certificate of Designation) and we issued 1,131,669 shares of our common stock upon conversion. From initial issuance inMay 2015 through the time of conversion inNovember 2021 , the Series B Preferred had accrued 10% dividends aggregating$7,217,800 and, in accordance with the terms of the Series B Certificate of Designation, we issued 3,295,778 shares of our unregistered common stock in payment of the accrued dividends. Following this conversion there were no additional shares of Series B Preferred outstanding and no further accrual of dividends on the Series B Preferred.
Six months ended comparison
The following table summarizes our results of operations for the six months ended
Six Months Ended September 30, 2022 2021 Sublicense revenue $ (582 ) $ 712 Operating expenses: Research and development 28,186 15,394 General and administrative 8,494 5,864 Total operating expenses 36,680 21,258 Loss from operations (37,262 ) (20,546 ) Interest income, net 8 10 Loss before income taxes (37,254 ) (20,536 ) Income taxes (6 ) (3 ) Net loss (37,260 ) (20,539 ) Accrued dividend on Series B Preferred Stock - (737 ) Net loss attributable to common stockholders$ (37,260 ) $ (21,276 ) -29-
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Table of Contents Revenue We derecognized$582,500 in sublicense revenue pursuant to the AffaMed Agreement during the six months endedSeptember 30, 2022 , compared to recognizing revenue of$712,100 during the six months endedSeptember 30, 2021 . As described more completely in Note 3 and Note 11 to our Condensed Consolidated Financial Statements in Part I of this Report, onJune 24, 2020 , we entered into the AffaMed Agreement, pursuant to which we received a non-refundable upfront license fee payment of$5.0 million onAugust 3, 2020 , which payment permitted the commencement of our revenue recognition under the AffaMed Agreement. We recognize revenue on a straight-line basis over the period in which we expect to perform our obligation under the AffaMed Agreement. Revenue related to our performance obligation, which is satisfied over time, could be materially impacted as a result of changes in our estimates of the time or effort necessary to satisfy the performance obligation. Due to the failure of PALISADE-1 to meet its primary efficacy endpoint and the resulting anticipated delay in subsequent clinical and regulatory processes for PH94B in SAD, atSeptember 30, 2022 , we estimated that we would complete our performance obligation under the AffaMed Agreement during mid-calendar 2027. As described in Note 3, as a result of the change in our estimate of the time required to complete our performance obligation under the AffaMed Agreement, we recorded a cumulative catch-up adjustment atSeptember 30, 2022 pursuant to which we derecognized previously recorded revenue, resulting in negative revenue of$582,500 in the six months endedSeptember 30, 2022 , including$310,000 of revenue that had been recognized in the quarter endedJune 30, 2022 . Following the cumulative catch-up adjustment, throughSeptember 30, 2022 , we have recognized an aggregate of$1,615,900 as revenue under the AffaMed Agreement and expect to recognize the remaining$3,384,100 as revenue over the estimated performance period as our obligation is completed. We will adjust our estimates, as necessary, in subsequent periods should more definitive information on which to base our projections become available. While we may potentially receive additional cash payments and royalties in the future under the AffaMed Agreement in the event certain performance-based milestones and commercial sales are achieved, there can be no assurance that the AffaMed Agreement will provide any additional revenue beyond that noted or cash payments to us in the near term, or at all.
