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Cassava Sciences, Inc.

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FY2022 Annual Report · Cassava Sciences, Inc.
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UNITED STATES 
SECURITIES AND EXCHANGE COMMISSION 
Washington, D.C. 20549 
_______________ 
Form 10-K 
_______________ 

(Mark One) 

  ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 

For the Fiscal Year Ended December 31, 2022 
or 

 

TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 

For the transition period from _____ to _____ 

Commission File Number: 000-29959 

Cassava Sciences, Inc. 

(Exact name of registrant as specified in its charter) 

Delaware  
(State or other jurisdiction of 
incorporation or organization) 

91-1911336  
(I.R.S. Employer 
Identification Number) 

6801 N. Capital of Texas Highway, Building 1; Suite 300, Austin, TX 78731 
 (512) 501-2444 
(Address, including zip code, of registrant's principal executive offices and 
telephone number, including area code) 

Securities registered pursuant to Section 12(b) of the Act: 

0 

Title of each class 
Common Stock, $0.001 par value 

Trading 
Symbol(s) 
SAVA 

Name of each exchange on which registered 
NASDAQ Capital Market 

Securities registered pursuant to Section 12(g) of the Act:  None 

Indicate by check mark if the registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act. Yes   No  
Indicate by check mark if the registrant is not required to file reports pursuant to Section 13 or Section 15(d) of the Act. Yes   No  
Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 
during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) ha s been subject to such filing 
requirements for the past 90 days.  Yes   No  

Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of 
Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files).  
Yes   No . 

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, smaller reporting company, or an 
emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and “emerging growth company” 
in Rule 12b-2 of the Exchange Act.  (Check one):  
Large accelerated filer   
Non-accelerated filer   

Accelerated filer   
Smaller reporting company    
Emerging growth company    

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any 

new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act.  

Indicate by check mark whether the registrant has filed a report on and attestation to its management’s assessment of the effectiveness of its internal 
control over financial reporting under Section 404(b) of the Sarbanes-Oxley Act (15 USC. 7262(b)) by the registered public accounting firm that prepared or 
issued its audit report.  

If securities are registered pursuant to Section 12(b) of the Act, indicate by check mark whether the financial statements of the registrant included in the 

filing reflect the correction of an error to previously issued financial statements.  ◻ 

Indicate  by  check  mark  whether  any  of  those  error  corrections  are  restatements  that  required  a  recovery  analysis  of  incentive-based  compensation 

received by any of the registrant’s executive officers during the relevant recovery period pursuant to §240.10D-1(b). ◻ 

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Act).  Yes   No  

The aggregate market value of the voting and non-voting common equity held by non-affiliates was approximately $1.1 billion computed by reference 
to the last sales price of $28.12 as reported on the Nasdaq Capital Market, as of the last business day of the Registrant's most recently completed second fiscal 
quarter, June 30, 2022. The number of shares outstanding of the Registrant's common stock, par value $0.001 per share, on February 23, 2023 was 41,735,557. 

DOCUMENTS INCORPORATED BY REFERENCE 
1 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
  
  
  
  
 
 
 
 
 
 
 
 
 
 
Portions of the Registrant's proxy statement for its 2023 Annual Meeting of Stockholders (the “Proxy Statement”), to be filed with the U.S. Securities 
and Exchange Commission, no later than 120 days after the Registrant’s fiscal year ended December 31, 2022, are incorporated by reference to Part III of 
this Annual Report on Form 10-K.  

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CASSAVA SCIENCES, INC. 

FORM 10-K 
INDEX 

PART I 

Business  
Risk Factors  
Unresolved Staff Comments  
Properties 
Legal Proceedings 
Mine Safety Disclosures  

PART II 

Market  for  Registrant’s  Common  Equity,  Related  Stockholder  Matters  and  Issuer  Purchases  of 
Equity Securities 
[Reserved]  
Management’s Discussion and Analysis of Financial Condition and Results of Operations  
Quantitative and Qualitative Disclosures About Market Risk  
Consolidated financial Statements and Supplementary Data  
Changes in and Disagreements with Accountants on Accounting and Financial Disclosure  
Controls and Procedures  
Other Information  
Disclosure Regarding Foreign Jurisdiction that Prevent Inspection 

PART III 

Directors and Executive Officers and Corporate Governance  
Executive Compensation  
Security  Ownership  of  Certain  Beneficial  Owners  and  Management  and  Related  Stockholder 
Matters  
Certain Relationships and Related Transactions and Director Independence  
Principal Accountant Fees and Services  

Item 1. 
Item 1A. 
Item 1B. 
Item 2. 
Item 3. 
Item 4. 

Item 5. 

Item 6. 
Item 7. 
Item 7A. 
Item 8. 
Item 9. 
Item 9A. 
Item 9B. 
Item 9C. 

Item 10. 
Item 11. 
Item 12. 

Item 13. 
Item 14. 

Item 15. 
Item 16. 

Exhibits and Consolidated Financial Statement Schedules  
Form 10-K Summary 

PART IV 

Signatures 

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PART I 

FORWARD-LOOKING STATEMENTS 

This  Annual  Report on  Form  10-K  and  the  documents  incorporated by  reference  contain  forward-looking  statements 
within the  meaning of the Private  Securities  Reform Act  of 1995. All statements other than statements of historical facts 
contained in this Annual Report are  forward-looking statements. We intend that such statements be protected by the safe 
harbor created thereby. Forward-looking statements relate to expectations, beliefs, projections, future plans and strategies, 
anticipated events or trends and similar expressions concerning matters that are not historical facts. In some cases, you can 
identify forward-looking statements by terms such as “anticipate,” “believe,” “could,” “estimate,” “expect,” “intend,” “may,” 
“plan,” “potential,” “should,” “will” and “would” or the negatives of these terms or other comparable terminology. 

The forward-looking statements are based on our beliefs, assumptions and expectations of our future performance, taking 
into account all information currently available to us. Forward-looking statements involve risks and uncertainties and our 
actual results and the timing of events may differ significantly from the results discussed in the forward-looking statements. 
Such forward-looking statements and our business are subject to numerous risks and uncertainties that you should consider 
before investing in our Company. These risks are described more fully in the section titled “Risk Factors.” Accordingly, you 
should not rely upon forward-looking statements as predictions of future events. Examples of such forward-looking statements 
include, but are not limited to statements about: 

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the number of patients with Alzheimer’s disease we expect to enroll in our on-going Phase 3 studies, the enrollment 
rates for these studies, and the length of time to complete patient enrollment for our studies and the expected safety 
profile or treatment benefits of simufilam for people with Alzheimer’s disease; 
our reliance on third-party contractors to conduct the clinical trials and make drug supply on a large-scale for our 
Phase 3 clinical program, or their ability to do so on-time or on-budget; 
limitations around data interpretation from results of our long-term open-label study, as compared to efficacy results 
from a fully completed, randomized controlled study design; 
the ability of clinical scales to assess cognition or health in our trials of Alzheimer’s disease; 
any significant changes we may make, or anticipate making, to the design of any of our on-going studies of simufilam 
in patients with Alzheimer’s disease; 
our ability to initiate, conduct or analyze additional clinical  and non-clinical studies with our product candidates 
targeted at Alzheimer’s disease and other neurodegenerative diseases; 
the impact of pre-clinical findings on our ability to develop our product candidates; 
the interpretation of results from our pre-clinical or early clinical studies, such as Phase 1 and Phase 2 studies; 
our plans  to  further  develop SavaDx,  our  investigational  blood-based  diagnostic,  and  to  evaluate  a  non-antibody 
approach for SavaDx; 
our ability or willingness to expand therapeutic indications for simufilam outside of Alzheimer’s disease; 
the safety, efficacy, or potential therapeutic benefits of our product candidates; 
our ability to file for and obtain regulatory approval of our product candidates; 
our strategy and ability to establish an infrastructure to commercialize any product candidates, if approved; 
the potential future revenues of our product candidates, if approved and commercialized; 
the market acceptance of our product candidates, if approved and commercialized; 
the pricing and reimbursement of our product candidates, if approved and commercialized; 
the utility of protection, or the sufficiency, of our intellectual property; 
our potential competitors or competitive products for the treatment of Alzheimer’s disease; 
our need to raise new capital from time to time to continue our operations or to expand our operations; 
our use of multiple third-party vendors, including a Clinical Research Organization (CRO), to conduct clinical studies 
of our lead product candidate; 
expectations  regarding  trade  secrets,  technological  innovations,  licensing  agreements  and  outsourcing  of  certain 
business functions; 
our expenses increasing by unanticipated amounts due to inflation; 
fluctuations in our financial or operating results; 
our operating losses, anticipated operating and capital expenditures and legal expenses; 
expectations regarding the issuance of shares of common stock, options or other equity to employees or directors 
pursuant to equity compensation awards, net of employment taxes; 
the development and maintenance of our internal information systems and infrastructure; 
our need to hire additional personnel and our ability to attract and retain such personnel; 
existing regulations and regulatory developments in the United States and other jurisdictions in which we operate; 

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our plans to expand the size and scope of our operations; 
the sufficiency of our current resources to continue to fund our operations; 
potential future agreements with third parties in connection with the commercialization of our product candidates; 
the accuracy of our estimates regarding expenses, capital requirements, and needs for additional financing; 
assumptions and estimates used for our disclosures regarding stock-based compensation; 
the expense, timing and outcome of pending or future litigation or other legal proceedings and claims, including U.S. 
government inquiries; and 
litigation, claims or other uncertainties that may arise from allegations made against us or our collaborators. 

Drug  development  and  commercialization  involve  a  high  degree  of  risk,  and  only  a  small  number  of  research  and 
development programs result in regulatory approval and subsequent commercialization of a product. Our clinical results from 
earlier-stage clinical trials may not be indicative of  future results from later-stage or larger scale clinical trials and do not 
ensure  regulatory approval. You should not place undue  reliance on these statements or any scientific data  we  present or 
publish. 

We cannot assure you that we will realize the results or developments we expect or anticipate or, even if substantially 
realized, that they will affect us or our operations in the  way we  expect.  The forward-looking statements included in this 
Annual Report on Form 10-K are made only as of the date hereof. We undertake no obligation to publicly update or revise 
any forward-looking statement as a result of new information, future events or otherwise, except as required by law. 

In addition, terms such as “we believe,” “may,” “anticipate,” “could,” “expect,” “would”, “forecast,” “intend,” “plan,” 
“possible,” “potential,” and other words and terms of similar meaning reflect our beliefs and opinions on the relevant subject 
at the time we use such words and terms. These statements are based upon information available to us as of the date of this 
report, and while we believe such information forms a reasonable basis for such statements, such information may be limited 
or incomplete, and our statements should not be read to indicate that we have conducted an exhaustive inquiry into, or review 
of, all potentially available relevant information. These statements are inherently uncertain and you are cautioned not to unduly 
rely upon these statements. 

Our research programs in neurodegeneration have benefited from longstanding scientific and financial support from the 
National Institutes of Health (NIH). The contents of this Annual Report are solely our responsibility and do not represent any 
views of NIH, the Department of Health and Human Services, or the United States government. 

Item 1.    Business 

Overview 

Cassava Sciences, Inc. is a clinical-stage biotechnology company based in Austin, Texas. Our mission is to detect and 
treat neurodegenerative diseases, such as Alzheimer’s disease. Our novel science is based on stabilizing – but not removing – 
a critical protein in the brain. Our lead therapeutic drug candidate, simufilam, is being evaluated for the proposed treatment 
of Alzheimer’s disease dementia in Phase 3 clinical studies. 

Over the past 10 years, we have combined state-of-the-art technology with new insights in neurobiology to develop novel 
solutions  for  Alzheimer’s  disease  and  other  neurodegenerative  diseases.  Our  strategy  is  to  leverage  our  unique 
scientific/clinical platform to develop a first-in-class program for treating neurodegenerative diseases, such as Alzheimer’s.  

We currently have two biopharmaceutical assets under development:  

• 

• 

our lead therapeutic product candidate, called simufilam, is a novel oral treatment for Alzheimer’s disease dementia; 
and  
our  lead  investigational  diagnostic  product  candidate,  called  SavaDx,  is  a  novel  way  to  detect  the  presence  of 
Alzheimer’s disease from a small sample of blood. 

Our scientific approach for the treatment of Alzheimer’s disease seeks to simultaneously suppress both neurodegeneration 
and neuroinflammation. We believe our ability to improve multiple vital functions in the brain represents a new, different and 
crucial approach to address Alzheimer’s disease.  

Our lead product candidate, simufilam, is a proprietary small molecule (oral) drug. Simufilam targets an altered form of 
a protein called filamin A (FLNA) in the Alzheimer’s brain. Published studies have demonstrated that the altered form of 

5 

  
  
 
 
 
 
 
 
 
 
 
 
 
 
FLNA causes neuronal dysfunction, neuronal degeneration and neuroinflammation.  We are currently conducting a Phase 3 
program with simufilam in patients with mild-to-moderate Alzheimer’s disease dementia.   

We believe simufilam improves brain health by reverting altered FLNA back to its native, healthy conformation, thus 
countering  the  downstream  toxic  effects  of  altered  FLNA.  We  have  generated  and  published  experimental  and  clinical 
evidence of improved brain health with simufilam. Importantly, simufilam is not dependent on clearing amyloid from the 
brain.  Since  simufilam  has  a unique mechanism of  action, we  believe  its  potential  therapeutic  effects  may  be  additive  or 
synergistic with those of other therapeutic candidates aiming to treat neurodegeneration. 

Simufilam  has  demonstrated  a  multitude  of  treatment  effects  in  animal  models  of  disease,  including  normalizing 

neurotransmission, decreasing neuroinflammation, suppressing neurodegeneration, and restoring memory and cognition.   

Phase 2a Study 

In 2019, we completed a small, first-in-patient, clinical-proof-of-concept, open-label Phase 2a study of simufilam in the 
U.S., with substantial support from the National Institute on Aging (NIA), a division of the NIH. Treatment with simufilam 
for  28  days  significantly  improved  certain  key  biomarkers  of  Alzheimer’s  pathology,  neurodegeneration  and 
neuroinflammation (p<0.001). Biomarkers effects were seen in all patients in both cerebrospinal fluid (CSF) and plasma. 

Phase 2b Study 

In September 2020, we announced final results of a Phase 2b study with simufilam in Alzheimer’s disease. In this clinical 
study funded by the NIH, Alzheimer’s patients treated with 50 mg or 100 mg of simufilam twice-daily for 28 days showed 
statistically  significant  (p<0.05)  improvements  in  CSF  biomarkers  of  disease  pathology,  neurodegeneration  and 
neuroinflammation, versus Alzheimer’s patients who took placebo. In addition, Alzheimer’s patients treated with simufilam 
showed  improvements  in  validated  tests  of  episodic  memory  and  spatial  working  memory,  versus  patients  on  placebo. 
Cognitive improvements correlated most strongly with decreases in levels of P-tau181, an exploratory ‘research use only’ 
non-safety related biomarker that suggests brain changes from Alzheimer’s disease. 

Open-label Study Strategy 

Much of the value of our open-label study is to support simufilam’s long-term safety profile in patients. We believe a 
well-designed, long-term, open-label study is an exercise in prudent risk-management. Clinical results serve as a tool to help 
inform and manage the inherent risks and uncertainties of drug development for undertaking a large, expensive Phase 3 clinical 
testing program. 

Open-label Study Top-line Results 

In March 2020, we initiated a long-term, open-label study to evaluate simufilam, our lead drug candidate, in patients 
with Alzheimer’s disease. This study was funded in part by a research grant award from NIH. The study was designed to 
evaluate the long-term safety and tolerability of simufilam 100 mg twice daily for 12 or more months. Another study 
objective was to assess exploratory efficacy endpoints, such as changes in cognition, and biomarkers. 

In January 2023, we announced positive top-line Phase 2 results for our open-label study. The study enrolled over 200 
patients with mild-to-moderate Alzheimer’s disease (MMSE 16-26). Endpoints were measured at baseline (study entry) and 
month 12. 

Top-line Results – mean scores, baseline to month 12 (lower is better, except for MMSE): 

•  ADAS-Cog11 scores changed from 19.1 (±9.2) to 19.6 (±13.3) 

•  MMSE scores changed from 21.5 (±3.6) to 20.2 (±6.4) 

•  NPI10 scores changed from 3.2 (±4.6) to 2.9 (±4.6) 

•  GDS scores changed from 1.8 (±1.8) to 1.4 (±1.9) 

Alzheimer’s is a degenerative disease of the brain. Over time, cognition progressively worsens in the mild-to-moderate 
stages of Alzheimer’s as the disease takes its toll.  ADAS-Cog scores that change minimally (or improve) over 1 year  is a 
highly desirable outcome in a clinical study of patients with mild-to-moderate Alzheimer’s disease. 

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Response Analysis – baseline to month 12 

•  ADAS-Cog scores improved in 47% of patients; this group had a mean change of -4.7 (±3.8) points (lower is better). 

•  In an additional 23% of patients, ADAS-Cog declined less than 5 points; this group had a mean change of 2.5 (±1.4) points. 

•  Patients with an NPI10 score of zero increased from 42% to 54%, indicating reduced dementia-related neuropsychiatric 

symptoms after 1 year on simufilam. 

Analysis of Efficacy Endpoints 

Efficacy outcomes were analyzed by an independent, outside biostatistical consulting firm led by Suzanne Hendrix, PhD. 
The  pre-specified  primary  efficacy  endpoint  was  change  in  baseline  on  ADAS-Cog11,  a  cognitive  scale  widely  used  in 
Alzheimer’s clinical research. Exploratory endpoints included the Mini-Mental State Examination (MMSE) to assess disease 
stage by cognitive impairment; the Neuropsychiatric Inventory (NPI10) to assess dementia related behavior; and the Geriatric 
Depression Scale (GDS). The Full Analysis Set (FAS) population (N=216) was used for the statistical analysis of efficacy 
endpoints. 

Alzheimer’s is a progressive disease. Severity of disease is typically assessed by MMSE score. In this study, mild patients 
are MMSE 21-26; moderate patients are MMSE 16-20. Mild and moderate sub-groups showed notable differences on changes 
in ADAS-Cog mean scores, baseline to month 12 (lower is better): 

• 
• 

In the mild sub-group, ADAS-Cog scores improved, from 15.0 (±6.3) to 12.6 (±7.8) 
In the moderate sub-group, ADAS-Cog scores worsened, from 25.7 (±9.2) to 30.1 (±13.1) 

We believe the improvement in ADAS-Cog over 1 year in mild patients taking simufilam is well outside the expected 
range of historic placebo decline rates from numerous other studies. Figure 1 presents a model of historical declines on ADAS-
Cog in early disease (MCI + mild) and mild disease. 

Figure 1: Statistical model of simufilam versus historical 1-year placebo declines on ADAS-Cog in early disease and mild 
disease.1 

Safety Data 

Simufilam 100 mg twice daily was generally safe and well tolerated in this open-label study. There were no drug-related 
serious adverse events. Three treatment-emergent adverse events (TEAEs) occurred in 7% or more of study patients: COVID-
19 (12%), urinary tract infection (10%) and headache (9%). Reported TEAEs are based on all study patients who received at 
least  one  dose  of  drug.  The  top  three  reasons  for  patient  discontinuations  were  withdrawal  of  informed  consent  (N=14), 
adverse events (N=13) and patient non-compliance (N=7). 

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1 Figure 1: Forest plot model by Pentara Corporation. Data was sourced from non-randomized studies (i.e., ADNI) and randomized, controlled trials conducted 
by other sponsors in patients with early (i.e., MCI + mild) and mild Alzheimer’s disease. 

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Biomarker Data 

Exploratory biomarkers were analyzed from cerebrospinal fluid (CSF) collected from 25 patients in the open-label study 
who agreed to undergo a lumbar puncture at baseline and again after 6 months of treatment. CSF samples were analyzed blind 
by our academic collaborator at  City University of New York.  All CSF biomarkers were  ‘research use  only’, non-safety-
related exploratory biomarkers. We previously announced results of this bioanalysis in a press release dated July 29, 2021. 

 P-values shown below are baseline vs. 6-month levels by paired t-test: 

•  CSF biomarkers of disease pathology, t-tau and p-tau181, decreased 38% and 18%, respectively (both p<0.00001) 

•  CSF biomarkers of neurodegeneration, neurogranin and neurofilament light chain (NfL), decreased 72% and 55%, 

respectively (both p<0.00001) 

•  CSF biomarkers of neuroinflammation, sTREM2 and YKL-40, decreased 65% and 44% (both p<0.00001) 

Of the 25 patients who provided 6-month CSF samples, 24 subsequently completed 1 year of treatment with open-label 
simufilam. This sub-set of patients improved -4.96 mean points on ADAS-Cog from baseline to month 12 (lower is better; ad 
hoc analysis conducted internally). We have not conducted further CSF sample analyses in the open-label study. 

Limitations of Open-label Study and Top-line Results 

Data results from our open-label safety study do not constitute, and should not be interpreted as, regulatory evidence of 
safety or efficacy for simufilam in Alzheimer’s disease. Rigorous evidence for drug safety and efficacy is derived from one 
or more large, randomized, placebo-controlled studies. The open-label design and size of this study may introduce clinical or 
statistical bias or may generate results that may not fully distinguish between drug effects and random variation. Different 
methods of statistical analysis on clinical data from the same study may lead to objectively different numerical results. These 
and  other  statistical  and  clinical  features  of  our  open-label  study  add  complexity  or  limitations  to  the  scope  of  data 
interpretation. In addition, ‘top-line data’ is a summary of the clinical data prior to the completion of a full and final audit or 
quality-control of the clinical database. We communicated top-line data so that stakeholders had timely access to a summary 
of the study’s findings prior to us receiving the final dataset. Final data may change from initial top-line data. 

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Cognition Maintenance Study 

In May 2021, we initiated a Cognition Maintenance Study (CMS). The CMS is a randomized, withdrawal study design. 
ICH2 defines this type of study design as follows: “In a randomized withdrawal trial, subjects receiving a test treatment for 
a specified time are randomly assigned to continued treatment with the test treatment or to placebo (i.e., withdrawal of active 
therapy) …….. Any difference that emerges between the group receiving continued treatment and the group randomized to 
placebo would demonstrate the effect of the active treatment.” 

The  CMS  study  design  is  intended  to  evaluate  simufilam’s  effects  on  cognition  and  health  outcomes  in  Alzheimer’s 
patients who continue with drug treatment versus patients who discontinue drug treatment. It is a double-blind, randomized, 
placebo-controlled study of simufilam in patients with mild-to-moderate Alzheimer’s disease. Study patients are randomized 
(1:1) to simufilam or placebo for six months. To enroll in this study, patients must have previously completed 12 months or 
more of open-label treatment with simufilam. Figure 2. 

Figure 2. Cognition Maintenance Study Design 

Patient enrollment for this study is closed. As of February 17, 2023, over 110 patients have completed this study. A small 
number of enrolled patients are still being treated in the randomized portion of this study. All randomized clinical data remain 
blinded. Our goal is to announce top-line clinical results for the CMS approximately third-quarter 2023.  

____________________________ 

2  International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use (ICH), Topic E10, Choice of Control Group in 
Clinical Trials. 

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End-of-Phase 2 (EOP2) Meeting with FDA  

In January 2021, we held an End-of-phase 2 (EOP2) meeting for simufilam with the U.S. Food and Drug Administration 
(FDA). The purpose of this EOP2 meeting was to gain general agreement around key elements of a pivotal Phase 3 program 
to treat Alzheimer’s disease  dementia. FDA attendees included Robert Temple, MD, Deputy Center Director for Clinical 
Science and Senior Advisor in the Office of New Drugs; Billy Dunn, MD, Director, Office of Neuroscience; Eric Bastings, 
MD, Director, Division of Neurology, and others. 

In February 2021, we announced the successful completion of our EOP2 meeting. Official meeting minutes confirm that 
we and FDA are aligned on key elements of a Phase 3 clinical program for simufilam. FDA has agreed that the completed 
Phase 2 program, together with an  ongoing and well-defined Phase 3 clinical program, are sufficient to show evidence of 
clinical efficacy for simufilam in Alzheimer’s disease. There is also agreement that the use of separate clinical scales to assess 
cognition (ADAS-cog1) and function (ADCS-ADL2) are appropriate co-primary endpoints of efficacy. A clinical scale that 
combines cognition and function, such as iADRS3, is a secondary efficacy endpoint, along with the NPI. 

1 ADAS-Cog = The Alzheimer’s Disease Assessment Scale – Cognitive Subscale, a measure of cognition  

2 ADCS-ADL = Alzheimer’s Disease Cooperative Study – Activities of Daily Living, a measure of health function 

3iADRS = integrated Alzheimer’s Disease Rating Scale, a composite measure of cognition and health function 

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Special Protocol Assessments 

In August 2021, we announced we had reached agreement with FDA under a Special Protocol Assessment (SPA) for 
both Phase 3 studies. These SPA agreements document that FDA has reviewed and agreed upon the key design features of 
our Phase 3 study protocols of simufilam for the treatment of patients with Alzheimer’s disease. 

An SPA agreement indicates concurrence by the FDA with the adequacy and acceptability of specific critical elements 
of overall protocol design (e.g., entry criteria, dose selection, endpoints, etc.). These elements are critical to ensure that our 
planned Phase 3 studies of simufilam in Alzheimer’s disease can be considered adequate and well-controlled studies in support 
of a future regulatory submission and marketing application. 

The  first clinical study protocol under the SPA is titled “A Phase 3, Randomized, Double-Blind, Placebo-Controlled, 
Parallel-Group,  52-Week  Study  Evaluating  the  Safety  and  Efficacy  of  One  Dose  of  Simufilam  in  Subjects  with  Mild-to-
Moderate Alzheimer’s Disease.” 

The second clinical study protocol under the SPA is titled “A Phase 3, Randomized, Double-Blind, Placebo-Controlled, 
Parallel-Group,  76-Week  Study  Evaluating  the  Safety  and  Efficacy  of  Two  Doses  of  Simufilam  in  Subjects  with  Mild-to-
Moderate Alzheimer’s Disease.” 

Phase 3 Drug Supply 

We previously announced we have entered into a drug supply agreement with Evonik Industries AG for simufilam. Under 
the agreement, Evonik is expected to supply us with large-scale, clinical-grade quantities of simufilam. Evonik is one of the 
world’s largest contract development and manufacturing organizations for pharmaceutical ingredients. Other vendors supply 
excipients, the finished dosage form (i.e., simufilam tablets), drug packaging, package labeling and other critical steps in the 
supply chain for Phase 3 drug supply. 

Phase 3 Clinical Program Overview 

Our Phase 3 program consists of two large, double-blind, randomized, placebo-controlled studies of simufilam in patients 
with mild-to-moderate Alzheimer’s disease dementia. Highlights of this clinical program are summarized in Figure 3. In June 
2021, we announced the selection of Premier Research International as our CRO to help conduct our Phase 3 clinical program. 

Figure 3. Summary of Our Phase 3 Clinical Program 

RETHINK-ALZ and REFOCUS-ALZ 

In Fall 2021, we announced initiation of our two Phase 3 studies of simufilam, respectively. As of February 28, 2023, a 
total of over 1,000 patients have been enrolled in our Phase 3 program. The target patient enrollment for the Phase 3 program 
is over 1,750 patients. We anticipate the completion of patient enrollment for both of our Phase 3 studies by yearend 2023. 
Patients continue to be screened in clinical trial sites in the U.S., Canada, Puerto Rico, Australia, and South Korea. 

The first Phase 3 study, called RETHINK-ALZ, is designed to evaluate the safety and efficacy of oral simufilam 100 mg 
in  enhancing  cognition  and  slowing  cognitive  and  functional  decline  over  52  weeks.  Secondary  objectives  include  the 
assessment  of  simufilam’s  effect  on  neuropsychiatric  symptoms  and  caregiver  burden.  This  randomized,  double-blind, 
placebo-controlled study plans to enroll approximately 750 patients with mild-to-moderate Alzheimer’s disease. 

Details of the RETHINK-ALZ Phase 3 study include: 

➢  Approximately 750 patients with mild-to-moderate Alzheimer’s disease to be enrolled. 
➢  Patients to be randomized (1:1) to simufilam 100 mg or placebo twice daily.  

11 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
➢  Patients to be treated for 12 months. 
➢  The co-primary efficacy endpoints are ADAS-Cog121, a cognitive scale, and ADCS-ADL2, a functional scale; both 

are standard clinical tools in trials of Alzheimer’s disease.  

➢  A secondary efficacy endpoint is  iADRS3, a  standard clinical tool in trials of Alzheimer’s disease that combines 

cognitive and functional scores from ADAS-Cog & ADCS-ADL.  

➢  Other secondary endpoints include plasma biomarkers of disease and NPI4, a clinical tool that assesses the presence 

and severity of dementia-related behavior. 

In November 2021, we announced initiation of a second Phase 3 study, called REFOCUS-ALZ, designed to evaluate the 
safety and efficacy of oral simufilam 100 mg and 50 mg over 76 weeks. This randomized, double-blind, placebo-controlled 
study plans to enroll approximately 1,000 patients with mild-to-moderate Alzheimer’s disease. 

Details of the REFOCUS-ALZ Phase 3 study include: 

➢  Approximately 1,000 patients with mild-to-moderate Alzheimer’s disease to be enrolled. 
➢  Patients to be randomized (1:1:1) to simufilam 100 mg, 50 mg, or placebo BID.  
➢  Patients to be treated for 76 weeks. 
➢  The co-primary efficacy endpoints are ADAS-Cog1, a cognitive scale, and ADCS-ADL2, a functional scale; both are 

widely used clinical tools in trials of Alzheimer’s disease.  

➢  A secondary efficacy endpoint is iADRS3, a widely used clinical tool in trials of Alzheimer’s disease that combines 

cognitive and functional scores from ADAS-Cog & ADCS-ADL.  

➢  Other secondary endpoints include CSF, plasma and imaging biomarkers of disease and NPI4, a clinical tool that 

assesses the presence and severity of dementia-related behavior. 

Phase 3 Entry Criteria Includes a Plasma Assay for Phosphorylated Tau (p-Tau) 

We  believe  plasma  levels  of  pTau  proteins  can  provide  independent  confirmation  of  Alzheimer’s    neuropathology. 
RETHINK-ALZ and REFOCUS-ALZ studies use a ‘research use only’, non-safety related exploratory P-tau181 plasma assay 
to  qualify  mild-to-moderate  Alzheimer’s  patients.  At  the  15th  International  Conference  on  Clinical  Trials  on  Alzheimer’s 
Disease (CTAD) 2022, a poster presentation indicated a 30 ng/L cut-point showed 100% sensitivity and 88% specificity for 
Alzheimer’s  diagnostic in 22 autopsy-confirmed samples5. The plasma assay we use does not rely on age, APOE-gene status 
or complex algorithms to provide a result. 

Open-label Extension Study for the Phase 3 Program 

In October 2022, we announced the initiation of an open-label extension study for our Phase 3 program. This study is 
designed to provide no-cost access to simufilam  for one year  to  Alzheimer’s  patients who have successfully completed a 
Phase 3 study of simufilam. 

The open-label extension study is expected to generate long-term safety and tolerability data for (oral) simufilam 100 mg 
twice daily over 52 weeks. There is no obligation for a patient or a physician to participate in the open-label extension study. 
Each clinical investigational site and each patient chooses whether to participate in this open-label extension study. Patient 
enrollment for this study began November 2022. 
_____________________________ 

1 ADAS-Cog = The Alzheimer’s Disease Assessment Scale – Cognitive Subscale, a measure of cognition  

2 ADCS-ADL = Alzheimer’s Disease Cooperative Study – Activities of Daily Living, a measure of health function 

3 iADRS = integrated Alzheimer’s Disease Rating Scale, a composite measure of cognition and health function 

4 Neuropsychiatric Inventory (NPI) 

5 Source: pTau181 Plasma Biomarker Performance as an Inclusion Criterion in the RETHINK-ALZ and REFOCUS-ALZ trials in mild-to-moderate 
Alzheimer’s disease, Mammel et al., CTAD 2022 

12 

  
  
 
 
 
 
 
 
 
 
SavaDx 

Our  investigational  product  candidate,  called  SavaDx,  is  early-stage  program  focused  on  detecting  the  presence  of 
Alzheimer’s disease from a small sample of blood. For business, technical and personnel reasons, we continue to prioritize 
the development of simufilam, our novel drug candidate, over SavaDx, our novel diagnostic candidate. SavaDx is a research-
use only, non-safety related exploratory biomarker. 

The regulatory pathway for SavaDx may eventually include formal analytical validation studies and clinical studies that 
support evidence of sensitivity, specificity and other variables in various healthy and diseased patient populations. We have 
not conducted such studies and do not expect to conduct such studies in 2023.  

SavaDx is currently designed as an antibody-based detection system for altered filamin A (FLNA). Working with third 

parties, we are evaluating the exploratory use of mass spectrometry to detect FLNA, i.e., without the use of antibodies. 

About Alzheimer’s Disease 

Alzheimer’s disease is a progressive neurodegenerative disorder that affects cognition, function and behavior. As of 2021, 
there were approximately 55 million people worldwide living with dementia, a figure expected to increase to 139 million by 
2050 according to outside sources. The annual global cost of dementia is now above  $1 trillion, according to Alzheimer’s 
Disease International, a charitable organization. 

Our Scientific Approach is Different 

Over the last ten years, we have developed a new and promising scientific approach for the treatment and diagnosis of 
neurodegenerative diseases, such as Alzheimer’s disease. Importantly, we do not seek to clear amyloid out of the brain. Rather, 
we seek to stabilize a critical protein in the brain that has many downstream effects. 

Our scientific approach is to treat neurodegeneration by targeting an altered form of a scaffold protein called FLNA. 
Through years of basic research, we and our academic collaborators identified FLNA as a structurally altered protein that 
enables both a neurodegeneration and a neuroinflammation pathway in the Alzheimer’s brain. We have shown that the altered 
form of FLNA is pervasive in the Alzheimer’s brain and undetectable in healthy control brains. 

Using scientific insight and lab techniques, we believe we have elucidated this protein dysfunction. Through this work, 
we have produced experimental evidence that altered FLNA plays a critical role in Alzheimer’s disease. We engineered a 
family of high-affinity, small molecules to target this structurally altered protein and restore its normal shape and function. 
This family of small molecules, including our lead therapeutic candidate, simufilam, was designed in-house and characterized 
by our academic collaborators.  

Our lead therapeutic product candidate, simufilam, is a small molecule (oral) drug with a novel mechanism of action. The 
target  of  simufilam  is  altered  FLNA,  the  brain  protein  we  seek  to  stabilize.  Importantly,  since  simufilam  has  a  unique 
mechanism of action, we believe its potential therapeutic effects may be additive or synergistic with those of other therapeutic 
candidates aiming to treat neurodegeneration. We are currently conducting a Phase 3 program with simufilam in patients with 
mild-to-moderate Alzheimer’s disease dementia. 

Given the biopharmaceutical industry’s challenging track record in Alzheimer’s research, we believe there is an urgent 
need to consider innovative approaches to combat this disease. We believe our scientific approach may broaden the range of 
possible treatment approaches for this complex disease. 

Our science is based on stabilizing a critical protein in the brain 

Proteins are essential for cell function because they participate in virtually every biological process. If protein function is 
impaired, the health consequences can be devastating. Technological advances in medicine and improvements in lifestyle are 
making our lives longer. But with age, genetic mutations and other factors conspire against healthy cells, resulting in altered 
proteins. Sometimes a cell can rid itself of altered proteins. However, when disease changes the shape and function of critical 
proteins,  multiple  downstream  processes  are  impaired.  There  are  many  clinical  conditions  in  which  proteins  become 
structurally  altered  and  impair  the normal  function  of  cells,  tissues  and  organs,  leading  to  disease.    Conversely, restoring 
altered proteins back to health –called proteostasis – is a well-accepted therapeutic strategy in clinical medicine. 

For over 100 years, scientists have ascribed various neurodegenerative diseases to proteins that misfold and are rendered 
pathological. In Alzheimer’s disease, certain proteins, such as amyloid and tau, lose their normal shape and function. Such 
misfolded proteins can break down or aggregate in clumps and form plaque or tangles in the brain. Destruction of neuronal 

13 

  
 
 
  
 
 
 
 
 
 
 
 
 
 
synapses,  accelerated  nerve  cell  death,  and  dysfunction  of  the  brain  support  cells,  are  all  widely  believed  to  be  direct 
consequences of misfolded proteins.  

FLNA is a scaffolding protein found in high levels in the brain. A healthy scaffolding protein brings multiple proteins 
together, coordinating their interaction. However, an altered form of FLNA protein is found in the Alzheimer’s brain. Our 
experimental evidence shows that altered FLNA protein contributes to Alzheimer’s disease by disrupting the normal function 
of  neurons,  leading  to  neurodegeneration  and  brain  inflammation.  Our  product  candidate,  simufilam,  aims  to  counter  the 
altered and toxic form of FLNA in the brain, thus restoring the normal function of this critical protein. Our novel science is 
based on stabilizing – but not removing – a critical protein in the brain. 

One drug, multiple effects  

Simufilam binds to altered FLNA with very high (femtomolar) affinity. This drug effect restores the normal shape of 
FLNA and the normal function of key brain receptors, including: the alpha-7 nicotinic acetylcholine receptor; the N-methyl-
D-aspartate (NMDA) receptor; and the insulin receptor. These receptors have pivotal roles in brain cell survival, cognition 
and memory.   

In animal models, treatment with simufilam resulted in dramatic improvements in brain health, such as reduced amyloid 
and  tau  deposits,  improved  receptor  signaling  and  improved  learning  and  memory.  In  addition,  simufilam  has  another 
beneficial  treatment  effect  of  significantly  reducing  inflammatory  cytokines  in  the  brain.  In  animal  models  of  disease, 
treatment with simufilam greatly reduced levels of IL-6 and suppressed TNF-alpha and IL-1beta levels by 86% and 80%, 
respectively, illustrating a powerful anti-neuroinflammatory effect.   

By restoring function to multiple receptors and exerting powerful anti-inflammatory effects, we believe our approach has 
potential to slow the progression of neurodegeneration in patients. Thus, we have designed simufilam to slow, or potentially 
even reverse the deterioration of brain cells. 

Our science is published in multiple peer-reviewed journals. In addition, our research has been supported by NIH under 
multiple research grant awards. Each grant was awarded following an in-depth, peer-reviewed evaluation of our approach for 
scientific and technical merit by a panel of outside experts in the field. Strong, long-term support from NIH has allowed us to 
advance our two product candidates for neurodegeneration, simufilam and SavaDx, into clinical development. 

Currently marketed drug therapies for Alzheimer’s disease have limited therapeutic effect 

We believe the FDA has not approved any new  drugs for  the treatment of  Alzheimer’s disease since 2003 except as 

follows:  

In  June  2021,  aducanumab  (marketed  as  Aduhelm®)  received  marketing  approval  from  FDA  for  the  treatment  of 
Alzheimer’s  disease  using  the  accelerated  approval  pathway  “based  on  the  drug’s  effect  on  a  surrogate  endpoint  that  is 
reasonably likely to predict a clinical benefit to patients, with a required post-approval trial to verify that the drug provides 
the  expected  clinical  benefit.”  Aducanumab  is  delivered  via  monthly  infusion.  It  is  a  proprietary  drug  of  Biogen,  Inc.,  a 
biopharmaceutical company. According to Biogen, the drug’s launch price was about $56,000 per patient per year in the U.S. 
In December 2021, Biogen reduced the price to about $28,200 per year. In May 2022, Biogen announced it was significantly 
scaling down infrastructure to produce Aduhelm in response to limited insurance coverage. 

In  January  2023,  lecanemab  (marketed  as  Leqembi®)  received  marketing  approval  from  FDA  for  the  treatment  of 
Alzheimer’s  disease  using  the  accelerated  approval  pathway  “based  on  the  drug’s  effect  on  a  surrogate  endpoint  that  is 
reasonably likely to predict a clinical benefit to patients”. Lecanemab is delivered via bi-weekly infusion. It is a proprietary 
drug of Eisai R&D Management Co., Ltd. and Biogen, Inc. According to Eisai, the drug’s launch price as of January 2023 
is about $26,500 per patient per year in the U.S. 

All FDA-approved anti-amyloid antibodies for Alzheimer’s disease currently lack Medicare coverage.  In  the  United 
States, Medicare coverage is limited to drugs that are deemed to be “reasonable and necessary” for the treatment of 
disease, as determined by the Centers for Medicare & Medicaid Services (CMS), a federal agency. As of February 
2023,  the  CMS has declined to provide  Medicare  coverage for  FDA approved monoclonal antibodies directed against 
amyloid for the treatment of Alzheimer’s disease. 

14 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
Currently marketed drugs, called cholinesterase inhibitors, focus solely on treating symptoms, mostly in patients with 
mild-to-moderate  Alzheimer's  disease.  The  Alzheimer’s  brain  has  low  levels  of  a  neurotransmitter  called  acetylcholine. 
Cholinesterase  inhibitors  prevent  an  enzyme  in  the  brain,  called acetylcholinesterase, from  breaking  down  acetylcholine. 
Currently  marketed  cholinesterase  inhibitors  include  donepezil  (marketed  by  Eisai Co., Ltd.  and  Pfizer, Inc.  as  Aricept®), 
rivastigmine  (marketed  by  Novartis  AG  as  Exelon®)  and  galantamine  (marketed  by  Janssen  Pharmaceuticals,  Inc.  as 
Razadyne®). Cholinesterase inhibitors may benefit some patients for several months, after which the targeted brain receptors 
are  desensitized,  and  drug  efficacy  is  lost.  Another  approved  medication  for  Alzheimer’s  disease  is  memantine,  a  non-
competitive antagonist of NMDA receptors (marketed by Lundbeck as Namenda®). 

Simufilam is our Proprietary Drug Candidate for the Treatment of Alzheimer’s Disease. 

We  have  generated  and  published  experimental  evidence  of  improved  brain  health  by  restoring  altered  FLNA  with 
simufilam, our lead therapeutic product candidate. Simufilam is a proprietary small molecule (oral) drug that represents an 
entirely new scientific approach to treat neurodegeneration. Published studies have demonstrated that simufilam targets an 
altered form of a protein called FLNA that is pervasive in the Alzheimer’s brain. Altered FLNA causes neuronal dysfunction, 
neuronal  degeneration  and  neuroinflammation.  We  believe  our  lead  drug  candidate,  simufilam,  improves  brain  health  by 
reverting altered FLNA back to its native, healthy conformation, thus countering downstream toxic effects of altered FLNA. 
Importantly,  simufilam  is  not  dependent  on  clearing  amyloid  from  the  brain.  From  time-to-time,  our  scientific  research 
includes  the  use  of  exploratory  biomarkers,  typically  labelled  ‘research-use  only’.  These  are  understood  to  mean 
investigational diagnostic products that are in the research phase of development and have not been proven to be effective or 
linked to a specific indication by the FDA. 

The following is additional detail on simufilam’s drug development program.   

IND submission to FDA 

Over the past ten years, we successfully conducted basic research, in vitro studies and preclinical studies in support of an 
Investigational New Drug (IND) submission to FDA for simufilam, including requisite studies around safety pharmacology, 
toxicology, genotoxicity and bioanalytical methods. In 2017 we filed an IND with FDA for simufilam. 

Clinical safety of simufilam in a Phase 1 study 

Following  FDA  acceptance  of  our  IND  in  2017,  we  investigated  the  safety,  dosing  and  pharmacokinetic  profile  of 
simufilam in healthy human volunteers. The design of our first-in-human Phase 1 study was based on regulatory feedback, 
clinical and scientific rationale and observations from previously conducted preclinical and in vitro studies.  

In  a  Phase  1  study,  simufilam  was  evaluated  in  24  healthy  human  volunteers  in  a  single  site  in  the  U.S.  for  safety, 
tolerability and pharmacokinetics. Study subjects were administered a single oral dose of 50, 100 or 200 mg of simufilam. 
Drug was well-tolerated in all subjects. Importantly, simufilam showed no treatment-related adverse effects and no dose-
limiting  safety  findings.  Pharmacokinetic  measurements  demonstrated  that  simufilam,  a  small  molecule,  was  rapidly 
absorbed. Dose-proportionality was observed over the full dose range of 50 to 200 mg. 

Given the absence of any observable dose-limiting effects in healthy adults in a Phase 1 study, a strong scientific rationale, 
and multiple peer-reviewed publications and research grant awards, we believe this program demonstrated favorable proof-
of-principle for the development of simufilam in Alzheimer’s disease.  

Mean PTI-125  Plasma  Concentration  Concentratio n (ng/mL) 0 500  100 150 0 0 4 8  12 16 g  200  mg Time ( 

Phase 2a Clinical Study  

In 2019, we completed a first-in-patient, clinical proof-of-concept study of simufilam in the U.S. Our Phase 2a was an 
open-label,  multi-center,  safety  and  pharmacokinetic  study  of  simufilam.  Thirteen  (13)  patients  with  mild-to-moderate 
Alzheimer’s disease, age 50-85, received 100 mg oral simufilam twice daily for 28 days. A diagnosis of Alzheimer’s disease 
was confirmed with Mini-Mental State Examination (MMSE) ≥ 16 and ≤ 24 and a cerebrospinal fluid (CSF) T-tau/Aβ42 ratio 
≥ 0.30. Safety was assessed by ECGs, clinical labs, adverse event monitoring and physical examinations.  CSF was drawn 
from patients before dosing started and again after 28 continuous days of dosing with simufilam. CSF samples were then 
analyzed for exploratory biomarkers of Alzheimer’s pathology (T-tau, P-tau, Aβ42); neurodegeneration (NfL, neurogranin); 
and neuroinflammation (YKL-40, IL-6, IL-1β and TNFα). All CSF biomarkers were ‘research use only’, non-safety related 
exploratory biomarkers. A consulting biostatistician conducted an independent analysis of the data set. 

