International Stem Cell
Written by
International Stem Cell |
Phase I progressing |
Financial update |
Pharma & biotech |
14 December 2016 |
Share price performance
Business description
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Analysts
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International Stem Cell recently announced that the first two patients in its Phase I trial in Parkinson’s disease (PD) had successfully undergone intracranial transplants of ISC-hpNSC without complications. The study will enroll 12 patients at three dosing regimens with a primary endpoint of safety, but will provide preliminary efficacy data measured at six and 12 months following the treatment.
Year |
Revenue ($m) |
PBT* |
EPS* |
DPS |
P/E |
Yield |
12/14 |
7.0 |
(8.7) |
(9.71) |
0.0 |
N/A |
N/A |
12/15 |
7.6 |
(4.6) |
(1.29) |
0.0 |
N/A |
N/A |
12/16e |
7.5 |
(4.8) |
(1.26) |
0.0 |
N/A |
N/A |
12/17e |
8.3 |
(6.0) |
(1.57) |
0.0 |
N/A |
N/A |
Note: *PBT and EPS are normalised, excluding amortization of acquired intangibles, exceptional items and share-based payments.
Parkinson’s trial ongoing
Patients on the study will be treated with 30m to 70m stem cells, delivered via intracranial injection. The single-arm, open-label study is being conducted at the Royal Melbourne Hospital in Australia. Clinical assessments are scheduled at six and 12 months following surgery, and the data from this trial will be used in the design of a future Phase II trial expected to initiate in late 2017 or 2018.
Trial will provide first evaluation of efficacy
Besides safety, the trial will also provide physiological and functional assessments of the patients, which will give the first indication of the efficacy of the treatment in humans. Brain function will be directly assessed via PET scan to assess the degree of disease progression. Additionally, patients will be assessed via the six-point Unified Parkinson Disease Rating Scale (UPDRS), a qualitative functional scale of a patient’s mental state, muscle tone and ability to perform daily tasks.
Preclinical safety studies published
In the 30 September issue of Scientific Reports, a journal from the publishers of Nature, data from in vitro and in vivo preclinical studies showed that the company’s ISC-hpNSC cells are devoid of undifferentiated pluripotent stem cells and are safe for transplantation due to the low risk of tumorigenicity. In another preclinical study, ISC-hpNSC cells improved cognitive performance and motor coordination in rodents with traumatic brain injury.
Valuation: $24m or $7.57 per basic share
We have decreased our valuation from $28m or $8.75 per basic share to $24m or $7.57 per basic share. This is primarily due to a lower value for the cosmetic business, due to lower than expected revenues, as well as a lower cash balance and a higher share count. There remain approximately 17.9m potentially dilutive shares from warrants, options and convertible preferred stock. We project that the company will need at least $73m (previously $76m) in additional financing before profitability in 2024, of which $10.5m will be required by the end of 2017.
ISC-hpNSC for Parkinson’s disease
International Stem Cell Corporation has announced that the first two patients in its Phase I trial in Parkinson’s disease (PD) have successfully undergone intracranial transplant of ISC-hpNSC without complications. It had initiated the Phase I trial of ISC-hpNSC for the treatment of PD in July. ISC-hpNSC are the company’s proprietary neural stem cells (NSC) derived from a human parthenogenetic stem cell line (hpSC). The trial is a dose escalation study designed to evaluate the safety of the intracranial injection of between 30m and 70m cells. The trial will also evaluate the treatment for efficacy by monitoring changes in brain function via PET scan, as well as functional assessment via the UPDRS over the course of 12 months. The study is being performed at the Royal Melbourne Hospital in Australia and has a targeted enrolment of 12 moderate to severe PD patients.
The UPDRS is the most common standardized assessment used to monitor the progression and severity of PD in the clinical setting. It comprises six sections, including both patient and clinician evaluation of motor function, mood and the ability to perform daily tasks (Exhibit 1).
