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spk05: Good afternoon and welcome to Voyager's Therapeutics First Quarter 2024 Financial Results Conference call. At this time, all participants are on listen-only mode. There will be a question-and-answer session at the end of this call. Please note that today's conference is being recorded. Your play of today's call will be available on the Investors section of the company's website approximately two hours after completion of this call. I would like to turn the call over to Trista Morrison, Chief Corporate Affairs Officer.
spk17: Thank you, and good afternoon. We issued our first quarter 2024 financial results press release this afternoon. The press release and 10Q are available on our website. Joining me on today's call are Dr. Al Sandrock, our Chief Executive Officer, Dr. Toby Ferguson, our Chief Medical Officer, and Dr. Todd Carter, our Chief Scientific Officer. We will also be joined for the Q&A portion of the call by our Chief Operating Officer and Principal Financial Officer, Robin Swartz. Before we get started, I would like to remind everyone that during this call, Voyager representatives may make forward-looking statements, as noted in slide two of today's deck. These statements are based on our current expectations and beliefs. They are subject to risks and uncertainties, and our actual results may differ materially. I encourage you to consult the risk factors discussed in our SEC filings, which are available on our website. And now, I will turn the call over to Al.
spk14: Thank you, Trista, and good afternoon, everyone. Please turn to slide three. I'd like to start by thanking the Voyager team for their dedication to creating transformative genetic medicines. We made tremendous progress advancing these medicines in the first quarter. We just announced that we have obtained IND clearance for our anti-Tau antibody VY-Tau-01 for Alzheimer's disease, and we expect to announce the dosing of the first subject in a single ascending dose trial in healthy volunteers in the coming week or so. Our gene therapy pipeline also advanced during the quarter, with development candidates selected in the GBA1 and Friedreich's ataxia programs partnered with Neurocrin. These programs, along with our wholly owned SOD1 ALS program, are advancing toward IND filings in 2025. In March, we appointed Dr. Toby Ferguson as our chief medical officer. Toby is an exceptional biotech executive with deep experience advancing novel therapies for CNS diseases. This includes Tofersen, the first genetically targeted therapy to be FDA approved for SOD1 ALS, and the first treatment to receive accelerated approval based on plasma neurofilament light chain response. Toby has hit the ground running. and we look forward to his leadership of our emerging clinical portfolio. In January, we announced an expansion of our relationship with Novartis through a new strategic collaboration and capsid license agreement to advance potential gene therapies for Huntington's disease and spinal muscular atrophy. This agreement, together with the public offering we completed in January, brought $200 million of total consideration to Voyager in the first quarter. This bolstered our balance sheet and extended our runway into 2027, and we expect that it will enable us to achieve multiple clinical data readouts. Finally, we presented a robust set of data at the recent ADPD and ASGCT meetings, including data on our multiple targeting programs in our second-generation capsules. Given this significant progress, we believe Voyager is emerging as a leader in neurogenetic medicine. Our pillars of value are summarized on slide four. First, we have a strong pipeline of four wholly owned and 13 partnered programs with the first expected to enter clinical trials in the coming weeks and the potential for three more to follow next year. Second, we have an industry-leading platform designed to overcome the delivery challenges inherent to CNS gene therapies. Our tracer platform enables us to create novel capsids that, following IV delivery, harness the extensive cerebrovasculature to enable widespread payload distribution across multiple brain regions and cell types. These capsids have demonstrated translatability in multiple species, and have enabled the selection of multiple development candidates in our wholly owned and partnered gene therapy programs. Third, we have blue chip partnerships anchored by Tracer's potential to transform the treatment of CNS diseases. In addition to Neurocrine, our partners include Novartis and Alexion. In total, our partnered programs could generate up to $8.2 billion in longer-term milestone payments. Finally, we continue to explore the potential to leverage receptors we have identified to shuttle non-viral genetic medicines into the brain. Ultimately, we aim to expand from gene therapy and antibodies into other modalities of neurogenetic medicine, broadening our impact. With that, I'll turn the call over to Toby.