Research and development expenses
Research and development (R&D) expense increased by approximately$12.8 million , from$15.4 million for the six months endedSeptember 30, 2021 to$28.2 million for the six months endedSeptember 30, 2022 . Activities related to conducting our PALISADE Phase 3Program for PH94B , including PALISADE-1, PALISADE-2 and the PALISADE OLS study, and the PH94B Phase 2 Study in AjDA, as well as nonclinical development, outsourced manufacturing and regulatory activities for both PH94B and PH10, accounted for increased expenses of approximately$11.8 million during the six months endedSeptember 30, 2022 in comparison to the activities conducted during the six months endedSeptember 30, 2021 . We expect R&D project expense for the remainder of Fiscal 2023 to decrease for PH94B due to completing the PALISADE-1 study, terminating the PALISADE OLS study and deferring certain previously projected NDA-enabling nonclinical and clinical development of PH94B, to be somewhat offset by anticipated costs for commencing the Phase 1 clinical trial of PH10 in MDD. Salaries and benefits expense for the six months endedSeptember 30, 2022 increased compared to those of the six months endedSeptember 2021 due to the hiring of additional regulatory, clinical, CMC and data management personnel during calendar 2021 and earlier in calendar 2022, partially offset by a reduction in the accrual for estimated additional compensation expense attributable to calendar 2022 corporate objectives compared to the estimated achievement of certain corporate objectives during the 2021 calendar year. Noncash research and development expense, primarily stock-based compensation and depreciation in both periods, accounted for approximately$851,000 and$606,000 for the six months endedSeptember 30, 2022 and 2021, respectively. The following table indicates the primary components of research and development expense for each of the periods (amounts in thousands): Six Months Ended September 30, 2022 2021 Salaries and benefits $ 3,396 $ 3,204 Stock-based compensation 796 554 Consulting and other professional services 445 300 Clinical and nonclinical studies and development expenses: PH94B and PH10 22,400 10,630 AV-101 732 251 All other 34 10 23,166 10,891 Rent 269 296 Depreciation 45 42 All other 69 107Total Research and Development Expense$ 28,186 $ 15,394 -30-
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Table of Contents The increase in salaries and benefits expense for the six months endedSeptember 30, 2022 primarily reflects the addition of ten new management and staff positions across multiple functional disciplines, including biostatistics and clinical analytics, clinical operations, chemistry, manufacturing and controls, and regulatory affairs sinceSeptember 30, 2021 , as well as the impact of salary increases effective inJanuary 2022 granted to our R&D management and staff. These increases are partially offset by the elimination during the six months endedSeptember 30, 2022 of the accrual for estimated additional compensation expense for R&D officers and employees as a result of the outcome of the PALISADE-1 study and delay or termination of other clinical trials and nonclinical activities related to calendar year 2022 corporate operational objectives compared to the accrual of approximately$1,130,000 atSeptember 30, 2021 for estimated achievement of calendar 2021 objectives. As previously noted, we expect R&D salaries and benefit expense to further decrease in future periods as a result of voluntary resignations of certain R&D employees subsequent toSeptember 30, 2022 . Stock-based compensation expense for the six months endedSeptember 30, 2022 reflects the amortization of option grants made to our R&D staff and certain clinical and scientific consultants sinceMay 2019 , in addition to grants to new employees as indicated above. All outstanding options granted to R&D employees and consultants prior toMay 2019 have become fully vested and amortized prior to the six months endedSeptember 30, 2022 and theMay 2019 grants became fully vested during the six months then ended. Grants awarded afterSeptember 30, 2021 , including those granted to new employees, account for approximately$347,000 of expense for the six months endedSeptember 30, 2022 , offset by an expense reduction of approximately$139,000 attributable to certain options granted betweenMay 2019 andMay 2020 that became fully vested and amortized prior to or during the six months endedSeptember 30, 2022 . Grants made during the six months endedSeptember 30, 2021 reflected a full six months of vesting and amortization during the six months endedSeptember 30, 2022 , or became fully vested and amortized, decreasing expense for such options by$68,000 . The extension of option exercisability by 90 days for a terminated employee accounted for approximately$109,000 of additional expense for the six months endedSeptember 30, 2022 . 