Exhibit 1: Unified Parkinson Disease Rating Scale
Section |
Description |
Assessments |
1 |
Mental assessment |
Intellectual impairment, thought disorder, depression and initiative |
2 |
Patient scored evaluation of ability to perform daily activities |
Hygiene, food preparation, dressing, avoiding falls, speech, tremor etc |
3 |
Clinician scored motor assessment |
Measures of function (tremor, rigidity, posture), functional assessments (ability to rise from a chair, gait, speech) and evaluation of specific muscle groups (fingers, face, legs) |
4 |
Complications associated with therapy |
Rate of dyskinesia, assessments of “off” periods, other complications of treatment (nausea, insomnia, etc) |
5 |
The Modified Hoehn Yahr Staging |
Global evaluation ranging from no visible signs of disease to wheelchair-bound state |
6 |
Schwab & England Activities of Daily Living Scale |
Degree of independence from care givers ranging from completely independent to inability to swallow or perform bowel movements |
Source: National Parkinson Foundation
The data from this trial will provide the first assessment of ISC-hpNSC in humans. However, the treatment was previously studied in non-human primates (Exhibit 2). In this model, the treatment successfully increased the number of dopaminergic neurons in the animals’ brains measured post-mortem. This was accompanied by an increase in the concentration of free dopamine (up to approximately 200% dependent on brain region), indicating that the neurons were functional. Finally, the animals treated with ISC-hpNSC showed statistically significant improvement over the control animal on an assessment of Parkinsonian symptoms (ParkScore).
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Exhibit 2: ISCO preclinical data |
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Source: International Stem Cell presentation |
PD affects 7-10 million people worldwide, with approximately 1.5 million in the US. The most widespread treatment for the disease is the combination of levodopa and carbidopa, which provides the brain with dopamine lost by the death of dopaminergic neurons. The majority of clinical development in the space has been focused on the reformulation of this and other treatment regimens and, to date, no disease-modifying therapies have been approved. A small number of gene and cell therapies focused on changing the course of the disease have entered the clinic (Exhibit 3).
Exhibit 3: Selected clinical-stage cell and gene therapy candidates in PD
Company (originator) |
Stage of development |
Description |
Therapeutic modality |
Milestones/comments |
Living Cell Technologies |
Phase IIa |
Choroid plexus cell product that secretes neurotrophins and cerebrospinal fluid (CSF) |
Cell therapy |
Phase IIb start Q116; NTCELL decreased UPDRS by an average of 16 points after 58 weeks, representing a three- to four-year reversal of neurological deterioration. |
International Stem Cell |
Phase I |
Neuronal cells derived from human parthenogenetic stem cells (hpSC) |
Cell therapy: Stem cell |
Phase I preliminary data (Q416). |
uniQure NV |
Phase I |
Adeno-associated viral (AAV) vector carrying the glial cell-derived neurotrophic factor (GDNF) gene |
Gene therapy: Viral vector: Adeno-associated virus (AAV) |
The aim of this clinical trial is to introduce GDNF in a targeted way to the brain to enhance outcomes. NIH research at UCSF with option to license. |
Voyager Therapeutics |
Phase II |
Adeno-associated virus (AAV) serotype 2 encoding the dopa decarboxylase (DDC; AADC) gene injected into the putamen |
Gene therapy: Viral vector: Adeno-associated virus (AAV) |
Phase Ib data (H216). |
Oxford BioMedica |
Phase I/II |
LentiVector carrying three genes encoding enzymes for dopamine synthesis |
Gene therapy: Viral vector: Lentivirus |
Preclinical studies in the industry standard in vivo model of Parkinson’s disease have shown that, following a single treatment, almost complete recovery of movement behavior was achieved after five to eight weeks. Therapeutic effect was statistically significant (p<.0.05) after two weeks and was maintained throughout the duration of the preclinical studies, with the latest time point being 44 months. |
Source: BioCentury, Edison Investment Research
The announcement that the first two patients have been dosed in this trial is consistent with our previously predicted timeline. We currently expect that the company will be able to progress to a Phase II study in late 2017 or 2018 depending on the safety and efficacy profile discovered in the current trial (preparations may begin at the six-month interim update if early efficacy is seen, or later if the maximum tolerable dose is not reached early); however, we do not expect preliminary data until Q117 (previously Q416). We currently model commercialization of the product in 2024.
Valuation
We have decreased our valuation from $28m or $8.75 per basic share to $24m or $7.57 per basic share. This is primarily due to a lower value for the cosmetic business due to lower than expected revenues, as well as a lower cash balance and a higher share count. There remain approximately 17.9m potentially dilutive shares from warrants, options and convertible preferred stock.