spk04: Thank you, Al, and good afternoon. please turn to slide five. This slide summarizes the four wholly owned programs and our 13 partner programs that Al mentioned earlier. Part of what attracted me to Voyager is that these programs are focused on targets validated by human biology and human genetics. As a drug developer and former practicing neurologist, I've dedicated my career to improving the lives of people living with neurologic diseases. And while our understanding of the genetic and biological basis of CNS diseases has advanced considerably. Translating that understanding to new therapies has been hindered by challenges with crossing the blood-brain barrier. I believe that the progress that Voyager has made in this regard is transformative and provides an unprecedented opportunity to redefine the treatment of CNS diseases. I'm delighted to join the company as we prepare to enter the clinic and realize the full potential of our pipeline of neurogenetic medicines. Turning to slide six, I want to focus for a moment on two of our wholly owned programs that target tau. We believe tau is a critically important target for the treatment of Alzheimer's disease. The presence of tau pathology in the brain is a cardinal feature of AD. Further, the spread of tau pathology through the brain closely correlates with clinical decline and can be visualized with tau PET imaging. Importantly, recent third-party clinical data generated using an intrathecally administered tau ASO have shown that reducing tau was associated with favorable trends on clinical outcomes. As Al mentioned, we're excited to announce that BY-Tau-01, our anti-tau monoclonal antibody, obtained IND clearance. And we look forward to announcing, in the coming weeks, the initiation of a single ascending dose trial in healthy volunteers. I'll talk more about that trial in a moment. First, a bit of background on this program. BY-Tau-01 aims to inhibit the cell-to-cell spread of the extracellular forms pathological tau in the brain. In contrast to third-party anti-tau antibody approaches that have targeted the N-terminus of tau and have been unsuccessful in the clinic, VY-tau-01 targets the C-terminal epitope of pathological tau. We believe the epitope matters. In a preclinical in vivo model of tau spread, the myriad surrogate of VY-tau-01 inhibited tau spread by approximately 70%. while N-terminally directed antibodies had no significant effect. This indicates the negative predictive value of this model. We look forward to establishing whether or not it has positive predictive value as we advance into clinical trials. Importantly, and in parallel, we are progressing a tau silencing gene therapy approach intended to inhibit the production of tau protein. This program deploys a tau-targeted sRNA package into an IV-administered tracer capsid. Using this approach, we've demonstrated robust reductions in tau mRNA and protein across the brain on a single IV administration in mice expressing human tau. We believe this program has the potential to provide a transformative single dose treatment for Alzheimer's disease. We anticipate filing an IND in 2026. Turning to slide seven, as I mentioned, we anticipate the announcement dosing of the first subjects in our single ascending dose trial VY tau 01 in the coming weeks. This will be a single-site study in which we expect to enroll approximately 48 participants. The primary aim of the trial is to generate initial safety and PK data that will inform a subsequent multiple ascending dose trial. We expect to conduct the multiple ascending dose trial for participants with early Alzheimer's disease. We expect to initiate this trial next year and generate initial tau PET imaging data in 2026. that has the potential to show slowing of Tau spread. Turning to slide eight. In addition to our programs targeting Tau, we are also advancing three gene therapy programs for which we expect to file INDs next year. They include our wholly owned SOD1 silencing program, targeting the genetic cause of SOD1 ALS, the Neurocrine Partnered Protaxin Gene Replacement Program, targeting the genetic cause of pre-drug cetaxia, the Neurocrine Partnered GBA1 Gene Replacement Program. Mutations in GBA1 represent both one of the most common genetic causes of Parkinson's disease, as well as the cause of other GBA1-related diseases. Each of these programs leverages an IV-administered blood-brain barrier penetrant tracer capsid and has the potential to provide a single-dose disease-modifying treatment. We look forward to advancing these promising suite of programs in the clinic. With that, I'll turn the call over to Todd.
spk06: Thanks, Toby. Please turn to slide nine.