A key objective of our Phase 2a study was to measure levels of exploratory CSF biomarkers in the brain. Key results of 

this study include (Figure 4):  

15 

  
 
 
 
 
 
 
 
 
 
 
 
 
•  Total tau (T-tau) decreased 20% (p<0.001) 
•  Phosphorylated tau (P-tau) decreased 34% (p<0.0001) 
•  Neurofilament light chain (NfL), a marker for neurodegeneration, decreased 22% (p<0.0001) 
•  Neurogranin, a marker for cognitive decline, decreased 32% (p<0.0001) 
•  Neuroinflammatory marker YKL-40, an indicator of microglial activation, decreased 9% (p<0.0001) 
•  Proinflammatory Interleukin 6 (IL-6) decreased 14% (p<0.0001) 
•  Proinflammatory Interleukin 1 beta (IL-1β) decreased 11% (p<0.0001) 
•  Proinflammatory Tumor Necrosis Factor alpha (TNFα) decreased 5% (p<0.001)  
•  The ratio of CSF P-tau to Aβ42, a widely accepted biochemical value of Alzheimer’s disease, improved in all patients 

(p<0.001) 

Figure 4: Simufilam Treatment Reduces Levels of Exploratory CSF Biomarkers in Patients with Alzheimer’s in a 
Phase 2a Study. 

Neurogranin*  NfL* 

+

T-tau

P-tau

181

* 

YKL40* 

IL-6* 

IL-1β* 

+

TNFα

Percent change from baseline in CSF biomarkers measured by ELISA. Eight CSF biomarkers of disease in Alzheimer’s 
patients were significantly reduced with simufilam treatment.  *p < 0.0001, +p < 0.001 in paired t test comparing Day 28 to 
pre-dose baseline.  

Neurogranin* NfL* T-tau+ P-tau181 * YKL40* IL-6* IL-1β * TNFα+ -32% -22% -20% -34% -9% -14% -11% -5%  

Consistent  with  over  10  years  of  basic  research  and  preclinical  data,  we  believe  our  Phase  2a  study  showed  clinical 

evidence of simufilam’s mechanism of action and drug-target engagement, including: 

Improvements in biomarkers of Alzheimer’s disease in CSF, plasma and lymphocytes; 

• 
•  Consistency across biomarker improvements in CSF, plasma, and lymphocytes;  
•  Significant reductions (p<0.01) in both nitrated and phosphorylated forms of tau protein; 
•  Evidence that each individual patient showed biomarker responses to simufilam; 
•  Evidence that simufilam reversed the shape of altered filamin A in lymphocytes; 
•  Evidence that simufilam reduced levels of amyloid bound to alpha 7 nicotinic receptors in lymphocytes; and 
•  Early clinical validation of the drug target – altered filamin A – as a facilitator protein between amyloid beta and 

both neuroinflammation and tau pathology.  

Phase 2b Clinical Study  

In March 2020, we announced the completion of a double-blind, randomized, placebo-controlled, multi-center clinical 
study of simufilam. Sixty-four patients with mild-to-moderate Alzheimer’s disease, age 50-85, were randomized (1:1:1) to 
100 mg or 50 mg oral simufilam or matching placebo. Treatment was administered twice daily for 28 days. Nine U.S. study 
sites enrolled patients. A clinical diagnosis was confirmed with the MMSE ≥16 and ≤26 and a CSF T-tau/Aβ42 ratio ≥0.28. 
Safety was assessed by ECGs, clinical labs, adverse event monitoring and physical examinations. This study was substantially 
funded by a research grant award from NIH. 

16 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
The Phase 2b clinical study was designed to evaluate safety, tolerability and drug effects of simufilam on  exploratory 
biomarkers  of  Alzheimer’s  disease.  The  primary  endpoint  was  improvement  in  biomarkers  of  Alzheimer’s  disease  from 
baseline to Day 28. CSF was drawn from patients before dosing started and again after 28 continuous days of dosing with 
simufilam. CSF samples were then analyzed for biomarkers of Alzheimer’s pathology (T-tau, P-tau, Aβ42); neurodegeneration 
(NfL, neurogranin); and neuroinflammation (YKL-40, IL-6, sTREM2, HMGB1) and BBB integrity (IgG, albumin). All CSF 
biomarkers were ‘research use only’, non-safety related exploratory biomarkers. A consulting biostatistician conducted an 
independent analysis of the data set. 

In May 2020, we announced that an outside lab with whom we had no prior work experience conducted a bioanalysis of 
CSF samples from our Phase 2b study. The data set from this initial bioanalysis showed unnaturally high variability and other 
problems. Overall, we believe data from the initial bioanalysis can be interpreted as anomalous and highly improbable. With 
its validity in question, we believe the initial bioanalysis serves no useful purpose. Backup CSF samples were subsequently 
sent to City University of New York for bioanalysis. All bioanalyses were conducted under blinded conditions to eliminate 
any possibility of bias. 

In September 2020, we reported final positive Phase 2b clinical study results. Simufilam was safe and well-tolerated in 
this study. Simufilam significantly (P<0.05) improved an entire panel of biomarkers of disease in patients with Alzheimer’s 
disease compared  to  a  placebo  group.  In  addition,  Alzheimer’s  patients  treated  with  simufilam  showed  directional 
improvements  in  validated  tests  of  episodic  memory  and  spatial  working  memory, versus  patients  on  placebo.  Cognitive 
improvements  correlated  most  strongly  (R=0.5)  with  decreases  in  levels  of  P-tau181  in  CSF.  The  study  achieved  a  98% 
response  rate, defined as the proportion of study participants taking simufilam who showed improvements in biomarkers. 
Importantly, we believe these data are consistent with prior clinical and preclinical results, the drug’s mechanism of action 
and over 10 years of basic research. 

To our knowledge, no drug candidate has demonstrated the ability to reduce an entire panel of biomarkers of disease in 
patients with Alzheimer’s disease. For this reason, clinical data generated in our Phase 2a and Phase 2b studies may not be 
directly comparable to results generated by our competitors. 

Key exploratory biomarker results include the following (all p-values versus placebo) (Figure 5): 

•  Core markers of Alzheimer’s pathology are total tau (T-tau), phosphorylated tau (P-tau181), and amyloid beta42 (Aβ42). 

In Alzheimer’s, tau and P-tau levels are elevated and Aβ42 is low. 

o  T-tau decreased 15% (p<0.01) for patients in the 50 mg drug group.  
o  T-tau decreased 18% (p<0.01) for patients in the 100 mg drug group. 
o  P-tau decreased 8% (p<0.01) for patients in the 50 mg drug group.  
o  P-tau decreased 11% (p<0.01) for patients in the 100 mg drug group.  
o  Aβ42 increased 17% (p<0.01) for patients in the 50 mg drug group. 
o  Aβ42 increased 14% (p<0.01) for patients in the 100 mg drug group.  

•  Elevated CSF levels of two proteins, Neurogranin (Ng) and Neurofilament Light Chain (NfL) indicate neurodegeneration.  

o  Ng decreased 36% (p<0.01) for patients in the 50 mg drug group.  
o  Ng decreased 43% (p<0.01) for patients in the 100 mg drug group. 
o  NfL decreased 28% (p<0.05) for patients in the 50 mg drug group.  
o  NfL decreased 34% (p<0.01) for patients in the 100 mg drug group. 

•  Proinflammatory IL-6 (Interleukin 6) is produced in response to tissue stress and injury. 

o  IL-6 decreased 10% (p<0.01) for patients in the 50 mg drug group. 
o  IL-6 decreased 11% (p<0.01) for patients in the 100 mg drug group. 

•  Elevated levels of neuroinflammatory marker YKL-40 indicate microglial activation.  

o  YKL-40 decreased 10% (p<0.01) for patients in the 50 mg drug group. 
o  YKL-40 decreased 12% (p<0.01) for patients in the 100 mg drug group. 

•  sTREM2 is a neuroinflammation biomarker that has commanded substantial recent attention from researchers for its role 

in Alzheimer’s disease and frontotemporal dementia. 

o  sTREM2 decreased 43% (p<0.01) for patients in the 50 mg drug group. 

17 

  
 
 
 
 
  
  
 
 
 
 
o  sTREM2 decreased 46% (P<0.01) for patients in the 100 mg drug group. 

•  Simufilam Significantly Reduced Levels of HMGB1 in CSF. 

o  HMGB1 decreased 33% (p<0.01) in patients treated with 50 mg simufilam 
o  HMGB1 decreased 32% (p<0.01) in patients treated with 100 mg simufilam   

•  Simufilam Significantly Improved the Integrity of the Blood-brain Barrier (BBB). 
o  CSF IgG decreased 30% (p<0.05) in patients treated with 50 mg simufilam 
o  CSF IgG decreased 30% (p<0.05) in patients treated with 100 mg simufilam 
o  CSF albumin decreased 15% (p<0.05) in patients treated with 50 mg simufilam 
o  CSF albumin decreased 28% (p<0.05) in patients treated with 100 mg simufilam 

•  Simufilam Improved the Albumin Ratio, a Test of Blood-brain Barrier (BBB) Permeability: 

o  BBB permeability can be clinically evaluated by comparing levels of albumin in CSF and plasma. The albumin 
ratio is a test for BBB permeability because albumin protein is not synthesized in CSF. Hence, albumin in CSF 
necessarily  comes  from  plasma  through  the  BBB.  The  albumin  ratio  is  frequently  elevated  in  patients  with 
dementia and various other disorders. 

o  In the Phase 2b study, the albumin ratio was unchanged for Alzheimer’s patients on placebo. The albumin ratio 
improved by approximately 5 and 7 points for patients treated with simufilam, 50 mg and 100 mg, respectively, 
over 28 days. 

Changes in the Albumin Ratio by Treatment Group 

Treatment 
Placebo 
50 mg simufilam 
100 mg simufilam 

Day 0 
24 
25 
25 

Day 28 
24 
20 
18 

Change-Day 0 to 28 
No change 
- 20% 
- 28% 

Figure 5. Simufilam Improved Levels of Exploratory CSF Biomarkers in Patients with Alzheimer’s in a Phase 2b 
Study. 

% Change  Baseline to Day 28 -55%  -45% -35% -25% -15% -5% 5% 1 5% 25% A42 T- tau P-tau18 1 Nurogranin NfL YKL-40 IL-6  sTRE M2 HMG B1 A lbumin IgG  Placebo 50 mg 100  mg +p < 0.05  p < 0.01, #  p < 0.001,  p < 0.0001  vs. placebo 

18 

  
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Figure 6. Study Response Rate, Defined as the Proportion of Study Participants Taking Simufilam Who Showed 
Improvements in Biomarkers. 

A further objective of this study was to measure drug effects on cognition. Patients were tested at baseline and again on 
Day 28. Changes in episodic memory and spatial working memory were assessed on CANTAB, a validated, computer-based 
battery of tests. CANTAB is designed to measure cognitive skills regardless of the subject’s language skills, speed, gender or 
education. 

% of Patients  Who Resp onded to  Simufila m on  CSF  Bio markets Tau/p- Tau Biomarkers 98%  Bio markers of Neuroinflammation 98%  Bio markers of Neurodegeneration 98% Biomarkers of BBB In tegrity 9 5% 0%  10% 2 0% 30% 40% 5 0% 60% 70% 8 0% 90% 10 0% 

Only directional trends were observed in memory improvements, due to limitations around study size (N=64). The final data 
analysis shown in Figure 7 excludes three patients who we subsequently learned showed no detectable level of simufilam in 
plasma and two patients who missed 25% or more of their doses by pill counts. In addition, outlier subjects with the most and 
fewest errors (by baseline score cutoffs) were removed from the final analysis of episodic memory (Figure 7): 

•  Alzheimer’s patients in both drug groups showed directional improvements on tests of episodic memory and spatial 

memory after 28 days of treatment, versus patients on placebo. 

•  Episodic memory improved by -5.7 (lower score is better) for Alzheimer’s patients in the 50 mg drug group, versus 

-1.5 for patients on placebo.  

•  Episodic memory improved by -4.5 (lower score is better) for Alzheimer’s patients in the 100 mg drug group, versus 

-1.5 for patients on placebo.  

•  Spatial memory improved by -2.31 (lower score is better) for Alzheimer’s patients in the 50 mg drug group, versus 

-0.4 for patients on placebo.  

•  Spatial memory improved by -3.35 (lower score is better) for Alzheimer’s patients in the 100 mg drug group, versus 

• 

-0.4 for patients on placebo.  
Improvements in cognition correlated most strongly (statistical R=0.5) with decreases in CSF P-tau181, a biomarker 
that, when elevated, leads to tangles in the brain. Simufilam decreased brain levels of Ptau-181 by 8-11%, versus 
placebo. 

19 

  
 
 
 
 
 
Figure 7. Episodic Memory and Spatial Working Memory Improvements 

SavaDx 

Change in Errors  Baseline to Day 2 8 -6.0 -5.0 -4.0  -3.0 -2.0 -1.0  0.0  Placebo -1.5 50  mg -5.7 10 0 mg -4. 5 37% Effect Size 2% Effect Size  -3.5 -3. 0 -2.5 -2.0 -1.5 -1. 0 -0.5 0.0  Placebo -0.41  50 mg  -1.65 100  mg -3.3 3  

Our  investigational  diagnostic  product  candidate,  called  SavaDx,  is  an  early-stage  program  focused  on  detecting  the 
presence of Alzheimer’s disease from a small sample of blood. For business, technical and personnel reasons, we continue to 
prioritize the development of simufilam, our novel drug candidate, over SavaDx, our novel diagnostic candidate. SavaDx is 
currently a ‘research use only’, non-safety related exploratory biomarker. 

The regulatory pathway for SavaDx may eventually include formal analytical validation studies and clinical studies that 
support evidence of sensitivity, specificity and other variables in various healthy and diseased patient populations. We have 
not conducted such studies and do not expect to conduct such studies in 2023.  

SavaDx is currently designed as an antibody-based detection system for altered filamin A (FLNA). Working with third 

parties, we are evaluating the use of mass spectrometry to detect FLNA, i.e., without the use of antibodies. 

Over  the  past  ten  years,  we  discovered  that  altered  FLNA  is  a  hallmark  feature  of  brain  pathology  in  patients  with 
Alzheimer’s disease. We believe SavaDx may reveal early traces of the disease, potentially even before the overt appearance 
of disease symptoms, such as memory loss.   

A  diagnostic  test  usually  measures  one  or  more  biomarkers,  which  are  biological  indicators  of  disease.  A  deep 
understanding of the biology of disease is required to identify and develop a diagnostic. A valid diagnostic has certain baseline 
characteristics to be functional and useful for clinical practice. It must detect disease in  patients and, conversely, not detect 
disease in healthy subjects; and it is preferably quantitative, giving some indication of severity or stage of disease. Collectively, 
the ability to selectively detect disease indicators can be useful to provide diagnostic information (i.e., detect the disease) or 
prognostic information (i.e., predict the disease or its future course).  

Currently,  the  most  definitive  method  to  diagnose  Alzheimer’s  disease  is  through  autopsy  after  death,  which  is  not 
particularly helpful. Methods to detect Alzheimer’s disease during its course can  be expensive, invasive, subjective, risky 
and/or uncomfortable. Importantly, because of the expense and invasiveness of current tests, most people are not tested until 
they show obvious cognitive decline.  

Current approaches for diagnosing Alzheimer’s disease include measurement of amyloid-β (specifically, Aβ42), total tau 
(T-tau)  or  phosphorylated  tau  (P-tau)  levels  in  CSF  or  plasma;  structural  neuroimaging  techniques,  including  magnetic 
resonance imaging (MRI) or computerized tomography (CT); positron-emission tomography (PET) imaging of brain amyloid 
(AmyVid®); and batteries of cognitive tests. Usually, a combination of more than one test is necessary to provide a working 
diagnosis. When such tests and techniques are used together, the totality of data can be sensitive and specific for the detection 
of  Alzheimer’s  disease.  In  practice,  however,  such  tests  and  techniques  are  only  used  after  overt  symptoms  of  impaired 
memory.   

20 

  
 
 
 
 
 
 
 
 
 
 
 
 
We  believe  there  is  a  profound  need  for  a  blood-based  diagnostic  test  for  Alzheimer’s  disease.  A  quick,  simple, 
inexpensive  test may benefit the  medical community in many ways. Advantages may include confirming the presence of 
Alzheimer’s disease earlier, when lifestyle changes and potential therapeutics may have the most impact, or conversely, to 
rule out Alzheimer’s disease at such early stages. Other potential benefits include discriminating Alzheimer’s disease from 
other causes of dementias; helping to identify stage of Alzheimer’s disease; selection and enrollment of appropriate patients 
into clinical studies of experimental product candidates; and better alignment of a patient’s specific diagnosis with a targeted 
therapeutic.   

It is widely accepted that in Alzheimer’s disease, pathological changes in the  brain occur at least 10-15 years before 
clinical symptoms appear. These “pre-symptomatic” changes include deposits of certain misfolded or impaired proteins in the 
brain.  Our  long-term  goal  with  SavaDx  is  to  identify  people  with  Alzheimer’s  disease,  potentially  long  before  clinical 
symptoms occur. Early detection may be critical for any intervention to cease –  or at least slow down –  brain damage before 
it is too late. Importantly, a non-invasive screen for latent Alzheimer’s disease prior to overt symptoms could be conducted 
as a general health screen, not just in patients at risk by family history or in patients already showing cognitive impairment. 
Once a disease-modifying treatment is found, early detection is likely to be critically important. Early detection and treatment 
may also be critical in identifying such a disease-modifying treatment, as many believe one reason for clinical study failures 
in Alzheimer’s disease is that treatment has routinely started too late in the course of disease to make any impact. 

Moreover,  with  repeat  measurements  over  time,  SavaDx  may  provide  a  probability  of  cognitive  decline  or  disease 
progression. Even if SavaDx does not provide a precise numerical cutoff value for Alzheimer’s disease, we believe it may be 
important to incorporate data from SavaDx into the overall diagnostic framework for neurodegeneration, and  Alzheimer’s 
disease in particular. As with any diagnosis of disease, some people may embrace a way to detect Alzheimer’s disease long 
before clinical symptoms appear, while others may prefer not to know – at least until a treatment is found. 

Diagnostic development program. 

Diagnostic development differs from drug development in many important ways. As a result, diagnostic development 

requires substantial differences in planning, study design and study execution. 

Some of the ways that diagnostic development differs from drug development include the following: 

•  We may need to choose among a wider range of regulatory pathways for approval of SavaDx, depending on factors 

such as intended use and user, test type and complexity and role in patient-care decisions; 

•  Drug studies usually deal primarily with one office within FDA, but the regulatory pathway for SavaDx may require 

us to consider the policies of multiple federal or state regulatory agencies and offices; 

•  Unlike drug programs, statistical analysis with SavaDx does not focus on efficacy and safety endpoints. Rather, study 
endpoints for SavaDx will focus on sensitivity (true positives), specificity (true negatives), positive predictive value 
(percentage  of  correct  positive  diagnoses  of  known  positive  cases)  and  negative  predictive  value  (percentage  of 
correct negative diagnoses of known negative cases). 

SavaDx is an investigational diagnostic product candidate that has not yet been reviewed by FDA. Clinical testing consists 
of collecting blood samples on a limited scale to test and validate SavaDx using antibodies. Our ability to test such samples 
depends on multiple factors, many of which are beyond our control. For example, optimal sample collection depends on risk 
of sample degradation, storage requirements to preserve samples, cost of sample storage and actual vs. predicted time of assay 
validation.  

We have conducted four early validation tests using SavaDx. In three blinded studies of test samples, SavaDx detected 
more than a 10-fold separation between Alzheimer’s patients and normal healthy control subjects (N=232 test samples). In 
these three proof-of-concept studies, SavaDx demonstrated nearly 100% accuracy and specificity. The three studies deployed 
a research grade antibody manufactured by an outside vendor.   

A fourth blinded study of SavaDx failed to generate meaningful diagnostic data. We believe the fourth study deployed a 
faulty  research  antibody  sourced  from  an  outside  vendor.  Commercially  available  research  antibodies  can  present  certain 
technical flaws, such as improper validation, significant batch-to-batch variations or inconsistent storage, any of which can 
jeopardize results of studies and experiments. For these reasons, and in order to increase consistency of quality, reliability and 
availability, we have attempted to develop and validate a proprietary, fit-for-purpose, monoclonal antibody system for use 
with SavaDx. This effort remains a work-in-progress.  

21 

  
 
 
 
 
 
 
 
 
 
 
 
 
In July 2021, we announced positive clinical data with SavaDx when used to measure plasma levels of altered filamin A 
before and after simufilam treatment in patients with Alzheimer’s disease. In a Phase 2b randomized, controlled trial sponsored 
by  the  National  Institutes  of  Health  (NIH),  simufilam  significantly  reduced  a  plasma  marker  of  altered  filamin  A  in 
Alzheimer’s patients treated for 28 days. Plasma levels of p-tau181 also dropped significantly in these same patients. 

The legal system for intellectual property around diagnostic methods is highly complex and uncertain. In the U.S., patent 
courts have struggled to define a clear means of patent eligibility for modern age diagnostics. Generally, a simple process 
involving correlations between blood test results and patient health is not eligible for patent claims because such processes 
incorporate “laws of nature”. However, different outcomes from different courts, including Federal Circuit, district court and 
Patent Trial and Appeal Board decisions, have continued to create a sometimes vague or conflicting legal framework for 
determining the eligibility of patent claims for diagnostic methods. As a result, we cannot be certain how SavaDx fits into the 
current  U.S.  legal  framework  for  obtaining  effective  patent  claims.  Furthermore,  claims  for  diagnostic  methods  can  be 
complicated to enforce. 

We currently have no issued patents in the United States with respect to SavaDx. 

Expansion of our science to other indications. 

It is well known that protein misfolds occur in a wide variety of biological processes and diseases. We may leverage our 
scientific insights in neurodegeneration and neuroinflammation and advanced tools in molecular biology,  biochemistry, and 
imaging to expand our science to other diseases. New indications and new drug development approaches may complement 
our initial focus on Alzheimer’s disease. 

Preclinical programs are always visionary, sometimes innovative and often of high biomedical potential. However, by 
definition, such programs are exploratory and risky. Moreover, most preclinical programs fail for scientific or other reasons, 
regardless of the amount of effort or resources that are brought to bear upon such programs. For these reasons, in general we 
do  not  intend  to  disclose  our  preclinical  programs  until  such  time  as  they  become  material  to  our  pipeline  of  product 
candidates. 

We own worldwide rights to our neurodegeneration program.  

We own intellectual property, including patents, patent applications, technology, trade secrets and know-how in the U.S. 
and  other  countries. The protection  of  patents, designs,  trademarks  and other proprietary  rights  that  we  own  or  license  is 
critical  to  our  success  and  competitive  position.  We  consider  the  overall  protection  of  our  patents  and  other  intellectual 
property rights to be of material value and act to protect these rights from infringement.  

We seek to protect our technology by, among other methods, filing and prosecuting U.S. and foreign patents and patent 
applications with respect to our technology and products and their uses.  The focus of our patent strategy is to secure and 
maintain intellectual property rights to technology for our program in neurodegeneration. 

Simufilam was discovered and designed in-house and was characterized by our academic collaborators during research 
activities  that  were  conducted  from  approximately  2008  to  date.  SavaDx  is  being  developed  in-house  with  outside 
collaborators. We own exclusive, worldwide rights to drug and diagnostic assets and related technologies, without royalty 
obligations to any third party. Our patent protection with respect to simufilam and use of simufilam for Alzheimer’s disease 
and other neurodegenerative diseases currently runs through 2039 and includes seven issued U.S. patents. In addition, we 
have patent protection with respect to simufilam for use in treating certain cancers that runs through 2034. Our patent estate 
further includes patents and patent applications for related compounds and treatments. Corresponding foreign filings have 
been made for each of the U.S. filings. 

Our Development Team  

Our product development team is led by seasoned professionals with a proven track record of innovation in drug discovery 

and development, as well as substantial business expertise.  

Our Founder and Chief Executive Officer, Remi Barbier, has over 25 years of biopharmaceutical industry experience and 
has led teams responsible for pioneering several pharmaceutical innovations, including abuse-deterrent drugs; the clinical 
development of multiple pain drugs; an innovative antibody program in cancer; and other programs in neuroscience and other 
therapeutics areas. Before founding Cassava Sciences, he held leadership roles and was founder or co-founder of four life 
science companies, three of which are now publicly traded or acquired. 

22 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
Our Chief Medical Officer, James Kupiec, MD, has two prior FDA drug approvals and previously served at Pfizer, Inc. 
as VP, Global Clinical Leader for Parkinson’s Disease and Clinical Head of the Neuroscience Research Unit. Dr. Kupiec also 
held leadership roles at Sanofi and Ciba-Geigy Pharmaceuticals and before that was a practicing neurologist. 

Lindsay Burns, PhD, SVP, Neuroscience, worked on the development of several product candidates in neuroscience and 

other therapeutics areas while at Neurex (acquired by Elan Pharmaceuticals) and Abgenix (acquired by Amgen). 

Michael Zamloot, SVP of Technology Operations, has four prior FDA drug approvals and has worked in drug operations 
and supply chain management at Boehringer Mannheim (acquired by Roche Diagnostics), Athena Neuroscience (acquired by 
Elan Pharmaceuticals) and Ciba-Geigy (acquired by Novartis). 

Michael  Marsman,  PharmD,  SVP  of  Regulatory  Affairs  previously  held  senior  positions  at  Impax  Laboratories, 
Millennium Pharmaceuticals, and Syntex, where he  had shared responsibility for the regulatory  approval of several high-
profile drugs. He also previously led regulatory affairs for our Company for nearly a decade until 2019. 

George (Ben) Thornton, PhD, SVP of Technology, has led research and development teams at Johnson & Johnson as 

well as translated basic science to the clinical setting at biotechnology start-ups such as GeneMedicine and Apovia. 

Our  management  team  is  further  supported  by  scientific  advisors  who  are  leading  experts  in  the  field  and  share  our 

commitment to advancing new treatments for neurodegenerative diseases, including Alzheimer’s disease.  

Our Strategy  

Our goal is to develop product candidates to diagnose and treat neurodegeneration, such as Alzheimer’s disease. Key 

elements of our business strategy to achieve this mission include:  

• 

• 

• 

• 

• 

building  a  lean  company  that  is  narrowly  focused  on  developing  innovative  product  candidates  for  Alzheimer’s 
disease and other areas of neurodegeneration; 

validating our unique scientific approach with competitive research grants and publishing our scientific data in peer-
reviewed journals; 

applying our development capabilities to advance our product candidates through clinical proof-of-concept studies 
and beyond; 

using  our  expertise  and  experience  to  continue  to  focus  on  discovering  new  indications  and  product  candidates, 
validated by experimental evidence and leading experts in the field; and 

continuing to outsource preclinical studies, clinical studies and formulation development activities in order to allow 
more efficient deployment of our resources 

We also conduct basic research and development in collaboration with academic and other partners. Our research and 
development expenses were $68.0 million, $24.8 million and $3.1 million for the year ended December 31, 2022, 2021 and 
2020,  respectively.  These  amounts  are  net  of  significant  reimbursement  received  from  NIH.  See  “Item  7.  Management’s 
Discussion and Analysis of Financial Condition and Results of Operations” for additional details regarding our research and 
development activities. 

Competition 

The drug discovery and development industry is characterized by rapidly advancing technologies, intense competition 
and  a  strong  emphasis  on  proprietary  products.  We  face  potential  competition  from  many  different  sources,  including 
pharmaceutical and biotechnology companies, academic institutions, governmental agencies, and public and private research 
institutions. Any product candidates that we  successfully develop and commercialize, such as simufilam or SavaDx, may 
compete with existing therapies and new therapies that may become available in the future. 

Historically, the drug industry has attempted to treat Alzheimer’s disease by developing drugs that block the synthesis 
of,  or  remove  or  dis-aggregate,  beta  amyloid  and,  more  recently,  another  protein  in  the  brain  called  tau.  Essentially,  the 
prevailing doctrine says amyloid (or tau) must be cleared out of the brain. This scientific approach – known as the amyloid 
hypothesis - has been repeatedly tested by our competitors in late-stage clinical studies using a variety of antibody backbones, 
epitopes, target conformations, biomarkers and in various stages of disease. More recent competitors in Alzheimer’s research 

23 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
are  focused  on  modulating  proteins  in  the  brain  that  have  anti-inflammatory  or  other  properties,  an  approach  known  as 
immunotherapy.  

In  contrast,  our  scientific  approach  seeks  to  simultaneously  improve  neurodegeneration  and  neuroinflammation.  We 
believe improving multiple vital functions in the brain represents a new, different and crucial approach to address Alzheimer’s 
disease. 

Regardless of scientific approach, improvement in both cognition and health function remains a key criterion for a new 
drug in Alzheimer’s disease to receive full, unconditional marketing approval from the FDA, a hurdle which, to date, no drug 
candidate has met with clear and compelling clinical data in nearly two decades. 

Our competitors may have significantly greater financial resources, an established presence in the market, expertise in 
research and development, manufacturing, preclinical and clinical testing, obtaining regulatory approvals and reimbursement 
and  marketing-approved  products.  These  competitors  compete  with  us  in  recruiting  and  retaining  qualified  scientific  and 
technical personnel, establishing clinical study sites and patient registration for clinical studies, as well as in acquiring or 
developing technologies complementary to, or necessary for, our programs. Smaller or early-stage companies may also prove 
to be significant competitors, particularly through collaborative arrangements with large and established companies.  

The  key competitive factors affecting the success of simufilam, and any other product candidates that we  develop to 
address neurodegenerative disorders, if approved, are likely to be their efficacy, safety, convenience, price, the level of generic 
competition, patient and physician acceptance and the availability of reimbursement from government and other third-party 
payors. Our commercial opportunity could be reduced or eliminated if our competitors develop and commercialize products 
that are more effective, have fewer or less severe side effects, are more convenient or are less expensive than products that 
we may develop. 

Our competitors also may obtain FDA approval for their products more rapidly than we may obtain approval for ours. 
For example, in June 2021, the FDA approved aducanumab (human monoclonal antibody; Biogen, Inc.) for the treatment of 
Alzheimer’s disease using an accelerated approval pathway. Aducanumab’s safety and efficacy profile is complex and subject 
to debate. Since its approval in 2021, aducanumab has had modest clinical utilization due to its high cost, lack of widespread 
reimbursement and other reasons. In January 2023, the FDA approved lecanumab (humanized version of a mouse monoclonal 
antibody; Eisai Co., Ltd) for the treatment of Alzheimer’s disease using an accelerated approval pathway. Both drugs are 
delivered by infusion.  

In recent years, we have observed ramped-up worldwide efforts aimed at developing blood-based techniques to detect 
and  monitor  Alzheimer’s  disease.  The  key  competitive  factors  affecting  the  success  of  SavaDx,  and  any  other  product 
candidates that we develop to diagnose neurodegeneration, if approved, are likely to be their measure of accuracy, such as 
specificity and sensitivity, as well as their convenience, patient acceptance, price and the availability of reimbursement from 
government  and  other  third-party  payors.  Our  competitors  in  the  diagnostic  area  are  pharmaceutical  and  biotechnology 
companies, academic institutions and governmental agencies and public and private research institutions. Despite increased 
research effort, the field has generally been hampered by lack of reproducibility and an unclear path on how to move academic 
discoveries into clinical utilization.  

In addition to blood-based techniques to detect Alzheimer’s disease, competitors are examining the use of novel tracing 
agents  and  imaging  techniques  to  map  the  course  of  neurodegeneration.  In  2012,  FDA  approved  Amyvid®  (Eli  Lilly 
Pharmaceuticals),  which  is  a  radioactive  diagnostic  agent  for  brain  imaging  of  amyloid  plaque.  Amyvid  can  rule  out 
Alzheimer’s disease but does not confirm its presence. That is, a negative scan means little or no plaque is present; however, 
a positive scan does not necessarily indicate Alzheimer’s disease. In addition, Amyvid cannot be used to stage Alzheimer’s 
disease because some people take years to show cognitive decline after amyloid plaque develops, while other others rapidly 
develop advanced Alzheimer’s disease within months. Since its approval in 2012, Amyvid has had modest clinical utilization 
due to its high cost, lack of widespread reimbursement and need for specialized training.   

Manufacturing 

Simufilam  must  be  manufactured  for  clinical  trial  use  in  compliance  with  cGMP  regulations.  These  regulations  are 
extensive,  stringent  and  complex,  and  may  include  requirements  regarding  the  organization  of  personnel,  buildings  and 
facilities,  equipment,  control  of  components  and  drug  product  containers  and  closures,  production  and  process  controls, 
packaging and labeling controls, holding and distribution, laboratory controls, records and reports, and returned or salvaged 
products. Our manufacturing vendors must have facilities to make simufilam in strict compliance with cGMP requirements 
and FDA or comparable foreign regulatory authority’s satisfaction. Our third-party vendors may also be subject to periodic 
inspections  of  their  respective  facilities  for  general  cGMP  compliance  by  the  FDA  and  other  foreign  authorities.  These 

24 

  
 
 
 
 
 
 
 
 
 
inspections  may  include  review  of  procedures  and operations  used  in  the  testing  and  manufacture of  simufilam  to  assess 
compliance with applicable regulations. Failure to comply with statutory and regulatory requirements subjects a manufacturer 
to possible legal or regulatory action, including warning letters, the seizure or recall of products, injunctions, consent decrees 
placing  significant  restrictions  on  or  suspending  manufacturing  operations  and  civil  and  criminal  penalties.  Contract 
manufacturers  often  encounter  difficulties  involving  production  yields,  quality  control  and  quality  assurance,  as  well  as 
shortages of qualified personnel. Any of these actions or events could have a material impact on the availability of simufilam. 
Our suppliers  may be forced to stop producing, storing, shipping or testing simufilam if they fall out of compliance with 
government regulations and standards. 

We do not own or lease any manufacturing facilities. We outsource formulation, manufacturing and related activities to 
third  parties.  For  the  foreseeable  future,  we  will  continue  to  rely  on  third  parties  to  conduct  certain  quality  control  and 
assurance testing, shipping or storage of our product candidates. 

We currently rely on one non-affiliated contract development and manufacturing organization (CDMO) to manufacture 

simufilam and expect to continue to do so. 

We believe our manufacturing strategy will continue to ensure sufficient drug supply for a Phase 3 program, including 
both drug substance (i.e., active ingredient) and drug product (i.e., oral tablets). In March 2021, we entered into an agreement 
with Evonik Corporation to supply large-scale, clinical-grade quantities of drug substance for simufilam. The goal is to ensure 
the integrity of the drug supply chain on a worldwide basis, in compliance with FDA standards. We believe raw materials for 
our drug product are readily available from reliable sources.  

Our suppliers must comply with current good manufacturing practices (cGMP) enforced by FDA and other government 
agencies. Our suppliers are subject to unannounced inspection by regulators, including pre-approval inspections by FDA, to 
ensure  they  are  in  strict  compliance  with  government  regulations  and  standards.  Our  suppliers  may  be  forced  to  stop 
producing,  storing,  shipping or  testing  our  drug  products  if  they  fall  out  of  compliance  with  government  regulations  and 
standards.  

We have  limited or  no control  over our suppliers’ compliance, or lack thereof, with the multitude of regulations and 
standards that affect our drug products. We cannot control decisions by our suppliers that affect their ability or willingness to 
continue to supply us on acceptable terms, or at all.  

Government Regulation  

Our operations are subject to various levels of governmental controls and regulations in the United States and in  other 
countries where we operate, including Canada, South Korea and Australia. We attempt to comply with all legal requirements 
in the conduct of our operations and employ business practices that we consider to be prudent under the circumstances in 
which we operate. Government authorities in the U.S. (federal, state and local), Canada, South Korea, Australia and other 
countries regulate, among other things, the research, development, testing, manufacture, quality control, approval, labeling, 
packaging, storage, record-keeping, promotion, advertising, distribution, post-approval monitoring and reporting, marketing 
and  export  and  import  of  drug  and  diagnostic  products.  Generally,  before  a  new  drug  or  diagnostic  can  be  marketed, 
considerable data demonstrating its quality, safety and efficacy and/or specificity must be obtained, organized into a format 
specific for each regulatory authority, submitted for review and approved by each regulatory authority.  

U.S. Drug Development  

In the U.S., FDA regulates drugs under the Food, Drug, and Cosmetic Act (FDCA). Both drugs and diagnostics also are 
subject  to  other  federal,  state  and  local  statutes  and  regulations.  The  process  of  obtaining  regulatory  approvals  and  the 
subsequent compliance with appropriate federal, state, local and foreign statutes and regulations requires the expenditure of 
substantial  time  and  financial  resources.  Failure  to  comply  with  the  applicable  U.S.  requirements  at  any  time  during  the 
product development process, approval process or post-market may subject an applicant to administrative or judicial sanctions. 
These  sanctions  could  include,  among  other  actions,  FDA’s  refusal  to  approve  pending  applications,  withdrawal  of  an 
approval, a clinical hold, untitled or warning letters, product recalls or market withdrawals, product seizures, total or partial 
suspension of production or distribution, injunctions, fines, refusals of government contracts, restitution, disgorgement and 
civil or criminal penalties. Any agency or judicial enforcement action could have a material adverse effect on us. 

Product candidates must be approved by FDA before they may be commercialized in the U.S. The drug approval process 

generally involves the following:  

25 

  
  
 
 
 
 
 
 
 
 
 
  
 
•  Completion of extensive preclinical studies in accordance with applicable regulations, including studies conducted 

in accordance with good laboratory practice; 

•  Submission to FDA of an IND, which must become effective before human clinical studies may begin; 

•  Approval by an independent institutional review board (IRB) or ethics committee before each study may be initiated; 

•  Performance of adequate and well-controlled human clinical studies in accordance with applicable IND regulations, 
code of good clinical practice (cGCP), requirements and other clinical trial-related regulations to establish the safety 
and efficacy of the investigational product for each proposed indication; 

•  Submission to FDA of an NDA; 

•  A determination by FDA within 60 days of its receipt of an NDA to accept the filing for review; 

•  Satisfactory completion of an FDA pre-approval inspection of the manufacturing facility or facilities where the drug 
will be produced to assess compliance with cGMP, requirements to assure that the facilities, methods and controls 
are adequate to preserve the drug’s identity, strength, quality and purity; 

•  Potential FDA audit of the preclinical study and/or clinical study sites that generated the data in support of the NDA; 

•  FDA review and approval of the NDA, including consideration of the views of any FDA advisory committee, prior 

to any commercial marketing or sale of the drug in the U.S.; and 

•  Compliance  with  any  post-approval  requirements,  including  the  potential  requirement  to  conduct  post-approval 

studies. 

The data required to support an NDA are generated in two distinct developmental stages: preclinical and clinical. The 
preclinical and clinical testing and approval process requires substantial time, effort and financial resources, and we cannot 
be certain that any approvals for any future product candidates will be granted on a timely basis, or at all.  

Preclinical Studies and IND  

The  preclinical  developmental  stage  generally  involves  laboratory  evaluations  of  drug  chemistry,  formulation  and 
stability, as well as studies to evaluate toxicity in animals, which support subsequent clinical testing. As sponsor, we must 
submit the results of the preclinical studies, together with manufacturing information, analytical data, any available clinical 
data or literature and a proposed clinical protocol, to FDA as part of the IND. An IND is a request for authorization from FDA 
to administer an investigational product to humans and must become effective before human clinical studies may begin.  

Preclinical studies include laboratory evaluation of product chemistry and formulation, as well as in vitro and animal 
studies to assess the potential for adverse events and in some cases to establish a rationale for therapeutic use. The conduct of 
preclinical studies is subject to federal regulations and requirements, including cGCP regulations for safety/toxicology studies. 
An IND sponsor must submit the results of the preclinical tests, together with manufacturing information, analytical data, any 
available clinical data or literature and plans for clinical studies, among other things, to FDA as part of an IND. Some long-
term preclinical testing, such as long-term toxicity tests, animal tests of reproductive adverse events and carcinogenicity, may 
continue after the IND is submitted. An IND automatically becomes effective 30 days after receipt by FDA, unless before 
that time FDA raises concerns or questions about any aspect of the program. In such a case, the IND sponsor and FDA must 
resolve any outstanding concerns before the clinical study can begin. 

Clinical Studies  

The  clinical  stage  of  development  involves  the  administration  of  the  investigational  product  to  healthy  volunteers  or 
patients under the supervision of qualified investigators, generally physicians not employed by or under the study sponsor’s 
control,  in  accordance  with  cGCP  requirements,  which  include  the  requirement  that  all  research  subjects  provide  their 
informed consent for their participation in any clinical trial. Clinical studies are conducted under protocols detailing, among 
other things, the objectives of the clinical trial, dosing procedures, subject selection and exclusion criteria and the parameters 
to be used to monitor subject safety and assess efficacy. Each protocol, and any subsequent amendments to the protocol, must 
be submitted to FDA as part of the IND. Furthermore, each clinical study must be reviewed and approved by an IRB for each 
institution at which the clinical study will be conducted to ensure that the risks to individuals participating in the clinical 
studies are minimized and are reasonable in relation to anticipated benefits. The IRB also approves the informed consent form 
that must be provided to each clinical study subject or his or her legal representative and must monitor the clinical study until 

26 

  
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
completed.  There  also  are  requirements  governing  the  reporting  of  ongoing  clinical  studies  and  completed  clinical  study 
results to public registries.  

A sponsor who wishes to conduct a clinical study outside of the U.S. may, but need not, obtain FDA authorization to 
conduct the clinical study under an IND. If a foreign clinical study is not conducted under an IND, the sponsor may submit 
data from the clinical study to FDA in support of an NDA. The FDA may accept a well-designed and well-conducted foreign 
clinical study not conducted under an IND if the study was conducted in accordance with cGCP requirements and FDA is 
able to validate the data through an onsite inspection if deemed necessary. We currently have clinical sites outside of the U.S. 
in Canada, Puerto Rico, South Korea and Australia. 

Clinical studies in the U.S. generally are conducted in three sequential phases, known as Phase 1, Phase 2 and Phase 3, 

and may overlap.  

•  Phase 1 clinical studies generally involve a small number of healthy volunteers or disease-affected patients who are 
initially exposed to a single dose and then multiple doses of the product candidate. The primary purpose of these 
clinical studies is to assess the metabolism, pharmacologic action, tolerability and safety of a drug candidate. 

•  Phase 2 clinical studies involve studies in disease-affected patients to determine the proper dose required to produce 
the  desired  benefits.  At  the  same  time,  safety  and  further pharmacokinetic  and pharmacodynamic  information  is 
collected, possible adverse effects and safety risks are identified, and a preliminary evaluation of efficacy may be 
observed. 

•  Phase 3 clinical studies generally involve enrolling many patients at multiple sites and are designed to provide the 
data necessary to demonstrate the effectiveness of the product for its intended use, its safety in use and to establish 
the overall benefit/risk relationship of the product and provide an adequate basis for product approval. These studies 
may  include  comparisons  with  placebo  and/or  other  comparator  treatments.  The  duration  of  treatment  is  often 
extended to mimic the actual use of a product during marketing. 

Post-approval  studies,  sometimes  referred  to  as  Phase 4  clinical  studies,  may  be  conducted  after  initial  marketing 
approval.  These  studies  are  used  to  gain  additional  experience  from  the  treatment  of  patients  in  the  intended  therapeutic 
indication. In certain instances, FDA may mandate the performance of Phase 4 clinical studies as a condition of approval of 
an NDA.  

Progress reports detailing the results of the clinical studies, among other information, must be submitted at least annually 
to  FDA.  Written  safety  reports  and  the  investigators  for  serious  and  unexpected  adverse  events,  or  any  other  findings 
suggesting a significant risk to humans exposed to the drug must be submitted to FDA.  

Phase 1, Phase 2, and Phase 3 clinical studies may not be completed successfully within any specified period, if at all. 
The FDA or the sponsor may suspend or terminate a clinical study at any time on various grounds, including a finding that 
the research subjects or patients are being exposed to an unacceptable health risk. Similarly, an IRB can suspend or terminate 
approval  of  a  clinical  study  at  its  institution  if  the  clinical  study  is  not  being  conducted  in  accordance  with  the  IRB’s 
requirements or if the drug has been associated with unexpected serious harm to patients. Additionally, some clinical studies 
are overseen by an independent group of qualified experts organized by the clinical study sponsor, known as a data  safety 
monitoring board. This group provides authorization for whether a study may move forward at designated check-points based 
on access to certain data from the trial. Concurrent with clinical studies, companies usually complete additional animal studies 
and must develop additional information about the chemistry and physical characteristics of the drug as well as finalize a 
process for manufacturing the product in commercial quantities in accordance with cGMP requirements. The manufacturing 
process must be capable of consistently producing quality batches of the product and, among other things, companies must 
develop methods for testing the identity, strength, quality and purity of the final product. Additionally, appropriate packaging 
must be selected and tested, and stability studies must be conducted to demonstrate that our product candidates do not undergo 
unacceptable deterioration over their shelf life. 