Exhibit 4: Risk-adjusted NPV valuation model
Product |
Status |
Launch |
Peak sales ($m) |
NPV |
Probability |
rNPV |
NPV/share ($/share) |
Cosmetic and biomedical business |
Commercial |
Current |
22 |
26 |
90% |
24 |
7.38 |
Parkinson’s disease (royalties at 12% of sales) |
Phase I/IIa |
2024 |
2,800 |
408 |
7.5% |
31 |
9.58 |
G&A expenses – after tax |
100% |
(31) |
(9.62) |
||||
Net cash (at end Q316) |
0.7 |
100% |
0.7 |
0.48 |
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Valuation |
|
|
|
435 |
|
24 |
7.57 |
Source: Edison Investment Research estimates
Financials
International Stem Cell reported revenues of $1.9m for Q316, down 9% compared to Q315. This decline was due to weakness in the cosmetic business, which reported sales of $0.65m for the quarter, down 30% compared to the same quarter last year. The reason for this weakness has not been disclosed, but the company has said previously that the cosmetic business is non-core and it would limit investments in that area. The biomedical business continues to grow, reporting revenues of $1.3m in Q316, up 7% compared to Q315. For the company as a whole, the operating loss was $1.3m. We have adjusted our model to reflect weaker cosmetic business sales than we had forecast as well as lower R&D spending in 2016 thus far.
Exhibit 5: Changes to estimates
$000s |
Revenue |
Operating profit |
Profit after tax |
||||||
Old |
New |
% change |
Old |
New |
% change |
Old |
New |
% change |
|
2016e |
8,167 |
7,471 |
(8.5%) |
(5,052) |
(4,803) |
4.9% |
(5,532) |
(4,803) |
13.2% |
2017e |
9,043 |
8,311 |
(8.1%) |
(4,746) |
(5,130) |
(8.1%) |
(5,826) |
(5,970) |
(2.5%) |
2018e |
9,924 |
9,156 |
(8.4%) |
(6,339) |
(6,749) |
(6.5%) |
(8,019) |
(8,189) |
(2.1%) |
Source: Edison Investment Research. Note: Operating profit and profit after tax exclude amortization of acquired intangibles, exceptional items and share-based payments.
We project the company will need at least $73m (previously $76m) in additional financing before profitability in 2024, of which $10.5m will be required by the end of 2017, which we record as illustrative debt in Exhibit 6.
Exhibit 6: Financial summary
US$000 |
2013 |
2014 |
2015 |
2016e |
2017e |
2018e |
||
Year end 31 December |
US GAAP |
US GAAP |
US GAAP |
US GAAP |
US GAAP |
US GAAP |
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PROFIT & LOSS |
||||||||
Revenue |
|
|
6,150 |
7,017 |
7,551 |
7,471 |
8,311 |
9,156 |
Cost of Sales |
(1,643) |
(1,921) |
(2,056) |
(2,017) |
(2,244) |
(2,381) |
||
Gross Profit |
4,507 |
5,096 |
5,495 |
5,454 |
6,067 |
6,776 |
||
Research and development |
(3,560) |
(5,386) |
(2,707) |
(2,800) |
(4,000) |
(6,000) |
||
EBITDA |
|
|
(8,007) |
(9,138) |
(5,036) |
(5,131) |
(5,458) |
(7,077) |
Operating Profit (before amort. and except.) |
(7,543) |
(8,680) |
(4,564) |
(4,803) |
(5,130) |
(6,749) |
||
Intangible Amortization |
0 |
0 |
0 |
0 |
0 |
0 |
||
Exceptionals |
0 |
0 |
0 |
1,676 |
0 |
0 |
||
Other |
(2,930) |
(3,796) |
1,929 |
0 |
0 |
0 |
||
Operating Profit |