spk03: In support of our advancing gene therapy pipeline, we were pleased to present a robust set of data on the potential clinical translatability, manufacturing, and overall performance of our tracer capsids at the American Society of Gene and Cell Therapy annual meeting last week. Voyager scientists presented a total of 12 abstracts at the meeting, and I'd like to review a few highlights. First, we presented new data on our second generation IV delivered tracer capsids. This session was standing room only with a line out of the door and down the hall, which I think speaks to the high level of interest in novel capsids engineered to cross the blood-brain barrier. Our second generation capsids showed further enhanced blood-brain barrier penetrance and reduced liver expression compared to our own first generation tracer derived capsids. These second-gen capsids demonstrated robust transduction of 50% to 75% of cells across diverse brain regions, with upwards of 95% transduction in certain T-cell types, such as Purkinje neurons, at a clinically relevant dose of 3 times 10 to the 13 vector genomes per kilogram. This also included transduction of 98% of dopaminergic neurons of the substantia nigra and over 80% of spinal motor neurons. Importantly, our tracer capsids have enabled selection of development candidates for the three lead gene therapy programs that Toby just reviewed. We presented data at ASGCT on VY9323, our wholly-owned SOD1 silencing gene therapy, which uses a second-generation tracer capsid. The data demonstrated that a single IV dose of VY9323 at the 3E13 vector genomes per kilogram dose reduced SOD1 mRNA by up to 80% in spinal cord motor neurons in non-human primates. Finally, as part of our strategy to mitigate the risks of developing tracer capsid-derived product candidates and maximize the probability of success in the clinic, Voyager has been working to identify the receptors that mediate the delivery of these capsids into the CNS and confirm their expression in humans. At ASGCT, we identified tissue nonspecific alkaline phosphatase, or ALPL, formerly known as Receptor X, as the highly conserved receptor expressed on the brain vasculature that mediates the delivery of tracer capsids, VCAP 101 and 102, across the blood-brain barrier. These capsids bind human, primate, and urine ALPL isoforms further strengthening our confidence in the clinical potential of tracer capsids. More broadly, these data establish ALPL as a novel brain delivery shuttle, and we are exploring the opportunity to leverage this receptor to deliver multiple therapeutic modalities across the blood-brain barrier. We look forward to sharing these data in the future. The data package we presented at ASGCT represents the most extensive validation to date of the potential clinical translatability of our tracer capsids. And we look forward to evaluating their ability to transform the course of a broad range of neurological diseases. I will now turn the call back over to Al.
spk06: Thanks, Todd.
spk14: Turning to slide 10, you can see Voyager has had an incredibly strong start to the year. As I mentioned before, this would not be possible without the hard work and dedication of our employees. I know many of them are listening, so I want to say again, thank you. With a robust slate of upcoming clinical milestones, a maturing partnership portfolio, and cash runway into 2027, we believe Voyager is poised to drive significant value over both the near and long term. With that, we will open the call for questions. Operator?
spk05: Thank you. At this time, we'll conduct the question and answer session. As a reminder to ask a question, you will need to press star 1-1 on your telephone and wait for your name to be announced. To withdraw your question, please press star 1-1 again. Please stand by while we compile the Q&A roster. Our first question comes from the line of June Lee of True Securities. Your line is now open.
spk12: Hi. Good afternoon, and congrats on the great progress. This is Medion for June. Last week at ASGCD, you showed great data related to Receptor X ALPL. So could you please elaborate on the ways that you are planning to use this knowledge for delivery of the other modalities to CNS specifically, do you think antisense oligos and LMPs could see similar levels of transcytosis seen with AAVs? Thank you.
spk14: Yeah, thanks for the question. This is Al Sandrock. So briefly, you know, we know that these receptors mediate the transport of these very large AAV capsids across the BBB. And what we're going to do now is to make ligands against the receptor, conjugate them to various macromolecules to see if we can get them to cross the BBB. We believe by transcytosis. And the range of molecules we could look at include protein therapeutics as well as oligonucleotides. And we're progressing those experiments as we speak. Todd?
spk03: Thanks, Al. So, we are looking at a variety of different modalities. As Al indicated, we're looking at antibodies, oligos, other sorts of proteins. Al mentioned that we're in the process of identifying ligands, and we have identified some ligands. And we're looking forward in the future to hopefully sharing some of those data when we're ready to.
spk06: Appreciate it. Thank you. Thank you. We'll move on to our next question. Our next question comes from the line of Jack Allen of Baird.
spk05: Your line is now open.
spk11: All right. Thanks so much for taking the questions, and congratulations on the progress. I wanted to ask about some of the work you presented at ASJCT around the optimization of manufacturing. How are you thinking about optimizing manufacturing before you bring candidates into a clinic with your gene therapies? And what do you expect the benefits will be as it relates to COGs of your more potent gene therapies as well?
spk14: Well, I'll start and I'll ask Todd to help here. So we're planning to use HEC 293 cells to manufacture these products. We have a very robust internal technical operations team. And part of the development candidate selection, we assess manufacturability, both as well as the, you know, downstream as well as upstream processes. And, of course, we're going to be verifying percentage of full capsids, partially full capsids, as well as empty capsids. And so we assess manufacturability as part of the development candidate selection. Todd?
spk03: So as Al mentioned, we do have that. Manufacturability is a key component. It's actually part of our whole assessment of our novel capsids as we identify them. In each case, the payload can make a difference. so that for any given program, we have to establish the manufacturability with the capsid in question and the particular payload for the disease indication as well. All that goes into our assessment, and we begin with research-grade material, and then once we develop the development candidate, then we proceed to the process development to move that into manufacturability. You also asked a question about COGS, and of course, It's not exactly necessarily a one-to-one trade-off, but you can imagine as we're looking with our novel capsids that have a potency approximately about an order of magnitude greater than what the dose is currently used in the clinic. We expect to see substantial savings because we need much less material to deliver the same level or actually greater levels of delivery to the CNS than the conventional capsids.