NDA Review Process 

Following completion of the clinical studies, data is analyzed to assess whether the investigational product is safe and 
effective for the proposed indicated use or uses. The results of preclinical studies and clinical studies are then submitted  to 
FDA as part of an NDA, along with proposed labeling, chemistry and manufacturing information to ensure product quality 
and other relevant data. In short, the NDA is a request for approval to market a drug for one or more specified indication and 
must contain proof of safety and efficacy for a drug’s purity and potency. The application may include both negative and 
ambiguous results of preclinical studies and clinical  studies, as well as positive findings. Data may come from company-
sponsored  clinical  studies  intended  to  test  the  safety  and  efficacy  of  a  product’s  use  or  from  several  alternative  sources, 

27 

  
 
 
  
 
 
 
 
 
 
 
including studies initiated by investigators. To support marketing approval, the data submitted must be sufficient in quality 
and quantity to establish the safety and efficacy of the investigational product to the satisfaction of FDA. FDA approval of an 
NDA must be obtained before a drug may be marketed in the U.S.  

Under the Prescription Drug User Fee Act (PDUFA), as amended, each NDA must be accompanied by a user fee. FDA 
adjusts  the  PDUFA  user  fees  on  an  annual  basis.  According  to  FDA’s  fiscal  year  2023  fee  schedule,  effective  through 
September 30, 2023, the user fee for an application requiring clinical data, such as an NDA, is approximately $3.2 million. 
Fee  waivers  or  reductions  are  available  in  certain  circumstances,  including  a  waiver  of  the  application  fee  for  the  first 
application filed by a small business. Additionally, no user fees are assessed on NDAs for products designated as orphan 
drugs, unless the product also includes a non-orphan indication.  

The FDA reviews all submitted NDAs before it accepts them for filing and may request additional information rather 
than accept the NDA for filing. The FDA must decide whether to accept an NDA for filing within 60 days of receipt. Once 
the submission is accepted for filing, FDA begins an in-depth review of the NDA. Under the goals and policies agreed to by 
FDA under PDUFA, FDA has 10 months, from the filing date, in which to complete its initial review of a new molecular-
entity NDA and respond to the applicant, and six months from the filing date of a new molecular-entity NDA designated for 
priority review. The FDA does not always meet its PDUFA goal dates for standard and priority NDAs, and the review process 
is often extended by FDA requests for additional information or clarification.  

Before  approving  an  NDA,  FDA  may  conduct  a  pre-approval  inspection  of  the  manufacturing  facilities  for  the  new 
product  to  determine  whether  they  comply  with  cGMP  requirements.  The  FDA  will  not  approve  the  product  unless  it 
determines that the manufacturing processes and facilities fully comply with cGMP requirements and are adequate to assure 
consistent production of the product within required specifications. The FDA also may audit data from clinical studies to 
ensure compliance with cGCP requirements. Additionally, FDA may refer applications for novel product candidates which 
present difficult questions of safety or efficacy to an advisory committee, typically a panel that includes clinicians and other 
experts,  for  review,  evaluation  and  a  recommendation  as  to  whether  the  application  should  be  approved  and  under  what 
conditions,  if  any.  The  FDA  is  not  bound  by  recommendations  of  an  advisory  committee,  but  it  considers  such 
recommendations when making decisions on approval. The FDA likely will reanalyze the clinical study data, which could 
result in extensive discussions between FDA and the applicant during the review process. After FDA evaluates an NDA, it 
will issue either an approval letter or a Complete Response Letter (CRL). An approval letter authorizes commercial marketing 
of  the  drug  with  specific  prescribing  information  for  specific  indications.  A  CRL  indicates  that  FDA’s  review  of  the 
application is complete and the application cannot be approved in its present form. A CRL usually describes the specific 
deficiencies in the NDA identified by FDA. The CRL may require additional clinical data, additional pivotal Phase 3 clinical 
trial(s)  and/or  other  significant  and  time-consuming  requirements  related  to  clinical  studies,  preclinical  studies  or 
manufacturing. If a CRL is issued, the applicant may either resubmit the NDA, addressing all the deficiencies identified in 
the CRL, or withdraw the application. Even if such data and information are submitted, FDA may decide that the NDA does 
not satisfy the criteria for approval. Data obtained from clinical studies are not always conclusive and FDA may interpret data 
differently than we interpret the same data. 

Commercialization Plan 

Our product candidates have not received marketing approval from the FDA, and we do not expect to have any approved 
product candidates in the near term. We currently have no company experience in marketing drugs and have no personnel, 
capabilities or infrastructure in sales, marketing, third-party payor programs or commercial product distribution. When and if 
any of our product candidates are approved for commercialization, we will need to develop a commercialization infrastructure 
for any such product in the U.S. and potentially in certain other key markets. As a matter of strategy, we may also rely on 
partnerships or collaborations with larger biopharmaceutical companies to provide commercialization infrastructure, such as 
sales and marketing and commercial distribution. 

Advertising and Promotion  

The FDA and other federal regulatory agencies closely regulate the marketing and promotion of drugs through, among 
other  things,  standards  and  regulations  for  direct-to-consumer  advertising,  communications  regarding  unapproved  uses, 
industry-sponsored scientific and educational activities, and promotional activities involving the Internet. None of our product 
candidates can be commercially promoted before receiving FDA approval. After approval, product promotion can include 
only  those  claims  relating  to  safety  and  effectiveness  that  are  consistent  with  the  labeling  approved  by  FDA.  Healthcare 
providers are permitted to prescribe drugs for “off-label” uses — that is, uses not approved by FDA and therefore not described 
in the drug’s labeling — because FDA does not regulate the practice of medicine. However, FDA regulations impose stringent 
restrictions on manufacturers’ communications regarding off-label uses. Failure to comply with applicable FDA requirements 
and restrictions in this area may subject  us to adverse publicity and enforcement action by FDA, the U.S. Department of 

28 

  
 
 
 
 
 
 
 
Justice, or the Office of the Inspector General of Health and Human Services, as well as state authorities. This could subject 
us to a range of penalties that could have a significant commercial impact, including civil and criminal fines and agreements 
that materially restrict the manner in which we promote or distribute our product candidates. 

Post-Approval Requirements 

After a product candidate receives regulatory approval, it is often subject to pervasive and continuing regulation by FDA, 
including,  among  other  things,  requirements  relating  to  drug  listing  and  registration,  recordkeeping,  periodic  reporting, 
product sampling and distribution, adverse event reporting and advertising, marketing and promotion restrictions.  

Adverse event reporting and submission of periodic reports is required following FDA approval of an NDA. The FDA 
also may require post-market testing, known as Phase 4 testing, or FDA may place conditions on an approval that could restrict 
the distribution or use of the product. In addition, quality control, drug manufacture, packaging, and labeling procedures must 
continue to conform to cGMP after approval. Drug manufacturers and certain of their subcontractors are required to register 
their  establishments  with  FDA  and  certain  state  agencies.  Registration  may  result  in  periodic  announced or unannounced 
inspections by FDA or these state agencies, during which the agency inspects manufacturing facilities to assess compliance 
with cGMP.  Accordingly, manufacturers must continue to expend time, money, and effort in the areas of production and 
quality control to maintain compliance with cGMP. Regulatory authorities may withdraw product approvals or request product 
recalls if a company fails to comply with regulatory standards, if it encounters problems following initial marketing, or if 
previously unrecognized problems are subsequently discovered. In addition, other regulatory actions may be taken, including, 
among other things, warning letters, the seizure of products, injunctions, consent decrees placing significant restrictions on or 
suspending manufacturing operations, refusal to approve pending applications or supplements to approved applications, civil 
penalties, and criminal prosecution.  

The FDA may require post-approval clinical studies to help assure continued safety or effectiveness of the approved drug. 
The FDA may also require a labeling change if it becomes aware of new safety information that it believes should be included 
in the labeling of a drug. 

In addition to the FDA, manufacturing, sales, promotion and other activities following product approval are also subject 
to regulation by numerous regulatory authorities in the U.S., including the Centers for Medicare and Medicaid Services, other 
divisions  of  the  Department  of  Health  and  Human  Services,  the  Department  of  Justice,  the  Consumer  Product  Safety 
Commission, the Federal Trade Commission, the Occupational Safety & Health Administration, the Environmental Protection 
Agency, the Affordable Care Act (ACA) and state and local governments. 

For example, in the United States, sales, marketing and scientific and educational programs must also comply with state 
and federal fraud and abuse laws. These laws include the federal Anti-Kickback Statute, which makes it illegal for any person, 
including a prescription drug manufacturer (or a party acting on its behalf), to knowingly and willfully solicit, receive, offer 
or pay any remuneration that is intended to induce or reward referrals, including the purchase, recommendation, order or 
prescription of a particular drug, for which payment may be made under a federal healthcare program, such as Medicare or 
Medicaid. Violations of this law are punishable by prison, criminal fines, administrative civil money penalties and exclusion 
from participation in federal healthcare programs. Moreover, the ACA provides that the government may assert that a claim 
including items or services resulting from a violation of the federal Anti-Kickback Statute constitutes a false or fraudulent 
claim for purposes of the False Claims Act.  

Pricing  and  rebate  programs  must  comply  with  the  Medicaid  rebate  requirements  of  the  U.S.  Omnibus  Budget 
Reconciliation Act of 1990 and more recent requirements in the ACA. If products are made available to authorized users of 
the Federal Supply Schedule of the General Services Administration, additional laws and requirements apply. Products must 
meet  applicable  child-resistant  packaging  requirements  under  the  U.S.  Poison  Prevention  Packaging  Act.  Manufacturing, 
sales,  promotion  and  other  activities  also  are  potentially  subject  to  federal  and  state  consumer  protection  and  unfair 
competition laws. 

The distribution of pharmaceutical products is subject to additional requirements and regulations, including extensive 
record-keeping,  licensing,  storage  and  security  requirements  intended  to  prevent  the  unauthorized  sale  of  pharmaceutical 
products. 

The failure to comply with any of these laws or regulatory requirements subjects firms to possible legal or regulatory 
action. Depending on the circumstances, failure to meet applicable regulatory requirements can result in criminal prosecution, 
fines or other penalties, injunctions, requests for recall, seizure of products, total or partial suspension of production, denial 
or withdrawal of product approvals or refusal to allow a firm to enter into supply contracts, including government contracts.  
Any action against us for violation of these laws, even if we successfully defend against it, could cause us to incur significant 

29 

  
 
 
 
 
 
  
  
  
 
legal expenses and divert our management’s attention from the operation of our business. Prohibitions or restrictions on sales 
or withdrawal of future products marketed by us could materially affect our business in an adverse way. 

Changes in regulations, statutes or the interpretation of existing regulations could impact our business in the future by 
requiring, for example: changes to  our manufacturing arrangements; additions or modifications to product labeling, if and 
when approved; the recall or discontinuation of our products; or additional record-keeping requirements. If any such changes 
were to be imposed, they could adversely affect the operation of our business.  

The Hatch-Waxman Amendments  

Orange Book Listing  

In seeking approval for our product candidates through an NDA, we will be required to list with FDA each patent whose 
claims cover the drug product. Upon receiving regulatory approval, each of the patents listed in the application for this drug 
is then published in FDA’s Approved Drug Products with Therapeutic Equivalence Evaluations, commonly known as the 
“Orange Book”. Drugs listed in the Orange Book can, in turn, be cited by potential generic competitors in support of approval 
of an abbreviated NDA, or ANDA. An ANDA provides for marketing of a drug product that has the same active ingredient 
in  the  same  strengths  and  dosage  form  as  the  listed  drug  and  has  been  shown  through  bioequivalence  testing  to  be 
therapeutically equivalent to the listed drug. Other than the requirement for bioequivalence testing, ANDA applicants are not 
required to conduct, or submit results of, preclinical or clinical tests to prove the safety or efficacy of their drug product. Drugs 
approved in this way are commonly referred to as “generic equivalents” to the listed drug, and can often be substituted by 
pharmacists under prescriptions written for the original listed drug.  

The ANDA applicant is required to make certain certifications to FDA concerning any patents listed for the approved 
product in FDA’s Orange Book. Specifically, the applicant must certify that: (i) the required patent information has not been 
filed; (ii) the listed patent has expired; (iii) the listed patent has not expired but will expire on a particular date and approval 
is sought after patent expiration; or (iv) the listed patent is invalid or will not be infringed by the new product. The ANDA 
applicant may also elect to submit a section viii statement certifying that its proposed ANDA label does not contain (or carves 
out) any language regarding the patented method-of-use rather than make certifications concerning a listed method-of-use 
patent. If the applicant does not challenge the listed patents, the ANDA application will not be approved until all the listed 
patents claiming the referenced product have expired.  

A certification that the new product will not infringe the already approved product’s listed patents, or that such patents 
are invalid, is called a Paragraph IV certification. If the ANDA applicant has provided a Paragraph IV certification to FDA, 
the applicant must also send notice of the Paragraph IV certification to the NDA and patent holders once the ANDA has been 
accepted for filing by FDA. The NDA and patent holders may then initiate a patent infringement lawsuit in response to the 
notice  of  the  Paragraph IV  certification.  The  filing  of  a  patent  infringement  lawsuit  within  45 days  of  the  receipt  of  a 
Paragraph IV certification automatically prevents FDA from approving the ANDA until the earlier of 30 months, expiration 
of the patent, settlement of the lawsuit, or a decision in the infringement case that is favorable to the ANDA applicant. The 
ANDA application also will not be approved until any applicable non-patent exclusivity listed in the Orange Book for the 
referenced product has expired.  

Disclosure of Clinical Study Information  

Sponsors  of  clinical  studies  of  FDA-regulated  products,  including drugs,  are required  to  register  and  disclose  certain 
clinical study information. Information related to the product, patient population, phase of investigation, clinical study sites 
and investigators, and other aspects of the  clinical study is then made public as part of the registration. Sponsors are also 
obligated to post certain information regarding the results of their clinical studies after completion. Disclosure of the results 
of these studies can be delayed until the new product or new indication being studied has been approved. Competitors may 
use this publicly available information to gain knowledge regarding the progress of development programs.  

30 

  
 
 
 
 
 
 
 
 
 
Other Regulatory Requirements 

We may be subject to federal, state and local environmental laws and regulations, including the Environmental Protection 
Act and the Clean Air Act. Although we believe that our safety procedures for handling and disposing of controlled materials 
comply with the standards prescribed by state and federal regulations, accidental contamination or injury from these materials 
may occur. In the event of such an occurrence, we could be held liable for any damages that result and any such liability could 
exceed our resources. 

We may also be subject to regulations under other federal, state, and local laws, including the Occupational Safety and 
Health Act, national restrictions on technology transfer, and import, export, and customs regulations. It is possible that any 
portion of the regulatory framework under which we operate may change and that such change could have a negative impact 
on our current and anticipated operations. Failure to comply with these requirements could result, among other things, in 
suspension of regulatory approval, recalls, injunctions or civil or criminal sanctions. 

Third-Party Payor Coverage and Reimbursement 

The commercial success of our product candidates, if approved, will depend, in part, upon the availability of coverage 
and  adequate  reimbursement  from  third-party  payors  at  the  federal,  state  and  private  levels.  Third-party  payors  include 
governmental programs such as Medicare or Medicaid, private insurance plans and managed care plans. These third-party 
payors may deny coverage or reimbursement for our product candidates in whole or in part if they determine that our product 
candidates are not medically appropriate or necessary. Also, third-party payors attempt to control costs by limiting coverage 
through  the  use  of  formularies  and  other  cost-containment  mechanisms  and  the  amount  of  reimbursement  for  particular 
procedures or drug treatments.  

Some third-party payors also require pre-approval of coverage for new or innovative devices or drug therapies before 
they  will  reimburse  healthcare  providers  who  use  such  therapies.  While  we  cannot  predict  whether  any  proposed 
cost-containment measures will be adopted or otherwise implemented in the future, these requirements or any announcement 
or adoption of such proposals could have a material adverse effect on our ability to obtain adequate prices for our approved 
product candidates to operate profitably.  

Human Capital 

Our  approach  to  human  capital  resource  management  starts  with  our  mission  to  detect  and  treat  neurodegenerative 
diseases, such as Alzheimer’s disease. Our industry exists in a complex regulatory environment. The unique demands of our 
industry,  together  with  the  challenges  of  running  an  enterprise  focused  on  the  discovery,  development,  manufacture  and 
commercialization of innovative medicines, require talent that is highly educated and/or has significant industry experience. 
Additionally,  for  certain  key  functions,  we  require  specific  scientific  expertise  to  oversee  and  conduct  research  and 
development activities and the complex manufacturing requirements for biopharmaceutical products.  

We  consider  our  ability  to  recruit,  retain  and  motivate  our  employees  to  be  critical  to  our  success.  We  are  an  equal 
opportunity  employer,  and  we  are  fundamentally  committed  to  creating  and  maintaining  a  work  environment  in  which 
employees  are  treated  with  respect  and  dignity.  All  human  resources  policies,  practices  and  actions  related  to  hiring, 
promotion, compensation, benefits and termination are administered in accordance with the principal of equal employment 
opportunity, meaning that they are made on the basis of individual skills, knowledge, abilities, job performance and other 
legitimate criteria and without regard to race, color, religion, sex, sexual orientation, gender expression or identity, ethnicity, 
national origin, ancestry, age, mental or physical disability, genetic  information, any veteran status, any military status or 
application for military service, or membership in any other category protected under applicable law. By focusing on employee 
retention and engagement, we also improve our ability to support our clinical trials, our pipeline, business and operations, and 
also protect the long-term interests of our stockholders. Our success also depends on our ability to attract, engage and retain 
a diverse group of employees. 

31 

  
 
 
 
 
 
 
 
 
 
Our base pay program aims to compensate management and staff members relative to the value of the contributions of 
their  role,  which  takes  into  account  the  skills,  knowledge  and  abilities  required  to  perform  each  position,  as  well  as  the 
experience brought to the job. We also provide cash incentive programs to reward our management team and staff members 
in alignment with achievement of Company-wide goals that are designed to drive aspects of our strategic priorities that support 
and advance our strategy across our Company. Our management team and staff members are eligible for the grant of equity 
awards under our long-term incentive program that are designed to align their long-term interests with that of our stockholders. 

Our benefit programs are also generally broad-based, promote health and overall well-being and emphasize saving for 
retirement. All management team and regular staff members are eligible to participate in the same core health and welfare and 
retirement  savings  plans.  Other  employee  benefits  may  include  medical  plans,  dental  plans,  vacation  and  sick-pay  plans, 
flexible spending accounts, life and accident insurance and short and long-term disability benefits.  

Our Compensation Committee provides oversight of our executive compensation plans, policies and programs. 

As of December 31, 2022, we had 26 full-time employees. None of our employees are represented by a labor union or 
covered under a collective bargaining agreement. We also engage numerous consultants to perform services on retainer, per 
diem or an hourly basis. 

Lawsuit Against Perpetrators of “Short and Distort” Campaign 

On November 3, 2022, we announced that we had filed a lawsuit in federal court against certain individuals who executed 
a “short and distort” campaign against Cassava Sciences. The 150+ page complaint alleges that the defendants’ disinformation 
campaign  caused  a  precipitous  decline  in  Cassava  Sciences’  stock  price,  a  multi-billion  dollar  decline  in  its  market 
capitalization, and delayed the Company’s work in developing a treatment for Alzheimer’s disease. The complaint identifies 
over 1,000 false and defamatory statements made by the defendants in submissions to the U.S. Food and Drug Administration 
as well as “reports” and presentations that defendants published online or on social media. The matter is pending in federal 
district court for the Southern District of New York. 

Publication Corrections 

An erratum or corrigendum is a correction of a published text, generally a human, production or author's error, that was 
not  caught  in  proofing.  Such  errors  generally  do  not  impact  data  conclusions.  We  note  the  following  corrections  in  our 
published works. 

In July 2021, we presented clinical data for SavaDx in a poster presentation titled, “SavaDx, a Novel Plasma Biomarker 
to Detect Alzheimer’s Disease, Confirms Mechanism of Action of Simufilam” at the Alzheimer’s Association International 
Conference  (AAIC)  in  Denver,  CO  and  virtually.  Publication  correction:  The  AAIC  data  and  data  analysis  are  correct, 
however, visual errors that were not caught in proofing were disclosed by the Company in September 2021. This error does 
not impact data conclusions. 

In 2017, we published in Neurobiology of Aging an article titled “PTI-125 binds and reverses an altered conformation 
of filamin A to reduce Alzheimer’s disease pathogenesis” (Vol 55, July 2017, Pages 99–114). Publication correction: Figure 
12 contains an image showing 12 control bands. It should show 13. The data analysis was based on all 13 control bands. Other 
human errors in this publication have been noted and are expected to be corrected and published. These errors do not impact 
data conclusions. 

In 2012, we published in the Journal of Neuroscience an article titled, “Reducing Amyloid-Related Alzheimer's Disease 
Pathogenesis  by  a  Small  Molecule  Targeting  Filamin  A”  (JNeurosci  2012;32:9773-9784).  Publication  correction:  A 
duplicated panel appears in Figure 8B of the article. This error does not impact data conclusions and the publisher printed a 
correction. 

Corporate Information 

We were incorporated as a Delaware corporation in May 1998 under the name Pain Therapeutics, Inc. In March 2019, 
we  changed  our  company  name  to  Cassava  Sciences,  Inc.  Our  principal  offices  are  located  at  6801  N.  Capital  of  Texas 
Highway,  Building  1;  Suite  300,  Austin,  TX,  78731.  Our  telephone  number  is  512-501-2444.  Our  website  address  is 
www.CassavaSciences.com. Information contained on our website is not a part of this Annual Report on Form 10-K and the 
inclusion of our website address in this Annual Report on Form 10-K is an inactive textual reference only.   

32 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
We use Cassava Sciences, the Cassava Sciences logo, artwork and other marks as trademarks in the United States and 
other  countries.  Solely  for  convenience,  trademarks  and  trade  names  referred  to  in  this  Annual  Report,  including  logos, 
artwork, and other visual displays, may appear without the ® or TM symbols, but such references are not intended to indicate 
in any way that we will not assert, to the fullest extent under applicable law, our rights, or the rights of the applicable licensor 
to these trademarks and trade names. We do not intend our use or display of other entities’ trade names, trademarks, or service 
marks to imply a relationship with, or endorsement or sponsorship of us by, any other entity. 

We file electronically with the Securities and Exchange Commission, or SEC, our annual reports on Form 10-K, quarterly 
reports on Form 10-Q and current reports on Form 8-K pursuant to Section 13(a) or 15(d) of the Securities Exchange Act of 
1934, as amended (the “Exchange Act”). The SEC maintains an Internet site that contains reports, proxy and information 
statements,  and  other  information  regarding  issuers  that  file  electronically  with  the  SEC.  The  address  of  the  site  is 
http://www.sec.gov. 

You may obtain a free copy of our annual reports on Form 10-K, quarterly reports on Form 10-Q and current reports on 
Form  8-K  and  amendments 
the  SEC  on  our  website  at 
http://www.cassavasciences.com,  by  contacting  our  corporate  offices  by  calling  512-501-2450  or  by  sending  an  e-mail 
message to IR@cassavasciences.com. 

the  day  of  filing  with 

reports  on 

those 

to 

33 

  
 
 
 
 
 
Item 1A.     Risk Factors 

RISK FACTORS  

Investing in our common stock involves a high degree of risk. You should carefully consider the risks described below, 
as well as other information contained in this Annual Report on Form 10-K, including our consolidated financial statements 
and the related notes and the section titled “Management’s Discussion and Analysis of Financial Condition and Results of 
Operations,” before deciding whether to invest in our common stock. The occurrence of any of the events or developments 
described below could harm our business, financial condition, results of operations, and growth prospects. In such an event, 
the market price of our common stock could decline, and you may lose all or part of your investment.  

Below is a summary of the principal factors that make an investment in our common stock speculative or risky. Additional 
risks  and  uncertainties  not  presently  known  to  us  or  that  we  currently  deem  immaterial  also  may  impair  our  business 
operations and the market price of our common stock. 

Risks Related to the Discovery, Development, and Commercialization of Our Product Candidates  

• 

Since 2017, we have concentrated a substantial portion of our research and development efforts on the treatment of 
Alzheimer’s disease, an area of research that has seen significant failure rates. Further, our product candidates are 
based on new scientific approaches and novel technology, which makes it difficult to predict the time and cost of 
product candidate development and likelihood of success. 

•  We are heavily dependent on the success of simufilam, our product candidate which  is still under development. If 
this product candidate does not receive regulatory approval, we will be unable to generate product revenue and our 
business will be harmed. 

•  We  have  a  limited  operating  history  in  our  business  targeting  Alzheimer’s  disease  and  no  history  of  product 
approvals for commercial sale, which may make it difficult to evaluate our current business and predict our future 
success and viability. 

•  We cannot give any assurance that we will file for regulatory approval for any of our product candidates, or that if 
we file for approval, our product candidates will receive regulatory approval, which is necessary before they can be 
commercialized.  

•  There  can  be  no  assurance  that  results  of  smaller  Phase  1  and  Phase  2  clinical  trials  or  open-label  study  with 
simufilam will be reproduced in our large Phase 3 studies that are required to demonstrate safety and efficacy in 
order to potentially receive regulatory approval. 

•  Clinical  results  observed  in  our  open-label  study  with  simufilam  are  not  regulatory  evidence  of  drug  safety  or 

efficacy.  

•  We may encounter substantial delays in our clinical studies or may not be able to conduct or complete our clinical 

studies on the timelines we expect, if at all. 

• 

If physicians and patients do not accept and use our drugs, we will not achieve sufficient product revenues and our 
business will suffer. 

Risks Related to Government Regulation and Other Legal Compliance Matters 

•  Our  financial  condition  and  operating  results  could  be  adversely  impacted  by  unfavorable  results  of  legal 

proceedings, government investigations or allegations and other claims. 

• 

If we are ultimately unable to file for and obtain regulatory approval for our product candidates, we will be unable 
to generate product revenue and our business will be substantially harmed. 

•  Our ability to market and promote our product candidates will be determined and limited by FDA-approved labeling. 

•  Our employees, independent contractors, consultants, commercial partners, and vendors may engage in misconduct 

or other improper activities, including noncompliance with regulatory standards and requirements. 

• 

If we fail to comply or stay in compliance with the complex set of federal, state, local and foreign laws and regulations 
that  apply  to  our  business,  we  could  suffer  severe  consequences  that  could  materially  and  adversely  affect  our 
operating results and financial condition. 

34 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
•  Government  agencies  may  establish  and  promulgate  usage  guidelines  that  could  limit  the  use  of  our  product 

candidates. 

Risks Related to Our Intellectual Property  

• 

If we are unable to obtain and maintain  sufficient  patent protection for any product candidates we develop, our 
competitors could develop and commercialize products similar or identical to ours, and our ability to successfully 
commercialize any product candidates we may develop may be adversely affected. 

•  U.S. intellectual property rights around diagnostic methods is a complex, evolving area of law and effective patent 
claims may not be available to us for our investigational diagnostic product candidate, SavaDx, in the United States. 

• 

• 

• 

Issued patents covering our product candidates and other technologies could be found invalid or unenforceable if 
challenged in court or before administrative bodies in the U.S. or abroad. 

If  we  do  not  obtain  patent  term  extension  and  data  exclusivity  for  any  product  candidates  we  may  develop,  our 
business may be materially harmed. 

If we are unable to protect the confidentiality of our trade secrets, our business and competitive position would be 
materially harmed. 

Risks Related to Our Business and Operations  

•  Our reputation and operations could be adversely impacted by allegations, regardless of their merits. 

•  Our ability to continue to operate without any significant disruptions will, in part, depend on our ability to source 

materials and clinical supplies via our product supply chains. 

•  Our reliance on third parties for both the supply and manufacture of materials for our product candidates carries 
the risk that we will not have sufficient quality or quantities of such materials or product candidates, or that such 
supply will not be available to us at an acceptable cost, which could delay, prevent, or impair our development or 
commercialization efforts. 

•  We expect to significantly grow the size and capabilities of our organization and we may experience difficulties in 

effectively managing this growth. 

•  Ownership of our corporate headquarters and property leasing to third parties are subject to numerous risks and 

uncertainties. 

•  Our internal computer systems, or those used by third parties on whom we rely, may fail or suffer other breakdowns, 
cyberattacks, or information security breaches that could compromise the confidentiality, integrity, and availability 
of such systems and data, result in material disruptions of our development programs and business operations, risk 
disclosure of confidential, financial, or proprietary information, and affect our reputation. 

•  Our business involves environmental risks that may result in liability for us. 

•  Business disruptions and lack of appropriate levels of commercial insurance could seriously harm our future revenue 

and financial condition and increase our costs and expenses. 

• 

Social media platforms have significantly altered the dynamics of corporate communications and present risks and 
challenges, some of which are, and may continue to be unknown to us. 

Risks Related to Financial Condition and Capital Requirements  

•  We have incurred significant net losses in each period since our inception and anticipate that we will continue to 

incur net losses for the foreseeable future. 

•  We have broad discretion in the use of the net proceeds from any of our financing transactions and may not use them 

effectively. 

•  We have no product revenues and may never achieve revenues or profitability based on product revenues. 

35 

  
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Risks Related to the Ownership of Our Common Stock  

•  We do not know whether a sufficient market will continue to develop for our common stock or what the market price 
of our common stock will be, and, as a result, it may be difficult for investors to sell shares of our common stock. 

•  The market price of our common stock has historically been highly volatile and we expect it to continue to be volatile, 

which could result in substantial losses for investors who purchase our shares. 

• 

If we are unable to maintain effective internal controls, our business, financial position, and results of operations 
could be adversely affected. 

•  Anti-takeover provisions in our charter documents and Delaware law may prevent or delay removal of incumbent 

management or a change of control. 

•  Changes in our ownership could limit our ability to utilize net operating loss carryforwards. 

Risks Related to the Discovery, Development, and Commercialization of Our Product Candidates  

Since  2017,  we  have  concentrated  a  substantial  portion  of  our  research  and  development  efforts  on  the  treatment  of 
Alzheimer’s disease, an area of research that has seen significant failure rates. Further, our product candidates are based 
on  new  scientific  approaches  and  novel  technology,  which  makes  it  difficult  to  predict  the  time  and  cost  of  product 
candidate development and likelihood of success. 

Since 2017, we have concentrated a substantial portion of our research and development efforts on experimental methods 
for  the  treatment  of  Alzheimer’s  disease.  Prior  efforts  by  biopharmaceutical  companies  to  develop  new  treatments  for 
Alzheimer’s disease have seen very limited clinical success. Notwithstanding these substantial challenges to date, we seek to 
improve brain health by addressing the neurodegeneration and neuroinflammation components of Alzheimer’s disease. Our 
lead drug candidate for Alzheimer’s disease is based on a new approach of stabilizing – but not removing – a critical protein 
in the brain. We cannot be certain that our novel technologies will lead to an approvable or marketable product. In addition, 
because  FDA  has  limited  comparators  to  evaluate  our  lead  drug  candidate,  we  could  experience  a  longer  than  expected 
regulatory review process and increased development costs. 

We are heavily dependent on the success of simufilam, our product candidate which is still under development. If this 
product candidate does not receive regulatory approval, we will be unable to generate product revenue and our business 
may be harmed.  

Since inception, we have not succeeded in getting regulatory approval for our product candidates and we may never do 
so.  In  recent  years,  we  have  invested  a  significant  portion  of  our  efforts  and  financial  resources  in  the  development  of 
simufilam and, to a much lesser extent, SavaDx, for the treatment and detection of Alzheimer’s disease, respectively. Our 
future success is substantially dependent on our ability to successfully complete clinical development and obtain regulatory 
approval for simufilam, which may never occur. We expect that a substantial portion of our efforts and expenditures over the 
next  few  years  will  be  devoted  to  simufilam  and,  to  a  much  lesser  extent,  SavaDx.  This  will  require  additional  clinical 
development, management of clinical and manufacturing activities, regulatory approval in one or more national jurisdictions 
and obtaining commercial-scale manufacturing supply. Substantial investment and significant efforts will be required before 
we can generate any revenues from any commercial sales of our product candidates. We cannot be certain that we will be able 
to successfully complete any of these activities.  

We have a limited operating history in our business targeting Alzheimer’s disease and no history of product approvals for 
commercial sale, which may make it difficult to evaluate our current business and predict our future success and viability.  

We are a clinical-stage biopharmaceutical company with a limited operating history in our business targeting Alzheimer’s 
disease. Since we commenced operations in 1998, we have had no product candidates approved for commercial sale and have 
not generated any revenue from product sales. Drug development is a highly uncertain undertaking and involves a substantial 
degree of risk. To date, we have not completed a pivotal Phase 3 clinical study in Alzheimer’s disease, obtained marketing 
approval  for  any  product  candidates,  or  conducted  sales  and  marketing  activities  necessary  for  successful  product 
commercialization. Our long operating history as a company without product revenue makes any assessment of our future 
success and viability subject to significant uncertainty. 

We  will  continue  to  encounter  risks  and  difficulties  frequently  experienced  by  clinical-stage  biopharmaceutical 
companies  in  rapidly  evolving  fields.  We  have  not  yet  demonstrated  an  ability  to  successfully  overcome  such  risks  and 

36 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
difficulties. If we  do not successfully address these risks and difficulties, our business, results of operations and financial 
condition will suffer materially.  

We cannot give any assurance that any of our product candidates will receive regulatory approval, which is necessary 
before they can be commercialized.  

To date, we  have invested substantial effort and financial  resources to identify, procure intellectual property for, and 
develop our programs in neurodegeneration, including conducting preclinical and clinical studies for our product candidates, 
simufilam and SavaDx, and providing general and administrative support for these operations. Our future success is dependent 
on  our  ability  to  successfully  develop,  obtain  regulatory  approval  for,  and  then  successfully  commercialize  our  product 
candidates, and we may fail to do so for many reasons, including the following:   

• 

• 

• 

• 

• 

• 

• 

• 

• 

our product candidates may not successfully complete preclinical studies or clinical studies; 

a product candidate may, on further study, be shown to have harmful side effects or other characteristics that 
indicate it is unlikely to be safe or effective or otherwise does not meet applicable regulatory criteria; 

our competitors may develop products that render our product candidates obsolete or less attractive; 

the product candidates that we develop may not be sufficiently covered by intellectual property; 

the product candidates that we develop may be challenged by third parties’ patents or other intellectual property or 
exclusive rights; 

the market for our product candidates may change so that the continued development of a product candidate is no 
longer reasonable or commercially attractive; 

our product candidates may not be capable of being produced in commercial quantities at an acceptable cost, or at 
all; 

if a product candidate obtains regulatory approval, we may be unable to establish sales and marketing capabilities, 
or successfully market such approved product candidate, to gain market acceptance; and 

 a product candidate may not be accepted as safe, effective or useful by patients, the medical community or third-
party payors, if applicable. 

If any of these events occur, we may be forced to abandon our development efforts for a program or programs, which 

would have a material adverse effect on our business and could potentially cause us to cease operations.  

We may not be successful in our efforts to further develop our product candidates. We are not permitted to market or 
promote any of our product candidates before we receive regulatory approval from FDA or comparable foreign regulatory 
authorities, and we may never receive such regulatory approval for any of our product candidates.  SavaDx is in the early 
stages of development. Simufilam, our late-stage product candidate, will require significant additional clinical development, 
management  of  preclinical,  clinical,  and  manufacturing  activities,  regulatory  approval,  adequate  manufacturing  supply,  a 
commercial organization, and significant marketing efforts before we generate any revenue from product sales, if at all.  

We have never completed a product development program in neurodegeneration. Further, we cannot be certain that any 
of our product candidates will be successful in clinical studies. We may in the future advance product candidates into clinical 
studies and terminate such studies prior to their completion.  

If any of our product candidates successfully complete clinical studies, we may seek regulatory approval to market our 
product candidates in the U.S., Japan, Canada, the United Kingdom or the European Union, and in additional foreign countries 
where we believe there is a viable commercial opportunity. We may never receive regulatory approval to market any product 
candidates anywhere even if such product candidates successfully complete clinical studies, which would adversely affect our 
viability. To obtain regulatory approval in countries outside the U.S., we would need to comply with numerous and varying 
regulatory  requirements  of  such  other  countries  regarding  safety,  efficacy,  manufacturing  and  controls,  clinical  studies, 
commercial sales, pricing, and distribution of our product candidates. Even if we are successful in obtaining approval in one 
jurisdiction, we cannot ensure that we will obtain approval in any other jurisdictions. If we are unable to obtain approval for 
our  product  candidates  in  multiple  jurisdictions,  our  business,  financial  condition,  results  of  operations,  and  our  growth 
prospects could be negatively affected.  

Even if we receive regulatory approval to market any of our product candidates, whether for the treatment or diagnosis 
of  neurodegenerative  diseases  or  other  diseases,  we  cannot  provide  assurance  that  any  such  product  candidate  will  be 

37 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
successfully  commercialized,  widely  accepted  in  the  marketplace  or  more  effective  than  other  commercially  available 
alternatives.  

Investment in biopharmaceutical product development involves significant risk that any product candidate will fail to 
demonstrate adequate efficacy or an acceptable safety profile, gain regulatory approval, and become commercially viable. We 
cannot  provide  any  assurance  that  we  will  be  able  to  successfully  advance  any  of  our  product  candidates  through  the 
development process or, if approved, successfully commercialize any of our product candidates.  

There can be no assurance that results of smaller Phase 1 and Phase 2 clinical trials or open-label study with simufilam 
will be reproduced in our large Phase 3 studies that are required to demonstrate safety and efficacy in order to 
potentially receive regulatory approval. 

Results of our Phase 1, Phase 2 and open-label safety studies with simufilam are not predictive of the results of Phase 3 
clinical trials. Simufilam may fail to show the desired safety and efficacy in Phase 3 clinical trials despite having progressed 
successfully through preclinical studies and initial clinical trials. Many biopharmaceutical companies have suffered significant 
setbacks in Phase 3 clinical trials due to lack of efficacy or adverse safety profiles, notwithstanding promising results in earlier 
trials. In addition, conclusions based on data from analyses of Phase 1 and Phase 2 clinical studies and open-label results may 
not  be  reproduced  when  implemented  in  large,  well-controlled,  randomized  clinical  trials.  Even  if  our  clinical  trials  for 
simufilam are completed as planned, we cannot be certain that their results will support the safety and efficacy sufficient to 
obtain regulatory approval. 

Clinical results observed in our open-label study with simufilam is not regulatory evidence of drug safety or efficacy. 

Data results from our open-label safety study do not constitute, and should not be interpreted as, regulatory evidence of 
safety or efficacy for simufilam in Alzheimer’s disease. Rigorous evidence for drug safety and efficacy is derived from one 
or more large, randomized, placebo-controlled studies. The open-label design and size of this study may introduce clinical or 
statistical bias or may generate results that may not fully distinguish between drug effects and random variation. Different 
methods of statistical analysis on clinical data from the same study may lead to objectively different numerical results. These 
and  other  statistical  and  clinical  features  of  our  open-label  study  add  complexity  or  limitations  to  the  scope  of  data 
interpretation. 

We may encounter substantial delays in our clinical studies or may not be able to conduct or complete our clinical studies 
on the timelines we expect, if at all.  

Clinical testing is expensive, time consuming, and subject to uncertainty. We cannot guarantee that any clinical studies 
will be conducted as planned, enroll patients as planned or be completed on schedule, if at all. Moreover, even after our studies 
begin, safety or other issues may arise that could suspend or terminate such clinical studies. A failure of one or more clinical 
studies  can  occur  at  any  stage  of  testing,  and  our  future  clinical  studies  may  not  be  successful.  Events  that  may  prevent 
successful or timely initiation or completion of clinical studies include:  

• 

• 

• 

• 

• 

• 

• 

• 

inability to generate sufficient or necessary preclinical, toxicology, or other in vivo or in vitro data to support the 
initiation or continuation of clinical studies or to support the filing of a New Drug Application for simufilam; 

delays in confirming target engagement, patient selection, or other relevant biomarkers to be utilized in preclinical 
and clinical product candidate development; 

delays in reaching a consensus with regulatory agencies on study design; 

delays in reaching an agreement on acceptable terms with prospective and clinical study sites, the terms of which 
can be subject to extensive negotiation and may vary significantly among different clinical study sites; 

delays in identifying and recruiting suitable clinical investigators; 

delays in obtaining required IRB approval for each clinical study site; 

 a new safety finding that presents unreasonable risk to clinical study participants; 

a negative finding from an inspection of our CRO, clinical study operations or study sites; or 

38 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

the finding that the investigational protocol or plan is deficient to meet its stated objectives; 

delays in identifying, recruiting, and enrolling suitable patients to participate in our clinical studies, and delays 
caused by patients withdrawing from clinical studies, or failing to return for post-treatment follow-up; 

delays caused by disease epidemics or pandemics, such as COVID-19; 

difficulty collaborating with patient groups and investigators; 

failure by our CRO or other third parties, or us to adhere to clinical study requirements; 

failure to perform in accordance with FDA’s or any other regulatory authority’s Code of Good Clinical Practice 
(GCPs) requirements, or other regulatory guidelines in other countries; 

occurrence of adverse events associated with the product candidate that are viewed to outweigh its potential 
benefits; 

changes in regulatory requirements and guidance that require amending or submitting new clinical protocols; 

changes in the standard of care on which a clinical development plan was based, which may require new or 
additional studies; 

the cost of clinical studies of our product candidates being greater than we anticipate; 

clinical studies of our product candidates producing negative or inconclusive results, which may result in our 
deciding, or regulators requiring us, to conduct additional clinical studies or abandon product development 
programs; and 

delays in manufacturing, testing, releasing, validating, or importing/exporting sufficient stable quantities of our 
product candidates for use in clinical studies or the inability to do any of the foregoing. 

Any inability to successfully initiate or complete clinical studies could result in additional costs to us or impair our ability 
to generate revenue. In addition, if we make manufacturing or formulation changes to our product candidates, we may be 
required  to,  or  we  may  elect,  to  conduct  additional  studies  to  bridge  our  modified  product  candidates  to  earlier  versions. 
Clinical study delays could also shorten any periods during which our products have patent protection and may allow our 
competitors  to  bring  products  to  market  before  we  do,  which  could  impair  our  ability  to  successfully  commercialize  our 
product candidates and may harm our business and results of operations.  

We may in the future advance product candidates into clinical studies and terminate such studies prior to their completion, 

which could adversely affect our business.  

Delays in the completion of any clinical study of our product candidates will increase our costs, slow down our product 
candidate development and approval process and delay, or potentially jeopardize our ability to commence product sales and 
generate revenue. In addition, many of the factors that cause, or lead to, a delay in the commencement or completion of clinical 
studies may also ultimately lead to the denial of regulatory approval of our product candidates. 

The FDA or other regulatory agency may put a clinical hold on our clinical studies and our business will suffer. 

A clinical hold is an order issued by FDA or other regulatory agency to suspend an ongoing clinical trial, typically due 
to newly identified deficiencies with our studies or our drug candidate. For example, we are aware that in 2022, FDA placed 
clinical holds on drug candidates for Alzheimer’s disease from two competitors, Cortexzyme Inc. and Denali Therapeutics 
Inc. The grounds for imposition of a clinical hold are complex, variable and somewhat arbitrary. If FDA imposes a clinical 
hold on us, no new patients may be enrolled and study patients already in a study may be taken off our drug candidate unless 
treatment is specifically permitted by FDA in the interest of patient safety. If we are issued a clinical hold, FDA will expect 
us to address the cited deficiencies and submit a detailed, written response. A clinical hold may require us to spend significant 
resources over many months to address the root causes of FDA’s concerns. We may not find and successfully address such 
root causes, which could adversely affect our business. Our response may not be adequate to lift such clinical hold, or we may 
disagree with FDA’s assessments of deficiencies. If we are on clinical hold for 1 year or longer, the FDA may consider our 

39 

  
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
IND for simufilam to fall into Inactive Status, which may result in termination of the clinical program for simufilam. To the 
extent we are not successful in lifting an FDA clinical hold, our results of operations and business will be materially adversely 
affected.  

If physicians and patients do not accept and use our drugs, we will not achieve sufficient product revenues and our business 
will suffer. 

Even if FDA approves our drugs, physicians and patients may not accept and use them. Acceptance and use of our drugs 

will depend on a number of factors including:  

•  when the drug is launched into the market and related competition; 
• 
• 

approved label claims; 
perceptions by members of the healthcare community, including physicians, about the safety and effectiveness of 
our drugs;  
perceptions by physicians regarding the cost-benefit of our product candidates;  
published studies demonstrating the cost effectiveness of our drugs relative to competing products;  
availability of reimbursement for our products from government or healthcare payers;  
effectiveness of marketing and distribution efforts by us and other licensees and distributors.  