(10,473) |
(12,476) |
(2,635) |
(3,127) |
(5,130) |
(6,749) |
||
Net Interest |
(3) |
(2) |
0 |
0 |
(840) |
(1,440) |
||
Profit Before Tax (norm) |
|
|
(7,546) |
(8,682) |
(4,564) |
(4,803) |
(5,970) |
(8,189) |
Profit Before Tax (reported) |
|
|
(10,476) |
(12,478) |
(2,635) |
(3,127) |
(5,970) |
(8,189) |
Tax |
0 |
0 |
0 |
0 |
0 |
0 |
||
Profit After Tax (norm) |
(10,476) |
(12,478) |
(2,635) |
(4,803) |
(5,970) |
(8,189) |
||
Profit After Tax (reported) |
(10,476) |
(12,478) |
(2,635) |
(3,127) |
(5,970) |
(8,189) |
||
Average Number of Shares Outstanding (m) |
0.8 |
1.3 |
2.0 |
3.8 |
3.8 |
3.8 |
||
EPS - normalised (US$) |
|
|
(12.77) |
(9.71) |
(1.29) |
(1.26) |
(1.57) |
(2.16) |
EPS - normalised fully diluted (US$) |
|
|
(12.77) |
(9.71) |
(1.29) |
(1.26) |
(1.57) |
(2.16) |
EPS - (reported) (US$) |
|
|
(12.77) |
(9.71) |
(1.29) |
(0.82) |
(1.57) |
(2.16) |
Dividend per share (c) |
0.0 |
0.0 |
0.0 |
0.0 |
0.0 |
0.0 |
||
Gross Margin (%) |
73.3 |
72.6 |
72.8 |
73.0 |
73.0 |
74.0 |
||
EBITDA Margin (%) |
N/A |
N/A |
N/A |
N/A |
N/A |
N/A |
||
Operating Margin (before GW and except.) (%) |
N/A |
N/A |
N/A |
N/A |
N/A |
N/A |
||
BALANCE SHEET |
||||||||
Fixed Assets |
|
|
3,113 |
3,563 |
4,147 |
4,835 |
5,429 |
6,040 |
Intangible Assets |
2,250 |
2,795 |
3,223 |
3,815 |
4,407 |
4,999 |
||
Tangible Assets |
830 |
714 |
864 |
960 |
962 |
981 |
||
Investments |
33 |
54 |
60 |
60 |
60 |
60 |
||
Current Assets |
|
|
4,626 |
3,616 |
2,991 |
4,965 |
6,922 |
6,644 |
Stocks |
1,369 |
1,517 |
1,348 |
1,334 |
1,484 |
1,635 |
||
Debtors |
306 |
453 |
539 |
533 |
593 |
654 |
||
Cash |
2,243 |
1,111 |
532 |
2,526 |
4,273 |
3,784 |
||
Other |
708 |
535 |
572 |
572 |
572 |
572 |
||
Current Liabilities |
|
|
(7,021) |
(6,858) |
(5,544) |
(7,255) |
(7,377) |
(7,499) |
Creditors |
(7,021) |
(6,858) |
(5,544) |
(7,255) |
(7,377) |
(7,499) |
||
Short term borrowings |
0 |
0 |
0 |
0 |
0 |
0 |
||
Long Term Liabilities |
|
|
0 |
0 |
0 |
(3,000) |
(10,500) |
(18,000) |
Long term borrowings |
0 |
0 |
0 |
(3,000) |
(10,500) |
(18,000) |
||
Other long term liabilities |
0 |
0 |
0 |
0 |
0 |
0 |
||
Net Assets |
|
|
718 |
321 |
1,594 |
(455) |
(5,525) |
(12,815) |
CASH FLOW |
||||||||
Operating Cash Flow |
|
|
(5,635) |
(6,413) |
(4,120) |
(4,212) |
(3,991) |
(5,610) |
Net Interest |
(3) |
(2) |
0 |
0 |
(840) |
(1,440) |
||
Tax |
0 |
0 |
0 |
0 |
0 |
0 |
||
Capex |
(896) |
(988) |
(738) |
(1,016) |
(922) |
(939) |
||
Acquisitions/disposals |
0 |
0 |
0 |
0 |
0 |
0 |
||
Financing |
8,123 |
6,270 |
1,169 |
3,519 |
0 |
0 |
||
Dividends |
0 |
0 |
0 |
0 |
0 |
0 |
||
Net Cash Flow |
1,589 |
(1,133) |
(3,689) |
(1,709) |
(5,753) |
(7,989) |
||
Opening net debt/(cash) |
|
|
(654) |
(2,243) |
(1,111) |
(532) |
474 |
6,227 |
HP finance leases initiated |
0 |
0 |
0 |
0 |
0 |
0 |
||
Other |
0 |
1 |
3,110 |
703 |
0 |
0 |
||
Closing net debt/(cash) |
|
|
(2,243) |
(1,111) |
(532) |
474 |
6,227 |
14,216 |
Source: International Stem Cell accounts, Edison Investment Research
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