spk14: Yeah, and I would just add, Jack, that in addition to the lower doses, What we note is that we're going to transfer the process to a CDMO for manufacturing. And the CDMO world has really come up to speed in terms of scalability. We're now seeing scale. And every time you increase the scale, we actually reduce the cost. And at the pace that it's going, we expect to see continued advancement in that area as well.
spk11: That's great. Can I just ask one final question on that? I know we haven't really gotten this far in the gene therapy space, but how does, you know, shelf life of these products play a role when you think about the commercial applicability of these manufacturing scale here?
spk14: Shelf life. Wow. That's a question I hadn't thought about yet. But anybody here has an answer to that?
spk03: So, we do assess the shelf life. And, of course, for gene therapy, We typically would need to require it to be held at particular cold temperatures. All that is part of the evaluation for stability, both short-term and long-term. So that's an important part of our manufacturability and our process development.
spk06: Thank you, Todd. Thanks so much. Congrats on the progress.
spk05: Thank you.
spk06: Thank you.
spk05: Thank you, Walnut, for our next question.
spk06: Our next question comes from the line of Patrick Truccio of HC Windward & Co.
spk05: Your line is now open.
spk13: Thanks. Good afternoon and congrats on all the progress. Just a couple of follow-up questions from me. The first is I'm wondering if you can discuss any potential read-through that you'll be looking for from the advisory committee meeting on June 10 regarding Denetimab in Alzheimer's disease to your Alzheimer's programs. And then separately, just a follow-up on the ASGCT data. specifically the data in human tau mouse model that showed reduction in tau mRNA levels up to 90% and 50 to 70% reduction in tau protein. Can you tell us how this data compare with prior generation capsids and how the data may support advancement of tau gene, tau silencing gene therapy IND in 2026?
spk14: Thanks, Patrick. I'll answer the first question and maybe I'll ask Todd to answer the second one. On the first question, well, it'll be a very interesting advisory committee. We do have a vectorized anti-amyloid program in our pipeline as well, so we're watching that advisory committee with interest. I think a lot of the questions might be unique to donanumab. It may not pertain very much to our program. Nevertheless, there might be some important features, for example, what are the outcome measures that are going to be important for approval. And of course, that's always something that we need to keep an eye on. But that's down the line for us. We have to get into the clinic first. So that's the kind of thing we may be paying attention to, but it'll be an interesting meeting. Todd?
spk03: So on our cow knockdown program, the data that you're referring to, we showed some at ADPD and also at The knockdown in the mouse was with a mouse-capable capsid, so we used that really to assess the payload and also to hopefully demonstrate, and we feel that we did, that the payload has the ability to knock down tau, both mRNA and protein, at a clinically relevant dose. So we think that that's what we showed in those mouse studies. With regard to the payload, we were able to see a well-tolerated and safe dose in those animals delivering sufficient vector to the brain that we saw quite remarkable knockdown of the mRNA in those animals. So it's building that proof of concept for the knockdown, and we're moving forward now and evaluating the novel capsids for non-human primates and humans with the payloads in question. So we're looking forward to share more of that in the future.
spk06: Great.
spk05: Thanks so much. Thank you. One moment for our next question. Our next question comes from the line of Philip Nadal of TCALIN. Your line is now open. Good afternoon.
spk16: Congrats on the progress, and thanks for taking our questions. First, a couple on VY Tau 01. Have you disclosed what doses you are going to be exploring in this single ascending dose trial? And can you talk a little bit how you're going to use the pharmacokinetic data that you gather to determine what doses should be explored in the MAD trial? How will you extrapolate from the single dose to the multiple doses, and particularly for MAD? peripheral versus maybe crossing the blood-brain barrier.
spk04: Thanks. Thanks for the call. This is Toby. We haven't disclosed our doses, but broadly speaking, we've examined our candidates in our preclinical model of tau spread where we've shown that we see reduction by about 70% of the spread of pathologic tau in our mouse models. In addition, we've done preclinical work in primates, I think, and fundamentally, This is a single ascending dose study in about 48 patients over multiple cohorts. We expect, based on that data, to get both, of course, safety information as well as PK information peripherally that we think we can appropriately translate into doses for the MAD in mid-2025. Broadly, we want to aim to estimate sort of the underlying exposures needed to get appropriate exposure in the brain to treat the disease.