2019 ESPP expense for the six months endedSeptember 30, 2022 was$25,400 compared to$16,700 during the six months endedSeptember 30, 2021 . Consulting and other professional services in both periods reflects fees incurred, generally on an as-needed basis, for project-based scientific, nonclinical and clinical development and regulatory advisory and analytical services rendered to us by third parties primarily in support of our PH94B and PH10 development initiatives. Expense for the six months endedSeptember 30, 2022 also includes nominal contract recruiting services for certain specialized R&D employee and consultant positions. PH94B and PH10 project expense increased by approximately$11.8 million in the six months endedSeptember 2022 compared to the six months endedSeptember 30, 2021 . PH94B expense for the six months endedSeptember 30, 2022 reflects (i) the costs associated with conducting and completing the PALISADE-1 study, including data analysis and root cause investigations, (ii) costs associated with the PALISADE-2 study prior to its pause and for the interim analysis of data available from PALISADE-2, (iii) costs associated with conducting the PALISADE OLS study prior to its termination, and (iv) on-going costs for conducting the Phase 2A study of PH94B in AjDA, as well as various other clinical, nonclinical, regulatory and manufacturing activities. The PALISADE-1 study commenced inMay 2021 and we announced the results inJuly 2022 . The PALISADE OLS study commenced inJuly 2021 , PALISADE-2 commenced inAugust 2021 and the PH94B AjDA study commenced inmid-June 2021 . Throughout the six months endedSeptember 30, 2022 and 2021, respectively, manufacturing, formulation, process validation and analysis of sufficient quantities of drug substance and drug product for clinical trials and other developmental requirements were significant initiatives for advancing both PH94B and PH10. Additionally, there was significant regulatory activity during the six months endedSeptember 30, 2022 leading to thelate-September 2022 submission to the FDA of the IND for PH10 in MDD. Due to its later stage of development, costs for PH94B initiatives have significantly exceeded those for PH10 during both Fiscal 2023 and Fiscal 2022. However, as a result of pausing PALISADE-2 inJuly 2022 and terminating the PALISADE OLS study inAugust 2022 , we expect costs associated with our continued PH94B-related initiatives, including our Phase 2 AjDA study and other nonclinical studies of PH94B, to substantially decrease in the near-term and then increase once again as we resume recruitment and enrollment in PALISADE-2 in the first quarter of calendar 2023. We anticipate increased clinical development expense associated with PH10 in the near term as we anticipate aU.S. Phase 1 clinical trial of PH10 to facilitate potentialU.S. Phase 2B development of PH10 for treatment of MDD. In both six-month periods, AV-101 project expense includes costs for certain preclinical studies related to the use of AV-101 with adjunctive probenecid and certain AV-101 manufacturing stability studies. Expense in the six months endedSeptember 30, 2022 also includes the impact of our ongoing exploratory Phase 1B AV-101 and probenecid clinical trial. Rent expense for both periods reflects our implementation of ASC 842 and the requirement to recognize, as an operating lease related to ourSouth San Francisco office and laboratory facility, a right-of-use asset and a lease liability, both of which must be amortized over the expected lease term. The underlying lease reflects commercial property rents prevalent in theSouth San Francisco real estate market at the time of ourNovember 2016 lease amendment extending the lease of our headquarters facilities inSouth San Francisco by five years fromJuly 31, 2017 toJuly 31, 2022 . As disclosed in Note 10, Commitments and Contingencies, in the Condensed Consolidated Financial Statements in Part I of this Report, inOctober 2021 , we entered into an amendment to this lease, pursuant to which the term of the lease was extended fromAugust 1, 2022 toJuly 31, 2027 and the base rent under the lease for the five-year extension period was specified. We allocate total rent expense for ourSouth San Francisco facility between R&D expense and G&A expense based generally on square footage dedicated to each function. In both periods reported, rent expense includes charges for such items as common area maintenance fees, taxes and insurance which are generally assessed to us by our landlord. -31-
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Table of Contents
General and adminsitrative expenses
General and administrative (G&A) expense increased by approximately$2.6 million to approximately$8.5 million for the six months endedSeptember 30, 2022 , compared to approximately$5.9 million for the six months endedSeptember 30, 2021 . Primary components of the increase include:
(i) Usual studies, analyses, projections, strategic plans prior to commercialization.