• 
• 
• 
• 

Because we expect to rely on sales generated by our current lead product candidates for substantially all of our revenues 
for the foreseeable future, the failure of any of these drugs to find market acceptance would harm our business and could 
require us to seek additional financing.  

We may not be successful in developing our product candidates in neurodegeneration.  

Our product candidates in neurodegeneration are still in development and will take several more years to develop and 
must  undergo  extensive  clinical  and  scientific  validations.  Even  if  we  are  successful  in  developing  any  of  our  product 
candidates through clinical and scientific validation, we may not be able to develop a drug or a diagnostic that: 

•  meets applicable regulatory standards, in a timely manner or at all; 
• 
• 
• 
• 
• 

successfully competes with other technologies and tests;  
avoids infringing the proprietary rights of others;  
is adequately reimbursed by third-party payors;  
can be performed at commercial levels or at reasonable cost; or 
can be successfully marketed. 

To  the  extent  we  are  not  successful  in  developing  our  new  product  candidates  in  neurodegeneration,  our  results  of 

operations and business will be materially adversely affected. 

Interim, “top-line” and preliminary data from our clinical trials that we announce or publish from time to time are likely 
to change as more patient data become available and are subject to audit and verification procedures that could result in 
material changes in the final dataset. 

From time to time, we may publish “top-line” or preliminary data from our clinical trials. We also make assumptions, 
estimations, calculations and conclusions as part of our analyses of data, and we may not have received or had the opportunity 
to fully and carefully evaluate all data. As a result, the top-line results that we report may differ from future results of the same 
studies, or different conclusions or considerations may qualify such results, once additional data have been received and fully 
evaluated. Such data from clinical trials may materially change as more study data become available. Preliminary or “top-
line” data also remain subject to audit and verification procedures that may result in the final data being materially different 
from the preliminary data we previously published. As a result, preliminary top-line data should be viewed with caution until 
the final data is available. Differences between preliminary or top-line data and final data could significantly harm our business 
prospects and may cause the trading price of our common stock to fluctuate significantly. 

Furthermore,  other  parties,  including  regulatory  agencies,  may  not  accept  or  agree  with  our  assumptions,  estimates, 
calculations, conclusions or analyses or may  interpret or weigh the importance of data differently, which could impact the 
value of the particular program, the approvability or commercialization of the particular product candidate and our company 
in general. In addition, the information we choose to publicly disclose regarding a particular study or clinical trial is typically 
selected from a more extensive amount of available information. You or others may not agree with what we determine is the 
material or otherwise appropriate information to include in our disclosure, and any information we determine not to disclose 

40 

  
 
 
 
 
 
 
 
 
 
 
 
may ultimately be deemed significant with respect to future decisions, conclusions, views, activities or otherwise regarding a 
particular product candidate or our business. If the preliminary or topline data that we report differ from late, final or actual 
results, or if others, including regulatory authorities, disagree with the conclusions reached, our ability to obtain approval for, 
and commercialize our product candidates may be harmed, which could harm our business, financial condition, results of 
operations and prospects. 

We are conducting Phase 3 clinical trials for our lead product candidates outside the United States, and the FDA and 
applicable foreign regulatory authorities may not accept ex-U.S. data from such trials. 

We are enrolling patients into our Phase 3 clinical trials in part outside of the U.S. The acceptance of data from clinical 
trials conducted outside the U.S. or another jurisdiction by the FDA or applicable foreign regulatory authority may be subject 
to  certain  conditions or restrictions.  In  cases  where  data  from  foreign  clinical  trials  are intended  to  serve  as  the  basis  for 
marketing approval in the U.S., the FDA may not approve the application on the basis of foreign data unless (i) the data are 
generally applicable to the U.S. population and medical practices, and (ii) the trials were performed by clinical investigators 
of  recognized  competence  and  pursuant  to  cGCP  regulations.  There  can  be  no  assurance  that  the  FDA  or  any  applicable 
foreign regulatory authority will accept data from patients enrolled in our Phase 3 program outside of the U.S. If the FDA or 
any applicable foreign regulatory authority does not accept such data, it may result in the need for additional trials, which 
would  be  costly  and  time-consuming  and  delay  aspects  of  our  business  plan,  and  which  may  result  in  our  lead  product 
candidate not receiving approval or clearance for commercialization in the U.S. or elsewhere. 

We currently have no in-house capabilities to manufacture or commercialize our product candidates and we rely on third-
party commercial drug manufacturers for clinical drug supplies. If we are unable to develop our own manufacturing, 
sales, marketing and distribution capabilities, or if we are not successful in contracting with third parties for these services 
on favorable terms, or at all, our product revenues could be adversely impacted.  

We rely on various third parties to manufacture, fill, label, store, test and ship our product candidates. We plan to continue 
to outsource formulation, manufacturing and related activities. These suppliers must comply with cGMP regulations enforced 
by FDA and other government agencies, and are subject to ongoing periodic unannounced inspection, including preapproval 
inspections by FDA and corresponding state and foreign government agencies to ensure strict compliance with cGMP and 
other standards. These manufacturers may subsequently be stopped from producing, manufacturing, filling, labeling, storing, 
testing and shipping our product candidates due to their non-compliance with federal, state or local regulations. We do not 
have control over our suppliers’ compliance with these regulations and standards and we cannot control decisions by our 
suppliers that affect their ability or willingness to continue to supply us on acceptable terms, or at all. 

Disputes  in  the  past  have  arisen  with  some  of  these  third  parties  with  respect  to  fulfilling  certain  conditions  and 
obligations. There can be no guarantee that such disputes will not arise again in the future, which may lead to termination of 
an agreement. If an agreement is terminated, we would not be able to commercialize our product candidates until another 
manufacturer is identified and we have entered into a manufacturing agreement with such manufacturer. We may not be able 
to replace a commercial supplier on commercially reasonable terms, or at all. Replacing any of our commercial suppliers 
would be expensive and time consuming. Failure by any of our suppliers to perform as expected could delay or prevent the 
commercialization  or  potential  regulatory  approval  of  our  product  candidates  for  an  extended  period  of  time,  result  in 
shortages, cost overruns or other problems and would materially harm our business. 

We  currently  have  no  sales,  marketing  or  distribution  capabilities.  We  have  not  established  commercial  strategies 
regarding any of our product candidates. In order to commercialize our products, if any are approved by FDA, we will either 
have to develop such capabilities internally or collaborate with third parties who can perform these services for us.  

If we decide to commercialize any of our drugs ourselves, we may not be able to  

• 
• 

• 
• 

hire and retain the necessary experienced personnel;  
build  sales,  marketing  and  distribution  operations  in  a  cost-effective  manner  which  are  capable  of  successfully 
launching new drugs; 
obtain access to adequate numbers of physicians to prescribe our products; or 
generate sufficient product revenues.  

In addition, establishing such operations on our own will take time and involve significant expense. If our commercial 
operations lack complementary products, we may not be able to compete in a cost-effective manner with competitors with 
more products to sell. If we engage third-party collaborators to perform any commercial operations, our future revenues may 
depend significantly upon the performance of those collaborators. 

41 

  
 
 
 
 
 
 
 
 
 
 
If we decide to enter into new co-promotion or other licensing arrangements with third parties, we may be unable to 
locate  acceptable  collaborators  because  the  number  of  potential  collaborators  is  limited  and  because  of  competition  from 
others for similar alliances. Even if we are able to identify one or more acceptable new collaborators, we may not be able to 
enter into any collaborative arrangements on favorable terms, or at all. 

In  addition,  due  to  the  nature  of  the  market  for  our  product  candidates,  it  may  be  necessary  for  us  to  license  all  or 
substantially all of our product candidates to a single collaborator, thereby eliminating our opportunity to commercialize these 
other products independently. If we enter into any such new collaborative arrangements, our revenues are likely to be lower 
than if we marketed and sold our products ourselves.  

In addition, any revenues we receive would depend upon our collaborators’ efforts which may not be adequate due to 
lack of attention or resource commitments, management turnover, change of strategic focus, business combinations or other 
factors  outside  of  our  control.  Depending  upon  the  terms  of  our  collaboration,  the  remedies  we  have  against  an  under-
performing collaborator may be limited. If we were to terminate the relationship, it may be difficult or impossible to find a 
replacement collaborator on acceptable terms, or at all.  

The majority of Phase 3 studies in Alzheimer’s disease have failed. 

Despite billions of dollars invested by NIH and the biopharmaceutical industry in research programs to develop novel 
therapeutics for Alzheimer’s disease, the FDA has not approved any new drugs for Alzheimer’s disease since 2003, except, 
however, that in June 2021, aducanumab (Biogen, Inc) and in January 2023 lecanumab (Eisai Pharmaceuticals) both received 
approval from FDA for the treatment of Alzheimer’s disease using the accelerated approval pathway. Since 2003, many new 
types and classes of drugs have been developed and tested in Alzheimer’s disease, including monoclonal antibodies, gamma 
secretase  modulators  and  inhibitors,  β-site  amyloid  precursor  protein  cleaving  enzyme  (BACE)  inhibitors,  receptor  for 
advanced glycation end-products (RAGE) inhibitors, nicotinic partial agonists and allosteric modulators, serotonin subtype 
receptor (5HT6) antagonists, and others. Virtually all of these scientific programs have failed in  Phase 3 testing, or earlier 
testing.  

We may not be successful in our efforts to expand our technology or product candidates in other indications.  

Our drug development strategy is to clinically test and seek regulatory approval for our product candidates in Alzheimer’s 
disease dementia, our primary indication. We may expand our research efforts outside of this primary indication and into 
other areas of clinical medicine based on genetic, biological or mechanistic overlap with the primary indication. Conducting 
clinical studies for additional indications for our product candidates will require substantial technical, financial and human 
resources and is prone to the inherent risks of failure in drug development. We cannot provide any assurance that we will be 
successful  in  our  effort  to  expand  our  technology  or  our  product  candidates  in  additional  indications,  even  if  we  obtain 
approval for our product candidate in Alzheimer’s disease.  

If we fail to successfully identify and develop additional product candidates, our commercial opportunity will be limited to 
Alzheimer’s disease or other neurodegenerations.  

Identifying, developing, obtaining regulatory approval for, and commercializing additional product candidates requires 
substantial expertise and funding and is prone to the risks of failure inherent in drug development. We cannot provide any 
assurance that we will be able to successfully identify or acquire additional product candidates, advance any additional product 
candidates  through  the  development  process,  or  assemble  sufficient  resources  to  identify,  acquire,  or  develop  additional 
product  candidates.  If  we  are  unable  to  successfully  identify,  acquire,  develop,  and  commercialize  additional  product 
candidates, our commercial opportunity may be limited. 

Early indications of safety and tolerability from our small clinical studies with simufilam may not predict the results of 
later studies. 

Results of our small, “first-in-human” Phase 1 study was designed to assess the initial safety characteristics of simufilam 
in  healthy  human  volunteers  and  this  study  was not designed  to,  and  did  not,  evaluate  safety,  tolerability  and  efficacy  of 
simufilam in patients. Additional large, well-controlled, multi-dose studies will be required to evaluate the safety, tolerability 
and efficacy of simufilam to treat patients with any indication, including Alzheimer’s disease. There can be no assurance that 
such future studies will demonstrate the safety, tolerability or efficacy of simufilam.  

Our Phase 2 clinical studies with simufilam were designed to assess the safety characteristics of simufilam in patients. 
Our Phase 2 program was not designed to, and did not, evaluate large-scale or long-term safety, tolerability and efficacy of 

42 

  
 
 
 
 
 
 
 
 
 
 
 
 
simufilam in patients. Additional large, well-controlled, multi-dose studies will be required to evaluate the safety, tolerability 
and efficacy of simufilam to treat patients with any indication, including Alzheimer’s disease. There can be no assurance that 
such future studies will demonstrate the safety, tolerability or efficacy of simufilam. The failure of simufilam to show safety, 
tolerability or efficacy in any future clinical studies would significantly harm our business. 

We have never obtained FDA approval for a diagnostic test and we may not be able to secure such approval in a timely 
manner or at all.  

We  are  developing  an investigational blood-based diagnostic test for Alzheimer’s disease, called SavaDx, which will 
require  FDA  approval  prior  to  commercialization.  Our  diagnostic  product  candidate,  marketing,  sales  and  development 
activities and manufacturing processes are subject to extensive and rigorous regulation by FDA pursuant to the FDCA, by 
comparable  agencies  in  foreign  countries,  and  by  other  regulatory  agencies  and  governing  bodies.  Under  the  FDCA,  a 
diagnostic  must  receive  FDA  clearance  or  approval  before  it  can  be  commercially  marketed  in  the  U.S.  The  process  of 
obtaining marketing approval or clearance from FDA or by comparable agencies in foreign countries for new products could: 

• 
• 
• 
• 
• 

take a significant period of time; 
require the expenditure of substantial resources; 
involve rigorous preclinical testing, as well as increased post-market surveillance;  
require changes to products; and  
result in limitations on the indicated uses of products. 

If we do not compete effectively with scientific and commercial competitors, we may not be able to successfully develop 
our diagnostic test for Alzheimer’s disease. 

The field of clinical laboratory testing is highly competitive. Diagnostic tests that are developed are characterized by 
rapid technological change. Our competitors in the U.S. and abroad are numerous and include, among others, major diagnostic 
companies,  reference  laboratories,  molecular  diagnostic  firms,  universities  and  other  research  institutions.  Most  of  our 
potential competitors have considerably greater financial, technical, marketing and other resources than we do, which may 
allow these competitors to discover important biological markers and determine their function before we do. We could be 
adversely  affected  if  we  do  not  discover  proteins  or  biomarkers  and  characterize  their  function,  develop  diagnostic  and 
pharmaceutical and clinical services based on these discoveries, obtain required regulatory and other approvals and launch 
these tests and their related services before our competitors. We also expect to encounter significant competition with respect 
to any diagnostic tests that we may develop or commercialize. Those companies that bring to market new diagnostic tests 
before we do may achieve a significant competitive advantage in marketing and commercializing their tests. We may not be 
able to develop additional diagnostic tests successfully and we may not obtain or enforce patents, if any, covering these tests 
that provide protection against our competitors. Moreover, our competitors may succeed in developing diagnostic tests that 
circumvent our technologies or tests. Furthermore, our competitors may succeed in developing technologies or tests that are 
more effective or less costly than those developed by us or that would render our technologies or tests less competitive or 
obsolete. We expect competition to intensify in the fields in which we are involved as technical advances in these fields occur 
and become more widely known and changes in intellectual  property laws generate challenges to our intellectual property 
position. 

We will need to develop our own proprietary antibodies or find alternative approaches that do not involve antibodies to 
advance our SavaDx and our diagnostic program. 

To  date,  most  of  our  tests  with  SavaDx  relied  on  the  use  of  commercially  available  antibodies,  which  are  complex 
molecules that can recognize and bind to an intended protein. Commercially available antibodies present certain technical 
flaws, such as improper validation, significant batch-to-batch variations or inconsistent storage, any of which can jeopardize 
our studies and experiments. Because antibody underperformance can be a significant drain on time and resources, we have 
attempted to develop and validate our own, fit-for-purpose antibody for use with SavaDx. The complexity of developing our 
own antibody gives rise to many technical issues that are challenging to solve, and we cannot be certain that we will be able 
to  successfully  complete  any  of  these  activities,  in  which  case  our  program  may  be  harmed.  We  are  also  evaluating  an 
alternative approach to detect Alzheimer’s disease that does not involve antibodies.  The complexity of such an alternative 
approach also gives rise to many technical issues that are challenging to solve. We cannot be certain that we will be able to 
successfully complete the development of a detection system for Alzheimer’s disease that does or does not involve antibodies. 

43 

  
 
 
 
 
 
 
 
 
We have concentrated a substantial portion of our research and development efforts on the treatment and detection of 
Alzheimer’s disease, an area of research that has seen significant failure rates. Further, our product candidates are based 
on  new  scientific  approaches  and  novel  technology,  which  makes  it  difficult  to  predict  the  time  and  cost  of  product 
candidate development.  

We  focus  substantially  all  of  our  research  and  development  efforts  on  addressing  neurodegenerations,  such  as 
Alzheimer’s disease. Collectively, efforts by biopharmaceutical companies in the field of neurodegenerative diseases have 
seen  many  failures  and  limited  success  in  drug  development.  Our  future  success  is  highly  dependent  on  the  successful 
development of our product candidates for treating Alzheimer’s disease. Developing and, if approved, commercializing our 
product  candidates  for  treatment  of  Alzheimer’s  disease  subjects  us  to  many  challenges,  including  obtaining  regulatory 
approval from FDA and other regulatory authorities who have only a limited set of precedents to rely on. We cannot be sure 
that our approach will yield satisfactory therapeutic products that are safe and effective, scalable, or profitable. 

Our  Phase 2 clinical studies  with simufilam in patients with Alzheimer’s disease  are generally  not designed to show a 
statistically meaningful difference in cognition or other health functions between those patients who receive placebo and 
those who receive drug. 

Clinical research data is often analyzed with statistical probability (p-value) to address the question of whether a clinical 
observation  is  related  to  a  treatment  effect,  a  random  effect  or  something  else.  This,  in  turn,  requires  a  clinical  study  to 
incorporate a sufficiently large sample patient population to infer the appropriate statistical analysis. By design, our Phase 2 
clinical studies with simufilam generally do not include a sufficiently large patient population to generate statistical probability 
on  measures  of  cognition  or  other  health  functions.  This  feature  may  make  it  difficult  for  investors  to  properly  interpret 
whether clinical observations in those Phase 2 studies with simufilam are important or meaningful. Conversely, our clinical 
studies  may  generate  statistically  significant  data  (i.e.,  p<0.05)  on  exploratory  biomarkers,  or  other  endpoints,  that  have 
unknown or no clinical importance. In general, the distinction between statistically significant data and clinically meaningful 
data is a complex area of research that continues to evolve and may be  subject to differences of opinion among scientists, 
clinicians, biostatisticians and other professionals, as well as among government regulators. 

In our open-label study, we observed apparent differences in treatment effects by stage of disease. These observations may 
or may not replicate in any of our subsequent clinical studies. 

Alzheimer’s dementia is a progressive, degenerate disease. Severity of disease is typically assessed by stage of disease 
progression,  a  continuum  that  ranges  from,  approximately,  mild  cognitive  impairment  (MCI),  to  early  stage,  to  mild,  to 
moderate  and  finally  to  severe  disease.  Over  time,  cognition  progressively  worsens  in  the  mild-to-moderate  stages  of 
Alzheimer’s as the disease takes its toll. However, we do not have a clear understanding of how our drug candidate simufilam 
impacts  patients  by  stage  of  disease,  if  at  all.  For  example,  in  our  open-label  study,  we  observed  apparent  differences  in 
treatment effects by stage of disease. These observations may or may not replicate in any of our subsequent clinical studies. 

We  may  encounter  difficulties  enrolling  patients  in  our  clinical  studies,  and  our  clinical  development  activities  could 
thereby be delayed or otherwise adversely affected.  

The timely completion of clinical studies in accordance with their protocols depends, among other things, on our ability 
to enroll enough patients who remain in the study until its conclusion. We may experience difficulties in patient enrollment 
in our clinical studies for a variety of reasons, including:  

• 

• 

• 

• 

• 

• 

• 

the size and severity of disease in the patient population; 

the patient eligibility criteria defined in the protocol, including biomarker-driven identification and/or certain highly-
specific  criteria  related  to  stage  of  disease  progression,  which  may  limit  the  patient  populations  eligible  for  our 
clinical studies to a greater extent than competing clinical studies for the same indication that do not have biomarker-
driven patient eligibility criteria; 

the size of the study population required for analysis of the trial’s primary endpoints; 

the design of our study protocol; 

our ability to recruit clinical study investigators with the appropriate competencies and experience; 

competing clinical studies for similar therapies or targeting patient populations meeting our patient eligibility criteria; 

clinicians’ and patients’ perceptions as to the potential advantages and side effects of the product candidate being 
studied in relation to other available therapies and product candidates; 

44 

  
 
 
 
 
 
 
 
  
 
 
 
 
 
 
• 

• 

• 

• 

our ability to obtain and maintain patient consents; 

physicians’ patient referral practices that are out of our control; 

our ability to adequately monitor patients and their caregivers during and after treatment; and 

the risk that patients enrolled in clinical studies will not complete such studies, for any reason. 

Our clinical  studies may fail to demonstrate  substantial evidence of the safety  and efficacy of our product candidates, 
which would prevent, delay, or limit the scope of regulatory approval and commercialization.  

Before obtaining regulatory approvals for any of our product candidates, we must demonstrate through lengthy, complex, 
and expensive preclinical experiments and clinical studies that our product candidates are both safe and effective for use in 
an intended population. Each product candidate must demonstrate an adequate risk versus benefit profile in its intended patient 
population and for its intended use.  

Clinical testing is expensive and can take many years to complete, and its outcome is inherently uncertain. Failure can 
occur at any time during the clinical study process. The results of preclinical studies of our product candidates may not be 
predictive  of  the  results  of  early-stage  or  later-stage  clinical  studies,  and  results  of  early  clinical  studies  of  our  product 
candidates may not be predictive of the results of later-stage clinical studies. The results of clinical studies in one set of patients 
or disease indications may not be predictive of those obtained in another. In some instances, there can be significant variability 
in safety or efficacy results between different clinical studies of the same product candidate due to numerous factors, including 
changes in study procedures set forth in protocols, differences in the size and type of the patient populations, changes in and 
adherence to the dosing regimen, and other clinical study protocols and the rate of dropout among clinical study participants. 
Open-label extension studies may also extend the timing and cost of a clinical study substantially. Product candidates in later 
stages of clinical studies may fail to show the desired safety and efficacy profile despite having progressed through preclinical 
studies and initial clinical studies. Many companies in the biopharmaceutical industry have suffered significant setbacks in 
advanced clinical studies due to lack of efficacy or unacceptable safety issues, notwithstanding promising results in earlier 
studies. This is particularly true in neurodegenerative diseases, including Alzheimer’s disease, where failure rates historically 
have been higher than in many other disease areas. Most product candidates that begin clinical studies are never approved by 
regulatory authorities for commercialization.  

We have limited experience in designing clinical studies in neurodegeneration and may be unable to design and execute 
a clinical study to support marketing approval. We cannot be certain that our current clinical studies or any other future clinical 
studies  will  be  successful.  Additionally,  any  safety  concerns  observed  in  any  one  of  our  clinical  studies  in  our  targeted 
indications could limit the prospects for regulatory approval of our product candidates in those and other indications, which 
could have a material adverse effect on our business, financial condition, and results of operations.  

In addition, even if such clinical studies are successfully completed, we cannot guarantee that FDA or foreign regulatory 
authorities will interpret the results as we do, and more studies could be required before we submit our product candidates for 
approval. To the extent that the results of the studies are not satisfactory to FDA or foreign regulatory authorities for support 
of a marketing application, we may be required to expend significant resources, which may not be available to us, to conduct 
additional studies in support of potential approval of our product candidates. Even if regulatory approval is secured for any of 
our product candidates, the terms of such approval may limit the scope and use of our product candidates, which may also 
limit its commercial potential. 

If our drug candidate causes or contributes to a death or a serious injury before or after approval, we will be subject to 
medical reporting regulations, which can result in voluntary corrective actions or agency enforcement actions. 

Our drug candidate in Alzheimer’s disease is aimed at elderly patients with dementia, some of whom may be frail due to 
advanced age or underlying health issues. Under FDA medical reporting regulations, we are required to report to the FDA 
information that our drug candidate has or may have caused or contributed to a death or serious injury. Any such serious 
adverse event involving our drug could result in future FDA action, such as an inspection, enforcement action or warning, or 
in more serious cases, a complete shutdown of our clinical program. In the context of our ongoing clinical trials, we report 
adverse  events  to  the  FDA  in  accordance  with  applicable  national  and  local  regulations.  Any  corrective  action,  whether 
voluntary  or  involuntary,  and  either  pre-  or  post-market,  needed  to  address  any  serious  adverse  events  will  require  the 
dedication  of  our  time  and  capital,  distract  management  from  operating  our  business,  and  may  harm  our  reputation  and 
financial results. 

45 

  
 
  
 
 
 
 
 
 
 
 
 
  
 
The market opportunities for simufilam and SavaDx, if approved, may be smaller than we anticipate. 

If  our  clinical  development  programs  succeed,  we  expect  to  seek  regulatory  approval  of  simufilam  and  SavaDx  for 
patients with Alzheimer’s disease. Our projections of the number of patients with Alzheimer’s disease is based on our beliefs 
and estimates. These estimates have been derived from a variety of  outside sources, including scientific literature, patient 
foundations and market research, and may prove to be incorrect. The actual number of patients may turn out to be lower than 
expected. Additionally, the potential patient population for our current programs or future product candidates may be limited. 
Even if we obtain  regulatory approval and capture  significant market share for any product candidate, the potential target 
populations may be smaller than anticipated, and we may never achieve profitability without obtaining marketing approval 
for additional indications.  

We face significant competition in an environment of rapid technological and scientific change, and there is a possibility 
that additional competitors may achieve regulatory approval before us or develop therapies that are safer, more advanced, 
or more effective than ours, any of which may harm our business operations.  

Drug discovery and development is highly competitive. Moreover, the neurodegenerative field is characterized by intense 
and increasing competition, and a strong emphasis on intellectual property. We may face competition with respect to any of 
our product candidates that we seek to develop or commercialize in the future from major pharmaceutical companies, specialty 
pharmaceutical  companies,  and  biotechnology  companies  worldwide.  Potential  competitors  also  include  academic 
institutions,  government  agencies,  and  other  public  and  private  research  organizations  that  conduct  research,  seek  patent 
protection, and establish collaborative arrangements for research, development, manufacturing, and commercialization.  

In  addition  to  Biogen,  Eisai  and  Eli  Lilly,  several  large  pharmaceutical  and  biotechnology  companies  are  currently 
pursuing the development of products for the treatment of neurodegenerative diseases, including Alzheimer’s disease. Many 
of  these  current  or  potential  competitors,  either  alone  or  with  their  strategic  partners,  have  significantly  greater  financial 
resources and expertise in research and development, manufacturing, preclinical testing, conducting clinical studies, obtaining 
regulatory approvals, and marketing approved products than we do.  

Our commercial opportunity could be reduced or eliminated if  other competitors develop and commercialize products 
that are safer, are more effective, have fewer or less severe side effects, are more convenient, or are less expensive than any 
products that we may develop. Furthermore, currently approved products could be discovered to have application for treatment 
of  neurodegenerative disease  indications,  which  could  give  such  products  significant  advantages  over  any of  our  product 
candidates. Competitors other than Biogen may also obtain FDA or other regulatory approval for their products more rapidly 
than we may obtain approval for ours, which could result in our competitors establishing a strong market position before we 
are able to enter the market. Additionally, products or technologies developed by our competitors may render our potential 
product candidates uneconomical or obsolete, and we may not be successful in marketing any product candidates we may 
develop against competitors.  

In  addition,  we  could  face  litigation  or  other  proceedings  with  respect  to  the  scope,  ownership,  validity,  and/or 
enforceability of our patents relating to our competitors’ products and our competitors may allege that our products infringe, 
misappropriate, or otherwise violate their intellectual property. The availability of our competitors’ products could limit the 
demand, and the price we are able to charge, for any products that we may develop and commercialize.  

Risks Related to Government Regulation and Other Legal Compliance Matters 

Our financial condition and operating results could be adversely impacted by unfavorable results of legal proceedings, 
government investigations or allegations and other claims. 

We are, and may in the future be, subject to various investigations and legal proceedings. 

In recent years, there has been a trend of increasing government investigations, legal proceedings and law enforcement 
activities against companies and executives operating in our industry, including those arising from whistleblower programs 
operated by the SEC and DOJ and the qui tam provisions of the False Claims Act. For instance, we are currently managing 
inquiries from U.S. government agencies, as well as civil claims under federal and state laws, relating to and/or arising out of 
research and development of our product candidates, including grant applications, securities disclosures and other aspects of 
our business. New claims or inquiries may arise in the future. 

In  response  to  government  document  requests  and  other  claims  asserted  against  us,  we  established  a  comprehensive 
document retention policy that strictly governs how we handle, store and protect our documents and data. Failure to comply 
with our document retention policy would expose us to risk of enforcement actions and penalties under applicable laws.  

46 

  
 
 
 
 
 
 
 
 
 
 
 
For  additional  information  regarding  legal  proceedings,  see  "Item  8.  Financial  Information—8.A.  Consolidated 

Statements and Other Financial Information—Legal Proceedings".   

Legal proceedings are inherently unpredictable, and large judgments or penalties sometimes occur. As a consequence, 
we may in the future incur judgments or penalties that could involve large cash payments, including the potential repayment 
of amounts allegedly obtained improperly and other penalties, including enhanced damages. In addition, such proceedings 
may affect our reputation, create a risk of potential exclusion from government reimbursement or grant programs and may 
lead to additional civil litigation. As a result, having taken into account all relevant factors, we may in the future enter into 
settlements of such claims without bringing them to final legal adjudication by courts or other such bodies, despite having 
potentially  significant  defenses  against  them,  in  order  to  limit  the  risks  they  pose  to  our  business  and  reputation.  Such 
settlements  may  require  us  to  pay  significant  sums  of  money  and  to  enter  into  corporate  integrity  or  similar  agreements 
intended to regulate company behavior for a period of years, which can be costly to operate under. 

Any such judgments or settlements, and any accruals that we may take with respect to potential judgments or settlements, 
could have a material adverse impact on our business, financial condition or results of operations, as well as on our reputation. 

While we maintain insurance coverage for certain types of claims, such insurance coverage may be insufficient to cover 
all losses or all types of claims that may arise. Even meritless claims could subject us to adverse publicity, hinder us from 
securing insurance coverage in the future or require us to incur significant legal costs. As a result, significant claims or legal 
proceedings to which we are a party could have a material adverse effect on our business, prospects, financial condition and 
results of operations. 

Additional future litigation against us could be costly and time-consuming to defend.  

Innovative  drug  development  is  highly  litigious,  and  we  may  become  subject,  from  time  to  time,  to  additional  legal 
proceedings, claims and allegations that arise in the ordinary course of business or pursuant to governmental or regulatory 
enforcement  activity.  Regardless  of  merit,  any  lawsuits  against  us,  individually  or  in  the  aggregate,  may  have  a  material 
adverse effect on our business, financial condition, results of operations or cash flows. In addition, any litigation to which we 
subsequently become a party might result in substantial costs and divert management's attention, time and resources, which 
might seriously harm our business, financial condition, results of operations and cash flows. Our insurance policies might not 
cover such claims, might not provide sufficient payments to cover all of the costs to resolve one or more such claims, and 
might not continue to be available on terms acceptable to us. In particular, any claim could result in potential liability for us 
if the claim is outside the scope of the indemnification agreement we have with our third-party partners, or our third-party 
partners do not abide by the indemnification agreement as required, or the liability exceeds the  amount of any applicable 
indemnification limits or available insurance coverage. A claim brought against us that is uninsured or underinsured could 
result in unanticipated costs and could have a material adverse effect on our financial condition, results of operations, cash 
flows or reputation. 

If we are ultimately unable to  file for and obtain regulatory approval for our product candidates, we will be unable to 
generate product revenue and our business will be substantially harmed. 

The time required to obtain approval by FDA and comparable foreign regulatory authorities is unpredictable, typically 
takes many years following the commencement of clinical studies, and depends upon numerous factors, including the type, 
complexity, and novelty of the product candidates involved. In addition, approval policies, regulations, or the type and amount 
of clinical data necessary to gain approval may change during the course of a product candidate’s clinical development and 
may  vary  among  jurisdictions,  which  may  cause  delays  in  the  approval  or  the  decision  not  to  approve  an  application. 
Regulatory authorities have substantial discretion in the approval process and may refuse to accept any application or may 
decide that our data are insufficient for approval and require additional preclinical, clinical, or other studies. We have not 
obtained regulatory approval for any product candidate, including our product candidates aimed at Alzheimer’s disease, and 
it is possible that none of our existing product candidates or any product candidates we may seek to develop in the future will 
ever obtain regulatory approval.  

Applications for our product candidates could fail to receive regulatory approval in an initial or subsequent indication for 

many reasons, including but not limited to the following:  

•  FDA or comparable foreign regulatory authorities may disagree with the design, implementation, or results of our 

clinical studies; 

47 

  
 
 
 
 
 
 
 
 
 
 
 
 
•  FDA  or  comparable  foreign  regulatory  authorities  may  determine  that  our  product  candidates  are  not  safe  and 
effective, only moderately effective or have undesirable or unintended side effects, toxicities, or other characteristics 
that preclude our obtaining marketing approval or prevent or limit commercial use; 

• 

the population studied in the clinical program may not be sufficiently broad or representative to assure efficacy and 
safety in the full population for which we seek approval; 

•  we may be unable to demonstrate to FDA or comparable foreign regulatory authorities that a product candidate’s 

risk-benefit ratio when compared to the standard of care is acceptable; 

•  FDA  or  comparable  foreign  regulatory  authorities  may  disagree  with  our  interpretation  of  data  from  preclinical 

studies or clinical studies; 

• 

the data collected from clinical studies of our product candidates may not be sufficient to support the submission of 
a new drug application (NDA), or other submission or to obtain regulatory approval in the United States or elsewhere; 

•  FDA or comparable foreign regulatory authorities may fail to approve the manufacturing processes, test procedures, 
and  specifications,  or  facilities  of  third-party  manufacturers  with  which  we  contract  for  clinical  and  commercial 
supplies; and 

• 

the approval policies or regulations of FDA or comparable foreign regulatory authorities may significantly change 
in a manner rendering our clinical data insufficient for approval. 

This lengthy approval process, as well as the unpredictability of the results of clinical studies, may result in our failing to 
obtain regulatory approval to market any of our product candidates, which would significantly harm our business, results of 
operations, and growth prospects.  

Our ability to market and promote our product candidates will be determined and limited by FDA-approved labeling.  

The  commercial  success  of  our  product  candidates  will  depend  upon  our  ability  to  obtain  FDA-approved  labeling 
describing their features. Our failure to achieve FDA approval of product labeling containing such information will prevent 
us from advertising and promoting the key features of our product candidates in order to differentiate them from other similar 
products. This would make our products less competitive in the market. 

Our employees, independent contractors, consultants, commercial partners, and vendors may engage in misconduct or 
other improper activities, including noncompliance with regulatory standards and requirements.  

We are  exposed to the risk of fraud, misconduct, or other illegal activity by our employees, independent contractors, 
consultants, commercial partners, and vendors. Misconduct by these parties could include intentional, reckless, and negligent 
conduct that fails to:  

• 
• 
• 
• 
• 

comply with the laws of FDA and other comparable foreign regulatory authorities;  
provide true, complete, and accurate information to FDA and other comparable foreign regulatory authorities; 
comply with manufacturing standards we have established; 
comply with healthcare fraud and abuse laws in the U.S. and similar foreign fraudulent misconduct laws; or 
report financial information or data accurately or to disclose unauthorized activities to us. 

Activities subject to laws also involve the improper use of information obtained in the course of patient recruitment for 
clinical studies, which could result in regulatory sanctions and cause serious harm to our reputation. Further, it is not always 
possible to identify and deter misconduct by employees and third parties, and the precautions we take to detect and prevent 
this activity may not be effective in controlling unknown or unmanaged risks or losses or in protecting us from governmental 
investigations or other actions or lawsuits stemming from a failure to comply with such laws. If any such actions are instituted 
against us, and we are not successful in defending ourselves or asserting our rights, those actions could have a significant 
impact on our business, including the imposition of significant fines or other sanctions. 

If we fail to comply or stay in compliance with the complex set of federal, state, local and foreign laws and regulations that 
apply to our business, we could suffer severe consequences that could materially and adversely affect our operating results 
and financial condition.  

We are obligated to comply with the laws of all countries and jurisdictions in which we operate. These laws cover an 
extremely  wide  and  growing  range  of  activities.  Such  legal  requirements  can  vary  from  country  to  country,  and  new 

48 

  
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
requirements may be imposed on us from time to time as government and public expectations regarding acceptable corporate 
behavior  change,  and  enforcement  authorities  modify  interpretations  of  legal  and  regulatory  provisions  and  change 
enforcement priorities. In addition, we rely on numerous associates, independent contractors, consultants, commercial partners 
and vendors who may put our business and our operations at risk of material impairment if they engage, or are alleged to 
engage, in misconduct or other improper activities, including noncompliance with regulatory standards and requirements, in 
violation of such laws and public expectations.    

The laws and regulations that govern our operations include, among others: 

•  The  Clinical  Laboratory  Improvement  Amendments  (CLIA)  of  1988,  which  are  United States  federal  regulatory 
standards  that  apply  to  all  clinical  laboratory  testing  performed  on  humans  in  the  United  States,  requires  that 
laboratories obtain certification from the federal government, and state licensure laws; 

•  FDA laws and regulations , including those relating to off-label marketing; 

•  The Health Insurance Portability and Accountability Act (HIPAA), which imposes comprehensive federal standards 
with  respect  to  the  privacy  and  security  of  protected  health  information  and  requirements  for  the  use  of  certain 
standardized  electronic  transactions,  including  penalties  for  violators,  enforcement  authority  to  state  attorneys 
general and requirements for breach notification; 

• 

• 

• 

• 

• 

• 

state laws regulating testing and protecting the privacy of test results, as well as state laws protecting the privacy and 
security of health information and personal data and mandating reporting of breaches to affected individuals and 
state regulators; 

the  federal  anti-kickback  law,  or  the  Anti-Kickback  Statute,  which  prohibits  knowingly  and  willfully  offering, 
paying, soliciting, receiving, or providing remuneration, directly or indirectly, in exchange for or to induce either the 
referral of an individual, or the furnishing, arranging for, or recommending of an item or service that is reimbursable, 
in whole or in part, by a federal health care program; 

the  federal  False  Claims  Act  (FCA),  which  imposes  liability  on  any  person  or  entity  that,  among  other  things, 
knowingly presents, or causes to be presented, a false or fraudulent claim for payment to the federal government and 
which, under its qui tam provisions, allows private litigants (called “relators”) to file claims under seal on behalf of 
the government and to receive a percentage of recoveries obtained as a result; 

the  federal  Civil  Monetary  Penalties  Law,  which  prohibits,  among  other  things,  the  offering  or  transfer  of 
remuneration to a Medicare or state health care program beneficiary if the person knows or should know it is likely 
to influence the beneficiary’s selection of a particular provider, practitioner, or supplier of services reimbursable by 
Medicare or a state health care program, unless an exception applies; 

other federal and state fraud and abuse laws, such as anti-kickback laws, prohibitions on self-referral, and false claims 
acts, which may extend to services reimbursable by any third-party payor, including private insurers; 

the  Foreign  Corrupt  Practices  Act  (FCPA)  and  other  worldwide  anti-bribery  laws,  including  those  that  prohibit 
companies and their intermediaries from making improper payments to government officials or other third parties 
for the purpose of obtaining or retaining business, and laws that prohibit commercial bribery; 

• 

import, export control and economic sanctions laws and regulations in the U.S. and elsewhere; 

•  Federal securities laws, including provisions of the Exchange Act and Dodd-Frank Act under which whistleblowers 

that report alleged violations of wrong doing can obtain up to 30% of related recoveries;  

• 

the  federal  Physician  Payments  Sunshine  Act,  which  requires  manufacturers  to  track  and  report  to  the  federal 
government certain payments and other transfers of value made to physicians and teaching hospitals and ownership 
or investment interests held by physicians and their immediate family members; 

•  Section  216  of  the  federal  Protecting  Access  to  Medicare  Act  of  2014  (PAMA),  which  requires  applicable 
laboratories  to  report  private  payer  data  in  a  timely  and  accurate  manner  every  three  years  (and  in  some  cases 
annually); 

• 

• 

state laws that impose reporting and other compliance-related requirements; and  

similar foreign laws and regulations that will apply to us in foreign countries in which we may choose to operate in 
the future.  

49 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Government agencies may establish and promulgate usage guidelines that could limit the use of our product candidates.  

Government agencies, professional and medical societies, and other groups may establish usage guidelines that apply to 
our product candidates. These guidelines could address such matters as usage and dose, among other factors. Application of 
such guidelines could limit the clinical use or commercial appeal of our product candidates.  

Our  product  candidates  may  cause  undesirable  side  effects  or  have  other  properties  that  could  halt  their  clinical 
development,  prevent  their  regulatory  approval,  limit  their  commercial  potential,  or  result  in  significant  negative 
consequences.  

During the conduct of clinical trials, study participants report changes in their health to their doctor, including illnesses, 
injuries  and  discomforts.  Often,  it  is  not  possible  to  determine  whether  our  product  candidate  caused  these  conditions. 
Regulatory authorities may draw different conclusions and may require us to pause our clinical trials or require additional 
testing to confirm these determinations, if they occur. In addition, we have not yet completed long-term safety studies with 
simufilam to determine if this product candidate is safe for humans. Adverse events or other undesirable side effects caused 
by simufilam could cause us or regulatory authorities to interrupt, delay, or halt clinical studies and could result in a more 
restrictive label or the delay or denial of regulatory approval by FDA or other comparable foreign regulatory authorities. Drug-
related side  effects could affect patient recruitment,  the ability of enrolled patients to complete the study, and/or result  in 
potential claims. 

We may be subject to legal liability associated with clinical trials. 

Our business requires us to engage in the conduct of clinical studies in human volunteers and in patients in the United 
States and abroad. There are circumstances under which a participant in one of our clinical trials could impose liability on us. 
For example, a clinical investigator who is a participant in one of our studies may intentionally or unintentionally deviate 
from a clinical protocol and cause harm to a clinical trial participant, or a clinical trial participant may seek to compel us to 
continue to supply drug to them after the completion of a study but prior to FDA approval. 

Claims may be brought against us for negligence, breach of contract, harm, injury or death, or other legal theories based 
on the nature of a study. Clinical trial liability is a complex and somewhat unsettled area of law and may vary by state and by 
country where we conduct clinical studies. Furthermore, claims may be brought against us by a clinical investigator, a clinical 
trial participant, or another party associated with a clinical study, long after the completion of a clinical study. Defense of 
such actions is a fact-intensive process that could be costly and involve significant time and attention of our management and 
other  resources,  may  result  in  monetary  liabilities  or  penalties,  and  may  require  us  to  change  our  business  in  an  adverse 
manner. 

Our insurance policies may be inadequate and potentially expose us to unrecoverable risks. 

Although we maintain product liability insurance coverage, such insurance may not be adequate to cover all liabilities 
that we may incur. We anticipate that we will need to increase our insurance coverage each time we commence a clinical trial 
and if we successfully commercialize any product candidate. Insurance availability, coverage terms and pricing continue to 
vary  with  market  conditions.  We  endeavor  to  obtain  appropriate  insurance  coverage  for  insurable  risks  that  we  identify; 
however, we may fail to correctly anticipate or quantify insurable risks, we may not be able to obtain appropriate insurance 
coverage and insurers may not respond as we intend to cover insurable events that may occur. Conditions in the insurance 
markets relating to nearly all areas of traditional corporate insurance change rapidly and may result in higher premium costs, 
higher policy deductibles and lower coverage limits. For some risks, we may not have or maintain insurance coverage because 
of cost or availability. 

We  are  and  will  be  required  to  maintain  product  liability  insurance  pursuant  to  certain  of  our  development  and 
commercialization  agreements.  We  may  not  be  able  to  maintain  insurance  coverage  at  a  reasonable  cost  or  in  sufficient 
amounts to protect us against losses due to liability. A successful product liability claim or series of claims brought against us 
could adversely affect our results of operations, business, and reputation. In addition, regardless of merit or eventual outcome, 
product liability claims may result in impairment of our business reputation, withdrawal of clinical study participants, costs 
due  to  related  litigation,  distraction  of  management’s  attention  from  our  primary  business,  initiation  of  investigations  by 
regulators, substantial monetary awards to patients or other claimants, the inability to commercialize our product candidates, 
and decreased demand for our product candidates, if approved for commercial sale. 

50 

  
 
 
 
 
  
 
 
 
 
 
If our product candidates receive regulatory approval, we and our collaborators will be subject to ongoing FDA obligations 
and continued regulatory review, such as continued safety reporting requirements, and we and our collaborators may also 
be subject to additional FDA post-marketing obligations or new regulations, all of which may result in significant expense 
and limit our and our collaborators’ ability to commercialize our potential drugs.  

Any regulatory approvals that our product candidates receive may also be subject to limitations on the indicated uses for 
which the drug may be marketed or contain requirements for potentially costly post-marketing follow-up studies. In addition, 
if  FDA  approves  any  of  our  product  candidates,  the  labeling,  packaging,  adverse  event  reporting,  storage,  advertising, 
promotion and record keeping for the drug will be subject to extensive regulatory requirements. The subsequent discovery of 
previously  unknown  problems  with  the  drug,  including  but  not  limited  to  adverse  events  of  unanticipated  severity  or 
frequency,  or  the  discovery  that  adverse  events  previously  observed  in  preclinical  research  or  clinical  studies  that  were 
believed to be minor actually constitute much more serious problems, may result in restrictions on the marketing of the drug, 
and could include withdrawal of the drug from the market.  

