Clinical Development - TSHA-102 is in clinical development for Rett syndrome, with the first two adult patients dosed in 2023 and cohort 1 (low dose) considered complete[162]. - The Independent Data Monitoring Committee approved early dose escalation to cohort 2 (high dose) in the adolescent and adult trial, with the first patient dosed in Q2 2024[162]. - TSHA-102 was generally well tolerated, with no serious adverse events reported as of the 20-week assessment in cohort 2[162]. - TSHA-102 has received orphan drug designation and Fast Track Designation from the FDA for the treatment of Rett syndrome[165]. - The FDA granted Regenerative Medicine Advanced Therapy designation for TSHA-102, aimed at expediting development and review processes[165]. - The first adult patient in cohort 1 demonstrated sustained improvements in motor function and communication, with the ability to sit unassisted and increased vocalizations by week 52 post-treatment[181]. - The second adult patient showed a 25% reduction in seizure frequency at week 25 post-treatment, with a significant improvement in overall seizure control[184]. - The first adult patient reported a 35-point improvement in the Rett Syndrome Behavior Questionnaire (RSBQ) total score at week 52 compared to baseline[186]. - The first adult patient also exhibited a 17-point improvement in the Revised Motor Behavior Assessment (R-MBA) total score at week 52, indicating enhanced motor and functional skills[187]. - The first pediatric patient in cohort 1 was dosed in December 2023, with ongoing trials expanding into the UK and Canada[174]. - The maximum tolerated dose (MTD) established in Part A of the trials will guide the dose expansion in Part B, focusing on efficacy endpoints and study duration[178]. - The company expects to report safety and efficacy data from cohort 2 of both the adolescent and adult trial and the pediatric trial in the first half of 2025[162][164]. - The first pediatric patient improved her ability to hold an object for up to three minutes at week 12, compared to 12 seconds at baseline[205]. - The first pediatric patient experienced a seven-point increase in RSBQ Total Score at week 12 compared to baseline[208]. - The first pediatric patient showed improvements in multiple clinical domains, including fine and gross motor skills, and communication abilities[205]. - The second pediatric patient exhibited improvements in fine and gross motor skills, including the ability to stand up from a chair and walk up stairs[207]. - The first pediatric patient demonstrated an improvement in age equivalence scores across multiple domains in the MSEL-A assessment at week 12[214]. - The second pediatric patient demonstrated a 13-point improvement in RSBQ Total Score at week eight post-TSHA-102 administration compared to week four[221]. - The second pediatric patient had an increase in days reported seizure-free post-treatment, with a reduction in seizure frequency observed two weeks post-TSHA-102[224]. Financial Performance - The company has raised an aggregate of 671.0millionfromvariousfundingsources,includinganIPOandfollow−onofferings,tosupportoperations[166].−NetlossesfortheninemonthsendedSeptember30,2024,were70.5 million, compared to 159.3millionforthesameperiodin2023[168].−AsofSeptember30,2024,theaccumulateddeficitwas583.5 million, with expectations of continued significant operating losses[169]. - Revenue for the three months ended September 30, 2024, was 1.8million,adecreaseof62.44.7 million for the same period in 2023[277]. - Revenue for the nine months ended September 30, 2024, was 6.3million,downfrom11.8 million in 2023, a decline of 46.2%[287]. - Research and development expenses increased to 14.9millionforthethreemonthsendedSeptember30,2024,upfrom11.8 million in 2023, representing a 26.5% increase[279]. - Research and development expenses for the nine months ended September 30, 2024, totaled 50.7million,anincreaseof15.544.1 million in 2023[288]. - General and administrative expenses decreased to 