modeling and awareness services, primarily for PH94B in SAD, started in
expectation of positive results from PALISADE Phase 3 clinical trials
Program;
(ii) Expenses for professional services incurred in anticipation of a possible
credit facility offering that we opted to forego as a result of the PALISADE-1 outcome; (iii) Increased insurance coverage limits and new coverages added to our insurance portfolio;
(iv) An increase in stock-based compensation expense related to the recent option
subsidies;
(v) Expansion of business awareness and public and investor relations initiatives;
Y
(vi) The impact of new G&A employees hired since
elimination during the fourth ended
for estimated additional compensation expense for G&A officers and
employees as a result of the PALISADE-1 outcome and delay or completion
of other clinical trials and non-clinical activities related to the calendar
2022 corporate operating targets compared to the build in
Noncash general and administrative expense, approximately$1,164,000 and$1,134,000 for the six months endedSeptember 30, 2022 and 2021, respectively, primarily reflects stock-based compensation and depreciation in both periods, an adjustment to contract acquisition amortization expense in the six months endedSeptember 30, 2022 and a write-off of deferred offering costs in the six months endedSeptember 30, 2021 . The following table indicates the primary components of general and administrative expense for each of the periods (amounts in thousands): Six Months Ended September 30, 2022 2021 Salaries and benefits $ 2,102 $ 2,186 Stock-based compensation 1,193 801 Board fees and other consulting services 317 216 Legal, accounting and other professional fees 1,470 905 Investor and public relations 696 288 Pre-launch marketing studies and analyses 1,727 577 Insurance 682 266 Travel expenses 60 3 Rent and utilities 194 219 Sublicense contract amortized acquisition expense (55 ) 67 Write off of deferred offering costs - 232 All other expenses 108 104 $ 8,494 $ 5,864 The decrease in salaries and benefits expense for the six months endedSeptember 30, 2022 primarily reflects the addition of six additional management and staff positions including our Vice President, Medical Affairs inOctober 2021 , our Vice President, Strategic Insights and Analytics inNovember 2021 , our Vice President, Human Resources inJanuary 2022 , our Chief Legal Officer inMay 2022 , our Vice President, Associate General Counsel inAugust 2022 and one additional administrative employee inJune 2022 , as well as the impact of salary increases effective inJanuary 2022 granted to our G&A management and staff. These increases are offset by the elimination during the six months endedSeptember 30, 2022 of the accrual for estimated additional compensation expense for G&A officers and employees as a result of the outcome of the PALISADE-1 study and delay or conclusion of other clinical trials and nonclinical activities related to calendar year 2022 corporate operational objectives compared to the accrual of approximately$862,000 atSeptember 30, 2021 for estimated achievement of calendar 2021 objectives. As previously noted, we expect G&A salaries and benefit expense to further decrease in future periods as a result of voluntary resignations of certain G&A employees subsequent toSeptember 30, 2022 . Stock-based compensation expense for the six months quarter endedSeptember 30, 2022 reflects the amortization of option grants made to our G&A officers and staff and certain consultants sinceMay 2019 , in addition to grants to new employees as indicated above. With the exception of options granted inMay 2019 ,September 2019 andApril 2020 , which became fully vested and amortized inMay 2022 ,September 2022 andApril 2022 , respectively, all outstanding options granted to G&A employees and consultants prior toOctober 2020 have become fully vested and amortized prior toSeptember 30, 2022 . Grants awarded afterSeptember 30, 2021 , including those granted to new employees, account for approximately$552,000 of expense during the six months endedSeptember 30, 2022 , offset by an expense reduction of approximately$331,000 attributable to certain options granted betweenMay 2019 andJune 2020 that became fully vested and amortized prior to or during the six months endedSeptember 30, 2022 . Grants made during the six months endedSeptember 30, 2021 reflected a full six months of expense during the six months endedSeptember 30, 2022 , increasing expense by approximately$153,000 compared to the prior year. 2019 ESPP expense for the six months endedSeptember 30, 2022 was approximately$9,000 compared to$8,700 for the six months endedSeptember 30, 2021 . -32-