The  FDA’s  policies  may  change,  and  additional  government  regulations  may  be  enacted  that  could  prevent  or  delay 
regulatory  approval  of  our  product  candidates.  We  cannot predict  the  likelihood,  nature or  extent  of  adverse  government 
regulation that may arise from future legislation or administrative action, either in the U.S. or abroad. If we are not able to 
maintain regulatory compliance, we may be subject to fines, suspension or withdrawal of regulatory approvals, product recalls, 
seizure of products, operating restrictions and criminal prosecution. Any of these events could prevent us from marketing our 
products and our business could suffer.  

Enacted and future legislation may increase the difficulty and cost for us to commercialize our product candidates and 
may reduce the prices we are able to obtain for our product candidates.  

Legislative and regulatory changes and future changes regarding the healthcare system could prevent or delay marketing 
approval  of  our  product  candidates,  restrict  or  regulate  post-approval  activities  or  affect  our  ability  to  profitably  sell  any 
product candidates for which we obtain marketing approval.  

In the U.S., the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (the Medicare Modernization 
Act) established the Medicare Part D program and provided authority for limiting the number of drugs that will be covered in 
any therapeutic class thereunder. The Medicare Modernization Act, including its cost reduction initiatives, could limit the 
coverage  and  reimbursement rate  that  we  receive  for  any  of  our  approved  products.  Private  payors  may  follow  Medicare 
coverage policies and payment limitations in setting their own reimbursement rates resulting in similar limits in payments 
from private payors.  

The Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act, or 
collectively, the Affordable Care Act, among other things, imposes a significant annual fee on companies that manufacture or 
import  branded  prescription  product  candidates.  It  also  contains  substantial  provisions  intended  to,  among  other  things, 
broaden  access  to  health  insurance,  reduce  or  constrain  the  growth  of  health  care  spending,  enhance  remedies  against 
healthcare fraud and abuse, add new transparency requirements for the healthcare and health insurance industries, and impose 
additional health policy reforms, any of which could have a material adverse effect on our business. A significant number of 
provisions are not yet, or have only recently become, effective, but the Affordable Care Act may result in downward pressure 
on  pharmaceutical  pricing,  especially  under  the  Medicare  program,  and  may  also  increase  our  regulatory  burdens  and 
operating costs.  

The Affordable Care Act, as well as other healthcare reform measures that have been and may be adopted in the future, 
may  result  in  more  rigorous  coverage  criteria  and  in  additional  downward  pressure  on  the  price  that  we  receive  for  any 
approved product, and could seriously harm our future revenues. Any reduction in reimbursement from Medicare or other 
government  programs  may  result  in  a  similar  reduction  in  payments  from  private  payors.  The  implementation  of  cost 
containment measures or other healthcare reforms may compromise our ability to generate  revenue, attain profitability or 
commercialize our products.  

The  Affordable  Care  Act  is  a  highly  complex  piece  of  legislation  that  continues  to  evolve.  We  do  not  and  cannot 
understand or anticipate the full impact and potential implications of the Affordable Care Act on our business or on our drugs. 

51 

  
 
 
 
 
 
 
 
 
 
Our relationships with customers and payors will be subject to applicable anti-kickback, fraud and abuse, transparency, 
and other healthcare laws and regulations, which could expose us to criminal sanctions, civil penalties, exclusion from 
government  healthcare  programs,  contractual  damages,  reputational  harm,  administrative  burdens,  and  diminished 
profits and future earnings.  

Healthcare providers, physicians and payors play a primary role in the recommendation and prescription of any product 
candidates for which we may obtain marketing approval. Our current or future arrangements with payors and customers may 
expose us to broadly applicable fraud and abuse and other healthcare laws and regulations that may constrain the business or 
financial arrangements and relationships through which we market, sell and distribute any product candidates for which we 
may obtain marketing approval. Even though we do not and will not control referrals of healthcare services or bill directly to 
Medicare, Medicaid or other third-party payors, federal and state healthcare laws and regulations pertaining to fraud and abuse 
and patients' rights are and will be applicable to our business. Restrictions under applicable federal, state and foreign healthcare 
laws and regulations may affect our ability to operate and expose us to areas of risk, including:  

• 

• 

the federal Anti-Kickback Statute, which prohibits, among other things, knowingly and willfully soliciting, offering, 
receiving or providing remuneration, directly or indirectly, in cash or in kind, to induce or reward either the referral 
of an individual for, or the purchase, order or recommendation of, any good or service, for which payment may be 
made under federal and state healthcare programs such as Medicare and Medicaid. A person or entity does not need 
to have actual knowledge of the statute or specific intent to violate it in order to have committed a violation;  

the  FCA,  which  imposes  criminal  and  civil  penalties,  including  through  civil  whistleblower  or  qui  tam  actions, 
against individuals or entities for knowingly presenting, or causing to be presented, to the federal government, claims 
for payment that are false or fraudulent or making a false statement to avoid, decrease or conceal an obligation to 
pay  money  to  the  federal  government.  In  addition,  the  government  may  assert  that  a  claim  including  items  and 
services resulting from a violation of the federal Anti-Kickback Statute constitutes a false or fraudulent claim for 
purposes of the FCA;  

•  HIPAA, which imposes criminal and civil liability for executing a scheme to defraud any healthcare benefit program 
or making false statements relating to healthcare matters. Similar to the federal Anti-Kickback Statute, a person or 
entity does not need to have actual knowledge of the statute to defraud any healthcare benefit program or specific 
intent to violate it in order to have committed a violation;  

•  HIPAA, as amended by the Health Information Technology for Economic and Clinical Health Act of 2009 and its 
implementing  regulations,  which  also  imposes  obligations  on  certain  covered  entity  healthcare  providers,  health 
plans, and healthcare clearinghouses as well as their business associates that perform certain services involving the 
use or disclosure of individually identifiable health information, including mandatory contractual terms, with respect 
to safeguarding the privacy, security and transmission of individually identifiable health information;  

• 

• 

federal  laws  requiring  drug manufacturers  to  report  information  related  to payments  and  other  transfers  of  value 
made to physicians and other healthcare providers, as well as ownership or investment interests held by physicians 
and their immediate family members, including under the federal Open Payments program, commonly known as the 
Sunshine Act, as well as other state and foreign laws regulating marketing activities; and  

state and foreign equivalents of each of the above laws, including state anti-kickback and false claims laws, which 
may apply to sales or marketing arrangements and claims involving healthcare items or services reimbursed by non-
governmental payors, including private insurers; state laws which require pharmaceutical companies to comply with 
the pharmaceutical industry's voluntary compliance guidelines and the relevant compliance guidance promulgated 
by the federal government or otherwise restricting payments that may be made to healthcare providers; and state and 
foreign laws governing the privacy and security of health information in certain circumstances, many of which differ 
from each other in significant ways and often are not preempted by HIPAA, thus complicating compliance efforts.  

Efforts  to  ensure  that  our  business  arrangements  with  third  parties  will  comply  with  applicable  healthcare  laws  and 
regulations  will  involve  substantial  costs.  Nonetheless,  it  is  possible  that  governmental  authorities  will  conclude  that  our 
business practices may not comply with current or future statutes, regulations or case law involving applicable fraud and abuse 
or  other  healthcare  laws  and regulations.  If  our operations are  found  to  be  in violation of  any  of  these  laws  or  any other 
governmental regulations that may apply to us, we may be subject to significant civil, criminal and administrative penalties, 
damages, fines, imprisonment, exclusion from participation in government funded healthcare programs, such as Medicare and 
Medicaid, and the curtailment or restructuring of our operations. 

52 

  
 
 
 
 
 
 
 
 
 
A federal court ruling may mandate significant new disclosure requirements for clinical data dating back over a decade 
which may lead to costly or burdensome disclosures. 

A federal court ruling may require all clinical study sponsors to report a decade’s worth of previously exempted clinical 
study data to the federal government for publication on ClinicalTrials.gov. In 2020, the U.S. District Court for the Southern 
District of New York invalidated a prior interpretation of NIH regulations that had exempted many clinical studies conducted 
between 2007 and 2017 from reporting requirements mandated by the Food and Drug Administration Amendments Act. If 
this court ruling takes effect without appeal, or if it is upheld on appeal, it could require us to submit an onerous amount of 
old clinical data to the federal government. In many cases, we were the responsible party for generating such clinical data, but 
such prior data may be difficult or not feasible for us to access as a result of our strategic shift away from analgesic drug 
development in 2019.  We may no longer have control over, or access to, prior clinical data that we may legally be required 
to report to NIH in the future.  Furthermore, it is unclear whether such new disclosure requirements apply to inactive, failed 
or  abandoned  drug  development  programs.  As  a  result  of  these  uncertainties,  the  government’s  ruling  may  leave  us  in  a 
conflicted position or out of compliance with new disclosure requirements.  We currently do not and cannot understand or 
anticipate the full impact and potential implications of this court ruling on our business. 

Risks Related to Our Intellectual Property  

If we are unable to obtain and maintain  sufficient patent protection for any product candidates, our competitors could 
develop and commercialize products similar or identical to ours, and our ability to successfully commercialize any product 
candidates we may develop may be adversely affected.  

Our success depends in large part on our ability to obtain and maintain patent protection in the U.S. and other countries 
with respect to our proprietary product candidates and other technologies we may develop. We seek to protect our proprietary 
position by filing patent applications in the U.S. and abroad relating to our core programs and product candidates, as well as 
other  technologies  that  are  important  to our business.  Given  that  our  product  candidates  are  in  early  or  clinical  stages  of 
development, our intellectual property portfolio with respect to certain aspects of our product candidates is also at an early 
stage.  For  example,  we  have  filed  or  intend  to  file  patent  applications  on  aspects  of  our  technology  and  core  product 
candidates; however, there can be no assurance that any such patent applications will issue as granted patents. Furthermore, 
in some cases, we have filed only provisional patent applications on certain aspects of our technology and product candidates 
and each of these provisional patent applications is not eligible to become an issued patent until, among other things, we file 
a non-provisional patent application within 12 months of the filing date of the applicable provisional patent application. Any 
failure  to  file  a  non-provisional  patent  application  within  this  timeline  could  cause  us  to  lose  the  ability  to  obtain  patent 
protection for the inventions disclosed in the associated provisional patent applications.  

Furthermore,  in  some  cases,  we  may  not  be  able  to  obtain  issued  claims  covering  compositions  relating  to  our  core 
programs and product candidates, as well as other technologies that are important to our business, and instead may need to 
rely on filing patent applications with claims covering a method of use and/or method of manufacture for protection of such 
core programs, product candidates, and other technologies. There can be no assurance that any such patent applications will 
issue as granted patents, and even if they do issue, such patent claims may be insufficient to prevent third parties, such as our 
competitors,  from  utilizing  our  technology.  Any  failure  to  obtain  or  maintain  patent  protection  with  respect  to  our  core 
programs  and  product  candidates  could  have  a  material  adverse  effect  on  our  business,  financial  condition,  results  of 
operations, and growth prospects.  

U.S. intellectual property rights around diagnostic methods is a complex, evolving area of law and effective patent claims 
may not be available to us for our investigational diagnostic product candidate, SavaDx, in the United States. 

The legal system for intellectual property around diagnostic methods is highly complex, remains uncertain and continues 
to evolve. In the U.S., patent courts have struggled to define a clear means of patent eligibility for modern age diagnostics. 
Case law interpretations from the U.S. Supreme Court have left certain important scientific advances in the area of diagnostics 
without effective patent claims. In 2012, the Supreme Court held that a simple process involving correlations between blood 
test results and patient health is not eligible for patent claims because such processes incorporate “laws of nature”. Since then, 
different outcomes from different courts, including Federal Circuit, district court and Patent Trial and Appeal Board decisions, 
have continued to create a sometimes vague or conflicting legal framework for determining the eligibility of patent claims for 
diagnostic methods. As a result, we cannot be certain how SavaDx fits into the current U.S. legal framework for obtaining 
effective patent protection. We currently have no U.S. patents or patent applications with respect to SavaDx, and we believe 
it may be protected in the United States only by trade secrets, know-how and other proprietary rights technology. Furthermore, 
claims for diagnostic methods can be complicated to enforce. For patent infringement to occur with a protected diagnostic, 
the patented method must generally either be performed by one person in its entirety or performed by multiple parties all 

53 

  
 
 
 
 
 
 
 
under the control or direction of a single party. Accordingly, even if effective patent claims are issued for SavaDx, it may be 
impractical, impossible or even undesirable to enforce potential infringement claims. 

Issued  patents  covering  our  product  candidates  and  other  technologies  could  be  found  invalid  or  unenforceable  if 
challenged in court or before administrative bodies in the U.S. or abroad.  

If  we  initiated  legal  proceedings  against  a  third  party  to  enforce  a  patent  covering  our  product  candidates  or  other 
technologies, the defendant could counterclaim that the asserted patent is invalid or unenforceable. In patent litigation in the 
U.S. and in other jurisdictions, defendant counterclaims alleging invalidity or unenforceability are commonplace. Grounds 
for a validity challenge could be an alleged failure to meet any of several statutory requirements, including lack of novelty, 
obviousness, or non-enablement. Grounds for an unenforceability assertion could be an allegation that someone connected 
with  prosecution  of  the  patent  withheld  relevant  information  from  the  USPTO,  or  made  a  misleading  statement,  during 
prosecution. Third parties may raise claims challenging the validity or enforceability of our patents before administrative 
bodies  in  the  U.S.  or  abroad,  even  outside  the  context  of  litigation.  Such  mechanisms  include  re-examination,  post-grant 
review,  inter  partes  review,  interference  proceedings,  derivation  proceedings,  and  equivalent  proceedings  in  foreign 
jurisdictions (e.g., opposition proceedings). Such proceedings could result in the revocation of, cancellation of, or amendment 
to our patents in such a way that they no longer cover our product candidates or other technologies. The outcome following 
legal assertions of invalidity and unenforceability is unpredictable. With respect to the validity question, for example, we 
cannot be certain that there is no invalidating prior art, of which we or our licensing partners and the patent examiner were 
unaware during prosecution. If a third party were to prevail on a legal assertion of invalidity or unenforceability, we would 
lose at least part, and perhaps all, of the patent protection on our product candidates or other technologies. Such a loss of 
patent protection would have a material adverse impact on our business, financial condition, results of operations, and growth 
prospects.  

If we do not obtain patent term extension and data exclusivity for any product candidates we may develop, our business 
may be materially harmed.  

Depending upon the timing, duration, and specifics of any FDA marketing approval of any product candidates we may 
develop, one or more of our U.S. patents may be eligible for limited patent term extension under the Drug Price Competition 
and Patent Term Restoration Act of 1984 (Hatch-Waxman Act). The Hatch-Waxman Act permits a patent term extension of 
up to five years as compensation for patent term lost during FDA regulatory review process. A patent term extension cannot 
extend the remaining term of a patent beyond a total of 14 years from the date of product approval, only one patent may be 
extended and only those claims covering the approved drug, a method for using it, or a method for manufacturing it may be 
extended. Similar extensions as compensation for patent term lost during regulatory review processes are also available in 
certain foreign countries and territories, such as in Europe under a Supplementary Patent Certificate. However, we may not 
be granted an extension in the U.S. and/or foreign countries and territories because of, for example, failing to exercise due 
diligence during the testing phase or regulatory review process, failing to apply within applicable deadlines, failing to apply 
prior to expiration of relevant patents, or otherwise failing to satisfy applicable requirements. Moreover, the applicable time 
period or  the  scope  of patent  protection  afforded  could be  less  than  we  request.  If  we  are  unable  to  obtain  a  patent term 
extension or the term of any such extension is shorter than what we request, our competitors may obtain approval of competing 
products following our patent expiration, and our business, financial condition, results of operations, and growth prospects 
could be materially harmed.  

If we are unable to protect the confidentiality of our trade secrets, our business and competitive position would be harmed.  

In  addition  to  seeking  patents  for  our  product  candidates  and  other  technologies,  we  also  rely  on  trade  secrets  and 
confidentiality agreements to protect our unpatented know-how, technology, and other proprietary information and to maintain 
our competitive position. We consider trade secrets and know-how to be one of our primary sources of intellectual property. 
Trade  secrets  and  know-how  can  be  difficult  to  protect.  We  expect  our  trade  secrets  and  know-how  to  over  time  be 
disseminated  within  the  industry  through  independent  development,  the  publication  of  journal  articles  describing  the 
methodology, and the movement of personnel from academic to industry scientific positions.  

We  seek  to  protect  these  trade  secrets  and  other  proprietary  technology,  in  part,  by  entering  into  non-disclosure  and 
confidentiality agreements with parties who have  access to them, such as our employees, corporate  collaborators, outside 
scientific collaborators, CROs, CDMOs, consultants, advisors, and other third parties. We also enter into confidentiality and 
invention or patent assignment agreements with our employees and consultants as well as train our employees not to bring or 
use proprietary information or technology from former employers to us or in their work, and remind former employees when 
they  leave  their  employment  of  their  confidentiality  obligations.  We  cannot  guarantee  that  we  have  entered  into  such 
agreements with each party that may have or have had access to our trade secrets or proprietary technology and processes. 
Despite our efforts, any of these parties may breach the agreements and disclose our proprietary information, including our 

54 

  
 
 
 
 
 
 
 
trade secrets, and we may not be able to obtain adequate remedies for such breaches. Enforcing a claim that a party illegally 
disclosed or misappropriated a trade secret is difficult, expensive, and time-consuming, and the outcome is unpredictable. In 
addition, some courts inside and outside the U.S. are less willing or unwilling to protect trade secrets. If any of our trade 
secrets were to be lawfully obtained or independently developed by a competitor or other third party, we would have no right 
to prevent them from using that technology or information to compete with us. If any of our trade secrets were to be disclosed 
to or independently developed by a competitor or other third party, our competitive position would be materially and adversely 
harmed.  

If any of our patent applications do not issue as patents in any jurisdiction, we may not be able to compete effectively.  

Changes in either the patent laws or their interpretation in the U.S. and other countries may diminish our ability to protect 
our inventions, obtain, maintain, and enforce our intellectual property rights and, more generally, could affect the value of our 
intellectual property or narrow the scope of our patents with respect to our product candidates. With respect to our intellectual 
property related to our product candidates, we cannot predict whether the patent applications we are currently pursuing will 
issue as patents in any particular jurisdiction or whether the claims of any issued patents will provide sufficient protection 
from competitors or other third parties.  

The patent prosecution process is expensive, time-consuming, and complex, and we may not be able to file, prosecute, 
maintain, or enforce all necessary or desirable patent applications at a reasonable cost or in a timely manner. It is also possible 
that we will fail to identify patentable aspects of our research and development output in time to obtain patent protection. 
Although  we  enter  into  nondisclosure  and  confidentiality  agreements  with  parties  who  have  access  to  confidential  or 
patentable aspects of our research and development output, such as our employees, outside scientific collaborators, CROs, 
CDMOs, consultants, advisors, and other third parties, any of these parties may breach the agreements and disclose such 
output before a patent application is filed, thereby jeopardizing our ability to seek patent protection. In addition, our ability to 
obtain and maintain valid and enforceable patents depends on whether the differences between our inventions and the prior 
art allow our inventions to be patentable. Furthermore, publications of discoveries in the scientific literature often lag behind 
the actual discoveries, and patent applications in the U.S. and other jurisdictions are typically not published until 18 months 
after filing, or in some cases not at all. Therefore, we cannot be certain that we were the first to make the inventions claimed 
in any of our patents or pending patent applications, or that we were the first to file for patent protection of such inventions.  

If the scope of any patent protection we obtain is not sufficiently broad, or if we lose any of our patent protection, our 
ability to prevent our competitors from commercializing similar or identical technology and product candidates would be 
adversely affected.  

The patent position of biotechnology and pharmaceutical companies generally is highly uncertain, involves complex legal 
and factual questions, and has been the subject of much litigation in recent years. As a result, the issuance, scope, validity, 
enforceability, and commercial value of our patent rights are highly uncertain. Our pending and future patent applications 
may not result in patents being issued which protect our product candidates or other technologies or which effectively prevent 
others from commercializing competitive technologies and product candidates.  

Moreover, the coverage claimed in a patent application can be significantly reduced before the patent is issued, and its 
scope can be reinterpreted after issuance. Even if patent applications we own currently or in the future issue as patents, they 
may not issue in a form that will provide us with any meaningful protection, prevent competitors or other third parties from 
competing with us, or otherwise provide us with any competitive advantage. Any patents to which we have rights may be 
challenged,  narrowed,  circumvented,  or  invalidated  by  third  parties.  Consequently,  we  do  not  know  whether  product 
candidates or other technologies will be protectable or remain protected by valid and enforceable patents. Our competitors or 
other third parties may be able to circumvent our patents by developing similar or alternative technologies or products in a 
non-infringing manner which could materially adversely affect our business, financial condition, results of operations and 
growth prospects.  

The issuance of a patent is not conclusive as to its inventorship, scope, validity, or enforceability, and our patents may be 
challenged in the courts or patent offices in the U.S. and abroad. We may be subject to a third-party pre-issuance submission 
of  prior  art  to  the  United  States  Patent  and  Trademark  Office  (USPTO)  or  become  involved  in  opposition,  derivation, 
revocation,  reexamination,  post-grant  and  inter  partes  review,  or  interference  proceedings  or  other  similar  proceedings 
challenging our patent rights. An adverse determination in any such submission, proceeding, or litigation could reduce the 
scope of, or invalidate or render unenforceable, such patent rights, allow third parties to commercialize our product candidates 
or  other  technologies  and  compete  directly  with  us,  without  payment  to  us,  or  result  in  our  inability  to  manufacture  or 
commercialize products without infringing third-party patent rights. Moreover, we may have to participate in interference 
proceedings  declared  by  the  USPTO  to  determine  priority  of  invention  or  in  post-grant  challenge  proceedings,  such  as 
oppositions in a foreign patent office, that challenge our priority of invention or other features of patentability with respect to 

55 

  
 
 
 
 
 
 
 
our patents and patent applications. Such challenges may result in loss of patent rights, loss of exclusivity, or in patent claims 
being narrowed, invalidated, or held unenforceable, which could limit our ability to stop others from using or commercializing 
similar or identical technology and products, or limit the duration of the patent protection of our product candidates and other 
technologies.  Such  proceedings  also  may  result  in  substantial  cost  and  require  significant  time  from  our  scientists  and 
management, even if the eventual outcome is favorable to us. If we are unsuccessful in any such proceeding or other priority 
or inventorship dispute, we may be required to obtain and maintain licenses from third parties, including parties involved in 
any  such  interference  proceedings  or  other  priority  or  inventorship  disputes.  Such  licenses  may  not  be  available  on 
commercially reasonable terms or at all or may be non-exclusive. If we are unable to obtain and maintain such licenses, we 
may need to cease the development, manufacture, and commercialization of one or more of the product candidates we may 
develop. The loss of exclusivity or the narrowing of our owned and licensed patent claims could limit our ability to stop others 
from using or commercializing similar or identical technology and products.  

In  addition,  given  the  amount  of  time  required  for  the  development,  testing,  and  regulatory  review  of  new  product 
candidates,  patents  protecting  such  product  candidates  might  expire  before  or  shortly  after  such  product  candidates  are 
commercialized.  As  a  result,  our  intellectual  property  may  not  provide  us  with  sufficient  rights  to  exclude  others  from 
commercializing products similar or identical to ours.  

We may not be able to protect our intellectual property and proprietary rights throughout the world.  

Filing, prosecuting, and defending patents on our product candidates and other technologies in all countries throughout 
the world would be prohibitively expensive, and the laws of foreign countries may not protect our rights to the same extent as 
the laws of the U.S.  

Consequently, we may not be able to prevent third parties from practicing our inventions in all countries outside the U.S., 
or from selling or importing products made using our inventions in and into the U.S. or other jurisdictions. Competitors may 
use our technologies in jurisdictions where we have not obtained patent protection to develop their own products, and, further, 
may export otherwise infringing products to territories where we have patent protection, but enforcement is not as strong as 
that in the U.S. These products may compete with our products, and our patents or other intellectual property rights may not 
be effective or sufficient to prevent them from competing.  

Many companies have encountered significant problems in protecting and defending intellectual property rights in foreign 
jurisdictions. The legal systems of certain countries, particularly certain developing countries, do not favor the enforcement 
of patents, trade secrets, and other intellectual property protection, particularly those relating to biotechnology products, which 
could make it difficult for us to stop the infringement of our patents or marketing of competing products in violation of our 
intellectual property and proprietary rights generally. Proceedings to enforce our intellectual property and proprietary rights 
in foreign jurisdictions could result in substantial costs and divert our efforts and attention from other aspects of our business, 
could put  our patents  at  risk of being  invalidated  or  interpreted  narrowly,  could  put  our  patent  applications  at  risk  of  not 
issuing, and could provoke third parties to assert claims against us. We may not prevail in any lawsuits that we initiate, and 
the damages or other remedies awarded, if any, may not be commercially meaningful. Accordingly, our efforts to enforce our 
intellectual property and proprietary rights around the world may be inadequate to obtain a significant commercial advantage 
from the intellectual property that we develop or license.  

Obtaining and maintaining our patent protection depends on compliance with various procedural, document submission, 
fee payment, and other requirements imposed by government patent agencies, and our patent protection could be reduced 
or eliminated for non-compliance with these requirements.  

Periodic maintenance fees, renewal fees, annuity fees, and various other government fees on patents and applications will 
be due to be paid to the USPTO and various government patent agencies outside of the U.S. over the lifetime of our owned 
or licensed patents and applications. The USPTO and various non-U.S. government agencies require compliance with several 
procedural, documentary, fee payment, and other similar provisions during the patent application process. In some cases, an 
inadvertent lapse can be cured by payment of a late fee or by other means in accordance with the applicable rules. There are 
situations, however, in which non-compliance can result in abandonment or lapse of the patent or patent application, resulting 
in a partial or complete loss of patent rights in the relevant jurisdiction. In such an event, potential competitors might be able 
to  enter  the  market  with  similar  or  identical  products  or  technology,  which  could  have  a  material  adverse  effect  on  our 
business, financial condition, results of operations, and growth prospects. 

56 

  
 
 
 
 
 
 
 
 
Changes in U.S. patent law could diminish the value of patents in general, thereby impairing our ability to protect our 
products.  

Changes in either the patent laws or interpretation of the patent laws in the U.S. could increase the uncertainties and costs 
surrounding the prosecution of patent applications and the enforcement or defense of issued patents. Assuming that other 
requirements for patentability are met, prior to March 2013, in the U.S., the first to invent the claimed invention was entitled 
to the patent, while outside the U.S., the first to file a patent application was entitled to the patent. After March 2013, under 
the Leahy-Smith America Invents Act (the America Invents Act) enacted in September 2011, the U.S. transitioned to a first 
inventor to file system in which, assuming that other requirements for patentability are met, the first inventor to file a patent 
application will be entitled to the patent on an invention regardless of whether a third party was the first to invent the claimed 
invention.  A  third  party  that  files  a  patent  application  in  the  USPTO  after  March  2013,  but  before  us  could  therefore  be 
awarded a patent covering an invention of ours even if we had made the invention before it was made by such third party. 
This will require us to be cognizant going forward of the time from invention to filing of a patent application. Since patent 
applications in the U.S. and most other countries are confidential for a period of time after filing or until issuance, we cannot 
be certain that we were the first to either (i) file any patent application related to our product candidates or other technologies 
or (ii) invent any of the inventions claimed in our patents or patent applications.  

The America Invents Act also includes a number of significant changes that affect the way patent applications will be 
prosecuted and also may affect patent litigation. These include allowing third party submission of prior art to the USPTO 
during patent  prosecution  and  additional  procedures  to  attack  the  validity  of  a  patent  by  USPTO  administered  post-grant 
proceedings, including post-grant review, inter partes review, and derivation proceedings. Because of a lower evidentiary 
standard in USPTO proceedings as compared to the evidentiary standard in U.S. federal courts necessary to invalidate a patent 
claim, a  third party could potentially provide  evidence in a USPTO proceeding sufficient for the USPTO to hold a claim 
invalid even though the same evidence would be insufficient to invalidate the claim if first presented in a district court action. 
Accordingly, a third party may attempt to use the USPTO procedures to invalidate our patent claims that would not have been 
invalidated if first challenged by the third party as a defendant in a district court action. Therefore, the America Invents Act 
and its implementation could increase the uncertainties and costs surrounding the prosecution of our patent applications and 
the enforcement or defense of our issued patents, all of which could have a material adverse effect on our business, financial 
condition, results of operations, and growth prospects.  

In  addition,  the  patent  positions  of  companies  in  the  development  and  commercialization  of  pharmaceuticals  are 
particularly uncertain. Various U.S. Supreme Court rulings have narrowed the scope of patent protection available in certain 
circumstances  and  weakened  the  rights  of  patent  owners  in  certain  situations.  This  combination  of  events  has  created 
uncertainty with respect to the validity and enforceability of patents, once obtained. Depending on future actions by the U.S. 
Congress, the federal courts, and the USPTO, the laws and regulations governing patents could change in unpredictable ways 
that could have a material adverse effect on our existing patent portfolio and our ability to protect and enforce our intellectual 
property in the future.  

We may be subject to claims challenging the inventorship of our patents and other intellectual property.  

We may be subject to claims that former employees, scientific collaborators or other third parties have an interest in our 
patents, trade secrets, or other intellectual property as an inventor or co-inventor. For example, we may have inventorship 
disputes arise from conflicting obligations of employees, consultants, or others who are involved in developing our product 
candidates  or  other  technologies.  Litigation  may  be  necessary  to  defend  against  these  and  other  claims  challenging 
inventorship or ownership of our patents, trade secrets, or other intellectual property. If the defense of any such claims fails, 
in addition to paying monetary damages, we may lose valuable intellectual property rights, such as exclusive ownership of, 
or  right  to  use,  intellectual  property  that  is  important  to  our  product  candidates  and  other  technologies.  Even  if  we  are 
successful in defending against such claims, litigation could result in substantial costs and be a distraction to management and 
other employees. Any of the foregoing could have a material adverse effect on our business, financial condition, results of 
operations, and growth prospects.  

We may not be successful in obtaining necessary rights to our product candidates or other technologies.  

Many pharmaceutical companies, biotechnology companies, and academic institutions that compete with us in the field 
of  neurodegeneration  therapy  may  have  patents  filed  and  are  likely  filing  patent  applications  potentially  relevant  to  our 
business. In order to avoid infringing these third-party patents, we may find it necessary or prudent to obtain licenses to such 
patents  from  such  third-party  intellectual  property  holders.  We  may  also  require  licenses  from  third  parties  for  certain 
technologies for use with future product candidates. In addition, with respect to any patents we co-own with third parties, we 
may wish to obtain licenses to such co-owner’s interest to such patents. However, we may be unable to secure such licenses 
or otherwise acquire any compositions, methods of use, processes, or other intellectual property rights from third parties that 

57 

  
 
 
 
 
 
 
 
we identify as necessary for our future product candidates. The licensing or acquisition of third-party intellectual property 
rights is a competitive area, and several more established companies may pursue strategies to license or acquire third-party 
intellectual property rights that we may consider attractive or necessary. These established companies may have a competitive 
advantage over us due to their size, capital resources, and greater clinical development and commercialization capabilities. In 
addition, companies that perceive us to be a competitor may be unwilling to assign or license rights to us. We also may be 
unable to license or acquire third-party intellectual property rights on terms that would allow us to make an appropriate return 
on our investment or at all. If we are unable to successfully obtain rights to required third-party intellectual property rights or 
maintain the existing intellectual property rights we have, we may have to abandon development of the relevant program or 
product candidate, which could have a material adverse effect on our business, financial condition, results of operations, and 
growth prospects.  

We may be subject to claims that our employees, consultants, or advisors have wrongfully used or disclosed alleged trade 
secrets  of  their  current  or  former  employers  or  claims  asserting  ownership  of  what  we  regard  as  our  own  intellectual 
property which may prevent or delay the development of our product candidates.  

The field of developing innovations for neurodegenerative diseases is highly competitive and dynamic. Due to the focused 
research and development that is taking place by several companies, including us and our competitors, the intellectual property 
landscape in this field is in flux, and it may remain uncertain in the future. Additionally, no products utilizing our underlying 
science and technology have yet reached the market. As such, there may be significant intellectual property related litigation 
and proceedings relating to our, and other third party, intellectual property and proprietary rights in the future.  

Many of our employees, consultants, and advisors are  currently or were previously employed at universities or other 
biotechnology or pharmaceutical companies, including our competitors and potential competitors. Although we try to ensure 
that our employees, consultants, and advisors do not use the proprietary information or know-how of others in their work for 
us, we  may be  subject to claims that we  or these individuals have used or disclosed intellectual property, including trade 
secrets or other proprietary information, of any such individual’s current or former employer. Litigation may be necessary to 
defend against these claims. If we fail in defending any such claims, in addition to paying monetary damages, we may lose 
valuable intellectual property rights or personnel. Even if we are successful in defending against such claims, litigation could 
result in substantial costs and be a distraction to management.  

In addition, while it is our policy to require our employees and contractors who may be involved in the conception or 
development of intellectual property to execute agreements assigning such intellectual property to us, we may be unsuccessful 
in executing such an agreement with each party who, in fact, conceives or develops intellectual property that we regard as our 
own. The assignment of intellectual property rights may not be self-executing, or the assignment agreements may be breached, 
and we may be forced to bring claims against third parties, or defend claims that they may bring against us, to determine the 
ownership of what we regard as our intellectual property. Such claims could have a material adverse effect on our business, 
financial condition, results of operations, and growth prospects.  

Our commercial success depends in part on our ability to develop, manufacture, market, and sell any product candidates 
that we  develop and to use our proprietary technologies without infringing, misappropriating, and otherwise violating the 
patents and other intellectual property rights of third parties. There is a substantial amount of complex litigation involving 
patents and other intellectual property rights in the biotechnology and pharmaceutical industries, as well as administrative 
proceedings for challenging patents, including interference, derivation, and reexamination proceedings before the USPTO or 
oppositions and other comparable proceedings in foreign jurisdictions. We may become party to, or threatened with, such 
actions in the future, regardless of their merit. As discussed above, recently, due to changes in U.S. law referred to as patent 
reform, new procedures including inter partes review and post-grant review have been implemented. As stated above, this 
reform adds uncertainty to the possibility of challenge to our patents in the future.  

Numerous U.S. and foreign issued patents and pending patent applications owned by third parties exist in the fields in 
which we are developing our product candidates. As the biotechnology and pharmaceutical industries expand and more patents 
are issued, the risk increases that our product candidates and other technologies may give rise to claims of infringement of the 
patent rights of others. Although we believe that we do not infringe on any third parties’ patents or other intellectual property, 
we  cannot assure you that our product candidates and other technologies that we  have developed, are developing or may 
develop in the future will not infringe existing or future patents owned by third parties. We may not be aware of patents that 
have already been issued to a third party, such as a competitor in the fields in which we are developing product candidates, 
who  might  assert  infringement  of  patents  it  may  hold  by  our  current  or  future  product  candidates  or  other  technologies, 
including claims to compositions, formulations, methods of manufacture or methods of use or treatment that cover our product 
candidates or other technologies. It is also possible that patents owned by third parties of which we are aware, but which we 
do not believe are relevant to our product candidates or other technologies, could be found to be infringed by our product 
candidates or other technologies. In addition, because patent applications can take many years to issue, there may be currently 

58 

  
 
 
 
 
 
 
pending  patent  applications  that  may  later  result  in  issued  patents  that  our  product  candidates  or  other  technologies  may 
infringe.  

Engaging  in  litigation  to  defend  against  third  parties  alleging  that  we  have  infringed,  misappropriated,  or  otherwise 
violated their patents or other intellectual property rights is very expensive, particularly for a company of our size, and time-
consuming.  Some  of  our  competitors  may  be  able  to  sustain  the  costs  of  litigation  or  administrative  proceedings  more 
effectively  than  we  can  because  of  greater  financial  resources.  Patent  litigation  and  other  proceedings  may  also  absorb 
significant  management  time.  Uncertainties  resulting  from  the  initiation  and  continuation  of  patent  litigation  or  other 
proceedings against us could impair our ability to compete in the marketplace. The occurrence of any of the foregoing could 
have a material adverse effect on our business, financial condition, results of operations, and growth prospects.  

We may become involved in lawsuits to protect or enforce our patents and other intellectual property rights, which could 
be expensive, time consuming, and unsuccessful.  

Competitors may infringe on our patents or the patents of our licensing partners, or we may be required to defend against 
claims  of  infringement.  In  addition,  our  patents  or  the  patents  of  our  licensing  partners  also  may  become  involved  in 
inventorship, priority, or validity disputes. To counter or defend against such claims can be expensive and time consuming. 
In an infringement proceeding, a court may decide that a patent in which we have an interest is invalid or unenforceable, the 
other party’s use of our patented technology falls under the safe harbor to patent infringement, or may refuse to stop the other 
party from using the technology at issue on the grounds that our patents do not cover the technology in question. An adverse 
result in any litigation proceeding could put one or more of our patents at risk of being invalidated or interpreted narrowly. 
Furthermore, because of the substantial amount of discovery required in connection with intellectual property litigation, there 
is a risk that some of our confidential information could be compromised by disclosure during this type of litigation.  

Even if resolved in our favor, litigation or other legal proceedings relating to intellectual property claims may cause us to 
incur  significant  expenses  and  could distract  our  personnel  from  their normal  responsibilities.  In  addition,  there  could  be 
public announcements of the results of hearings, motions, or other interim proceedings or developments, and if securities 
analysts or investors perceive these results to be negative, it could have a substantial adverse effect on the price of our common 
stock. Such litigation or proceedings could substantially increase our operating losses and reduce the resources available for 
development activities or any future sales, marketing, or distribution activities. We may not have sufficient financial or other 
resources to conduct such litigation or proceedings adequately. Some of our competitors may be able to sustain the costs of 
such litigation or proceedings more effectively than we can because of their greater financial resources and more mature and 
developed intellectual property portfolios. Uncertainties resulting from the initiation and continuation of patent litigation or 
other proceedings could have a material adverse effect on our ability to compete in the marketplace. 

Intellectual property rights do not necessarily address all potential threats.  

The  degree of  future  protection  afforded  by our  intellectual  property  rights  is  uncertain  because  intellectual  property 
rights have limitations and may not adequately protect our business or permit us to maintain our competitive advantage. For 
example:  

• 

others may be able to make products that are similar to our product candidates or utilize similar technology but that 
are not covered by the claims of the patents that we may own; 

•  we might not have been the first to make the inventions covered by the issued patent or pending patent application 

that we own now or in the future; 

•  we might not have been the first to file patent applications covering certain of our inventions; 

• 

• 

• 

• 

others may independently develop similar or alternative technologies or duplicate any of our technologies without 
infringing our owned intellectual property rights; 

it is possible that our current or future pending patent applications will not lead to issued patents; 

issued patents that we hold rights to may be held invalid or unenforceable, including as a result of legal challenges 
by our competitors or other third parties; 

our competitors or other third parties might conduct research and development activities in countries where we do 
not have patent rights and then use the information learned from such activities to develop competitive products for 
sale in our major commercial markets; 

•  we may not develop additional proprietary technologies that are patentable; 

59 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
• 

the patents of others may harm our business; and 

•  we may choose not to file a patent in order to maintain certain trade secrets or know-how, and a third party may 

subsequently file a patent covering such intellectual property. 

Should any of these events occur, they could have a material adverse effect on our business, financial condition, results 

of operations, and growth prospects.  

Risks Related to Our Business and Operations  

Our reputation and operations could be adversely impacted by allegations, regardless of their merits.  

We  believe  that  our  reputation  has  significantly  contributed  to  the  success  of  our  business.  We  also  believe  that 
maintaining and enhancing our reputation is critical to many of our core operations, such as conducting studies, working with 
outside vendors, hiring qualified employees, members of our Board of Directors or science collaborators, raising funds for 
future operations, or working with potential industry and government collaborators. Maintaining and enhancing our reputation 
will  depend  largely  on  our  ability  to  develop  innovative  drug  products,  continue  to  generate  credible  scientific  data  and 
respond appropriately to our critics, which we may not do successfully. 

Our reputation may be injured by published false statements purporting to be fact, or by hostile actions made by or paid 
for by parties who represent investors who seek a decline in the price of our securities (“short-sellers”). Such allegations and 
statements may be published on internet forums over which we have no control, such as social media, and may be adopted by 
the editors of scientific or technical journals that have published our research, potentially resulting in retractions or expressions 
of concern by the journals. Regardless of merit, allegations and false statements may spread quickly and erode confidence in 
our reputation. Maintaining and enhancing our reputation may require us to make substantial investments in legal actions or 
other  activities,  and  these  investments  could  be  expensive,  time  consuming,  and  unsuccessful.  If  we  fail  to  successfully 
maintain our reputation, or if we incur excessive expenses in this effort, our business, operations, future prospects, cash flows, 
and financial position may be adversely affected. 

Our ability to continue to operate without any significant disruptions will in part depend on our ability to source materials 
and clinical supplies via our product supply chains. 

The  widespread  outbreak  of  COVID-19  in  recent  years  generally  did  not  significantly  impact  our  ability  to  source 
materials and clinical supplies to date. However, we are broadly aware of some general supply chain disruptions in certain 
markets due primarily to the restriction of employee movements and, in North America, due to labor shortages, supply chain 
disruptions, an unexpected rise in inflation and transportation constraints. In addition, uncertainty regarding the emergence of 
new mutations or variants of the COVID virus, the likelihood of a resurgence of positive cases, the speed at which treatments 
and vaccines are administered or mandated and governmental actions in response to the pandemic could result in an unforeseen 
disruption to our  operations. In addition, our ability to conduct clinical trials require the use of a host of critical ancillary 
supplies. Clinical ancillary supplies are general consumable or disposable products, such as sample collection tubes, latex 
gloves, instruments and other products routinely used in a medical or clinical research setting. We rely on independent vendors 
globally to supply us or our clinical collaborators with ancillary supplies. Any disruptions, gaps or shortages in the global 
supply  chain  for  ancillary  supplies  could  increase  the  cost  or  complexity  of  our  supply  chain  management  and  delay  the 
completion of our Phase 3 clinical program. 

We  cannot  reasonably  predict  disruptions,  gaps  or  shortages  across  our  product  supply-chains.  With  prolonged 
disruptions, there exists the possibility of a material adverse impact on our business, clinical operations, future prospects, cash 
flows, and financial position. Should we be unable to obtain key materials and clinical supplies on a timely basis, it could 
have a material adverse effect on our business, financial condition, results of operations, and growth prospects. 

Our current dependence on single source suppliers for our drug substance and drug product could materially adversely 
affect our ability to manufacture our product candidates and materially increase our costs. 

We  rely on single source suppliers for materials that are  critical to the manufacturing of simufilam, our lead product 
candidate. This reliance subjects us to risks related to our potential inability to obtain an adequate supply of required materials. 
Our operating results could be materially adversely affected if we were unable to obtain adequate supplies of simufilam in a 
timely manner or if their cost increased significantly due to inflation or other factors. 

60 

  
  
 
 
 
 
 
 
 
 
 
 
 
Further, it would likely result in production and delivery delays if we needed to find alternative suppliers for simufilam, 
which could lead to delays in our clinical trials and have a material adverse effect on our business, results of operations and 
financial condition. 

Changes  in  funding  for  the  FDA  and  other  government  agencies,  or  changes  in  FDA’s  Guidance  for  Industry,  could 
hinder their ability to hire and retain key leadership and other personnel, or otherwise prevent our product candidates 
from being developed or commercialized in a timely manner, which could negatively impact our business. 

We rely on the FDA to assist  us with the development our product candidates. The ability of the FDA to review and 
approve new drug products can be affected by a variety of factors outside of our control, including government budget and 
funding levels, ability to hire and retain key personnel and accept the payment of user fees, and statutory, regulatory, and 
policy changes. Average review times at the agency have fluctuated in recent years as a result. In addition, government funding 
of  other  government  agencies  that  fund  research  and  development  activities  is  subject  to  the  political  process,  which  is 
inherently fluid and unpredictable. 

FDA Guidance for Industry are non-binding policy documents that are issued by FDA from time to time to assist sponsors 
with the clinical development of drug candidates. Even though such guidance documents do not set legal standards or impose 
binding requirements they are nonetheless broadly followed by sponsors, including us. In addition, sponsors who adhere in 
good faith with earlier guidance documents have no assurance against enforcement actions if the guidance documents are later 
replaced with conflicting guidance. We have relied heavily on current FDA guidance to advance simufilam through the drug 
development process. Any future changes to existing FDA Guidance for Industry for Alzheimer’s disease may have a material 
adverse effect on our business, may add significant time, cost or complexity to our drug development program for simufilam, 
or could cause us to cease or delay development of some or all our product candidates.  

Disruptions at the FDA and other agencies may also slow the time necessary for our product candidates to be reviewed 
and/or potentially approved by necessary government agencies, which would adversely affect our business. For example,  in 
recent history, including for 35 days beginning on December 22, 2018, the U.S. government has shut down several times and 
certain regulatory agencies, such as the FDA, have had to furlough critical FDA employees and stop critical activities. If a 
prolonged government shutdown occurs, it could significantly impact the ability of the FDA to timely review and process our 
regulatory  submissions,  which  could  have  a  material  adverse  effect  on  our  business.  If  the  timing  of  FDA’s  review  and 
approval of new products is delayed, the estimated timing of our drug development program may be delayed which would 
materially increase costs of drug development and harm our operations or business. 