spk14: Yeah, and Phil, I may want to add that You know, I mean, based on our preclinical studies, including an NHP, we don't want to anticipate any major surprises. This is likely to be very similar to other monoclonal antibodies, and therefore, the brain-to-plasma ratio will be in the 0.1% to 0.5% range. And as Toby said, we know the exposures that we need to get into the brain to inhibit tau spreading in the model that we use to choose the antibodies. So that'll give you some idea. And of course, we do expect that trial to inform the dose range in the upcoming multiple ascending dose trial.
spk16: That's really helpful. And then second, on the frataxin candidate, would you be able to disclose anything new about the candidate that was chosen? And anything notable that you'd be willing to tell us about what differentiated that candidate from the others?
spk14: Well, so, you know, that's a neurocrime program, and so we're, you know, we don't want to disclose these things. Suffice it to say that the development candidate, we had a set of criteria for the Capsid as well as the Capsid plus payload combination, both in terms of its mechanistic effects in animals as well as manufacturability. you know, we'll ask Neurocrin to answer your question.
spk16: Fair enough. Thanks for taking our questions. Congrats again on the progress.
spk14: Thank you.
spk05: Thank you. One moment for our next question.
spk06: Our next question comes from the line of Brian Forseth of Google Hand Security.
spk05: Your line is now open.
spk10: Hi, this is Rai from Debjit's team at Guggenheim. From the ASGCT data, now with Gen 3 technology maturing, where you're able to navigate pre-existing neutralizing antibodies, how are you framing the market opportunity expansion given the preclinical profile you're seeing to date?
spk14: I'll start and maybe Toby or Todd can add. But yes, so you notice that one of our posters that we are looking, we're leveraging tracer to see whether we can make modifications to capsids that affect immunogenicity. And by that, what we're doing is we're looking to see whether preexisting antibodies in humans can affect, can bind to the capsids actually, and therefore affect how they perform in the clinic. And so, obviously, if we can find novel capsids that can evade, if you will, the preexisting antibodies, more patients would be available for treatment. In addition, I would note that we and others are going to be evaluating ways in which we can lower preexisting antibody levels. And as you know, several other companies are investigating the use of various enzymes that can degrade pre-existing antibodies. So that would be another way to achieve essentially the same thing, which is to try to get more patients to be eligible for our treatment. Toby?
spk04: I would agree with Alan. I think the only point I would make in addition is that this may be particularly important in adult populations. There may be select pediatric populations, which is not as much of a concern. That may represent some of the reasons.
spk10: Fascinating work. Thanks.
spk06: Thank you. Thank you. One more for next question. Our next question comes from the line of David Hong of Citigroup.
spk05: Your line is now open.
spk01: Hi there. Congrats on the progress, and thanks for taking my question. I guess first, I just want to ask about how you think about the anti-Tau antibody fitting into the treatment landscape of Alzheimer's as compared to the Tau silencing gene therapy that you also have. What could be the advantages versus maybe disadvantages of each of those modalities? And then maybe just a second question. Have you... interrogated or to what extent have you interrogated other transporters besides ALPL for crossing the blood-brain barrier? And if you've done that work, how did ALPL compare to other potential transporters? Thanks.
spk14: So, I'll start on the first question, and then Toby, I'll ask Toby to help with that one. And then, Todd, maybe you can answer the second question. So, anti-tau versus tau silencing. So, very different approaches. Anti-tau, we expect to bind to extracellular forms of tau. And as Todd said earlier, what we're trying to do is to block the spread of pathological tau, which we demonstrated quite nicely in an animal model where we inject human pathological tau into the animals and look at spread. The tau knockdown is a very different, so that's an antibody that will need to be given, you know, on a regular basis. probably on the order of every month or so, every four weeks, we anticipate. The tau knockdown is a gene silencing that will be done by gene therapy. So that would be a once and done, essentially. And it decreases the expression of all forms of tau. It's akin to, you know, others have used an antisense approach to decrease the expression of tau. So it's a different mechanism of action. And we'll have to see the first thing is which one works the best. And then we'll see whether or not it can be done once and done or whether it'll need to be regular infusions. Toby?
spk04: Thank you, Al. I think what I would add is in concert, we fundamentally at this point don't have enough clinical data to understand the potential completeness of treatments with any of these modalities. I think first and foremost, the most important point is determining which ones work. And we're excited to have two opportunities to test how for our programs, both the antibody program and the knockdown program. I do think moving forward, we'll need to look and try to understand the combination as well. And that is a potential to be investigated in the future. And Todd, you want to take the second question?