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Table of Contents Board fees and other consulting services represents, in both periods, fees paid as consideration forBoard and Board Committee services to the independent members of our Board of Directors. We modified our cash compensation policy for our independent Board members at the beginning of Fiscal 2022, increasing payments to reflect current market conditions and we added one new independent Board member inApril 2021 and two additional independent members duringJuly 2021 . Expenses for the six months endedSeptember 30, 2022 also include recruiting fees for certain administrative positions. Legal, accounting and other professional fees for both periods include expenses related to routine and project-based legal services as well as accounting services related to the annual audit and quarterly review of our financial statements. Expense for both periods includes the cost of certain outsourced financial and accounting services and our information technology service provider. Expense in the six months endedSeptember 30, 2021 also included costs related to our implementation of new accounting software. Expense in both periods also includes legal counsel and other costs related to patent prosecution and protection pursuant to our stem cell technology license agreements, our AV-101 patents, or patents that we have elected to pursue for commercial purposes, recurring annual license fees, and costs we have incurred to advance various patent applications in theU.S. and numerous foreign countries, primarily with respect to AV-101 and our stem cell technology platform, but also nominally with respect to our PH94B and PH10 intellectual property portfolios. During the six months endedSeptember 30, 2022 , we expensed approximately$301,000 of professional services fees incurred in anticipation of a potential credit facility offering that we opted to forego following the results of PALISADE-1. Investor and public relations expense in both periods includes the fees of our various external service providers for a broad spectrum of investor relations, public relations and social media services, and, primarily in the six months endedSeptember 30, 2022 , additional market awareness and strategic advisory and support functions and initiatives. During both periods, we conducted numerous virtual meetings and other communication activities focused on expanding global market awareness of the Company, our CNS product candidate pipeline and technologies and our research and development programs, including among registered investment professionals and investment advisors, individual and institutional investors, and prospective strategic collaborators for development and commercialization of our product candidates in major pharmaceutical markets worldwide. During both periods, we incurred expenses for a number of pre-commercialization studies, analyses, projections, strategic modeling and awareness services, primarily attributable to PH94B as a potential acute treatment of anxiety in adults with SAD. Given the results of PALISADE-1 and the resulting delay to our anticipated commercialization timeline for PH94B in SAD, we have paused or concluded most of such activities and are evaluating the extent and timing of such future activities, and it is anticipated that such expenditures will not recur in the short term in excess of the level expended during the six months endedSeptember 30, 2022 . The increase in insurance expense is primarily attributable to the increased coverage obtained under our directors' and officers' liability insurance upon renewal of our policy inMay 2022 and additional coverages, including cybersecurity and employment practices liability, added to our insurance program during Fiscal 2022. As a result of periodic shelter-in-place restrictions and travel and workplace precautions and restrictions associated with the COVID-19 pandemic continuing throughout both Fiscal 2021 and Fiscal 2022, management presentations and historically in-person meetings held in multipleU.S. markets and certain international markets with existing and potential individual and institutional investors, investment professionals and advisors, media, and securities analysts, as well as various investor relations, market awareness and corporate development and partnering initiatives, generally occurred remotely without requiring in-person business travel by our executives. We incurred nominal travel expense during the six months endedSeptember 30, 2022 for attendance at seminars, and for vendor audits, clinical trial site visits and certain investor-focused events, as conditions have permitted. Rent expense for both periods reflects our implementation of ASC 842 and the requirement to recognize, as an operating lease related to ourSouth San Francisco office and laboratory facility, a right-of-use asset and a lease liability, both of which must be amortized over the expected lease term. The underlying lease reflects commercial property rents prevalent in theSouth San Francisco real estate market at the time