Our reliance on third parties for both the supply and manufacture of materials for our product candidates carries the risk 
that we will not have sufficient quality or quantities of such materials or product candidates, or that such supply will not 
be  available  to  us  at  an  acceptable  cost,  which  could  delay,  prevent,  or  impair  our  development  or  commercialization 
efforts. 

We do not have any manufacturing facilities. We currently rely on CDMOs for all of the manufacture of our materials 
for preclinical  studies and clinical studies and expect to continue to do so for preclinical studies, clinical studies, and for 
commercial supply of any product candidates that we may develop. We currently have established relationships with several 
CDMOs for the manufacturing of our product candidates. We may be unable to establish any further agreements with CDMOs 
or  to  do  so  on  acceptable  terms.  Even  if  we  are  able  to  establish  agreements  with  third-party  manufacturers,  reliance  on 
CDMOs entails additional risks, including:  

• 

• 

• 

the possible breach of the manufacturing agreement by the third party; 

the possible termination or nonrenewal of the agreement by the third party at a time that is costly or inconvenient for 
us; 

reliance on the third party for regulatory compliance, quality assurance, safety, and pharmacovigilance and related 
reporting; and 

• 

the inability to produce required volume in a timely manner and to quality standards. 

Third-party manufacturers may not be able to comply with cGMP regulations or similar regulatory requirements outside 
the U.S. Our failure, or the failure of our CDMOs, to comply with applicable regulations could result in clinical holds on our 
studies,  sanctions  being  imposed  on  us,  including  fines,  injunctions,  civil  penalties,  delays,  suspension  or  withdrawal  of 
approvals, seizures, or recalls of product candidates or product candidates, operating restrictions, and criminal prosecutions, 
any of which could significantly and adversely affect supplies of our product candidates and harm our business, financial 
condition, results of operations, and growth prospects.  

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Any product candidates that we  may develop may compete  with other product candidates and products for access to 
manufacturing facilities. There are a limited number of manufacturers that operate under cGMP regulations and that might be 
capable of manufacturing for us.  

Any performance failure on the part of our existing or future third-party manufacturers could delay clinical development 
or marketing approval. If any one of our current contract manufacturers cannot perform as agreed, we may be required to 
replace  that  manufacturer  and  may  incur  added  costs  and  delays  in  identifying  and  qualifying  any  such  replacement. 
Furthermore, securing and reserving production capacity with contract manufacturers may result in significant costs.  

We also rely on third-parties for the supply of the raw materials required for the production of our product candidates, 
and we expect to continue to rely on third party manufacturers for the commercial supply of any of our product candidates for 
which we obtain marketing approval. Our current and anticipated future dependence upon others for the manufacture of any 
product  candidates  we  may  develop  may  adversely  affect our  future  profit  margins  and  our  ability  to  commercialize  any 
medicines that receive marketing approval on a timely and competitive basis. 

Our employees, principal investigators, consultants and vendors may engage in misconduct or other improper activities, 
including noncompliance with regulatory standards and requirements and insider trading. 

We  are  exposed  to  the  risk  of  fraud  or  other  misconduct  by  our  employees,  principal  investigators,  consultants  and 
vendors. Misconduct by these parties could include intentional failures, reckless and/or negligent conduct or unauthorized 
activities that violate (i) the laws and regulations of FDA and other regulatory authorities, including those laws requiring the 
reporting of true, complete and accurate information to such authorities, (ii) manufacturing standards, (iii) federal and state 
data privacy, security, fraud and abuse and other healthcare laws and regulations in the United States and abroad and (iv) laws 
that require the true, complete and accurate  reporting of financial information or data. In particular, clinical and business 
arrangements in the biotechnology and healthcare industries are subject to extensive laws and regulations intended to prevent 
fraud, misconduct, kickbacks, self-dealing and other abusive practices. These laws and regulations restrict or prohibit a wide 
range of financial arrangements, incentive programs and other business arrangements. Such misconduct also could involve 
the improper use of individually identifiable information, including, without limitation, information obtained in the conduct 
of clinical trials, creating fraudulent data in our preclinical studies or clinical trials or illegal misappropriation of drug product, 
which could result in regulatory sanctions and cause serious harm to our reputation. It is not always possible to identify and 
deter misconduct by employees and other third parties, and the precautions we take to detect and prevent this activity may not 
be effective in controlling unknown or unmanaged risks or losses or in protecting us from government investigations or other 
actions or lawsuits stemming from a failure to comply with these laws or regulations.  

Additionally, we are subject to the risk that a person or government could allege such fraud or other misconduct, even if 
none occurred. If any such actions are instituted against us and we are not successful in defending ourselves or asserting our 
rights,  those  actions  could  result  in  significant  civil,  criminal  and  administrative  penalties,  damages,  fines,  disgorgement, 
imprisonment,  exclusion  from  participating  in  government-funded  healthcare  programs,  such  as  Medicare  and  Medicaid, 
additional reporting requirements and oversight if we become subject to a corporate integrity agreement or similar agreement 
to  resolve  allegations  of  noncompliance  with  these  laws,  contractual  damages,  reputational  harm  and  the  curtailment  or 
restructuring of our operations, any of which could have a negative impact on our business, financial condition, results of 
operations and prospects. 

Our disclosure controls and procedures may not prevent or detect all errors or acts of fraud. 

We  are  subject to the periodic reporting requirements of the Exchange Act. We designed our disclosure controls and 
procedures to reasonably assure that information we must disclose in reports we file or  furnish under the Exchange Act is 
accumulated and communicated to management, and recorded, processed, summarized and reported within the time periods 
specified in the rules and forms of the SEC. We believe that any disclosure controls and procedures or internal controls and 
procedures,  no  matter  how  well-conceived  and  operated,  can  provide  only  reasonable,  not  absolute,  assurance  that  the 
objectives of the control system are met. 

These inherent limitations include the realities that judgments in decision-making can be faulty, and that breakdowns can 
occur because of simple mistake or human error. Additionally, controls can be circumvented by the individual acts of some 
persons,  by  collusion of  two or  more  people  or  by  an  unauthorized  override  of  the  controls.  Accordingly,  because  of  the 
inherent limitations in our control system, misstatements due to error or fraud may occur and not be detected. 

62 

  
 
 
 
 
 
 
 
 
 
 
Failure to comply with laws regarding data privacy could expose us to risk of enforcement actions and penalties under 
such laws. 

We may be subject to privacy and security laws in the various jurisdictions in which we operate, obtain or store personally 
identifiable information. The legislative and regulatory landscape for privacy and data protection continues to evolve, and 
there has been an increasing focus on privacy and data protection issues with the potential to affect our business. Our ongoing 
efforts  to  comply  with  evolving  laws  and  regulations  may  be  costly  and  require  ongoing  modifications  to  our  policies, 
procedures and systems. Failure  to comply with laws regarding data protection  by us or our partners or service providers 
would expose us to risk of enforcement actions and penalties under such laws. Even if we are not determined to have violated 
these laws, government investigations into these issues typically require the expenditure of significant resources and generate 
negative publicity, which could harm our business, financial condition, results of operations or prospects. 

Within the U.S., there are numerous federal and state laws and regulations related to the privacy and security of personal 
information. For example, at the federal level, the Health Insurance Portability and Accountability Act of 1996, as amended 
(“HIPAA”), and its implementing regulations establish privacy and security standards that limit the use and disclosure of 
personally identifiable health information, or protected health information, and require the implementation of administrative, 
physical and technological safeguards to protect the privacy of protected health information. While we have determined that 
we are neither a “covered entity” nor a “business associate” directly subject to HIPAA, many of the U.S. health care providers 
with which we  interact are subject  to HIPAA, and we  may have assumed obligations related to protecting the privacy of 
personal information. States are increasingly regulating the privacy and security of personal information. For  example, the 
California Consumer Privacy Act (“CCPA”), which took effect on January 1, 2020, gives California consumers (defined to 
include all California residents) certain rights, including the right to ask covered companies to disclose the types of personal 
information  collected,  the  categories  of  sources  from  which  such  information  was  collected,  the  business  purpose  for 
collecting or selling the consumer’s personal information, the categories of third parties with whom a covered company shares 
personal  information,  and  specific  pieces  of  information  collected  by  a  covered  company.  The  CCPA  imposes  several 
obligations on covered companies to provide notice to California consumers regarding their data processing activities. The 
CCPA also gives California consumers the right to ask covered companies to delete a consumer’s personal information and it 
places limitations on a covered company’s ability to sell personal information, including providing consumers a right to opt 
out  of  sales  of  their  personal  information.  Additionally,  the  California  Privacy  Rights  Act  (“CPRA”),  which  became 
operational in 2023, significantly modifies the CCPA, including expanding consumers’ rights with respect to certain sensitive 
personal information, and creates a new state agency vested with authority to implement and enforce the CCPA and CPRA. 
The Virginia Consumer Data Protection Act (“CDPA”) went into effect on January 1, 2023. The CDPA provides consumers 
with new rights to access, correct, delete and obtain a copy of the personal information a covered business holds about them, 
and to opt out of certain data processing activities. 

Because we are developing our lead product candidate for the treatment of Alzheimer’s disease, a condition  for which 
there are no recent examples of new drug molecules that have received full FDA approval, and our trials employ endpoints 
or methodologies that may be considered subjective, there is a heightened risk that the FDA or other regulatory authorities 
may not consider our clinical trials, or the endpoints of our clinical trials, as evidence of clinically meaningful results or 
that our clinical results may be difficult to analyze. 

If our product candidates advance to the FDA review process, we will need to identify success criteria and endpoints such 
that the FDA will be able to determine  the  clinical  efficacy and safety profile of our product candidates.  Because we  are 
developing a novel treatment for Alzheimer’s disease, a condition in which there are very few examples of new drug approvals, 
and our trials employ endpoints or methodologies that may be considered subjective, there is heightened risk that the FDA or 
other regulatory bodies may not consider our clinical trials, or the endpoints of our clinical trials, as evidence of clinically 
meaningful results to patients. In addition, the resulting clinical data and results may be difficult to analyze. Even if the FDA 
does find our success criteria to be sufficiently validated and clinically meaningful, we may not achieve the pre-specified 
endpoints to a threshold of statistical significance (i.e., p-value <0.05). Even if we believe the data collected from clinical 
trials of our lead product candidates are promising, these data may not be sufficient to support approval by the FDA or foreign 
regulatory authorities. Pre-clinical and clinical data can be interpreted in different ways. Accordingly, the FDA or foreign 
regulatory authorities could interpret these data  in different ways from us, which could delay, limit or prevent regulatory 
approval. 

If data from one or both of our Phase 3 trials do not adequately demonstrate the safety or efficacy of our lead product 
candidate, the regulatory approval for such product candidate could be significantly delayed as we work to meet approval 
requirements, or, if we are not able to meet these requirements, such approvals could be denied.  

We are evaluating two doses (50 mg and 100 mg) of simufilam in on-going Phase 3 trials. If data from one dose in our 
Phase  3  trials  does  not  adequately  demonstrate  safety  or  efficacy,  the  regulatory  approval  for  the  other  dose  could  be 

63 

  
 
 
 
 
 
 
significantly  delayed  as  we  work  to  meet  approval  requirements,  or,  if  we  are  not  able  to  meet  these  requirements,  such 
approval could be denied.  

We  expect  to  significantly  grow  the  size  and  capabilities  of  our  organization  and  we  may  experience  difficulties  in 
effectively managing this growth.  

As  our  development  plans  and  strategies  develop,  we  expect  to  add  a  significant  number  of  additional  managerial, 
operational,  financial,  and  other  personnel.  Future  growth  will  impose  significant  added  responsibilities  on  members  of 
management, including:  

identifying, recruiting, integrating, retaining, and motivating additional employees; 
increasing employee headcount; 

• 
• 
•  managing our internal development efforts effectively, including the clinical and FDA review process for our current 
and future product candidates, while complying with our contractual obligations to contractors and other third parties; 
expanding our operational, financial and management controls, reporting systems, and procedures; and  

• 
•  managing increasing operational and managerial complexity. 

Our future financial performance and our ability to continue  to develop and, if approved, commercialize our product 
candidates will depend, in part, on our ability to effectively manage any future growth. Our management may also have to 
divert a disproportionate amount of its attention away from day-to-day activities in order to manage these growth activities.  

We  currently  rely,  and  for  the  foreseeable  future  will  continue  to  rely,  in  substantial  part  on  certain  independent 
organizations,  advisors,  and  consultants  to  provide  certain  services.  There  can  be  no  assurance  that  the  services  of  these 
independent organizations, advisors, and consultants will continue to be available to us on a timely basis when needed, or that 
we  can find qualified replacements. In addition, if we are unable to effectively manage our outsourced activities or if the 
quality  or  accuracy  of  the  services  provided  by  consultants  is  compromised  for  any  reason,  our  clinical  studies  may  be 
extended, delayed, or terminated, and we may not be able to obtain regulatory approval of our product candidates or otherwise 
advance  our  business.  There  can  be  no  assurance  that  we  will  be  able  to  manage  our  existing  consultants  or  find  other 
competent outside contractors and consultants on economically reasonable terms, if at all.  

If  we  are  not  able  to  effectively  expand  our  organization  by  hiring  new  employees  and  expanding  our  groups  of 
consultants and contractors, we may not be able to successfully implement the tasks necessary to further develop our product 
candidates and, accordingly, may not achieve our research, development, and commercialization goals.  

Ownership of our corporate headquarters and property leasing are subject to numerous risks and uncertainties. 

In August 2021, we made an all-cash purchase of an office complex in Austin, Texas, a portion of which serves as our 
corporate  headquarters.  Title  to  this  property  is  held  by  Austin  Innovation  Park,  LLC,  a  Texas  limited  liability  company 
wholly owned by Cassava Sciences.  The purchase required a substantial upfront  cash investment and may require further 
commitments of our resources in the future. We have assumed or entered into lessor commitments with independent third 
parties for portions of our office complex and will continue to do so in the future. Commercial property ownership and related 
leasing activity are subject to many factors that pose substantial financial risks and uncertainties, including tenant default or 
non-payment of lease obligations by tenants. Macro-economic or other factors outside of our control could have an adverse 
effect  on  the  demand  for  leased  office  space  in  our  locale  or  may  cause  a  decline  in  the  market  value  of  our  corporate 
headquarters. If we fail to lease unoccupied office space at favorable rates, or if we incur excessive expenses in this effort or 
incur  excessive  leasehold  improvements  or  property ownership  expenses,  our business,  operations,  future  prospects,  cash 
flows, and financial position may be adversely affected. In addition, our property is located in a semi-rural, wooded area of 
Austin,  Texas  that  is  subject  to  natural disasters  such  as  extreme  weather  conditions,  including but  not  limited  to  floods, 
tornadoes, wildfires, winter storms, lighting, heat waves and drought. Such natural disasters could damage, destroy or impair 
the value of our property or reduce the number of tenants who are willing or able to continue to lease office space in our 
property. We may incur substantial expenses as a result of our property’s exposure to natural disasters, which could have a 
material adverse effect on our business and prospects. 

New SEC guidance, or pending or proposed guidance, around climate change and environmental, social and governance 
(ESG)  matters  could  result  in  material  costs,  complexities  and  changes  to  our  development  programs  and  business 
operations, or may negatively affect our reputation, or may impact our ability to attract investors who seek sustainable 
investing. 

Social issues such as climate change and ESG continue to receive significant attention from the general public, the SEC 
and institutional investors. For example, in March 2022, the SEC proposed climate change disclosure rules that may require 

64 

  
 
 
 
 
 
 
 
 
 
us to broadly disclose extensive climate-related information in our SEC filings, including but not limited to the material effects 
of climate transition risks over the short, medium and long-term and their impact on our upstream and downstream operations; 
climate-related metrics in our financial statements; litigation risks related to climate change; sustainability reports; greenhouse 
gas emissions that included an attestation report from an independent source, etc. We do not currently know how disclosures 
related to environmental or ESG matters can be appropriately tailored to a company of our size and our scope of operations, 
if  at  all.  We  do  not  currently  know  how  to  identify,  measure  or  integrate  climate  change  risk  factors  into  our  business 
operations, or how to align those risk factors with proposed SEC reporting mandates. There can be no assurance that we will 
be successful in our efforts to comply with any pending or proposed guidance and disclosures mandates related to climate 
change  and  ESG  matters.  Failure  to  comply  with  such  guidance  and  disclosures  may  adversely  affect  our  business  and 
operations, which could result in financial, legal, business, or reputational harm to us, or may impact our ability to attract 
institutional investors for whom sustainable investing is a key investment criterion. 

Our  internal  computer  systems,  or  those  used  by  third  parties  on  whom  we  rely,  may  fail  or  suffer  other  breakdowns, 
cyberattacks, or information security breaches that could compromise the confidentiality, integrity, and availability of such 
systems and data, result in material disruptions of our development programs and business operations, risk disclosure of 
confidential, financial, or proprietary information, and affect our reputation.  

In  the  ordinary  course  of  our  business,  we  collect  and  store  sensitive  data,  including  legally  protected  patient  health 
information,  personally  identifiable  information  about  our  employees,  intellectual  property,  and  proprietary  business 
information. We manage and maintain our applications and data utilizing on-site systems, as well as extensive cloud-based 
applications and data storage. These applications and data encompass a wide variety of business-critical information including 
research  and  development  information,  commercial  information  and  business  and  financial  information.  Despite  the 
implementation  of  security  measures,  our  internal  computer  systems  and  those  of  our  current  or  future  CROs  and  other 
contractors and consultants may be vulnerable to damage from computer viruses and unauthorized access. As the cyber-threat 
landscape  evolves,  these  attacks  are  growing  in  frequency,  sophistication,  and  intensity,  and  are  becoming  increasingly 
difficult  to  detect.  Such  attacks  could  include  the  use  of  key  loggers  or  other  harmful  and  virulent  malware,  including 
ransomware or other denials of service, and can be deployed through malicious websites, the use of social engineering, and/or 
other means. If a breakdown, cyberattack, or other information security breach were to occur  and cause interruptions in our 
operations, it could result in a misappropriation of confidential information, including our intellectual property or financial 
information, and a material disruption of our development programs and our business operations. For example, the loss of 
clinical study data from completed, ongoing, or future clinical studies could result in delays in our regulatory approval efforts 
and significantly increase our costs to recover or reproduce the data. Likewise, we rely on our third-party research institution 
collaborators for research and development of our product candidates and other third parties for the manufacture of our product 
candidates and to conduct clinical studies, and similar events relating to their computer systems could also have a material 
adverse effect on our business. To the extent that any disruption or security breach were to result in a loss of, or damage to, 
our data or systems, or inappropriate disclosure of confidential, financial, or proprietary information, including data related 
to  our  personnel,  we  could  incur  liability  or  risk  disclosure  of  confidential,  financial,  or  proprietary  information,  and  the 
further development and commercialization of our product candidates could be delayed. There can be no assurance that we 
and  our  business  counterparties  will  be  successful  in  efforts  to  detect,  prevent,  or  fully  recover  systems  or  data  from  all 
breakdowns, service interruptions, attacks, or breaches of systems that could adversely affect our business and operations 
and/or result in the loss of critical or sensitive data, which could result in financial, legal, business, or reputational harm to us. 

Our  reliance  on  third  parties  requires  us  to  share  our  proprietary  information,  which  increases  the  possibility  that  a 
competitor  will  discover  this  information  or  that  our  proprietary  information  will  be  misappropriated  or  inadvertently 
disclosed. 

Our  reliance  on  third-party  vendors  requires  us  to  disclose  our  proprietary  information  to  these  parties,  which  could 
increase the risk that a competitor will discover this information or that our proprietary information will be misappropriated 
or disclosed without our intent to do so. If any of these events were to occur, then our ability to obtain patent protection or 
other intellectual property rights could be irrevocably jeopardized, and costly, distracting litigation could ensue. Furthermore, 
if these third-party vendors cease to continue operations and we are not able to quickly find a replacement provider or we lose 
information or items associated with our products or product candidates, our development programs may be delayed. Although 
we carefully manage our relationships with our third-party collaborators and CROs, there can be no assurance that we will 
not encounter challenges or delays in the future or that these delays or challenges will not have a material adverse impact on 
our business, clinical operations, financial condition and prospects. 

Our business involves environmental risks that may result in liability for us. 

In connection with our research and development activities, we, and our collaborators and vendors, are subject to federal, 
state and local laws, rules, regulations and policies governing the use, generation, manufacture, storage, air emission, effluent 

65 

  
 
 
 
 
 
 
discharge, handling and disposal of certain materials, biological specimens, chemicals and wastes. Although we believe that 
we comply with such applicable laws, regulations and policies in all material respects and have not been required to correct 
any material noncompliance, we may incur significant costs to comply with environmental and health and safety regulations 
in the future. Although we believe that our safety procedures for handling and disposing of controlled materials comply with 
the standards prescribed by state and federal regulations, accidental contamination or injury from these materials may occur. 
In the event of such an occurrence, we could be held liable for any damages that result and any such liability could exceed 
our resources. 

Business disruptions and lack of appropriate levels of commercial insurance could seriously harm our future revenue and 
financial condition and increase our costs and expenses.  

Our  operations,  and  those  of  our  third-party  research  institution  collaborators,  CROs,  CDMOs,  suppliers,  and  other 
contractors and consultants, could be subject to earthquakes, power shortages, telecommunications failures, water shortages, 
floods, hurricanes, typhoons, fires, extreme weather conditions, disease epidemics or pandemics, such as COVID-19 and other 
natural or man-made disasters or business interruptions, for which we are partly or entirely uninsured. In addition, we rely on 
our third-party research institution collaborators for conducting research and development of our product candidates, and they 
may be affected by government shutdowns or withdrawn funding. The occurrence of any of these business disruptions could 
seriously  harm  our  operations  and  financial  condition  and  increase  our  costs  and  expenses.  We  rely  on  third  party 
manufacturers to produce and process our product candidates. Our ability to obtain clinical supplies of our product candidates 
could  be  disrupted  if  the  operations  of  these  suppliers  are  affected  by  a  man-made  or  natural  disaster  or  other  business 
interruption.  

Our  day-to-day  operations  are  located  in  a  single  office  facility  in  Austin,  Texas.  Damage  or  extended  periods  of 
interruption to our corporate, development, or research facilities could cause us to cease or delay development of some or all 
our product candidates. Our insurance might not cover losses under such circumstances and our business may be seriously 
harmed by such delays and interruption.  

Social  media  platforms  have  significantly  altered  the  dynamics  of  corporate  communications  and  present  risks  and 
challenges, some of which are, and may continue to be unknown to us. 

As social media continues to expand, it also presents us with new challenges. The inappropriate or unauthorized use of 
our confidential information on media platforms could cause brand damage or information leakage, which would cause legal 
or  regulatory  issues  for  us.  In  addition,  negative,  inappropriate  or  inaccurate  posts  or  comments  about  us  or  our  product 
candidates on social media internet sites could quickly and irreversible damage our reputation, image and goodwill. Further, 
the accidental or intentional disclosure of non-public sensitive information by our workforce or others through media channels 
could lead to information loss or could lead to legal or regulatory issues for us. In addition, there is a risk of a fraudulent third-
party hijacking our information technology systems without our knowledge to access our confidential documents or to use 
our company name, logo or brand without authorization. If any of these events were to occur or we otherwise fail to comply 
with applicable regulations, we could incur liability, face restrictive regulatory actions or incur other harm and costs to our 
business.  

We expect to rely on third parties to conduct our studies and some aspects of our research, and such third parties may not 
perform satisfactorily, which could delay or harm our studies, research, and testing.  

We  substantially  rely  and  expect  to  continue  to  rely  on  third  parties,  such  as  CROs,  clinical  data  management 
organizations, medical institutions, and clinical investigators, to conduct some aspects of our research and preclinical testing 
and  our  clinical  studies.  Any  of  these  third  parties  may  terminate  their  engagements  with  us  or  be  unable  to  fulfill  their 
contractual obligations. If we need to enter into alternative arrangements, it will delay our product development activities.  

Our reliance on these third parties for research and development activities reduces our control over these activities but 
does not relieve us of our responsibilities. For example, we remain responsible for ensuring that all of our clinical studies are 
conducted in accordance with the general investigational plan and protocols for the trial. Moreover, FDA requires us to comply 
with the norms of Good Clinical Practice (GCPs) for conducting, recording,  and reporting the results of clinical studies to 
assure that data and reported results are credible, reproducible, and accurate and that the rights, integrity, and confidentiality 
of study participants are protected. We also are required to register ongoing clinical studies and post the results of completed 
clinical studies on a government-sponsored database within certain timeframes. Failure to do so can result in fines, adverse 
publicity, and civil and criminal sanctions.  

If  our  third-party  vendors  do not  successfully  carry  out  their  contractual duties,  meet  expected  deadlines, or  conduct 
studies in accordance with regulatory requirements or our stated protocols, we will not be able to obtain, or may be delayed 

66 

  
 
 
 
 
 
 
 
 
 
in obtaining, marketing approvals for any product candidates we may develop and will not be able to, or may be delayed in 
our efforts to, successfully commercialize our product candidates. For example, one of our vendors failed to fully comply 
with certain Good Laboratory Practice (GLP) norms in its research facility, which required us to repeat a lab study at a different 
research site. 

We also rely on other third parties to label, store and distribute drug supplies for our clinical studies. Any performance 
failure on the part of our distributors, including with the shipment of any drug supplies, could delay clinical development or 
marketing approval of any product candidates we may develop or commercialization of our product candidates, producing 
additional losses and depriving us of potential product revenue.  

We do not own any manufacturing facilities and we rely on third-party commercial drug manufacturers for clinical drug 
supply.  

We do not own any manufacturing facilities. We plan to continue to outsource formulation, manufacturing and related 
activities. We rely on a limited number of third-party suppliers to formulate, manufacture, fill, label, ship or store all of our 
product candidates. These suppliers must comply with  current cGMP regulations enforced by FDA and other government 
agencies,  and  are  subject  to  ongoing  periodic  unannounced  inspection,  including  preapproval  inspections  by  FDA  and 
corresponding  state  and  foreign  government  agencies  to  ensure  strict  compliance  with  cGMP  and  other  government 
regulations and corresponding foreign standards. These manufacturers may subsequently be stopped from producing, storing, 
shipping or testing our drug products due to their non-compliance with federal, state or local regulations. We do not have 
control over our suppliers’ compliance with these regulations and standards. We cannot control decisions by our suppliers 
that affect their ability or willingness to continue to supply us on acceptable terms, or at all. We may not be able to replace a 
commercial  supplier  on  commercially  reasonable  terms,  or  at  all.  Replacing  any  of  our  commercial  suppliers  would  be 
expensive  and  time  consuming.  Failure  by  any  of  our  suppliers  to  perform  as  expected  could  delay  or  prevent 
commercialization of our product candidates or result in shortages, cost overruns, or other problems and would materially 
harm our business. 

We are a small company with a limited number of employees. We are highly dependent on our key personnel, and if we 
are not successful in attracting, motivating, and retaining highly qualified personnel, we may not be able to successfully 
implement our business strategy.  

Our ability to compete in the highly competitive biotechnology and pharmaceutical industries depends upon our ability 
to attract, motivate, and retain highly qualified managerial, scientific, and medical personnel. We are highly dependent on our 
management, particularly our President and Chief Executive Officer, Remi Barbier, and our scientific and technical personnel. 
The loss of the services provided by any of our executive officers, other key employees, and other scientific and medical 
advisors, and our inability to find suitable replacements, could result in delays in the development of our product candidates 
and harm our business.  

Competition for skilled personnel is intense and the turnover rate can be high, which may limit our ability to hire and 
retain highly qualified personnel on acceptable terms or at all. We expect that we may need to recruit talent from outside of 
our region in Austin, Texas, and doing so may be costly and difficult.  

To induce valuable employees to remain at our company, in addition to salary and cash incentives, we have provided 
equity option grants that vest over time and/or a cash bonus plan. The value to employees of these equity grants that vest over 
time or cash bonus plans may be significantly affected by movements in our stock price that are beyond our control and may 
at  any  time  be  insufficient  to  counteract  more  lucrative  offers  from  other  companies.  Although  we  have  employment 
agreements with our key employees, these employment agreements provide for at-will employment, which means that any of 
our employees could leave our employment at any time, with or without notice. If we are unable to attract and incentivize 
quality personnel on acceptable terms, or at all, it may cause our business and operating results to suffer.  

We may need to cease our operations if we are unable to attract and retain key personnel. 

We are engaged in developing early-stage technologies and will continue to do so for the foreseeable future.  Unlike 
larger organizations, we rely on a very small number of highly skilled, and highly sought after, employees to continue the 
advancement of our development stage technologies. The knowledge and skills contributed by our key employees may be 
irreplaceable and the loss of a key employee may cause substantial negative financial, operational and scientific consequences 
for our business.  As an example, any research grant awards from NIH depend in part on the continued participation of certain 
key employees, known as a Principal Investigator. The loss of a Principal Investigator may result in the loss of one or more 
of any research grant awards from NIH, which would have significant adverse effects on our ability to continue to conduct, 
conclude or fund our research programs in Alzheimer’s disease. Likewise, the intellectual property that is intended to protect 

67 

  
 
 
 
 
 
 
 
 
 
our  development  stage  technologies  is  still  evolving  and  its  evolution  remains  highly  dependent  on  a  small  number  of 
employees with specific expertise. The loss of a key employee may jeopardize our existing or pending intellectual property 
or may prevent us from accessing the technical information and knowledge necessary to extend our portfolio of intellectual 
property. Furthermore, we believe the adverse effects that may result from losing a key employee’s participation cannot be 
compensated with any specific insurance policies, such as “key person” or “business life” insurance. If we are not successful 
in retaining key employees, our business and financial condition will suffer, and we may need to cease our operations. 

If our current research collaborators or scientific advisors terminate their relationships with us or develop relationships 
with a competitor, our ability to continue our business operations could be adversely affected. 

We have relationships with unaffiliated research collaborators at academic and other institutions who conduct research 
at our request. These research collaborators are not our employees. As a result, we have limited control over their activities 
and,  except  as  otherwise  required  by  our  collaboration  agreements,  can  expect  only  limited  amounts  of  their  time  to  be 
dedicated  to  our  activities.  Our  ability  to  discover  drugs  and  biomarkers  involved  in  human  disease  and  validate  and 
commercialize diagnostic tests will depend in part on the continuation of these collaborations. If any of these collaborations 
are terminated, we may not be able to enter into other acceptable collaborations. In addition, our existing collaborations may 
not be successful. Our research collaborators and scientific advisors may have relationships with other commercial entities, 
some of which could compete with us. Our research collaborators and scientific advisors sign agreements which provide for 
the confidentiality of our proprietary information and the results of studies conducted at our request. We may not, however, 
be able to maintain the confidentiality of our technology and other confidential information related to all collaborations. The 
dissemination of our confidential information could have a material adverse effect on our business. 

Our business may be impacted by political events, war, terrorism, business interruptions and other geopolitical events and 
uncertainties beyond our control. 

War, terrorism, geopolitical uncertainties and other business interruptions could cause damage to, disrupt or cancel 
the conduct of our clinical studies on a global or regional basis, which could have a material adverse effect on our business, 
clinical sites or vendors with which we do business. Such events could also decrease patient demand to enroll in our clinical 
studies or make it difficult or impossible for us to deliver products and services to our clinical investigational sites. In addition, 
territorial invasions can lead to cybersecurity attacks on technology companies, such as ours, located far outside of the conflict 
zone. In the event of prolonged business interruptions due to geopolitical events, we could incur significant losses, require 
substantial recovery time and experience significant expenditures in order to resume our business or clinical operations. We 
have no operations in Russia or the Ukraine, but we do not and cannot know if the current uncertainties in these geopolitical 
areas may escalate and result in broad economic and security conditions or rationing of medical supplies, which could limit 
our  ability  to  conduct  clinical  trials  outside  the  U.S.  or  result  in  material  implications  for  our  business.  In  addition,  our 
insurance policies typically contain a war exclusion of some description and we do not know how our insurers are likely to 
respond in the event of a loss alleged to have been caused by geopolitical uncertainties. 

Risks Related to Financial Condition and Capital Requirements  

We have incurred significant net losses in each period since our inception and anticipate that we will continue to incur net 
losses for the foreseeable future.  

We have incurred net losses in each reporting period since our inception, including a net loss of $76.2 million for the year 

ended December 31, 2022. As of December 31, 2022, we had an accumulated deficit of $283.6 million.  

We have invested significant financial resources in research and development activities for product candidates. We do 
not expect to generate revenue from product sales for several years, if at all. The amount of our future net losses will depend, 
in part, on the level of our future expenditures and revenue. Moreover, our net losses may fluctuate significantly from quarter 
to quarter and year to year, such that a period-to-period comparison of our results of operations may not be a good indicator 
of our future performance.  

We expect to continue to incur significant expenses and higher operating losses for the foreseeable future. We anticipate 

our expenses will remain substantial as we:   

• 

• 

• 

continue our research and discovery activities; 

advance our current and any future product candidates through preclinical and clinical development; 

initiate and conduct additional preclinical, clinical, or other studies for our product candidates; 

68 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
•  work with our CDMO’s to scale up the manufacturing processes for our product candidates; 

• 

• 

• 

• 

seek regulatory approvals and marketing authorizations for our product candidates; 

obtain, maintain, protect, defend and enforce our intellectual property portfolio; 

attract, hire, and retain qualified personnel; 

provide  additional  internal  infrastructure  to  support  our  continued  research  and  development  operations  and  any 
planned commercialization efforts in the future; 

• 

experience any delays or encounter other issues related to our operations; 

•  meet the requirements and demands of being a public company; and 

• 

defend  against  litigation,  claims  or  other  uncertainties  that  may  arise  from  allegations  made  against  us  or  our 
collaborators. 

Our prior losses and expected future losses have had and will continue to have an adverse effect on our stockholders’ 
equity and working capital.  In any quarter, our operating results could be below the expectations of securities analysts or 
investors, which could cause our stock price to decline. 

We have broad discretion in the use of the net proceeds from  any of our financing transactions and may not use them 
effectively.  

We have broad discretion in the application of the net proceeds from our financing transactions,  and investors will not 
have the opportunity to assess whether the net proceeds are being used appropriately. We could spend the net proceeds from 
offerings in ways that vary substantially from their intended use, do not improve our results of operations or enhance the value 
of our common stock. Our failure to apply these funds effectively could result in financial losses that could have a material 
adverse effect on our business, cause the price of our common stock to decline and delay the development of our product 
candidates.  Pending  their  use,  we  may  invest  the  net  proceeds  from our financing  transactions  in  a  manner  that  does not 
produce income or that loses value. 

We have no product revenues and may never achieve revenues or profitability based on product revenues.  

We have no products approved for commercial sale. To obtain revenues from the sales of our product candidates that are 
significant or large enough to achieve profitability, we must succeed, either alone or with third parties, in developing, obtaining 
regulatory  approval  for,  manufacturing,  and  marketing  product  candidates  with  significant  commercial  value.  This  is  a 
significant  endeavor  that  few  early-stage  biopharmaceutical  companies  can  successfully  achieve.  Our  ability  to  generate 
revenue and achieve profitability depends on many factors, including:  

• 

• 

• 

• 

• 

• 

completing research and preclinical and clinical development of our product candidates; 

obtaining  regulatory  approvals  and  marketing  authorizations  for  product  candidates  for  which  we  successfully 
complete clinical development; 

developing a sustainable and scalable manufacturing process for our product candidates, as well as establishing and 
maintaining  commercially  viable  supply  relationships  with  third  parties  that  can  provide  adequate  products  and 
services to support clinical activities and commercial demand for our product candidates; 

identifying, assessing, acquiring, and/or developing new product candidates; 

negotiating favorable terms in any collaboration, licensing, or other arrangements into which we may enter; 

addressing any competing technological and market developments; 

•  maintaining,  protecting,  expanding,  and  enforcing  our  portfolio  of  intellectual  property  rights,  including  patents, 

trade secrets, and know-how; and  

• 

attracting, hiring, and retaining qualified personnel. 

Because of the numerous risks and uncertainties associated with drug development, we are unable to predict the timing 
or amount of our expenses, or when we will be able to generate any meaningful revenue or achieve or maintain profitability, 
if  ever.  In  addition,  our  expenses  could  increase  beyond  our  current  expectations  if  we  are  required  by  FDA  or  foreign 

69 

  
  
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
  
regulatory agencies to perform studies in addition to those that we currently anticipate, or if there are any delays in any of our 
clinical studies or the development of any of our product candidates.  

We may require additional capital to fund our operations and to complete the development of our product candidates. A 
failure to obtain this necessary capital on acceptable terms, or at all, could force us to delay, limit, reduce, or terminate 
our commercialization efforts, product development, or other operations.  

Our  operations  have  required  substantial  amounts  of  cash  since  inception,  and  we  expect  our  expenses  to  remain 
substantial for the foreseeable future. To date, we have financed our operations primarily through the sale of equity securities, 
research  grants  and  payments  received  from  prior  third-party  collaborations.  Developing  our  product  candidates  and 
conducting  clinical  studies  for  the  treatment  of  neurodegenerative  diseases,  including  Alzheimer’s  disease,  will  require 
substantial amounts of capital. We will also require a significant amount of capital to commercialize any approved products.  

As of December 31, 2022, we had cash and cash equivalents of $201 million. Based on our current operating plan, we 
believe that our existing cash and cash equivalents will be sufficient to fund our projected operations for at least the next 
12 months. Our estimate as to how long we expect our existing cash and cash equivalents to be available to fund our operations 
is based on assumptions that may prove inaccurate, and we could use our available capital resources sooner than we currently 
expect.  In  addition,  changing  circumstances  may  cause  us  to  increase  our  spending  significantly  faster  than  we  currently 
anticipate, and we may need to spend more money than currently expected because of circumstances beyond our control. We 
may need to raise additional funds sooner than we anticipate if we choose to expand more rapidly than we presently anticipate.  

We may require additional capital for the further development of our product candidates. Additional capital may not be 
available  when  we  need  it,  or  on  terms  acceptable  to  us  or  at  all.  We  have  no  committed  source  of  additional  capital.  If 
adequate capital is not available to us on a timely basis, we may be required to significantly delay, limit, reduce or terminate 
our research and development programs or the commercialization of product candidates, if approved, or be unable to continue 
or expand our operations, or otherwise capitalize on our business opportunities, as desired, which could materially affect our 
business, financial condition, results of operations, and growth prospects and cause the price of our common stock to decline.  

To  the  extent  that  we  raise  additional  capital  through  the sale  of  equity  or  convertible debt  securities,  the  ownership 
interest of our stockholders will be diluted, and the terms of these securities may include liquidation or other preferences that 
adversely  affect  your  rights  as  a  common  stockholder.  Debt  financing,  if  available,  may  involve  agreements  that  include 
covenants  limiting  or  restricting  our  ability  to  take  specific  actions,  such  as  incurring  additional  debt,  making  capital 
expenditures,  or  declaring  dividends.  If  we  raise  additional  funds  through  collaborations,  strategic  alliances,  or  licensing 
arrangements with pharmaceutical partners, we may have to relinquish valuable rights to our technologies, future revenue 
streams, research programs, or product candidates, or grant licenses on terms that may not be favorable to us. 

Global credit  and  financial market conditions  and inflation  could negatively  impact the value of our portfolio of cash 
equivalents and our ability to meet our financing objectives. 

Our cash and cash equivalents are generally maintained in highly liquid investments with original maturities of 90 days 
or less at the time of purchase. While, as of the date of this filing, we are not aware of any downgrades, material losses, or 
other significant deterioration in the fair value of our cash equivalents since December 31, 2022, no assurance can be given 
that deterioration in conditions of the global credit and financial markets, including inflationary pressure, would not negatively 
impact our current portfolio of cash equivalents or our ability to meet our financing objectives. 

Our operations are subject to the effects of rising inflation. 

The United States has recently experienced historically high levels of inflation. According to the U.S. Department of 
Labor, the annual inflation rate for the United States was approximately 6.50% for the 12 months ended December 31, 2022, 
after rising over 7.0% in 2021. If the inflation rate continues to increase, for example due to increases in the costs of labor and 
supplies, it may affect our expenses, such as employee compensation and research and development charges. Research and 
development expenses account for a significant portion of our operating expenses. Additionally, the U.S. is experiencing an 
acute workforce shortage, which in turn has created a very competitive wage environment that may increase our operating 
costs. To the extent inflation results in further interest rate increases and has other adverse effects on the market, inflation may 
adversely affect our consolidated financial condition and results of operations or business prospects.  

70 

  
 
 
 
 
 
 
 
 
Risks Related to the Ownership of Our Common Stock  

We do not know whether a sufficient market will continue to develop for our common stock or what the market price of 
our common stock will be, and, as a result, it may be difficult for investors to sell shares of our common stock.  

If a market for our common stock is not sustained, it may be difficult to sell shares of our common stock at an attractive 
price or at all. We cannot predict the prices at which our common stock will trade. It is possible that in one or more future 
periods our results of operations and progression of our product pipeline  may not meet the expectations of public market 
analysts and investors, and, as a result of these and other factors, the price of our common stock may fall.  

The market price of our common stock has historically been highly volatile, and we expect it to continue to be volatile, 
which could result in substantial losses for investors who purchase our shares.  

For example, the closing price of our common stock has fluctuated from a low of $16.33 to a high of $51.06 over the 12 
months preceding the filing date of this Annual Report on Form 10-K. Some of the factors that may cause the market price of 
our common stock to fluctuate include:  

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

the success of existing or new competitive products or technologies; 

the timing and results of clinical studies for our current product candidates and any future product candidates that we 
may develop; 

failure or discontinuation of any of our product development and research programs; 

results of preclinical studies, clinical studies, or regulatory approvals of product candidates of our competitors, or 
announcements about new research programs or product candidates of our competitors; 

regulatory or legal developments in the United States and other countries; 

developments or disputes concerning patent applications, issued patents, or other proprietary rights; 

the recruitment or departure of key personnel; 

the level of expenses related to any of our research programs, clinical development programs, or product candidates 
that we may develop; 

the results of our efforts to develop additional product candidates or products; 

actual or anticipated changes in estimates as to financial results or development timelines; 

announcement or expectation of additional financing efforts; 

sales of our common stock by us, our insiders, or other stockholders; 

variations in our financial results or those of companies that are perceived to be similar to us; 

changes in estimates or recommendations by securities analysts, if any, that cover our stock; 

•  market conditions in the pharmaceutical and biotechnology sectors; 

• 

• 

general economic, industry, and market conditions; and 

securities litigation, regardless of merit. 

In recent years, the stock market in general, Nasdaq, and the markets for early stage companies and pharmaceutical and 
biotechnology  companies,  has  experienced  significant  price  and  volume  fluctuations  that  have  often  been  unrelated  or 
disproportionate  to  changes  in  the  operating  performance  of  the  companies  whose  stock  is  experiencing  those  price  and 
volume fluctuations. Broad market and industry factors may seriously affect the market price of our common stock, regardless 
of  our  actual  operating  performance.  Following  periods  of  such  volatility  in  the  market  price  of  a  company’s  securities, 
securities class action litigation has often been brought against that company. Because of the potential volatility of our stock 
price, we are currently and may become the target of securities litigation in the future. Securities litigation could result in 
substantial costs and divert management’s attention and resources from our business.  

71 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
If securities analysts do not publish research or reports about our business, or we are the subject of negative publicity, 
the price of our stock could decline.  

The trading market for our common stock depends, in part, on the research and reports that securities or industry analysts 
publish about us or our business. We do not control these analysts. If one or more of the analysts who cover us downgrade 
our stock or publish inaccurate or unfavorable evaluations of our company or our stock, the price of our stock could decline. 
If one or more of these analysts cease coverage of our company or fail to publish reports covering our company regularly, our 
stock may lose visibility in the market, which in turn could cause our stock price to decline. In addition, if we are the subject 
of negative publicity, whether from an analyst, academic, social media, industry group or the general or financial press, our 
stock price may decline. 

General Risk Factors 

If we are unable to maintain effective internal controls, our business, financial position, and results of operations could 
be adversely affected.  

As a public company, we are subject to reporting and other obligations under the Exchange Act including the requirements 
of Section 404(a) of the Sarbanes-Oxley Act (“SOX”), which require annual management assessments of the effectiveness of 
our internal control over financial reporting. Section 404(b) of SOX also requires our independent auditors to attest to, and 
report on, the effectiveness of our internal control over financial reporting.  

The rules governing the standards that must be met for management to assess our internal control over financial reporting 
are complex and require significant documentation, testing and possible remediation to meet the detailed standards under the 
rules. During testing, our management may identify material weaknesses or deficiencies which may not be remedied in time 
to meet the deadline imposed by SOX. These reporting and other obligations place significant demands on our management 
and administrative and operational resources, including accounting resources.  