spk03: Sure. The second question, just to recap, would be the evaluation of ALPL and other in the context of other potential shuttles or shuttle targets for BBB delivery. So we absolutely would need to evaluate ALPL in the context of other receptors, such as transferrin, and there are a few others. While we're not in a position to share any data today, you can imagine that anything we would choose to move forward would need to perform at least as well as the existing BBB transporters. And so that would be part of our assessment and our evaluation. And looking forward to hopefully in the future being able to share more about our work in that area.
spk14: And then, Todd, I thought, I think maybe David was also asking whether we have other receptors as well and how we're looking at those perhaps, you know, in comparing them to ALPL.
spk03: So we have identified some other receptors. We have multiple capsid families. that target different receptors. And so, in terms of our novel receptor discovery, we have identified a few, and we are in the process of evaluating all of them for non-viral delivery.
spk06: Thank you. We'll move to our next question. Our next question comes from the line of Jay Olson of Opco.
spk05: Your line is now open.
spk15: Oh, hi, this is Chong on the line for Jay. Thanks for taking the question and congrats on the progress. Maybe a two-part question on the ALPL target is disclosed. Just first, I'm just wondering if you can talk about the expression variability of ALPL in humans and maybe whether the expression may change over time with aging or with some underlying diseases. And secondly, for the development of other therapeutic modality or delivery modality using ALPL, are you planning to do that internally or through collaboration? Thank you.
spk14: So Todd will answer the first question. I'll answer the second one.
spk03: So on the first question, differences or changes of ALPL expression. So we can look at different genetic variation of ALPL and we're in the process of doing that. In terms of the expression level, we know that ALPL is expressed at a quite robust level starting at birth from the databases and also from internal work on preclinical models. That expression goes up a bit with age. So, if anything, we might expect even better delivery in older populations, but all the evidence to date suggests that the level of expression in the vasculature is quite robust, even starting at a very early age.
spk14: Yeah, and in terms of the second question, we do expect to be doing a lot of the work internally, and we have already started to do that. But we're always looking for collaborations. that can enhance that discovery and development efforts.
spk06: So, stay tuned. Yes, thank you so much. Thank you. One more for next question.
spk05: Our next question comes from the line of Sumant Kulkarni of Kenco, January. Your line is now open.
spk08: Good afternoon. Nice to see all the progress, and thanks for taking our questions. I guess these are welcome questions for Dr. Toby Ferguson. So on your SOD1 ALS program, given the limited patient population and because Tofersen is on the market already, do you expect to involve Tofersen in preclinical work, and how do you expect eventual trial recruitment to play out for Voyager's SOD1 ALS program?
spk04: Thanks for the question. So fundamentally, I think at first I'd So first one, obviously, is approved, and I think it's approved on the basis of biomarker, particularly neurofilament, and it is indeed a disease-modifying therapy for ALS administered once intrinsically. I think what I point to in our programs... Once a month. Excuse me. Once a month, correct. Yeah. What I point to in our programs is that we did discuss recently at ASGCT, really, the transduction data. I think I'll highlight that to start. In motor neurons, we saw 80 to 93% transduction and up to 68% in cortex when we looked at second-gen V-cap capsids. So that's really quite important. And that was with an intravenous administered dose. In the context of our VOA9323 program, we saw 73% reduction of mRNA and SOD1 mRNA and 82% in motor neurons in the cord. So I think fundamentally, We'll take some lessons learned from Tufursen, particularly around the biomarkers. We'll apply these to our clinical development program. We think this provides us an opportunity to understand not only the potential proof of concept in people with SELD1 ALS, but also the potential importance for our tracer platform as a whole.
spk14: And Suma, maybe I'll add that, you know, if we look forward to the potential approval of our SOD1 gene therapy, I'll note that in the case of SMA, Spinraza was approved a couple of years prior to Zolgensma, and the two are used sort of in some ways concurrently in the real world. So, for example, we're aware that many patients can get treated with Zolgensma right after birth, and then if necessary, they add Spinraza. And so, you know, taking a gene therapy doesn't preclude continued treatment with Tofersin when necessary. And so, I think if we take a page from the SMA story, we could see both products, Tofersin, as well as hopefully our SOD1 gene therapy being used together essentially by physicians to treat their patients optimally.
spk08: Got it. And as a quick follow-up, what... percentage reduction on NFL is considered clinically relevant in the SOD1 ALS context? We've seen the data that Biogen had, but what would be considered clinically relevant, I guess, for what's out there already and for a gene therapy?