of ourNovember 2016 lease amendment extending the lease of our headquarters facilities inSouth San Francisco by five years fromJuly 31, 2017 toJuly 31, 2022 . As disclosed in Note 10, Commitments and Contingencies, in the Condensed Consolidated Financial Statements in Part I of this Report, inOctober 2021 , we entered into an amendment to this lease, pursuant to which the term of the lease was extended fromAugust 1, 2022 toJuly 31, 2027 and the base rent under the lease for the five-year extension period was specified. We allocate total rent expense for ourSouth San Francisco facility between R&D expense and G&A expense based generally on square footage dedicated to each function. In both periods reported, rent expense includes charges for such items as common area maintenance fees, taxes and insurance which are generally assessed to us by our landlord. Beginning in the quarter endedSeptember 30, 2020 , we began to amortize the deferred contract acquisition costs related to our acquisition of the AffaMed Agreement, composed of the cash payment of$220,000 for sublicense fees which we were obligated to make pursuant to our PH94B license from Pherin, and the$125,000 cash payment and$125,000 fair value of common stock issued for consulting services, in each case exclusively related to our acquisition of the AffaMed Agreement. The contract acquisition costs are amortized over the expected term of the services to be provided under the AffaMed Agreement. As described above in the section entitled Revenue, the outcome of the PALISADE-1 study resulted in an estimated extension of the period over which we will recognize both revenue under the AffaMed Agreement and the period over which we will amortize the deferred contract acquisition costs. Our extended estimate of the time required to satisfy our performance obligation required a cumulative catch-up adjustment to amortization of the contract acquisition costs. During the six months endedSeptember 30, 2022 , we reversed previously recorded expense of$54,800 , including$29,100 which had been expensed in the quarter endedJune 30, 2022 . During the six months endedSeptember 30, 2021 , we amortized$66,900 of contract acquisition costs. InJune 2021 , we terminated our previous equity line agreement withLincoln Park Capital . Upon termination of the agreement, we expensed the remaining$232,100 of deferred offering costs related to the agreement as a noncash charge to G&A expense. -33-
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Table of Contents Interest and Other Expense Interest income, net totaled$8,400 for the six months endedSeptember 30, 2022 , compared to$10,200 for the six months endedSeptember 30, 2021 . The following table indicates the primary components of interest income and expense for each of the periods (amounts in thousands): Six Months Ended September 30, 2022 2021 Interest income $ 22 $ 10 Interest expense on financing lease and insurance premium financing note (14 ) - Interest income, net $ 8 $ 10 For the six months endedSeptember 30, 2022 and 2021, interest income relates to cash deposits in interest-bearing cash equivalent accounts. Although interest rates have increased during the six months endedSeptember 30, 2022 , our cash deposit balances have declined as we used such amounts to fund our operations. Interest expense for the six months endedSeptember 30, 2022 relates to interest paid on the insurance premium financing note executed inMay 2022 and in both periods on our financing lease of office equipment subject to ASC 842. We did not finance insurance premiums for policies that renewed inFebruary 2021 ,February 2022 orMay 2021 . We recognized approximately$737,000 during the six months endedSeptember 30, 2021 attributable to the 10% cumulative dividend accrued on then-outstanding shares of our Series B 10% Convertible Preferred Stock (Series B Preferred) as an additional deduction in arriving at net loss attributable to common stockholders in the Condensed Consolidated Financial Statements. InNovember 2021 , the custodial holder of 1,131,669 outstanding shares of our Series B Preferred exercised its rights for conversion into common stock under the terms of the Certificate of Designation of the Relative Rights and Preferences of the Series B 10% Convertible Preferred Stock (Series B Certificate of Designation) and we issued 1,131,669 shares of our common stock upon conversion. From initial issuance inMay 2015 through the time of conversion inNovember 2021 , the Series B Preferred had accrued 10% dividends aggregating$7,217,800 and, in accordance with the terms of the Series B Certificate of Designation, we issued 3,295,778 shares of our unregistered common stock in payment of the accrued dividends. Following this conversion there were no additional shares of Series B Preferred outstanding and no further accrual of dividends on the Series B Preferred.