7.9millionforthethreemonthsendedSeptember30,2024,from8.6 million in 2023, a reduction of 8.2%[280]. - General and administrative expenses for the nine months ended September 30, 2024, were 22.3million,adecreaseof4.323.3 million in 2023[289]. - A non-cash impairment charge of 4.8millionwasrecordedforthethreemonthsendedSeptember30,2024,comparedto0.6 million in the same period of 2023[281]. - Net loss for the three months ended September 30, 2024, was 25.5million,significantlyimprovedfromanetlossof117.1 million in 2023[277]. - A non-cash impairment charge of 4.8millionwasrecordedfortheninemonthsendedSeptember30,2024,comparedto0.6 million in the same period of 2023[290]. - Interest income increased to 2.1millionforthethreemonthsendedSeptember30,2024,comparedto1.1 million in 2023, a growth of 90.9%[284]. - Interest income increased to 5.2millionfortheninemonthsendedSeptember30,2024,upfrom1.7 million in the same period of 2023, primarily due to dividends from a money market fund[293]. - Interest expense significantly decreased to 0.1millionfortheninemonthsendedSeptember30,2024,from4.3 million in the same period of 2023, a reduction of approximately 4.2million[294].−Thecompanyexperiencedanetchangeincash,cashequivalents,andrestrictedcashof13.7 million for the nine months ended September 30, 2024, down from 76.4millionin2023[310].−FortheninemonthsendedSeptember30,2024,thenetcashusedinoperatingactivitieswas62.9 million, compared to 56.9millionforthesameperiodin2023[310][311][312].−CashprovidedbyfinancingactivitiesfortheninemonthsendedSeptember30,2024,was77.0 million, a decrease from 140.6millioninthesameperiodof2023[310][314].−Investingactivitiesused0.4 million in cash for the nine months ended September 30, 2024, compared to 7.3millioninthesameperiodof2023[310][313].−Thecompanyhasnotrecognizedanyrevenuefromproductsalestodateanddoesnotexpecttogeneraterevenuefromproductsalesintheforeseeablefuture[269].StrategicInitiatives−Thecompanyhasdeprioritizedcertainclinical−stageprogramsandisseekingexternalstrategicoptionsforfurtherdevelopment[170].−Thecompanyenteredintoaresearch,collaboration,andlicenseagreementwithUTSouthwestern,obtainingexclusive,worldwide,royalty−freelicensesforcertainpatentrightsandknow−how[250].−Thecompanyissued2,179,000sharesofcommonstocktoUTSouthwesternandhasnofuturemilestoneorroyaltyobligationsundertheUTSouthwesternAgreement,exceptforpatentmaintenancecosts[252].−Thecompanypaidaone−timeupfrontlicensefeeof3.0 million to Abeona for the CLN1 Agreement and is obligated to pay up to 26.0millioninregulatory−relatedmilestonesandupto30.0 million in sales-related milestones per licensed product[256]. - The company recognized a 3.0millionregulatorymilestonepaymentinDecember2021relatedtotheAbeonaCLN1AgreementfollowingtheapprovalofitsCTAfilingforTSHA−118[257].−Thecompanypaidaone−timeupfrontlicensefeeof3.0 million to Abeona for the Rett Agreement and is obligated to pay up to 26.5millioninregulatory−relatedmilestonesandupto30.0 million in sales-related milestones per licensed product[261]. - The company recognized a 3.5millionmilestonepaymentinAugust2023relatedtotheRettAgreementafterdosingthefirstpatientwithTSHA−102inaclinicaltrial[262].−ThecompanyrecognizedrevenuefromtheAstellasTransactionsfortheninemonthsendedSeptember30,2024,asresearchanddevelopmentactivitiesrelatedtotheRettprogramwereperformed[268].FutureOutlook−Thecompanyanticipatesneedingsubstantialadditionalfundingforongoingoperationsandresearchanddevelopment,particularlyforRettclinicaltrials[304].−Thecompanyexpectsexistingcashandcashequivalentstofundoperationsintothefourthquarterof2026,butwillrequireadditionalcapitalforresearch,manufacturing,andcommercializationactivities[306].−Thecompanymayneedtorelyonadditionalfinancingtoachieveitsbusinessobjectives,whichmaynotbeavailableonacceptableterms[309].−Thecompanyisclassifiedasasmallerreportingcompany,withamarketvalueofsharesheldbynon−affiliatesbelow700 million[321]. - The company may continue to take advantage of reduced disclosure requirements as an emerging growth company until it no longer qualifies[320].