spk04: So I think we've all seen the reductions that Biogen is highlighting with neurofilm reductions. I think fundamentally what a clinically relevant reduction is not clear, but I guess the points I would highlight is it has to be substantially greater than the variability of your assay and biologic variability, and that the traversing data does inform the magnitude of needs of reduction.
spk06: Thank you. Thank you. One moment for our next question. Our next question comes from the line of Ian and Sue of Wells Fargo Security.
spk05: Your line is now open.
spk02: Great. Thanks for taking our questions, and congrats on the progress. So first, I'm wondering about the ALPL receptor. Is there expression of this receptor on any other tissue, and how does that potentially impact or not impact a brain delivery drug in terms of delivery into other tissues? Thanks.
spk03: Sure. This is Todd. I can take that question. So thank you for it. So the ALPL is expressed across the vasculature in the entire body and in some other cell types. However, what we think is going on is that AEV capsids, AEV gene therapies, do not need to harness these other mechanisms to get into other tissues. But the blood-brain barrier is blocking for most conventional capsids or all conventional capsids to get into the brain. So the harnessing of ALPL to cross the blood-brain barrier is really only important. to get into the brain. What we also see is that the use of ALPL is giving us some significant cross-species activity. So it provides us not only with in vitro evidence of cross-species activity in transcytosis assays, but also in vivo cross-species activity, which we see in multiple species. So we have examples of four species. African green monkeys, sonomogus macaques, marmosets, and mice. And ultimately, what we're able to see is that at relatively low doses, we're able to achieve these kinds of high delivery and transduction that Toby mentioned. 80% of motor neurons in the spinal cord, 95% in Purkinje neurons, 98% of dopaminergic neurons in the substantia nigra. And then finally, I'll just comment that With regard to the tissue and cell delivery, what we're seeing is a significant detargeting from the liver. That's probably not specifically driven by ALPL or hypotheses. That's based on other characteristics of the capsid, but we see a quite substantial detargeting from the liver with the simultaneous increase in delivery into the CNS.
spk02: Great, that's very nice to hear. And also at ASGCT, there are quite a few presentations on BBB-penetrating capsid work from different industry players, and some of them also begin to touch upon receptors. I think you might have started a trend. Just wondering, after taking a survey of the landscape, how do you feel of your BBB capsid and where it stands in the landscape?
spk14: Thanks. Maybe I'll start and Todd will complete the answer. So listen, it's great to see that a lot of people are finding what we found years ago and that, you know, Yeah, I mean, I think what we're seeing is that I think the world appreciates the need for new capsids that cross the blood-brain barrier so as to improve delivery. And look, the competition is heating up, you know. I would say that we're very proud of our capsids. As Todd said, we get the key cells that are relevant for the diseases of interest. We get 80, 90%, as Todd just mentioned, of cells transduced at relatively low doses of 3E13 VGs per kg. And we have demonstrated in vivo multiple cross-species experiments have been done with three different non-human primate species as well as mice. Knowing the receptor is also very helpful. And then, look, we have already selected three development candidates, two with our partners at Neurocrine and one are wholly owned, and we expect to be in the clinic soon. So, you know, Todd?
spk03: I think you've captured everything that I was going to say, Alan. And I do think the important point, in addition to the cross-species activity, is over the past quarter or so, those three candidates that will be moving into the clinics. We think the next step is really the clinics.
spk02: Got it. Yep. Yep. Got it. Thank you. Very helpful.
spk06: Thank you. One more for our next question. Our next question comes from the line of Laura Chico of Wedbush.
spk05: Your line is now open.
spk00: Good afternoon and thanks very much for taking the questions. Just one housekeeping question. I believe there was one milestone payment that was triggered in the second quarter But I'm curious if you could just kind of elaborate or if you've disclosed any additional milestones that we should be watching out for over the remainder of 2024. And then I have a quick follow-up for you.
spk07: Hi, this is Robin. Thank you for the question. So we were very pleased with the advancement of our NERC and programs and the achievement of the DC milestone. However, we don't provide guidance on potential future milestone payments across the 13 partner programs. It is also important to note that further milestone payments are not included in our cash guidance, which is into 2027.
spk00: Okay. Thank you very much. And then in terms of follow-up, obviously there's a lot of discussion on the ALPL receptor data from ASGCT, but I'm wondering if you can just talk perhaps, Al, strategically what would happen in terms of the direction of focus for Voyager and with the VYTAL1 data, if that reads out positively in the patients, what does that mean strategically in terms of the focus? Obviously, that's as an antibody right now, but how does that shift or change the focus on other traits or programs assuming success there?