Our management is responsible for establishing and maintaining adequate internal control over financial reporting. Our 
internal  control  over financial  reporting  is  a  process designed  to  provide  reasonable  assurance regarding  the reliability  of 
financial  reporting  and  the  preparation  of  consolidated  financial  statements  for  external  purposes  in  accordance  with 
accounting principles generally accepted in the U.S. Any failure to maintain effective internal controls, or if our independent 
registered public accounting firm is unable to attest to the effectiveness of our internal control over financial reporting, could 
have an adverse effect on our business, financial position, and results of operations.  

Anti-takeover  provisions  in  our  charter  documents  and  Delaware  law  may  prevent  or  delay  removal  of  incumbent 
management or a change of control.  

Anti-takeover provisions of our amended and restated certificate of incorporation and amended and restated bylaws and 
Delaware law may have the effect of deterring or delaying attempts by our stockholders to remove or replace management, 
engage in proxy contests and effect changes in control. The provisions of our charter documents include:  

• 

• 

• 

• 

• 

a classified board so that only one of the three classes of directors on our Board of Directors (the “Board”) is elected 
each year;  

elimination of cumulative voting in the election of directors;  

procedures for advance notification of stockholder nominations and proposals;  

the ability of the Board to amend our bylaws without stockholder approval; and 

the ability of the Board to issue up to 10,000,000 shares of preferred stock without stockholder approval upon the 
terms and conditions and with the rights, privileges and preferences as the Board may determine.  

In addition, as a Delaware corporation, we are subject to Delaware law, including Section 203 of the Delaware General 
Corporation Law. In general, Section 203 prohibits a Delaware corporation from engaging in any business combination with 
any interested stockholder for a period of three years following the date that the stockholder became an interested stockholder 
unless certain specific requirements are met as set forth in Section 203.  

These provisions, alone or together, could have the effect of deterring or delaying changes in incumbent management, 

proxy contests or changes in control.  

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Our  amended  and  restated  bylaws  provide  that  the  federal  district  courts  of  the  United  States  of  America  shall  be  the 
exclusive forum for the resolution of any complaint asserting a cause of action arising under the Securities Laws of 1933, 
which could limit our stockholders’ ability to obtain a favorable judicial forum for disputes with us or our directors, officers 
or employees. 

Our amended and restated bylaws provide that the federal district courts of the United States of America shall be the 

exclusive forum for the resolution of any complaint asserting a cause of action arising under the Securities Act of 1933. 

While the Delaware courts have determined that such choice of forum provisions are factually valid, a stockholder 
may nevertheless seek to bring a claim in a venue other than those designated in the exclusive forum provisions. In such 
instance,  we  would  expect  to  vigorously  assert  the  validity  and  enforceability  of  the  exclusive  forum  provisions  of  our 
amended and restated bylaws. This may require significant additional costs associated with resolving such action in other 
jurisdictions and there can be no assurance that the provisions will be enforced by a court in those other jurisdictions. 

These exclusive-forum provisions may limit a stockholder’s ability to bring a claim in a judicial forum that it finds 
favorable for disputes with us or our directors, officers or other employees, which may discourage these types of lawsuits. 
Furthermore, the enforceability of similar choice of forum provisions in other companies’ certificates of incorporation  or 
bylaws has been challenged in legal proceedings, and it is possible that a court could find these types of provisions to be 
inapplicable or unenforceable. If a court were to find the exclusive-forum provision contained in our amended and restated 
bylaws to be inapplicable or unenforceable in an action, we may incur further significant additional costs associated with 
resolving such action in other jurisdictions, all of which could harm our business. 

Changes in our ownership could limit our ability to utilize net operating loss carryforwards. 

As of December 31, 2022, we had aggregate federal net operating loss carryforwards of approximately $133.4 million, 
which  begin  to  expire  in  2029.  Under  Section  382  of  the  Internal  Revenue  Code  of  1986,  as  amended,  changes  in  our 
ownership may limit the amount of our net operating loss carryforwards that could be utilized annually to offset our future 
taxable income, if any. This limitation would generally apply in the event of a cumulative change in ownership of our company 
of more than 50% within a rolling three-year period. Any such limitation may significantly reduce our ability to utilize our 
net operating loss carryforwards and tax credit carryforwards. Any such limitation, whether as the result of past offerings, 
sales of our common stock by our existing stockholders or additional sales of our common stock by us in the future could 
have a material adverse effect on our results of operations in future years. We have not completed a study to assess whether 
an ownership change for purposes of Section 382 has occurred, or whether there have been multiple ownership changes since 
our inception, nor do we plan to do so due to the significant costs and complexities associated with such study. 

We may sell additional equity or debt securities to fund our operations, and have outstanding securities exercisable for our 
common stock, which may result in dilution to our stockholders and impose restrictions on our business. 

In order to raise additional capital to support our operations, we may sell additional shares of our common stock or other 

securities convertible into or exchangeable for our common stock which could result in dilution our stockholders.  

We cannot assure you that we will be able to sell shares or other securities in any other offering at a price per share that 
is equal to or greater than the price per share paid by investors in prior offerings, and investors purchasing our shares or other 
securities in the future could have rights superior to existing shareholders. The price per share at which we sell additional 
shares of our common stock or securities convertible into or exchangeable for our common stock in future transactions may 
be higher or lower than the price per share in prior offerings. You may also be diluted upon the exercise of outstanding stock 
options as of December 31, 2022 to purchase 2,529,448 shares of our common stock at a weighted average price of $12.13 
per  share,  and  the  future  issuance  of  up  to  4,070,688  compensatory  equity  awards  authorized  under  our  2018  Omnibus 
Incentive Plan and up to 58,017 shares we may sell under our Employee Stock Purchase Plan. 

The estimates and judgments we make, or the assumptions on which we rely, in preparing our consolidated financial 
statements could prove inaccurate. 

Our consolidated financial statements have been prepared in accordance with accounting principles generally accepted 
in the U.S. The preparation of these consolidated financial statements requires us to make estimates and judgments that affect 
the reported amounts of our assets, liabilities and expenses, the amounts of charges accrued by us and related disclosure of 
contingent  assets  and  liabilities.  Such  estimates  and  judgments  include  development  expenses,  valuation  of  stock-based 
awards and income tax. We base our estimates on historical experience, facts and circumstances known to us and on various 
other assumptions that we believe to be reasonable under the circumstances. We cannot provide assurances, however, that our 
estimates, or the assumptions underlying them, will not change over time or otherwise prove inaccurate. If this is the case, we 

73 

  
 
 
 
 
 
 
 
 
may be required to restate our  consolidated financial statements, which could, in turn, subject us to securities class action 
litigation. Defending against such potential litigation relating to a restatement of our consolidated financial statements would 
be expensive and would require significant attention and resources of our management. Moreover, our insurance to cover our 
obligations with respect to the ultimate resolution of any such litigation may be inadequate. As a result of these factors, any 
such potential litigation could have  a material adverse effect on our financial results and cause our stock price to decline, 
which could in turn subject us to securities class action litigation. 

Item 1B.     Unresolved Staff Comments 

None. 

Item 2.     Properties 

We own an office complex in Austin, Texas, a portion of which serves as our corporate headquarters. This property is 
intended to accommodate our anticipated growth and expansion of our operations in the coming years. Maintenance, physical 
facilities,  leasing,  property  management  and  other  key  responsibilities  related  to  property  ownership  are  outsourced  to 
professional real-estate managers. The office complex measures approximately 90,000 rentable square feet. The property was 
over 60% leased at December 31, 2022. We also occupied approximately 25% of the property as of December 31, 2022.  

Item 3.     Legal Proceedings 

From  time  to  time,  we  may  become  involved  in  litigation  or  other  legal  proceedings  and  claims,  including  U.S. 
government inquiries, investigations and Citizen Petitions submitted to FDA, and may receive inquiries from government 
authorities relating to matters arising from the ordinary course of business in the future. The outcome of these proceedings is 
inherently uncertain. Regardless of  outcome, legal proceedings can have an adverse  impact on us because of defense and 
settlement costs, diversion of management resources, and other factors. At this time, no assessment can be made as to their 
likely outcome or whether the outcome will be material to us. No information is available to indicate that it is probable that a 
loss has been incurred or can be reasonably estimated as of the date of the consolidated financial statements and, as such, no 
accrual for these matters has been recorded within the consolidated financial statements. 

Government Investigations 

On November 15, 2021, we disclosed that certain government agencies had asked us to provide them with corporate 
information and documents. These were confidential requests. We have been voluntarily cooperating and will continue to 
cooperate  with  government  authorities.  No  government  agency  has  informed  us  that  it  has  found  evidence  of  research 
misconduct. No government agency has informed us that any wrongdoing has occurred by any party. No government agency 
has filed any charges against us, or anyone associated with us. We cannot predict the outcome or impact of any these ongoing 
matters, including whether a government agency may pursue an enforcement action against us or others.  

FDA Citizen Petitions 

In August 2021, an attorney representing anonymous clients submitted a Citizen Petition to the FDA. This Citizen Petition 
requested  that  the  FDA  Commissioner  immediately  halt  the  clinical  development  of  simufilam,  our  drug  candidate  for 
Alzheimer’s disease. The attorney subsequently disclosed that his clients are short sellers, that is, investors who earn a profit 
from a decline in our stock price. In September 2021, the same attorney filed another Citizen Petition, which requested that 
the FDA Commissioner immediately rescind previously granted Special Protocol Assessments (SPAs) for our Phase 3 clinical 
program with simufilam. FDA has not halted the clinical development of simufilam and has not rescinded our SPAs. 

In February 2022, FDA denied both Citizen Petitions and their supplements. As of January 17, 2023, FDA’s denial letter 
could be found at: https://www.regulations.gov/document/FDA-2021-P-0930-0228. 

Securities Class Actions and Shareholder Derivative Actions 

Between August 27, 2021 and October 26, 2021, four putative class action lawsuits were filed alleging violations of the 
federal securities laws by us and certain named officers. The complaints rely on allegations contained in Citizen Petitions that 
were  submitted  to  FDA,  and  allege  that  various  statements  made  by  the  defendants  regarding  simufilam  were  rendered 
materially false and misleading. The Citizen Petitions were all subsequently denied by FDA. These actions were filed in the 
U.S. District Court for the Western District of Texas. The complaints seek unspecified compensatory damages and other relief 
on behalf of a purported class of purchasers. 

74 

  
 
 
 
 
 
 
 
 
 
 
On June 30, 2022, a federal judge consolidated the four class action lawsuits into one case and appointed a lead plaintiff 
and a lead counsel. Lead plaintiff filed a consolidated amended complaint on August 18, 2022 on behalf of a putative class of 
purchasers of our securities between September 14, 2020 and July 26, 2022. Briefing on defendants’ motion to dismiss  was 
completed  on  January  23,  2023.  We  believe  the  claims  are  without  merit  and  intend  to  defend  against  these  lawsuits 
vigorously. We are unable to estimate the possible loss or range of loss, if any, associated with these lawsuits. 

On November 4, 2021, a related shareholder derivative action was filed, purportedly on behalf of the Company, in the 
U.S. District Court for the Western District of Texas, asserting claims under the U.S. securities laws and state fiduciary duty 
laws against certain named officers and the members of the Company’s board of directors. This complaint relies on allegations 
made in Citizen Petitions that were submitted to (and subsequently denied by) FDA. The complaint alleges, among other 
things, that the individual defendants exposed the Company to unspecified damages and securities law liability by causing it 
to make materially false and misleading statements, in violation of the U.S. securities laws and in breach of their fiduciary 
duties  to  the  Company.  The derivative  case  seeks,  among  other  things,  to recover  unspecified  compensatory damages  on 
behalf  of  the  Company  arising  out  of  the  individual  defendant’s  alleged  wrongful  conduct.  Although  the  plaintiff  in  this 
derivative  case  does  not  seek  relief  against  the  Company,  the  Company  has  certain  indemnification  obligations  to  the 
individual  defendants.  Since  November  4,  2021,  three  additional  shareholder  derivative  actions  were  filed  alleging 
substantially similar claims, two in the U.S. District Court for the Western District of Texas, and one in Texas state court 
(Travis County District Court).  All four actions have been stayed pending the resolution of the motions to dismiss in the 
securities class actions. On July 5, 2022, the three federal court actions were consolidated into a single action. 

On August 19, 2022, a shareholder derivative action was filed, purportedly on behalf of the Company, in the Delaware 
Court  of  Chancery,  asserting  claims  under  state  fiduciary  duty  laws  against  certain  named  officers  and  members  of  the 
Company’s  board  of  directors.  The  complaint  alleges,  among  other  things,  that  the  individual  defendants  breached  their 
fiduciary  duties  by  approving  the  2020  Cash  Incentive  Bonus  Plan  in  August  2020.  The  complaints  seek  unspecified 
compensatory damages and other relief. On January 6, 2023, the plaintiffs filed an amended complaint. Although the plaintiffs 
in this derivative case do not seek relief against the Company, the Company has certain indemnification obligations to the 
individual defendants.  

We are unable to estimate the possible loss or range of loss, if any, associated with these lawsuits. 

Item 4.     Mine Safety Disclosures 

Not applicable. 

PART II 

Item 5.    Market for Registrant's Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities 

Market Information 

Our common stock is quoted on Nasdaq, under the symbol "SAVA." 

Holders  

As of February 20, 2023, there were approximately 25 registered holders of record of our common stock. We believe the 
actual number of stockholders is greater than this number of record holders and includes stockholders who are beneficial 
owners but whose shares are held in street name by brokers and other nominees. 

Sales of Non-Registered Securities 

None. 

Purchases of Equity Securities by the Issuer 

None. 

Dividend Policy 

We  currently  expect  to  retain  future  earnings,  if  any,  for  use  in  the  operation  and  expansion  of  our  business  and, 

75 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
notwithstanding  our  special  non-dividend  distributions  in  December  2012  (of  $0.75  per  share  of  common  stock  totaling 
$34.0 million) and December 2010 (of $2.00 per share of common stock totaling $85.7 million), we do not anticipate paying 
any cash dividends in the foreseeable future. 

Stock Performance Graph 

The following graph compares the cumulative total return to stockholder return on our common stock relative to the 
cumulative total returns of the NASDAQ Composite Index and the NASDAQ Biotechnology Index. An investment of $100 
is assumed to have been made in our common stock and each index on January 1, 2018 and its relative performance is tracked 
through  December  31,  2022.  Pursuant  to  applicable  Securities  and  Exchange  Commission  rules,  all  values  assume 
reinvestment of the full amount of all dividends, however no dividends have been declared on our common stock to date. The 
stockholder  returns  shown  on  the  graph  below  are  based  on  historical  results  and  are  not  necessarily  indicative  of  future 
performance, and we do not make or endorse any predictions as to future stockholder returns. 

Item 6.    [Reserved] 

76 

  
 
 
  
 
 
 
Item 7.    Management’s Discussion and Analysis of Financial Condition and Results of Operations 

This discussion and analysis of our financial condition and results of operations should be read in conjunction with our 
consolidated financial statements and accompanying notes included elsewhere in this Annual Report on Form 10-K. This 
discussion contains forward-looking statements that involve risk and uncertainties, such as statements of our plans, objectives, 
expectations, and intentions, that are based on the beliefs of our management. Operating results are not necessarily indicative 
of results that may occur in future periods.  Factors that could cause or contribute to such differences include, but are not 
limited to, those discussed in the “Risk Factors” section of this Annual Report on Form 10-K. 

Overview  

We  are  a  clinical-stage  biotechnology  company  based  in  Austin,  Texas.  Our  mission  is  to  detect  and  treat 
neurodegenerative diseases, such as Alzheimer’s disease. Our novel science is based on stabilizing  – but not removing – a 
critical protein in the brain. Our lead therapeutic drug candidate, simufilam, is being evaluated for the proposed treatment of 
Alzheimer’s disease dementia in Phase 3 clinical studies. 

Over the past 10 years, we have combined state-of-the-art technology with new insights in neurobiology to develop novel 
solutions  for  Alzheimer’s  disease  and  other  neurodegenerative  diseases.  Our  strategy  is  to  leverage  our  unique 
scientific/clinical platform to develop a first-in-class program for treating neurodegenerative diseases, such as Alzheimer’s.  

We currently have two biopharmaceutical assets under development:  

• 

• 

our lead therapeutic product candidate, called simufilam, is a novel oral treatment for Alzheimer’s disease dementia; 
and  
our  lead  investigational  diagnostic  product  candidate,  called  SavaDx,  is  a  novel  way  to  detect  the  presence  of 
Alzheimer’s disease from a small sample of blood. 

Our scientific approach for the treatment of Alzheimer’s disease seeks to simultaneously suppress both neurodegeneration 
and neuroinflammation. We believe our ability to improve multiple vital functions in the brain represents a new, different and 
crucial approach to address Alzheimer’s disease.  

Our lead product candidate, simufilam, is a proprietary small molecule (oral) drug. Simufilam targets an altered form of 
FLNA  in  the  Alzheimer’s  brain.  Published  studies  have  demonstrated  that  the  altered  form  of  FLNA  causes  neuronal 
dysfunction, neuronal degeneration and neuroinflammation. We are currently conducting a Phase 3 program with simufilam 
in  patients  with  mild-to-moderate  Alzheimer’s  disease  dementia.  We  are  currently  conducting  a  Phase  3  program  with 
simufilam in patients with mild-to-moderate Alzheimer’s disease dementia. 

We believe simufilam improves brain health by reverting altered FLNA back to its native, healthy conformation, thus 
countering  the  downstream  toxic  effects  of  altered  FLNA.  We  have  generated  and  published  experimental  and  clinical 
evidence of improved brain health with simufilam.  Importantly, simufilam is not dependent on clearing amyloid from the 
brain.  Since  simufilam  has  a unique mechanism of  action, we  believe  its  potential  therapeutic  effects  may  be  additive  or 
synergistic with those of other therapeutic candidates aiming to treat neurodegeneration.  

In Fall 2021, we announced initiation of our two Phase 3 studies of simufilam. As of February 28, 2023, a total of over 
1,000 patients have been enrolled in the Phase 3 program. Patients are now being screened in clinical trial sites in the U.S., 
Canada, Puerto Rico, Australia, and South Korea. 

The first Phase 3 study, called RETHINK-ALZ, is designed to evaluate the safety and efficacy of oral simufilam 100 mg 
in  enhancing  cognition  and  slowing  cognitive  and  functional  decline  over  52  weeks.  Secondary  objectives  include  the 
assessment  of  simufilam's  effect  on  neuropsychiatric  symptoms  and  caregiver  burden.  This  randomized,  double-blind, 
placebo-controlled study plans to enroll approximately 750 patients with mild-to-moderate Alzheimer’s.  

The second Phase 3 study, called REFOCUS-ALZ, is designed to evaluate the safety and efficacy of oral simufilam 100 
mg and 50 mg over 76 weeks. This randomized, double-blind, placebo-controlled study plans to enroll approximately 1,000 
patients with mild-to-moderate Alzheimer’s disease. 

Our investigational diagnostic product candidate, called SavaDx, is an early-stage program focused on detecting the 
presence of Alzheimer’s disease from a small sample of blood. The goal is to make the detection of Alzheimer’s disease as 
simple as getting a blood test. 

77 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Financial Overview 

We  have  yet  to  generate  any  revenues  from  product  sales.  We  have  an  accumulated  deficit  of  $283.6 million  at 
December 31, 2022. These losses have resulted principally from costs incurred in connection with research and development 
activities,  salaries  and  other personnel-related  costs  and  general  corporate  expenses.  Research  and  development  activities 
include costs of preclinical and clinical studies as well as clinical supplies associated with our product candidates. Salaries 
and other personnel-related costs include stock-based compensation associated with options and other equity awards granted 
to employees and non-employees. Our operating results may fluctuate substantially from period to period as a result of the 
timing of preclinical activities, enrollment rates of clinical studies for our product candidates and our need for clinical supplies. 

We believe that our cash and cash equivalents at December 31, 2022, will enable us to fund our operating expenses for 
at least the next 12 months. In addition, we may seek in the future to fund our operations through additional public or private 
equity or debt financings or other sources. However, we  may be unable to raise additional funds or enter into such other 
arrangements when needed on favorable terms or at all. If we are unable to obtain financing or reach profitability, the related 
lack of liquidity will have a material adverse effect on our operations and future prospects, and we may have to significantly 
delay, scale back or discontinue the development and commercialization of simufilam, our lead drug candidate, or delay our 
efforts to expand our product pipeline. 

We expect to continue to use significant cash resources in our operations for the next several years. Our cash requirements 

for operating activities and capital expenditures may increase in the future as we: 

continue our ongoing Phase 3 program with simufilam; 

conduct other preclinical and clinical studies for our product candidates; 
seek regulatory approvals for our product candidates;  
develop, formulate, manufacture and commercialize our product candidates;  
implement additional internal systems and develop new infrastructure; 
acquire or in-license additional products or technologies, or expand the use of our technology;  

• 
•  manufacture large-scale supplies for simufilam; 
• 
• 
• 
• 
• 
•  maintain, defend and expand the scope of our intellectual property; 
• 
• 

incur costs related to legal proceedings and claims, including U.S. government inquiries; and 
hire additional personnel. 

Product  revenue  will  depend on  our  ability  to  receive  regulatory  approvals  for,  and  successfully  market,  our  product 
candidates.  If  our  development  efforts  result  in  regulatory  approval  and  successful  commercialization  of  our  product 
candidates, we expect to generate revenue from direct sales of our drugs and/or, if we license our drugs to future collaborators, 
from  the  receipt  of  license  fees  and  royalties  from  sales  of  licensed  products.  We  conduct  our  research and  development 
programs through a combination of internal and collaborative programs. We rely on arrangements with universities, certain 
collaborators, CDMOs, CROs and clinical research sites for a significant portion of our product development efforts. 

Components of Operating Results 

Operating Expenses 

Research and Development Expenses 

We focus substantially all our research and development efforts on research and development in the areas of neurology. 

The following table summarizes expenses by category for research and development efforts (in thousands):  

Compensation 
Contractor fees and supplies 
Other common costs 

Years ended December 31, 

2022 

2021 

2020 

$ 

$ 

 7,262    $ 

 59,767   
 1,003   

 68,032    $ 

 5,935    $ 

 17,970   
 908   
 24,813    $ 

 1,575   
 980   
 498   
 3,053   

78 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
Research and development expenses include compensation, contractor fees and supplies as well as allocated common 
costs.  Contractor  fees  and  supplies  generally  include  expenses  for  clinical  studies  and  preclinical  studies  and  costs  for 
formulation  and  manufacturing  activities.  Other  common  costs  include  the  allocation  of  common  costs  such  as  facilities. 
During  the  years  ended  December 31,  2022,  2021  and  2020,  we  received  $0.9  million,  $3.9 million  and  $4.2 million  in 
research  grants  from  the  NIH,  respectively.  These  reimbursements  were  recorded  as  a  reduction  to  our  research  and 
development expenses. 

Our  technology  has  been  applied  across  certain  of  our  portfolio  of  product  candidates.  Data,  know-how,  personnel, 
clinical results, research results and other matters related to the research and development of any one of our product candidates 
also relate to, and further the development of, our other product candidates. As a result, costs allocated to a specific product 
candidate may not necessarily reflect the actual costs surrounding research and development of such product candidate due to 
cross application of the foregoing. 

Estimating  the  dates  of  completion  of  clinical  development,  and  the  costs  to  complete  development,  of  our  product 
candidates  would be highly  speculative,  subjective  and  potentially  misleading.  Pharmaceutical  products  take  a  significant 
amount of time to research, develop and commercialize. The clinical study portion of the development of a new drug  alone 
usually spans several years. We expect our research and development expenses to increase in 2023 and beyond as we seek to 
advance  our  product  candidates  through  the  clinical  development  process  and,  potentially  to  seek  regulatory  approval  of 
simufilam. We expect to reassess our future research and development plans based on our review of data we receive from our 
current research and development activities. The cost and pace of our future research and development activities are linked 
and subject to change. 

Critical Accounting Estimates 

The preparation of our consolidated financial statements in accordance with U.S. generally accepted accounting principles 
requires us to make estimates and assumptions that affect the reported amounts of assets, liabilities, revenues, expenses and 
interest income in our consolidated financial statements and accompanying notes. We evaluate our estimates on an ongoing 
basis,  including  those  estimates  related  to  agreements  and  research  collaborations.  We  base  our  estimates  on  historical 
experience and various other assumptions that we believe to be reasonable under the circumstances, the results of which form 
the basis for making judgments about the  carrying values of assets and liabilities that are not readily apparent from other 
sources. Actual results may differ from these estimates under different assumptions or conditions. 

Our significant accounting policies are described in Note 2 to our consolidated financial statements appearing elsewhere 
in this Annual Report on Form 10-K, and we believe that the accounting policies discussed below involve the greatest degree 
of complexity and exercise of significant judgments and estimates by our management. The methods, estimates and judgments 
that we use in applying our accounting policies have a significant impact on our results of operations and, accordingly, we 
believe the policies described below are the most critical for understanding and evaluating our financial condition and results 
of operations. 

•  Research Contracts,Prepaids and Accruals. We have entered into various research and development contracts with 
research  institutions  and  other  third-party  vendors.  Related  payments  are  recorded  as  research  and  development 
expenses as incurred. We record prepaids and accruals for estimated ongoing research costs. When evaluating the 
adequacy of the accrued liabilities, we analyze progress of the studies including the phase or completion of events, 
invoices received and contracted costs. Certain judgments and estimates are made in determining the  prepaid and 
accrued balances at the end of any reporting period. Actual results could differ from our estimates. Our historical 
prepaid and accrual estimates have not been materially different from actual costs. 

•  Legal and other contingencies. The Company is subject to lawsuits, claims, allegations and investigations regarding 
simufilam  and  SavaDx.  The Company  believes  the  claims  are  without  merit  and  intends  to  defend  against  these 
lawsuits vigorously. The Company is unable to estimate the possible loss or range of loss, if any, associated with 
these lawsuits. However, litigation is subject to inherent uncertainties, and unfavorable rulings could occur. If an 
unfavorable ruling were to occur, it may cause a material adverse impact on the results of operations, cash flows, or 
financial condition for the period in which the ruling occurs, or future periods. Refer to Note 12 to the Consolidated 
Financial Statements for further information on contingencies. 

• 

2020  Cash  Incentive  Bonus  Plan.  In  2020,  we  established  the  2020  Cash  Incentive  Bonus  Plan  (the  “Plan”)  to 
incentivize Plan participants. Awards under the Plan are accounted for as liability awards under ASC 718, “Stock-
based  Compensation”. The  fair  value  of  each potential  Plan award will  be determined once a grant  date  occurs 
and will be remeasured each reporting period. Compensation expense associated with the Plan will be recognized 

79 

  
 
 
  
 
 
 
 
 
 
over the expected achievement period for each Plan award, when a Performance Condition is considered probable 
of being met.   

The  Plan was established to  promote the  long-term success of the Company by creating an “at-risk” cash bonus 
program that rewards Plan participants with additional cash compensation in lockstep with significant increases in 
our  market  capitalization.  The  Plan  is  considered  “at-risk”  because  Plan  participants will not  receive  a  cash 
bonus unless our  market  capitalization  increases significantly  and  (1)  we  complete  a merger  or  acquisition 
transaction  that  constitutes  a  sale  of  ownership  of  the  Company  or  its  assets  (a  Merger  Transaction)  or  (2)  the 
Compensation Committee of the Board (the Compensation Committee) determines the Company has sufficient cash 
on hand, as defined in the Plan, to render payment (each, a “Performance Condition”), neither of which may ever 
occur.  Because of  the  inherent  discretion  and  uncertainty  regarding these requirements,  we  have  concluded 
that a Plan grant date has not occurred as of December 31, 2022. No actual cash payments were authorized or made 
to participants under the Plan through December 31, 2022. 

•  Stock-based Compensation. We recognize non-cash expense for the fair value of all stock options and other share-
based awards. We use the Black-Scholes option valuation model to calculate the fair value of stock options, using 
the single-option award approach and straight-line attribution method. Significant judgments and estimates are made 
in  determining  inputs  to  the  Black-Scholes  option  valuation  model.  See  Note  7  to  our  Consolidated  Financial 
Statements for significant assumptions regarding stock-based compensation. 

Recent Accounting Pronouncements 

See Note 2.  Summary of Significant Accounting Policies, in Notes to the Consolidated Financial Statements in Item 8 
of Part II of this Annual Report on Form 10-K for a full description of recent  accounting pronouncements, including the 
expected dates of adoption and estimated effects on financial condition and results of operations, which is incorporated herein 
by reference. 

Results of Operations – Comparison of years ended December 31, 2022 and 2021 

Research and Development Expense 

Research and development expenses consist primarily of costs of drug development work associated with our product 

candidates, including: 

• 
• 
• 
• 

clinical studies, 
preclinical testing, 
clinical supplies and related formulation and design costs, and 
compensation and other personnel-related expenses. 

Research and development expenses increased to $68.0 million in 2022 from $24.8 million in 2021, representing a 174% 
increase. This increase was due primarily to costs related to conducting the ongoing Phase 3 clinical program of simufilam, 
costs of an on-going cognition maintenance study and open-label study in simufilam, and costs related to the manufacture of 
clinical trial supplies compared to the prior year. Higher pre-clinical study costs as well as increased personnel costs also 
contributed to the increase. Grant funding received from NIH, recorded as a reduction in research and development expenses, 
also decreased compared to the prior year. During the years ended December 30, 2022 and 2021, we received $0.9 million 
and $3.9 million in research grants from NIH, respectively. 

We expect research and development expense to increase in future periods as we manufacture drug supply and continue 

our Phase 3 clinical program, the Cognition Maintenance Study, an open-label extension study and pre-clinical studies. 

80 

  
 
 
 
 
 
 
 
 
 
 
 
 
General and Administrative Expense 

General  and  administrative  expenses  consist  of  personnel  costs,  allocated  expenses  and  other  expenses  for  outside 
professional services, including legal, human resources, audit and accounting services. Personnel costs consist of salaries, 
bonus,  benefits  and  stock-based  compensation.  Allocated  expenses  consist  primarily  of  existing  facility  costs.  We  incur 
insurance, audit, investor relations, SOX compliance and other administrative and professional services expenses associated 
with operating as a public company, including expenses related to compliance with the rules and regulations of the SEC and 
Nasdaq. General and administrative expense increased to $12.0 million in 2022 from $8.1 million in 2021. The 49% increase 
was due primarily to higher legal fees, personnel costs and insurance expenses compared to the prior year. In addition, 2022 
expense  included  over  $1,000,000 of  depreciation  and  amortization,  compared  to $500,000  in  2021,  for  the  two-building 
office complex in Austin, Texas, purchased in third quarter 2021. 

We  expect  general  and  administrative  expense  for  2023  will  increase  compared  to  2022  due  primarily  to  anticipated 
higher  legal  and  professional  fees  related  to  ongoing  securities  class  action  and  derivative  lawsuits,  governmental 
investigations as well as higher operating costs such as compliance costs and depreciation and amortization. 

Interest Income 

Interest and other income, net, was $2.8 million in 2022 compared to $49,000 in 2021. The increase in interest income 

was due to increases in interest rates in 2022 compared to the prior year. 

We expect interest income to increase in 2023 compared to 2022 due to the increases in interest rates. 

Other income, net  

We record the activities related to leasing office space to third parties in buildings we own as other income, net, as leasing 
is  not  core  to  the  Company’s  operations.  Other  income, net,  was  $1.0 million  during  the  year  ended  December 31,  2022 
compared to $434,000 during 2021. Other income, net, was higher in 2022 as we acquired the two-building office complex 
in August 2021. 

Depreciation  and  amortization  for  the  office  complex  is  included  in  general  and  administrative  and  research  and 

development expense, and thus not reflected in other income, net. 

Comparison of the years ended December 31, 2021 and 2020 

Refer to “Item 7. Management’s Discussion and Analysis of Financial Condition and Results of Operations—Results of 
Operations” in our 2021 Annual Report on Form 10-K for a discussion of the results of operations for the year ended December 
31, 2021 compared to the year ended December 31, 2020. 

Liquidity and Capital Resources 

Since inception, we have financed our operations primarily through public and private stock offerings, payments received 
under collaborative agreements and interest earned on our cash and cash equivalents balances. We intend to continue to use 
our capital resources to fund research and development activities, capital expenditures, working capital requirements and other 
general corporate purposes. As of December 31, 2022, cash and cash equivalents totaled $201 million. 

2022 Registered Direct Offering 

On November 22, 2022, we completed a common stock offering pursuant to which certain investors purchased 1,666,667 
shares of common stock at a price of $30.00 per share. Net proceeds of the offering were approximately $47.3 million after 
deducting offering expenses. 

2021 Registered Direct Offering 

On February 12, 2021, we completed a common stock offering pursuant to which certain investors purchased 4,081,633 
shares of common stock at a price of $49.00 per share. Net proceeds of the offering were approximately $189.7 million after 
deducting offering expenses. 

81 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
2020 Follow-on Public Offering 

On  November 13,  2020,  we  completed  the  sale  of 9,375,000 shares  of  our  common  stock  in  an  underwritten  public 
offering  at  a  price  of $8.00 per  share.  We  received  net  proceeds  from  the  offering  of approximately  $70.3  million after 
deducting underwriting discounts and offering expenses. 

Common Stock Warrants 

In  August  2018,  we  issued  warrants  to purchase  up  to  an  aggregate  of 9.1 million  shares  of  its  common  stock  in 

conjunction with an offering of our common stock. 

During 2021, we received proceeds of $0.7 million from the exercise of 0.6 million shares pursuant to warrants. During 

2020, we received proceeds of $4.9 million from the exercise of 4.0 million shares pursuant to warrants.  

There were no warrants outstanding following the 2021 exercises. 

At the Market (ATM) Common Stock Issuance  

On March 27, 2020, we established an at-the-market offering program (ATM) to sell, from time to time, shares of our 
common  stock  having  an  aggregate  offering  price  of  up  to $100 million in  transactions  pursuant  to  a  shelf  registration 
statement that was declared effective by the U.S. Securities and Exchange Commission (the SEC) on May 5, 2020. We are 
obligated to pay a commission of 3.0% of the gross proceeds from the sale of shares of common stock in the offering. We are 
not obligated to sell any shares in the offering. 

There were no common stock sales under the ATM during the years ended December 31, 2022, 2021 and 2020. 

NIH Research Grant Awards 

Our research has been supported by NIH under multiple research grant awards. Strong, long-term support from NIH has 

allowed us to advance our two lead product candidates, simufilam and SavaDx, into clinical development. 

In May 2021, we were awarded a new research grant award from NIH of up to $2.7 million to support clinical readiness 
activities for a Phase 3 program with simufilam. In April 2020, we were awarded a research grant from NIH of up to $2.5 
million. In March 2020, we were awarded a supplemental research funding grant from NIH of up to $374,000. These non-
dilutive  research  grants  are  intended  to  strengthen  our  clinical  program  of  simufilam,  our  investigational  drug  to  treat 
Alzheimer’s disease. All of our NIH research grant awards are paid out on a reimbursement basis and require milestone-based 
technical progress. There were no remaining funds for NIH grant awards as of December 31, 2022. 

2020 Cash Incentive Bonus Plan Obligations 

In August 2020, the Board approved the 2020 Cash Incentive Bonus Plan (the Plan). The Plan was established to promote 
the  long-term  success  of  the  Company  by  creating  an  “at-risk”  cash  bonus  program  that  rewards Plan participants  with 
additional  cash  compensation  in  lockstep  with  significant  increases  in  the  Company’s  market  capitalization.  The  Plan  is 
considered  “at-risk”  because  Plan  participants will not  receive  a  cash  bonus unless the  Company’s  market  capitalization 
increases significantly  and certain other conditions  specified  in  the  Plan are  met. Specifically,  Plan  participants will not be 
paid any  cash  bonuses  unless  (1)  the  Company  completes  a merger  or  acquisition  transaction  that  constitutes  a  sale  of 
ownership of the Company or its assets (a Merger Transaction) or (2) the Compensation Committee determines the Company 
has sufficient cash on hand, as defined in the Plan. Plan participants will be paid all earned cash bonuses in the event of a 
Merger Transaction. 

The Company’s market capitalization, including all outstanding stock options, was $89.4 million at the inception of the 
Plan in August 2020. If the Company were to exceed a $5 billion market capitalization for no less than 20 consecutive trading 
days, and conditions noted above for payment are met, all Plan milestones would be deemed achieved, in which case total 
cash bonus awards would range from a minimum of $139.1 million up to a hypothetical maximum of $322.3 million. 

The Company’s potential financial obligation to plan participants at December 31, 2021 totaled $7.3 million, based upon 
the achievement of one Plan milestone in the Company’s market capitalization in 2020. No actual cash bonus payments have 
been made to any Plan participant, as the Company has not yet satisfied all the conditions necessary for amounts to be paid 
under the Plan. During the year ended December 31, 2021, the Company’s market capitalization increased substantially. These 

82 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
increases triggered the achievement of 11 additional Plan milestones. Collectively, the achievement of such milestones could 
trigger potential Company obligations to Plan participants ranging from a minimum of $93.7 million up to a  hypothetical 
maximum of $225.0 million, with exact amounts to be determined by the Compensation Committee and contingent upon 
future satisfaction of a Performance Condition.  

No actual cash payments were authorized or made to participants under the Plan as of December 31, 2022, or through the 

filing date of this Annual Report on Form 10-K. 

Use of Cash 

The following table sets forth a summary of the primary sources and uses of cash for each of the periods presented below 

(in thousands): 

Net cash used in operating activities 
Net cash (used in) provided by investing activities 
Net cash provided by financing activities 
Net (decrease) increase in cash and cash equivalents 

$ 

$ 

 (77,514)  
 (2,712)  
 47,804   
 (32,422)  

$ 

$ 

 (30,196)  
 (22,214)  
 192,341   
 139,931   

$ 

$ 

 (5,382) 
 360  
 75,447  
 70,425  

Years ended December 31, 

2022 

2021 

2020 

Net cash used in operating activities was $77.5 million for the year ended December 31, 2022, resulting primarily from 
the net loss reported of $76.2 million, a decrease in accounts payable of $3.4 million, accrued compensation and benefits of 
$1.7 million and a decrease in accrued developmental expenses of $0.5 million, partially offset by a decrease in in prepaid 
and other assets of $1.2 million, and stock-based compensation expense of $2.1 million. 

Net cash used in operating activities was $30.2 million for the year ended December 31, 2021, resulting primarily from 
the  net  loss  reported of  $32.4  million  and  an  increase  in  prepaid  and  other  assets  of  $11.0  million, partially  offset  by  an 
increase in accounts payable of $6.2 million, accrued development expense of $2.1 million, accrued compensation and benefits 
of $1.8 million, other current liabilities of $0.7 million and stock-based compensation expense of $1.8 million. 

Net cash used in investing activities during the year ended December 31, 2022 was $2.7 million related to renovations 

and fixtures for our corporate headquarters. 

Net cash used in investing activities during the year ended December 31, 2021 was $22.2 million related primarily to the 

purchase of a two-building office complex in Austin, Texas, a portion of which serves as our corporate headquarters. 

Net cash provided by financing activities during the year ended December 31, 2022 was $47.8 million, consisting of 
$47.3 million in proceeds from our registered direct offering of common stock in November 2022 and $0.5 million from the 
exercise of stock options. 

Net cash provided by financing activities during the year ended December 31, 2021 was $192.3 million, consisting of 
$189.8 million  in  proceeds  from  our  registered  direct  offering  of  common  stock  in  February  2021,  $1.8 million  from  the 
exercise of stock options and $0.7 million in proceeds from the exercise of common stock warrants. 

Use of Cash – Comparison of the years ended December 31, 2021 and 2020 

Refer to “Item 7. Management’s Discussion and Analysis of Financial Condition and Results of Operations—Results of 
Operations” in our 2021 Annual Report on Form 10-K for a discussion of use of cash for the year ended December 31, 2021 
compared to the year ended December 31, 2020. 

Realization of our deferred tax assets is dependent on future earnings, if any. We are uncertain about the timing and 

amount of any future earnings. Accordingly, we offset these net deferred tax assets with a valuation allowance. 

83 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Property and Leases 

In August 2021, we  completed the purchase of an office complex in Austin, Texas, a portion of which serves as our 
corporate headquarters. This property is intended to accommodate our anticipated growth and expansion of our operations in 
the  coming years. Maintenance, physical  facilities, leasing, property management and other key responsibilities related to 
property ownership are outsourced to professional real-estate managers. The purchase price of the property was $22.0 million, 
including closing costs, funded with cash on hand. The office complex measures approximately 90,000 rentable square feet. 
The  property  was  over  60%  leased  at  December  31,  2022.  We  also  occupied  approximately  25%  of  the  property  as  of 
December 31 2022. 

We leased approximately 6,000 square feet of office space pursuant to a non-cancelable operating lease in Austin, Texas 

expiring in April 2024. We terminated this lease on February 22, 2023 with no continuing obligations. 

We  have  an  accumulated  deficit  of  $283.6 million  at  December 31,  2022.  We  expect  our  cash  requirements  to  be 
significant  in  the  future.  The  amount  and  timing  of  our  future  cash  requirements  will  depend  on  regulatory  and  market 
acceptance of our product candidates and the resources we devote to researching and developing, formulating, manufacturing, 
commercializing and supporting our products. We believe that our current resources should be sufficient to fund our operations 
for at least the next 12 months. We may seek additional future funding through public or private financing in the future, if 
such funding is available and on terms acceptable to us. 

If we raise additional funds by issuing debt financing or equity securities, our stockholders will experience dilution. Any 
future debt financing into which we enter may impose upon us additional covenants that restrict our operations, including 
limitations  on  our  ability  to  incur  liens  or  additional  debt,  pay  dividends,  repurchase  our  common  stock,  make  certain 
investments and engage in certain merger, consolidation or asset sale transactions. Any debt financing or additional equity 
that we raise may contain terms that are not favorable to us or our stockholders. If we are unable to raise additional funds 
when needed, we may be required to delay, reduce, or terminate some or all of our development programs and clinical trials. 
We may also be required to sell or license to others rights to our drug candidates in certain territories or indications that we 
would prefer to develop and commercialize ourselves. 

Item 7A.    Quantitative and Qualitative Disclosures about Market Risk 

We are exposed to market risks in the ordinary course of our business, primarily related to interest rate sensitivities and, 

to a lesser extent, currency fluctuations related to our clinical operations outside the U.S. 

Interest Rate Sensitivity 

We are exposed to market risk related to changes in interest rates. We had cash and cash equivalents of $201 million as 

of December 31, 2022, which consisted primarily of U.S. Treasury securities and money market accounts. 

The primary objective of our investment activities is to preserve capital to fund our operations. We also seek to maximize 
income from our investments without assuming significant risk. To achieve our objectives, we maintain investment vehicles 
with high credit quality and short-term duration, in accordance with our board-approved investment policy. Such interest-
earning  instruments  carry  a degree of  interest  rate  risk.  However,  due  to  the  generally  short-term  maturities  and  low risk 
profile of our cash equivalents, an immediate 100 basis point increase or decrease in interest rates during any of the periods 
presented would increase or decrease our annual net loss by less than $2 million in our condensed consolidated financial 
statements. 

Item 8.    Consolidated Financial Statements and Supplementary Data 

INDEX TO CONSOLIDATED FINANCIAL STATEMENTS 

Report of Independent Registered Public Accounting Firm (PCAOB ID: 42) 
Consolidated Balance Sheets 
Consolidated Statements of Operations 
Consolidated Statements of Stockholders’ Equity  
Consolidated Statements of Cash Flows 
Notes to Consolidated Financial Statements 

84 

Page 
85 
87 
88 
89 
90 
91 

  
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Report of Independent Registered Public Accounting Firm 

To the Stockholders and the Board of Directors of Cassava Sciences, Inc. 

Opinion on the Financial Statements  

We have audited the accompanying consolidated balance sheets of Cassava Sciences, Inc. (the Company) as of December 31, 
2022 and 2021, the related consolidated statements of operations, stockholders' equity and cash flows for each of the three 
years in the period ended December 31, 2022, and the related notes (collectively referred to as the “consolidated financial 
statements”). In our opinion, the consolidated financial statements present fairly, in all material respects, the financial position 
of the Company at December 31, 2022 and 2021, and the results of its operations and its cash flows for each of the three years 
in the period ended December 31, 2022, in conformity with U.S. generally accepted accounting principles. 

We also have audited, in accordance with the standards of the Public Company Accounting Oversight Board (United States) 
(PCAOB), the Company's internal control over financial reporting as of December 31, 2022, based on criteria established in 
Internal Control-Integrated Framework issued by the Committee of Sponsoring Organizations of the Treadway Commission 
(2013 framework) and our report dated February 28, 2023 expressed an unqualified opinion thereon. 

Basis for Opinion 
These financial statements are the responsibility of the Company's management. Our responsibility is to express an opinion 
on the Company’s financial statements based on our audits. We are a public accounting firm registered with the PCAOB and 
are  required  to  be  independent  with  respect  to  the  Company  in  accordance  with  the  U.S.  federal  securities  laws  and  the 
applicable rules and regulations of the Securities and Exchange Commission and the PCAOB. 