Liquidity and Capital Resources
Since our inception inMay 1998 throughSeptember 30, 2022 , we have financed our operations and technology acquisitions primarily through the issuance and sale of our equity and debt securities for cash proceeds of approximately$208.7 million , as well as from an aggregate of approximately$22.7 million of government research grant awards (excluding the fair market value of government sponsored and funded clinical trials), strategic collaboration payments and intellectual property licensing, and other revenues. Additionally, we have issued equity securities with an approximate value at issuance of$38.2 million in noncash acquisitions of product licenses and in settlements of certain liabilities, including liabilities for professional services rendered to us or as compensation for such services. During Fiscal 2022, holders of outstanding warrants to purchase an aggregate of approximately 7.3 million shares of our common stock exercised such warrants, and we received cash proceeds of approximately$6.2 million . InMay 2021 , we entered into an Open Market Sale Agreement SM (the Sales Agreement) with respect to an at-the-market offering program (the ATM) under which we may offer and sell, from time to time, shares of our common stock having an aggregate offering price of up to$75.0 million through our sales agent. During Fiscal 2022, we sold an aggregate of 1,517,798 shares of our common stock and received net cash proceeds of approximately$4.3 million under the ATM. We have not sold any additional shares of our common stock under the Sales Agreement fromOctober 2, 2021 through the date of this Report. During our fiscal year endedMarch 31, 2021 (Fiscal 2021), we received approximately$119 million in net cash proceeds, primarily from public offerings conducted inAugust 2020 andDecember 2020 , the exercise of approximately 6.6 million outstanding warrants and the upfront license payment pursuant to our sublicense and collaboration agreement for PH94B (the AffaMed Agreement), which is described more completely in Note 11, Sublicensing and Collaboration Agreements. The financings and other transactions consummated during Fiscal 2022 and Fiscal 2021 have been the primary sources of our liquidity during Fiscal 2022 and through the date of this Report. During the six months endedSeptember 30, 2022 , we received approximately$160,500 in proceeds from the exercise of outstanding stock options and sales under our 2019 Employee Stock Ownership Program (the ESPP). We had cash and cash equivalents of approximately$35.3 million atSeptember 30, 2022 , which we believe is probable not to be sufficient to fund our planned operations for the twelve months following the issuance of these consolidated financial statements, which raises substantial doubt that we can continue as a going concern. We are continuing to evaluate our cash resources given the results of PALISADE-1 and our decisions to (i) resume recruitment and enrollment in PALISADE-2 following the independent third-party interim analysis of data from subjects randomized in PALISADE-2 to date, (ii) end recruitment and enrollment in the PALISADE OLS study of PH94B, (iii) continue our small exploratory Phase 2A clinical study of PH94B in adults experiencing AjDA, and (iv) prepare to conduct a small and brief Phase 1 clinical safety study of PH10 to facilitate potential Phase 2B development, on our own or with a collaborator, of PH10 as a potential stand-alone rapid-onset treatment for MDD. We are continuing to evaluate the resulting implications for the conduct and timing of other clinical trials and strategies and opportunities for the development and commercialization, on our own or with collaborators, all of our product candidates. However, as we have not yet developed products that generate recurring revenue and, in the event we successfully complete future clinical and/or nonclinical programs, we will need to invest substantial additional capital resources to develop and commercialize our drug candidates. -34-
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Table of Contents When necessary and advantageous, we will seek additional financial resources to fund our planned operations through (i) sales of our equity and/or debt securities in one or more public offerings and/or private placements, (ii) non-dilutive government grants and research awards and (iii) non-dilutive strategic collaborations to advance development and commercialization of our product candidates. For example, we may seek to enter research, development and/or commercialization collaborations similar to the AffaMed Agreement, which applies to development of PH94B in certain Pacific-Asian territories, to provide non-dilutive funding for our operations, while also reducing a portion of our future cash outlays and working capital requirements. Although we may seek additional collaborations that could generate revenue and/or provide non-dilutive funding for development and commercialization of our product candidates, no assurance can be provided that any such collaborations, awards or agreements will occur in the future. Subject to certain restrictions, our Registration Statement on Form S-3 (the S-3 Shelf Registration Statement) remains available for future sales of our equity securities in one or more public offerings from time to time. While we may make additional sales of our equity securities under the S-3 Shelf Registration Statement, we do not have an obligation to do so. Our future working capital requirements will depend on many factors, including, without limitation, potential impacts related to the on-going COVID-19 pandemic, adjustments in the size of our staff, the scope and nature of opportunities related to our success and the