spk14: Well, Laura, thanks for the question. I think what you're implying is that we would have a choice of whether we proceed with the BY-TAO-01 program as an intravenous antibody or whether we could vectorize the antibody. We actually do have that option. We may actually do both, in fact. I've always been thinking, though, that strategically it wouldn't make sense for a Voyager, a small company like us, to try to go into phase three or commercialize an Alzheimer's disease. It's too large, too expensive. So, we've always thought we will likely get a partner if the BY Tau 01 program is positive. But I do think that the option to potentially vectorize a once and done antibody could be of high interest to us. And we'll make that decision when the time comes.
spk06: Thanks very much. Thank you. One moment for our next question. Our next question comes from the line of June Lee of True Securities.
spk05: Your line is now open.
spk12: Hi. Following Laura's question, last week in ASGCT, Bridgeron suggested in some of the presentations that compared to cathode-inserted vexillized antibodies, the expression of cathode-inserted the vectorized antibodies had a lower expression. Do you expect the same for your vectorized antibody platform in general, and specifically for the Alzheimer's vectorized antibody? And if, you know, could you share any plans that you have for preclinical data opted in this program?
spk14: Yeah, let me start, and then I'll ask Todd to help. So, when we vectorize an antibody, we did show at a meeting, I think it was last year or two years ago, that we can vectorize an anti-amyloid antibody and get enough expression to bind to amyloid plaques in transgenic mice. And correct me if I'm wrong on that, Todd. So we can get enough expression to bind to amyloid plaques in animals. We'll have to see. My view is that a lot's going to change relative to IV. So we're going to lose the C maxes, if you will, the high concentrations that you get immediately after IV dosing. We expect to have more constitutive expression. from within the central nervous system. So we expect that they'll have mainly glial cells producing the antibody, as we've shown in the past, and that we will, and so it'll be sort of an inside-out, if you will, approach, rather than giving it IV and having it cross the vasculature to get into the brain. It'll be made in the brain directly. And then we would be able to look in animal models at the, not only binding to amyloid plaques, but we will be assessing whether or not we can lower amyloid plaques. And there's some precedents we can follow in vivo studies that have been done with the anti-amyloid antibodies. And then, of course, we'll have to see whether or not we affect any adverse events. One concept would be that ARIA the rates of ARIA may be affected by the fact that we don't get the CMAXs and we have constitutive expression from within the brain. We'll have to see if that's true. And there are some animal models that mimic ARIA, whether they truly are ARIA or not. Well, I'm not certain, but we can even assess that. And finally, I would say that one of the things we're investigating right now is whether or not we can regulate the expression. of the antibody with a small molecule. And so a regulatable vectorized antibody program would, I think, be ideal. And so those are the kinds of things we're thinking about in terms of preclinical experiments that would help us get to a development candidate. Todd, did you want to add anything?
spk03: I can add a little bit. So while the VY tau O1, the focus there is on the antibody itself, not on a vectorized form. We do have substantial experience going back several years on vectorization of antibodies in general, including tau antibodies and the amyloid that Al mentioned and others. And we found that the payload can matter quite a bit, the structure of the vector payload, the vector genome, and of course the promoter. So there are a lot of things that we can do, some of which Al mentioned, to tweak the expression level. not just on the promoter, but by the kinds of cells, the specific cell types that you target as well. And so we'll be looking at all of those characteristics when we move any vectorized form of an antibody, a gene therapy-based antibody forward.
spk14: You know, I would just add that in the real world, being able to give it a vectorized anti-amyloid once, IV, and not have to give it every other week or every month could really relieve the strain on the healthcare system that I think we're witnessing now with antibody treatments for Alzheimer's disease.
spk12: Very helpful. And if I can sneak in one last question. So between now and second half of 26 that you hopefully present like PET imaging data or rewrite tasks, how we should think about like cadence of, you know, any interim data release related to your findings along the way.
spk06: Toby?
spk04: I think what we've highlighted for the SAD program, it will inform the MAD program, and I think really the key data readout in that timeframe really is the MAD data in the latter half of 2026. Yeah.
spk06: Thank you very much.
spk05: Thank you. I'm showing no further questions at this time. I would now like to turn it back to Alcindor for closing remarks.
spk14: Thank you, everyone, for joining us today, and feel free to follow up directly with any questions. Thanks again. Bye.
spk05: Ladies and gentlemen, this concludes today's presentation. Thank you once again for your participation. You may now disconnect.
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