success of certain other companies in nonclinical and clinical trials, including our development and commercialization of our current product candidates, the availability of, and our ability to enter into collaborations on terms acceptable to us. To further advance the clinical development of PH94B, PH10, and AV-101, as well as support our operating activities, we plan to continue to carefully manage our routine operating costs, including, but not limited to, our clinical and nonclinical programs. Notwithstanding the foregoing, there can be no assurance that future financings will be available to us in sufficient amounts, in a timely manner, or on terms acceptable to us, if at all, or that our current strategic collaboration under the AffaMed Agreement or other strategic collaborations will generate revenue from future potential milestone payments. Further, onSeptember 6, 2022 , we received a letter from the Listing Qualifications Staff ofThe Nasdaq Stock Market, LLC (Nasdaq) indicating that, based upon the closing bid price of our common stock for the previous 30 consecutive business days, we are not currently in compliance with the requirement to maintain a minimum bid price of$1.00 per share for continued listing on the Nasdaq Capital Market. While the letter has no immediate effect on the listing of our common stock on theNasdaq Capital Market, failure to meet applicable Nasdaq continued listing standards could potentially result in a delisting of our common stock, which could materially reduce the liquidity of our common stock, result in a further reduction in the price of our common stock, require us to implement a reverse stock split, and/or impair our ability to raise capital through alternative financing sources on terms acceptable to us, or at all. If we are unable to obtain additional financing on a timely basis when needed, our business, financial condition, and results of operations may be harmed, the price of our stock may decline, we may be required to reduce, defer, or discontinue certain of our research and development activities and we may not be able to continue as a going concern. The Condensed Consolidated Financial Statements included in Part I of this Report do not include any adjustments that might result from the negative outcome of this uncertainty. Cash and Cash Equivalents
The following table summarizes the changes in cash and cash equivalents for the periods indicated (in thousands):
Six Months Ended September 30, 2022 2021 Net cash used in operating activities$ (32,309 ) $ (17,623 ) Net cash used in investing activities (200 ) (200 ) Net cash provided by (used in) financing activities (339 ) 8,342 Net decrease in cash and cash equivalents (32,848 ) (9,481 ) Cash and cash equivalents at beginning of period 68,135 103,108 Cash and cash equivalents at end of period$ 35,287 $ 93,627 As described above, the combination of the net proceeds we received from public offerings in Fiscal 2021, from transactions under our ATM in Fiscal 2022 and from warrant exercises in both Fiscal 2021 and Fiscal 2022, have been the primary sources of our available cash during Fiscal 2022 and during the six months endedSeptember 30, 2022 . The increase in cash used in operations during the six months endedSeptember 30, 2022 reflects our continued conduct, completion, pause or termination of PH94B clinical trials including PALISADE-1, PALISADE-2, the PALISADE OLS, and the Phase 2 AjDA study, as previously described, as well as ongoing manufacturing and regulatory initiatives and other nonclinical studies of our product candidates. Additionally, during Fiscal 2022, we expanded our internal capabilities with the addition of numerous senior personnel with significant expertise in disciplines critical to the advancement of our product pipeline. In both periods, but to a much greater extent during the six months endedSeptember 30, 2022 , in parallel with our clinical and regulatory initiatives, and in expectation of positive results from the PALISADE Phase 3 Program, we have engaged in customary pre-commercialization analyses, modeling, planning and awareness initiatives. Given the results of the PALISADE-1 study, we have paused most of such activities and are evaluating the extent and timing of such future activities. Cash used in investing activities during the six months endedSeptember 30, 2022 reflects laboratory analytical equipment acquired for our internal studies and experiments on both PH94B and PH10 and cash used during the six months endedSeptember 30, 2021 primarily reflects the cost of laboratory analytical equipment acquired for use by our CMO in connection with the development and production of PH94B drug product. Cash used by financing activities during the six months endedSeptember 30, 2022 is primarily the result of the proceeds of option exercises and the purchase of common stock under our ESPP, net of principal payments on our insurance premium financing note and expenditures related to the ATM transaction with Jefferies which are recorded as deferred offering costs. Cash provided by financing activities during the six months endedSeptember 30, 2021 is primarily the result of warrant exercises, net of expenditures related to the ATM transaction with Jefferies and recorded as deferred offering costs. -35-
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Off-Balance Arrangements
We have no off-balance sheet deals.
Recent Accounting Pronouncements
For information related to recent accounting pronouncements and the expected impact of such pronouncements on our condensed consolidated financial statements, see Note 3 of the Notes to the Condensed Consolidated Financial Statements included in Part I of this Report.
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