We conducted our audits in accordance with the standards of the PCAOB. Those standards require that we plan and perform 
the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement, whether due 
to  error  or fraud.  Our  audits included performing  procedures  to  assess  the  risks  of  material  misstatement  of  the  financial 
statements, whether due to error or fraud, and performing procedures that respond to those risks. Such procedures included 
examining, on a test basis, evidence regarding the amounts and disclosures in the financial statements. Our audits also included 
evaluating the accounting principles used and significant estimates made by management, as well as evaluating the overall 
presentation of the financial statements. We believe that our audits provide a reasonable basis for our opinion. 

Critical Audit Matters 

The critical audit matters communicated below are matters arising from the current period audit of the financial statements 
that were communicated or required to be communicated to the audit committee and that: (1) relate to accounts or disclosures 
that are material to the consolidated financial statements and (2) involved our especially challenging, subjective or complex 
judgments. The communication of critical audit matters does not alter in any way our opinion on the consolidated financial 
statements, taken as a whole, and we are not, by communicating the critical audit matters below, providing separate opinions 
on the critical audit matters or on the accounts or disclosures to which they relate. 

Description of 
the Matter 

Prepaid  and  Accrued  Development  Expenses  Related  to  CRO  Pass  Through 
Costs for Clinical Trials 
As  explained  in  Note  2  to  the  consolidated  financial  statements,  the  Company 
contracts  with  a  contract  research  organization  (CRO)  to  assist  the  Company  in 
conducting  clinical  trials,  the  costs  for  which  are  recorded  as  research  and 
development expenses as incurred. A portion of these costs are pass through costs, 
which are costs incurred by third parties contracted by the CRO to perform certain 
services for clinical trials. These costs are passed through to the Company by the CRO. 
Depending on the timing of CRO payments, the Company records these costs as either 
prepaid  or  accrued  development  expenses.  These  prepaid  or  accrued  development 
expenses are based on management’s determination of pass through costs incurred by 
the  third  parties  based  on  the  status  of  the  clinical  trials.  At  December  31,  2022, 
prepaid  and  accrued  development  expenses  for  CRO  pass  through  costs  were  $2.7 
million and $14 thousand, respectively. 

Auditing the Company’s prepaid and accrued development expenses related to CRO 
pass through costs for clinical trials was challenging because the recorded amounts 

85 

  
 
 
 
 
 
 
 
 
 
 
 
 
involved management’s validation of the completeness and accuracy of costs incurred 
for services provided but not yet billed by third parties to the CRO. 

How We 
Addressed the 
Matter in Our 
Audit 

We  obtained  an  understanding,  evaluated  the  design,  and  tested  the  operating 
effectiveness of controls over the Company’s process of accounting for prepaid and 
accrued development expenses related to CRO pass through costs for clinical trials, 
including management’s review of the progress of clinical trial activity in comparison 
to budgets and invoices received from the CRO. 

To  evaluate  the  adequacy  of  the  Company’s  prepaid  and  accrued  development 
expenses related to CRO pass through costs for clinical trials, our audit procedures 
included, among others, testing the completeness and accuracy of the underlying data 
used by management to determine the prepaid and accrued development expenses. To 
evaluate completeness and accuracy of the data, on a sample basis, we: (i) obtained 
confirmation directly from the CRO of key clinical trial contract terms and conditions 
and any amendments thereto, as well as pass through costs incurred to date, (ii) agreed 
data  used  in  the  calculation  to  the  contracts  with  the  CRO,  and  any  amendments 
thereto,  and/or  the  data  obtained  from  the  CRO,  (iii)  corroborated  the  progress  of 
clinical trials through inquiry of Company personnel who oversee clinical trials, and 
(iv) obtained and reviewed subsequent invoices received from the CRO to corroborate 
the prepaid and accrued development expenses at the end of the reporting period. 

Loss Contingencies 
The Company is subject to lawsuits, claims, allegations, and investigations regarding 
simufilam  and  SavaDx.  As  described  in  Note  12  to  the  consolidated  financial 
statements,  such  allegations  and  claims  could  result  in  adverse  consequences.  At 
December 31, 2022, the Company was unable to determine the likelihood of a loss, if 
any,  associated  with  these  lawsuits  and  investigations  and  therefore  was  unable  to 
reasonably estimate a loss or range of loss. 

Auditing management’s accounting for, and disclosure of, loss contingencies related 
to the lawsuits and investigations was challenging because management’s evaluation 
of the likelihood of loss required judgment. 

Description of 
the Matter 

How We 
Addressed the 
Matter in Our 
Audit 

We  obtained  an  understanding,  evaluated  the  design,  and  tested  the  operating 
effectiveness of controls over the Company’s process of evaluation of the accounting 
for  and  disclosure  of  these  matters.  This  included  controls  over  management’s 
assessment of the likelihood of incurrence of a loss and whether the loss or range of 
loss was reasonably estimable, and the development of related disclosures. 

Our  audit  procedures  included  gaining  an  understanding  of  the  status  of  ongoing 
lawsuits and investigations, reading the meeting minutes of the board of directors and 
of the committees of the board of directors, reading summaries of the proceedings and 
related  correspondence,  requesting  letters  from  internal  and  external  legal  counsel, 
meeting with internal and external legal counsel to discuss developments related to 
the lawsuits and investigations together with our forensic professionals, and obtaining 
written representations from the Company on these matters. We also evaluated the 
Company’s disclosures in relation to these matters. 

/s/ Ernst & Young LLP  

We have served as the Company’s auditor since 2002. 

Austin, Texas 
February 28, 2023 

86 

  
 
 
 
 
 
 
 
 
 
 
 
 
CASSAVA SCIENCES, INC. 

CONSOLIDATED BALANCE SHEETS 
(In thousands, except share and par value data) 

December 31, 

2022 

2021 

ASSETS 

Current assets: 

Cash and cash equivalents 
Prepaid expenses and other current assets 

Total current assets 

Operating lease right-of-use assets 
Property and equipment, net 
Intangible assets, net 
Other assets 

Total assets 

$ 

 201,015   $ 
 10,211  
 211,226  
 122  
 22,864  
 622  

 —    

$ 

 234,834   $ 

LIABILITIES AND STOCKHOLDERS' EQUITY 

Current liabilities: 
Accounts payable 
Accrued development expense 
Accrued compensation and benefits 
Operating lease liabilities, current 
Other current liabilities 
Total current liabilities 

Operating lease liabilities, non-current 
Other non-current liabilities 

Total liabilities 

$ 

 4,017   $ 
 2,280  
 170  
 104  
 492  
 7,063  
 35  
 197  
 7,295  

 233,437 
 11,045 
 244,482 
 210 
 20,616 
 1,075 
 399 
 266,782 

 7,126 
 2,803 
 1,877 
 97 
 631 
 12,534 
 139 
 194 
 12,867 

Commitments and contingencies (Notes 10, 11 and 12) 
Stockholders' equity: 
Preferred  stock,  $0.001  par  value;  10,000,000  shares  authorized,  none  issued  and 
outstanding 
Common  stock,  $0.001  par  value;  120,000,000  shares  authorized;  41,735,557  and 
40,016,792 shares issued and outstanding at December 31, 2022 and 2021, respectively  

Additional paid-in capital 
Accumulated deficit 

Total stockholders' equity  
Total liabilities and stockholders' equity 

$ 

 —    

 42    

 511,049  
 (283,552)  
 227,539  
 234,834   $ 

 — 

 40 
 461,181 
 (207,306) 
 253,915 
 266,782 

See accompanying notes to consolidated financial statements. 

87 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
CASSAVA SCIENCES, INC. 

CONSOLIDATED STATEMENTS OF OPERATIONS 
(In thousands, except per share data) 

Years ended December 31, 
2021 

2022 

2020 

Operating expenses: 

Research and development, net of grant reimbursement 
General and administrative  
Gain on sale of property and equipment 

Total operating expenses 

Operating loss 
Interest income 
Other income, net 
Net loss 
Net loss per share, basic and diluted 
Shares used in computing net loss per share, basic and diluted 

$ 

$ 
$ 

 68,032   $ 
 11,988  
 —  
 80,020  
 (80,020)  
 2,777  
 997  
 (76,246)   $ 
 (1.90)   $ 

 24,813   $ 
 8,055  
 —  
 32,868  
 (32,868)  
 49  
434  
 (32,385)   $ 
 (0.82)   $ 

 40,202  

 39,405  

 3,053 
 3,739 
 (346) 
 6,446 
 (6,446) 
 112 
 — 
 (6,334) 
 (0.24) 
 26,105 

See accompanying notes to consolidated financial statements. 

88 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CASSAVA SCIENCES, INC. 

 CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY 
(In thousands, except share data) 

Common stock 

Additional 

  comprehensive 

  Accumulated 

  Accumulated 

other 

Shares 

 21,841,810   $ 

  Par value 
 22 

  paid-in capital 
 $ 

 190,664   $ 

income 

 — 

 $ 

deficit 
 (168,587)   $ 

 Balance at December 31, 2019 
Stock-based compensation for: 
Stock options for employees 
Stock options for non-employees 

Issuance of common stock pursuant to exercise of stock options 
Issuance of common stock pursuant to exercise of warrants 
Common stock issued in conjunction with follow-on public offering, net of 
issuance costs 
Net loss 

 Balance at December 31, 2020 
Stock-based compensation for: 
Stock options for employees 
Stock options for non-employees 

Issuance of common stock pursuant to exercise of stock options 
Issuance of common stock pursuant to exercise of warrants 
Common stock issued in conjunction with registered direct offering, net of 
issuance costs 
Net loss 

 Balance at December 31, 2021 
Stock-based compensation for: 
Stock options for employees 
Stock options for non-employees 

Expiration of restricted stock Performance Awards 
Issuance of common stock pursuant to exercise of stock options 
Common stock issued in conjunction with registered direct offering, net of 
issuance costs 
Net loss 

 — 
 — 
 71,105 
 3,950,072 

 9,375,000 
 — 

 35,237,987    

 — 
 — 
 143,153 
 554,019 

 4,081,633 
 — 

 40,016,792   $ 

 — 
 — 

 (57,143)    
 109,241 

 1,666,667 
 — 

 — 
 — 
 — 
 4 

 9 
 — 

 35 

 — 
 — 
 — 
 1 

 4 
 — 
 40 

 — 
 — 
 — 
 — 

 2 
 — 

Total 
stockholders' 
equity 
 22,099 

 — 
 — 
 — 
 — 

 961 
 27 
 256 
 4,940 

 — 
 (6,334)    

 70,251 
 (6,334) 

 (174,921)   $ 

 92,200 

 961 
 27 
 256 
 4,936 

 70,242 
 — 

 267,086    

 1,706 
 53 
 1,824 
 691 

 — 
 — 
 —    
 — 

 — 
 — 

 — 

 — 
 — 
 —    
 — 

 — 
 — 
 — 
 — 

 — 

 1,706 
 53 
 1,824 
 692 

 189,825 
 (32,385) 
 253,915 

 1,972 
 94 
 — 
 475 

 47,329 
 (76,246) 

 189,821 
 — 
 461,181   $ 

 $ 

 — 
 — 
 — 

 (32,385)    
 (207,306)   $ 

 $ 

 1,972 
 94 
 — 
 475 

 47,327 
 — 

 — 
 — 
 — 
 —    

 — 
 — 

 — 
 — 
 — 
 — 

 — 

 (76,246)    

 Balance at December 31, 2022 

 41,735,557   $ 

 42 

 $ 

 511,049   $ 

 — 

 $ 

 (283,552)   $ 

 227,539 

See accompanying notes to consolidated financial statements. 
89 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
   
 
   
 
   
 
 
 
     
     
     
     
     
 
 
   
 
   
 
   
 
   
 
   
 
 
 
   
 
   
 
   
 
   
 
   
 
 
 
   
 
   
 
   
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
  
 
 
 
 
 
 
 
 
 
    
    
    
    
    
 
  
  
  
  
  
  
  
  
  
  
   
 
 
   
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
    
    
    
    
    
 
  
  
  
  
  
  
  
  
  
  
   
 
 
   
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
    
    
    
    
    
 
  
  
  
  
  
  
  
  
  
  
  
  
  
  
   
 
 
   
  
  
  
  
  
  
  
  
  
  
 
 
     
     
     
     
     
 
CASSAVA SCIENCES, INC. 

CONSOLIDATED STATEMENTS OF CASH FLOWS 
(In thousands) 

Years ended December 31, 
2021 

2022 

2020 

Cash flows from operating activities: 

Net loss 

Adjustments to reconcile net loss to net cash used in operating activities: 

$ 

 (76,246)   $   (32,385)   $ 

 (6,334) 

Stock-based compensation 

Depreciation 

Amortization of intangible assets 

Gain on sale of property and equipment 

Changes in operating assets and liabilities: 

Prepaid and other assets 

Operating lease right-of-use assets and liabilities 

Accounts payable 

Accrued development expense 

Accrued compensation and benefits 

Other liabilities 

Net cash used in operating activities 

Cash flows from investing activities: 

Purchase of property and equipment 

Proceeds from sale of property and equipment 

Net cash (used in) provided by investing activities 

Cash flows from financing activities: 

Proceeds from issuance of common stock upon exercise of stock options 
Proceeds  from  issuance  of  common  stock  upon  exercise  of  common  stock 
warrants 
Proceeds from common stock offering, net of issuance costs 

Net cash provided by financing activities 

Net (decrease) increase in cash and cash equivalents 

Cash and cash equivalents at beginning of period 

 2,066  

 1,759  

 804  

 497  

 —  

 310  

 224  

 —  

 988 

 22 

 — 

 (346) 

   1,189  

  (10,956)  

 (220) 

 (9)  

  (3,449)  

 (523)  

  (1,707)  

 (136)  

 28  

  6,215  

  2,084  

  1,794  

 731  

 (2) 

 458 

 (58) 

 25 

 85 

 (77,514)  

 (30,196)  

 (5,382) 

 (2,712)  

   (22,214)  

 —  

 —  

  (2,712)  

 (22,214)  

 475  

 —  

 1,824  

 692  

 47,329  

 189,825  

  47,804  

 192,341  

 (32,422)  

 139,931  

 233,437  

 93,506  

 — 

 360 

 360 

 256 

 4,940 

 70,251 

 75,447 

 70,425 

 23,081 

Cash and cash equivalents at end of period 

$   201,015   $   233,437   $ 

 93,506 

Supplemental cash flow information: 

Non-cash investing activities 

Purchases of property and equipment included in accounts payable 

$ 

 340   $ 

 —   $ 

 — 

See accompanying notes to consolidated financial statements.  

90 

 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
     
 
   
 
   
     
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
 
   
 
   
 
   
   
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
  
 
  
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
   
 
 
 
 
 
 
 
   
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
   
   
 
   
 
   
   
 
   
 
   
 
   
 
   
 
   
 
 
CASSAVA SCIENCES, INC. 
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS 

1. General, Liquidity and Basis of Presentation 

Cassava Sciences, Inc. and its wholly-owned subsidiary (collectively referred to as the “Company”) discovers and 
develops  proprietary  pharmaceutical  product  candidates  that  may  offer  significant  improvements  to  patients  and 
healthcare professionals. The Company generally focuses its product discovery and development efforts on disorders of 
the nervous system.  

Coronavirus Disease 2019 (COVID-19) 

The  widespread  outbreak  of  COVID-19  has  not  significantly  impacted  the  Company’s  operations  or  financial 
condition as of February 28, 2023. However, this pandemic has created a dynamic and uncertain situation in the national 
economy. The Company continues to closely monitor the latest information to make timely, informed business decisions 
and public disclosures regarding the potential impact of pandemic on its operations and financial condition. The scope of 
pandemic  is  unprecedented  and  its  long-term  impact  on  the  Company’s  operations  and financial  condition  cannot  be 
reasonably estimated at this time. 

Basis of Consolidation 

The consolidated financial statements include the accounts of the Company and its wholly-owned subsidiary. All 

intercompany transactions have been eliminated in consolidation. 

Liquidity   

The  Company  has  incurred  significant net  losses  and  negative  cash flows  since  inception,  and  as  a  result has  an 
accumulated deficit of $283.6 million at December 31, 2022. The Company expects its cash requirements to be significant 
in the future. The amount and timing of the Company’s future cash requirements will depend on regulatory and market 
acceptance  of  its  product  candidates  and  the  resources  it  devotes  to  researching  and  developing,  formulating, 
manufacturing, commercializing and supporting its products. The Company may seek additional funding through public 
or private financing in the future, if such funding is available and on terms acceptable to the Company. There are no 
assurances that additional financing will be available on favorable terms, or at all. However, management believes that 
the current working capital position will be sufficient to meet the Company’s working capital needs for at least the next 
12 months. 

2.  Summary of Significant Accounting Policies 

Use of Estimates 

The Company makes estimates and assumptions in preparing its consolidated financial statements in conformity with 
accounting  principles  generally  accepted  in  the  United  States.  These  estimates  and  assumptions  affect  the  reported 
amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the consolidated financial 
statements and the reported amount of revenue earned and expenses incurred during the reporting period. The Company 
evaluates its estimates on an ongoing basis, including those estimates related to manufacturing agreements and research 
collaborations. Actual results could differ from these estimates and assumptions. 

Proceeds from Grants 

In 2022, 2021, and 2020, the Company received $0.9 million, $3.9 million and $4.2 million of reimbursement from 
the National Institutes of Health and National Institute on Drug Abuse, respectively. The Company records the proceeds 
from these grants as reductions to its research and development expenses. 

91 

 
 
  
 
 
 
 
 
 
 
  
 
 
 
 
 
Cash and Cash Equivalents and Concentration of Credit Risk 

The Company invests in cash and cash equivalents. The Company considers highly-liquid financial instruments with 
original maturities of three  months or less to be cash equivalents. Highly liquid investments that are considered cash 
equivalents include money market accounts and funds, certificates of deposit and U.S. Treasury securities. The Company 
maintains its cash and cash equivalents at one financial institution. 

Fair Value Measurements  

The Company recognizes financial instruments in accordance with the authoritative guidance on fair value measurements 
and disclosures for financial assets and liabilities. This guidance defines fair value, establishes a framework for measuring 
fair  value  in  accordance  with  GAAP,  and  expands  disclosures  about  fair  value  measurements.  The  guidance  also 
establishes a three-tier fair value hierarchy, which prioritizes the inputs used in measuring fair value. These tiers include: 

•  Level 1 includes quoted prices in active markets. 
•  Level 2 includes significant observable inputs, such as quoted prices for identical or similar securities, or other 
inputs that are observable and can be corroborated by observable market data for similar securities. The Company 
uses market pricing and other observable market inputs obtained from third-party providers. It uses the bid price 
to  establish  fair  value  where a  bid  price  is  available.  The Company  does not have  any financial  instruments 
where the fair value is based on Level 2 inputs. 

•  Level 3 includes unobservable inputs that are supported by little or no market activity. The Company does not 

have any financial instruments where the fair value is based on Level 3 inputs. 

If a financial instrument uses inputs that fall in different levels of the hierarchy, the instrument will be categorized 
based  upon  the  lowest  level  of  input  that  is  significant  to  the  fair  value  calculation.  The  fair  value  of  cash  and  cash 
equivalents was based on Level 1 inputs at December 31, 2022 and 2021. 

Business Segments 

The Company reports segment information based on how it internally evaluates the operating performance of its 
business units, or segments. The Company’s operations are confined to one business segment: the development of novel 
drugs and diagnostics. 

Stock-based Compensation  

The Company recognizes non-cash expense for the fair value of all stock options and other share-based awards. The 
Company uses the Black-Scholes option valuation model (“Black-Scholes”) to calculate the fair value of stock options, 
using the single-option award approach and straight-line attribution method. This model requires the input of subjective 
assumptions  including  expected  stock  price  volatility,  expected  life  and  estimated  forfeitures  of  each  award.  These 
assumptions consist of estimates of future market conditions, which are inherently uncertain, and therefore, are subject to 
management’s judgment. For all options granted, it recognizes the resulting fair value as expense on a straight-line basis 
over the vesting period of each respective stock option, generally four years.  

The  Company  has  granted  share-based  awards  that  vest  upon  achievement  of  certain  performance  criteria 
(“Performance Awards”). The Company multiplies the number of Performance Awards by the fair value of its common 
stock on the date of grant to calculate the fair value of each award. It estimates an implicit service period for achieving 
performance criteria for each award. The Company recognizes the resulting fair value as expense over the implicit service 
period  when  it  concludes  that  achieving  the  performance  criteria  is  probable.  It  periodically  reviews  and  updates  as 
appropriate its estimates of implicit service periods and conclusions on achieving the performance criteria. Performance 
Awards vest and common stock is issued upon achievement of the performance criteria. 

92 

 
 
 
 
 
 
 
 
 
 
 
 
 
Net Loss per Share 

The Company computes basic net loss per share on the basis of the  weighted-average number of common shares 
outstanding for the reporting period. Diluted net loss per share is computed on the basis of the weighted-average number 
of  common  shares  outstanding  plus  potential  dilutive  common  shares  outstanding  using  the  treasury-stock  method. 
Potential  dilutive  common  shares  consist  of  outstanding  common  stock  options  and  warrants.  There  is  no  difference 
between the Company’s net loss and comprehensive loss. The numerators and denominators in the calculation of basic 
and diluted net loss per share were as follows (in thousands, except net loss per share data): 

Numerator: 
Net loss 
Denominator: 

Years ended December 31, 
2021 

2022 

2020 

$ 

 (76,246)   $ 

 (32,385)   $ 

 (6,334) 

Shares used in computing net loss per share, basic and diluted 

Net loss per share, basic and diluted 

 40,202   

 39,405   

$ 

 (1.90)   $ 

 (0.82)   $ 

 26,105  
 (0.24) 

 Dilutive common stock options excluded from net loss per share, diluted 
Common stock warrants excluded from net loss per share, diluted 

 2,055   
 -  

 2,211   
 -  

 2,145  
 554  

The Company excluded common stock options and warrants outstanding , along with 57,143 restricted stock awards, 
from the calculation of net loss per share, diluted, because the effect of including outstanding options and warrants would 
have been anti-dilutive. The 57,143 restricted stock awards expired during the year ended December 31, 2022. 

Fair Value of Financial Instruments  

Financial instruments include accounts payable and accrued liabilities. The estimated fair value of certain financial 
instruments  may  be  determined  using  available  market  information  or  other  appropriate  valuation  methodologies. 
However, considerable judgment is required in interpreting market data to develop estimates of fair value; therefore, the 
estimates  are  not  necessarily  indicative  of  the  amounts  that  could  be  realized  or  would  be  paid  in  a  current  market 
exchange.  The  effect  of  using  different  market  assumptions  and/or  estimation  methodologies  may  be  material  to  the 
estimated  fair  value  amounts.  The  carrying  amounts  of  accounts  payable  and  accrued  liabilities  are  at  cost,  which 
approximates fair value due to the short maturity of those instruments. 

Research Contracts, Prepaids and Accruals 

The Company has entered into various research and development contracts with research institutions and other third-
party vendors. These agreements are generally cancelable. Related payments are recorded as research and development 
expenses as incurred. The Company records prepaids and accruals for estimated ongoing research costs. When evaluating 
the adequacy of the accrued liabilities, the Company analyzes progress of the studies including the phase or completion 
of events, invoices received and contracted costs. Significant judgments and estimates are made in determining the prepaid 
and accrued balances at the end of any reporting period. Actual results could differ from the Company’s estimates. The 
Company’s historical prepaid and accrual estimates have not been materially different from actual costs. 

Incentive Bonus Plan 

In 2020, the Company established the 2020 Cash Incentive Bonus Plan (the “Plan”) to incentivize Plan participants.  
Awards under the Plan are accounted for as liability awards under Accounting Standards Codification (ASC) 718 “Stock-
based Compensation”. The fair value of each potential Plan award will be determined once a grant date occurs and will 
be remeasured  each  reporting  period. Compensation  expense  associated  with  the  Plan will  be recognized  over  the 
expected  achievement  period  for  each Plan  award,  when a  Performance  Condition (as  defined  below)  is  considered 
probable of being met.  See Note 11 for further discussion of the Plan. 

93 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
Leases 

The Company recognizes assets and liabilities that arise from leases. For operating leases, the Company is required 
to recognize a right-of-use asset and a lease liability, initially measured at the present value of the lease payments during 
the lease term, in the consolidated balance sheets. The Company elected the short-term lease recognition exemption for 
all leases that qualify. This means, for those leases that qualify, the Company does not recognize right-of-use assets or 
lease liabilities. As the Company`s leases do not provide an implicit rate, it uses its incremental borrowing rate based on 
the information available at the commencement date in determining the present value of lease payments. Lease expense 
for lease payments is recognized on a straight-line basis over the lease term. 

Property and equipment 

Property  and  equipment  is  recorded  at  cost,  net  of  accumulated  depreciation.  Depreciation  is  recorded  using  the 
straight-line  method  over  the  estimated  useful  lives  of  the  assets.  Owned  buildings  and  related  improvements  have 
estimated useful lives of 39 years and approximately 10 years, respectively. Tenant improvements related to leased space 
are  amortized  using  the  straight-line  method  over  the  useful  lives  of  the  improvements  or  the  remaining  term  of  the 
corresponding leases, whichever is shorter. The remaining term of the corresponding leases is approximately 1.4 years. 

Property and equipment are reviewed for impairment when events or changes in circumstances indicate the carrying 
amount of an asset may not be recoverable. If property and equipment are considered to be impaired, an impairment loss 
is recognized. 

Intangible assets 

Acquired intangible assets are recorded at fair value at the date of acquisition and primarily consist of lease-in-place 
agreements  and  leasing  commissions.  Intangible  assets  are  amortized  over  the  estimated  life  of  the  lease-in-place 
agreements, which approximates 1.3 years at December 31, 2022. 

Intangible assets are reviewed for impairment on an annual basis, and when there is reason to believe that their values 

have been diminished or impaired. If intangible assets are considered to be impaired, an impairment loss is recognized. 

Income Taxes 

The Company accounts for income taxes under the asset and liability method. Deferred tax assets and liabilities are 
recognized for the estimated future tax consequences attributable to differences between the financial statement carrying 
amounts of existing assets and liabilities and their respective tax bases.  Deferred tax balances are adjusted to reflect tax 
rates based on currently enacted tax laws, which will be in effect in the years in which the temporary differences are 
expected  to  reverse. The  Company  has  accumulated  significant  deferred  tax  assets  that  reflect  the  tax  effects  of  net 
operating loss and tax credit carryovers and temporary differences between the carrying amounts of assets and liabilities 
for financial reporting purposes and the amounts used for income tax purposes. Realization of certain deferred tax assets 
is  dependent  upon  future  earnings.  The  Company  is  uncertain  about  the  timing  and  amount  of  any  future  earnings. 
Accordingly, the Company offsets these deferred tax assets with a valuation allowance. 

The Company accounts for uncertain tax positions in accordance with ASC 740, “Income Taxes”, which clarifies the 
accounting for uncertainty in tax positions. These provisions require recognition of the impact of a tax position in the 
Company’s financial  statements  only  if  that  position  is  more  likely  than  not  of  being  sustained  upon  examination by 
taxing  authorities,  based  on  the  technical  merits  of  the  position.  Any  interest  and  penalties  related  to  uncertain  tax 
positions will be reflected as a component of income tax expense. 

94 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
3.  Prepaid and Other Current Assets 

Prepaid and other current assets at December 31, 2022 and 2021 consisted of the following (in thousands): 

Prepaid insurance 
Contract research organization and other deposits 
Other 
  Total prepaid expenses and other current assets 

$ 

$ 

December 31, 

2022 

2021 

 874   
 9,177  
 160   
 10,211  

$ 

$ 

 662  
 10,330  
 53  
 11,045  

Contract research organization and other deposits represent cash payments made to vendors in excess of expenses 

incurred. 

4.  Real Property Acquisition 

On August 4, 2021, the Company completed the all-cash purchase of a two-building office complex in Austin, Texas, 
a  portion  of  which  serves  as  its  corporate  headquarters.  This  property  is  intended  to  accommodate  the  Company’s 
anticipated growth and expansion of its operations in the coming years. Maintenance, physical facilities, leasing, property 
management and other key responsibilities related to property ownership are being outsourced to professional real-estate 
managers. The purchase price of the property was $22.0 million, including transaction costs. The office complex measures 
approximately 90,000 rentable square feet. At December 31, 2022, the property was over 60% leased. The Company also 
occupied approximately 25% of the property as of December 31, 2022. The seller was a third party not affiliated with the 
Company. 

The purchase was accounted for as an asset acquisition under ASC 805, Business Combinations. As substantially all 
of the fair value of the gross assets acquired were concentrated into a single identifiable asset, the Company concluded 
that the screen was met, and the transaction is considered an asset acquisition rather than an acquisition of a business. 
Pursuant  to  the  cost  accumulation  method  as  prescribed  in  ASC  805,  the  cost  of  the  acquisition,  including  certain 
transaction costs, is allocated to the assets acquired on the basis of relative fair values. The value of acquired in-place 
leases is measured as the sum of lost revenues that would be incurred during a prospective lease-up period that would be 
necessary to achieve occupancy similar to that at the time of acquisition. The value is calculated as the average number 
of  months  of  lease-up  multiplied  by  the  gross  monthly  market  rental  rate  (base  rent  plus  reimbursements)  for  each 
particular suite. 

The assets acquired are summarized as follows (in thousands): 

Land 

Buildings 

Site improvements 

Tenant improvements 

  Total tangible assets 

Lease-in-place agreements 

Leasing commissions and other 

  Total intangible assets 

Consideration paid 

$ 

$ 

$ 

$ 

$ 

 3,734  

 15,980  

 453  

 567  

 20,734  

 1,053  

 246  

 1,299  

 22,033  

The Company records the net income from building operations and leases as other income, net, as leasing is not core 
to the Company’s operations. Building depreciation and amortization for space not occupied by the Company is included 
in general and administrative expense.  Building depreciation and amortization for space occupied by the Company is 

95 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
allocated  between  general  and  administrative  expense  and  research  and  development  expense.  Components  of  other 
income, net, for the periods presented were as follows (in thousands): 

Lease revenue 
Property operating expenses 
  Other income, net 

2022 

Years ended December 31, 
2021 

2020 

$ 

$ 

 2,459    $ 
 (1,462)  

 997    $ 

 911    $ 
 (477)  
 434    $ 

 — 
 — 
 — 

      The Company had accrued property taxes related to the building totaling  $433,000 and $450,000 at December 31, 
2022 and 2021, respectively, included in other current liabilities. 

5.  Property and Equipment 

The components of property and equipment, net, as of December 31, 2022 and 2021 were as follows (in thousands):  

Land 

Buildings 

Site improvements 

Tenant improvements 

Furniture and equipment 

Construction in progress 

  Gross property and equipment 

Accumulated depreciation 

  Property and equipment, net 

December 31, 

2022 

2021 

$ 

$ 

$ 

 3,734   
 15,980   
 470   
 3,016   
 851   
 13   
 24,064   
 (1,200)  
 22,864   

$ 

$ 

$ 

 3,734  

 15,980  

 470  

 567  

 178  

 83  

 21,012  

 (396) 

 20,616  

Depreciation  expense 

for  property  and  equipment  was $804,000,  $310,000 and $22,000 for 

the  years 

ended December 31, 2022, 2021 and 2020, respectively.  

There were no sales of property and equipment during the years ended December 31, 2022 and 2021. 

During the year ended December 31, 2020, the Company sold surplus manufacturing equipment to an independent 
third party and received proceeds totaling $360,000. The original cost of the property and equipment was $892,000 and 
accumulated depreciation was $878,000, resulting a gain on sale of property and equipment of $346,000 during the year 
ended December 31, 2020. 

96 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
6.  Intangible assets 

The components of intangible assets, net, as of December 31, 2022 and 2021 were as follows (in thousands): 

Lease-in-place agreements 

Leasing commissions and other 

  Gross intangible assets 

Accumulated amortization 

  Intangible assets, net 

December 31, 

2022 

2021 

$ 

$ 

$ 

 1,053   
 290   
 1,343   
 (721)  
 622   

$ 

$ 

$ 

 1,053  

 246  

 1,299  

 (224) 

 1,075  

Amortization expense for intangible assets was $497,000 and $224,000 for the years ended December 31, 2022 and 

2021, respectively. There was no amortization expense for the year ended December 31, 2020.  

Amortization expense for finite-lived intangible assets is expected to be as follows (in thousands): 

For the year ending December 31, 

2023 

2024 

2025 

Total amortization 

 451  

 167  

 4  

 622  

$ 

7.  Stockholders' Equity and Stock-Based Compensation 

Preferred Stock 

The Company’s Board of Directors (the “Board”) has the authority to issue preferred stock in one or more series and 
to fix the rights, preferences, privileges, restrictions and the number of shares constituting any series or the designation 
of the series. 

2022 Registered Direct Offering 

On  November 22,  2022,  the  Company  completed  a  common  stock  offering  pursuant  to  which  certain  investors 
purchased  1,666,667  shares  of  common  stock  at  a  price  of  $30.00  per  share.  Net  proceeds  of  the  offering  were 
approximately $47.3 million after deducting offering expenses. 

2021 Registered Direct Offering 

On  February 12,  2021,  the  Company  completed  a  common  stock  offering  pursuant  to  which  certain  investors 
purchased  4,081,633  shares  of  common  stock  at  a  price  of  $49.00  per  share.  Net  proceeds  of  the  offering  were 
approximately $189.8 million after deducting offering expenses. 

2020 Follow-on Public Offering 

On  November 13,  2020,  the  Company  completed  the  sale  of 9,375,000 shares  of  Cassava  common  stock  in  an 
underwritten  public  offering  at  a  price  of $8.00 per  share.  The  Company  received  net  proceeds  from  the  offering 
of approximately $70.3 million after deducting underwriting discounts and offering expenses. 

97 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
Common Stock Warrants  

In August 2018, the Company issued warrants to purchase up to an aggregate of 9.1 million shares of its common 

stock in conjunction with an offering of its common stock.  

During 2021, the Company received proceeds of  $0.7 million from the exercise of  0.6 million shares pursuant to 

common stock warrants. There were no common stock warrants outstanding following the 2021 exercises. 

During 2020, the Company received proceeds of  $4.9 million from the exercise of  4.0 million shares pursuant to 

common stock warrants. 

At the Market (ATM) Common Stock Issuance  

On March 27, 2020, the Company established an at-the-market offering program (ATM) to sell, from time to time, 
shares of Company common stock having an aggregate offering price of up to $100 million in transactions pursuant to a 
shelf registration statement that was declared effective by the U.S. Securities and Exchange Commission (the SEC) on 
May 5, 2020. The Company is obligated to pay a commission of 3.0% of the gross proceeds from the sale of shares of 
common stock in the offering. The Company is not obligated to sell any shares in the offering. 

There were no common stock sales under the ATM during the years ended December 31, 2022, 2021 and 2020. 

2008 Equity Incentive Plan  

Under the Company’s 2008 Equity Incentive Plan, or 2008 Equity Plan, its employees, directors and consultants 
received share-based awards, including grants of stock options and performance awards. The 2008 Equity Plan expired 
in December 2017. Share-based awards generally expire ten years from the date of grant. 

2018 Equity Incentive Plan  

The Company’s Board or a designated Committee of the Board is responsible for administration of the Company’s 
2018 Omnibus Incentive Plan (the 2018 Plan) and determines the terms and conditions of each option granted, consistent 
with the terms of the 2018 Plan. The Company’s employees, directors, and consultants are eligible to receive awards 
under the 2018 Plan, including grants of stock options and performance awards. Share-based awards generally expire ten 
years from the date of grant. The 2018 Plan, as amended on May 5, 2022, provides for issuance of up to 5,000,000 shares 
of common stock, par value $0.001 per share, subject to adjustment as provided in the 2018 Plan.  

When stock options or performance awards are exercised net of the exercise price and taxes, the number of shares of 
stock issued is reduced by the number of shares equal to the amount of taxes owed by the award recipient and that number 
of shares are cancelled. The Company may then use its cash to pay tax authorities the amount of statutory taxes owed by 
and on behalf of the award recipient. 

98 

 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
Stock Options 

The following summarizes information about stock option activity during 2022: 

Number of 
Options 

Weighted 
Average 
Exercise Price   

Weighted 
Average 
Remaining 
Contractual 
Term in Years  

Aggregate Intrinsic 
Value in Millions 

Outstanding as of December 31, 2021 

Options granted 
Options exercised 
Options forfeited/canceled 

Outstanding as of December 31, 2022 
Vested and expected to vest at December 31, 2022 
Exercisable at December 31, 2022 

 2,663,727    $ 
 104,000     
 (203,640)    
 (34,639)    
 2,529,448     
 2,529,448     
 2,270,464    $ 

 11.56  
 36.50  
 15.56  
 20.59  
 12.13  
 12.13  
 10.02  

  $ 

  $ 
  $ 
  $ 

3.94 
3.94 
3.43 

49.6 
49.6 
46.9 

Of the stock options exercised during the year ended December 31, 2022, 94,399 stock options were net settled in 

satisfaction of the exercise price, with no cash proceeds received. 

The following summarizes information about stock options at December 31, 2022 by a range of exercise prices: 

Range of exercise prices 
To 
From 
1.88 
0.95 
3.24 
3.24 
12.04 
4.09 
35.00 
12.39 
77.00 
36.40 

  $ 
  $ 
  $ 
  $ 
  $ 

$ 
$ 
$ 
$ 
$ 

Options outstanding 
Weighted 
average 
remaining 
contractual 
life (in years) 
5.6 
3.0 
4.1 
1.6 
8.8 
3.9 

  $ 
  $ 
  $ 
  $ 
  $ 
  $ 

Weighted 
average 
exercise 
price 
1.51 
3.24 
7.09 
20.82 
52.64 
12.13 

Number of 
outstanding 
options 

 585,833   
 550,000   
 536,951   
 655,874   
 200,790   
 2,529,448   

Options exercisable 

Number of 
 vested 
options 

 505,833    $ 
 550,000    $ 
 512,888    $ 
 653,290    $ 
 48,453    $ 
 2,270,464    $ 

Weighted 
average 
exercise 
price 
1.46 
3.24 
7.07 
20.79 
62.61 
10.02 

The Company uses Black-Scholes to estimate the fair value of options granted. Black-Scholes considers a number of 
factors, including the market price of the Company’s common stock. Factors utilized in Black-Scholes to value each stock 
option granted, and the weighted average fair value of options granted during the years ended December 31, 2022, 2021 
and 2020 were as follows: 

Volatility 
Risk-free interest rates 
Expected life of option 
Dividend yield 
Forfeiture rate 
Weighted average fair value of stock options granted 

2022 
151% to 154% 
1.98% to 3.69% 
7.0 years 
zero 
zero 
$35.16 

2021 
  147% to 151% 
 1.12% to 1.42% 
7.0 years 
zero 
zero 
$65.83 

2020 
  123% to 139% 
 0.46% to 0.78% 
7 years 
zero 
zero 
$6.69 

Volatility is based on reviews of the historical volatility of the Company’s common stock. Risk-free interest rates are 
based on yields of U.S. treasury notes in effect at the date of grant. Expected life of option is based on actual historical option 
exercises. Dividend yield is zero because the Company does not anticipate paying cash dividends in the foreseeable future.  

As of December 31, 2022, the Company expects to recognize compensation expense of $7.7 million related to non-

vested options held by equity plan participants over the weighted average remaining recognition period of 2.4 years. 

99 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Performance Awards 

The following summarizes information about performance award activity during 2022: 

Outstanding as of December 31, 2021 

Granted 
Vested 
Forfeited/canceled 

Outstanding as of December 31, 2022 

Number of Performance 
Awards 

 138,055 
 — 
 — 
 (130,913) 
 7,142 

During the year ended December 31, 2022, a total of 57,143 shares of restricted stock awards expired as performance 
criteria related to these Performance Awards were not attained. These shares of restricted stock were returned to the 2008 
Equity Incentive Plan, which expired in December 2017, and thus were retired.  

If  and  when  outstanding  performance  awards  vest,  the  Company  would  recognize  $101,000  in  stock-based 

compensation expense. These performance awards expire in 2026. 

Stock-Based Compensation Expense 

The following summarizes information about stock-based compensation expense, in thousands: 

Research and development 

General and administrative 

Total stock-based compensation expense 

8.  Employee 401(k) Benefit Plan 

2022 

Years ended December 31, 
2021 

2020 

$ 

$ 

 1,631  

 $ 

 1,302  

 $ 

 435  

 457  

 2,066    $ 

 1,759    $ 

 453  

 535  

 988  

The Company has a defined-contribution savings plan under Section 401(k) of the Internal Revenue Code. The plan 
covers substantially all employees. Employees are eligible to participate in the plan the first day of the month after hire 
and may contribute up to the current statutory limits under Internal Revenue Service regulations. The 401(k) plan permits 
the Company to make additional matching contributions on behalf of all employees. Through  December 31, 2022, the 
Company has not made any matching contributions to the 401(k) plan. 

9.  Income Taxes 

The Company did not provide for income taxes during the periods presented because it had book and federal taxable 
losses in those years and the tax benefit that would have resulted from the pre-tax losses was fully offset by a change in 
the valuation allowance.  

100 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
The reconciliation of the statutory federal income tax rate to the Company’s effective tax rate for periods presented 

was as follows: 

Tax at federal statutory rate 
State tax, net of federal benefit 
Share-based compensation 
Research and development credits 
Section 162(m) limitation 
Other 
Change in valuation allowance 
Effective income tax rate 

Deferred tax assets and valuation allowance 

Year ended December 31, 
2021 

2022 

2020 

 21.0 %  
 —  
 (0.5)  
 4.9  
 (0.2)  
 (1.8)  
 (23.4)  

 — %  

 21.0 %   
 —  
 1.2  
 2.3  
 (0.5)  
 (0.2)  
 (23.8)  

 — %   

 21.0 % 
 —  
 (42.8)  
 1.6  
 —  
 —  
 20.2  

 — % 

Deferred tax assets reflect the tax effects of net operating loss and tax credit carryforwards and temporary differences 
between the carrying amounts of assets and liabilities for financial reporting purposes and the amounts used for income 
tax purposes. The Company’s deferred taxes assets at December 31, 2022 and 2021 were valued at the corporate tax rate 
of 21%. The Company offsets its deferred tax assets by a valuation allowance because it is uncertain about the timing and 
amount of any future profits. Significant components of its deferred tax assets are as follows (in thousands): 

Deferred tax assets: 

Net operating loss carryforwards 
Share-based compensation 
Research and development credit carryforwards 
Capitalized research and development expenses 
Other 

Total deferred tax assets 
Valuation allowance 
Net deferred tax assets 
Deferred tax liabilities: 

Operating lease right-of-use assets 

Total deferred tax liabilities 
Net deferred tax asset (liability) 

December 31,  

2022 

2021 

$ 

 28,017   $ 

 2,706  
 9,681  
 12,690  
 934  
 54,028  
 (54,002)  
 26  

 (26)  
 (26)  
 —   $ 

$ 

 24,777 
 2,870 
 7,439 
 — 
 1,130 
 36,216 
 (36,166) 
 50 

 (50) 
 (50) 
 — 

The valuation allowance increased by $17.8 million and $7.7 million in 2022 and 2021, respectively, due primarily 

to continuing operations. 

The  Company’s  net  operating  loss  carryforwards  of  $133.4 million  are  federal,  of  which  $74.1 million  expires 
between  2029  and  2037  and  $43.9 million  carries  forward  indefinitely.  As  of  December 31,  2022,  the  Company  had 
federal research and development tax credits of approximately  $16.1 million, which expire in the years  2024 through 
2042.  

101 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
 
 
 
 
   
 
 
   
 
 
 
 
   
 
 
 
 
   
 
 
 
 
   
 
 
 
 
   
 
 
 
 
   
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Unrecognized tax benefits 

As of December 31, 2022, 2021 and 2020, the Company has unrecognized tax benefits related to tax credits of $6.5 
million, $5.0 million and $4.5 million, respectively. None of the unrecognized tax benefits as of December 31, 2022, if 
recognized, would impact the effective tax rate  due to the valuation allowance and no interest or penalties have been 
recognized. A reconciliation of the beginning and ending balance of unrecognized tax benefits is as follows (in thousands):  

Beginning balance 
Additions based on tax positions related to the current year 
Ending balance 

$ 

$ 

 5,001   $ 
 1,495  
 6,496   $ 

 4,500   $ 
 501  
 5,001   $ 

2022 

Year ended December 31, 
2021 

2020 

 4,400 
 100 
 4,500 

As of December 31, 2022, there were no unrecognized tax benefits that we expect would change significantly 

over the next 12 months. 

The Company files U.S. and Texas income tax returns. In the United States, the statute of limitations with respect 
to the federal income tax returns for tax years after 2018 are open to audit; however, since the Company has net operating 
losses, the taxing authority has the ability to review tax returns prior to the 2019 tax year and make adjustments to these 
net operating loss carryforwards. We are not under audit in any taxing jurisdiction at this time. 

10.  Leases and Commitments 

Right-of-use Asset and Liability 

The Company had an operating lease for approximately 6,000 square feet of office space in Austin, Texas expiring 
April 30, 2024. The Company terminated this lease on February 22, 2023 with no continuing obligations. The Company 
also had a short-term lease agreement for an additional 3,600 square feet of office space in Austin, Texas that expired on 
October 31, 2022. Future expected minimum lease payments as of December 31, 2022 are as follows (in thousands). 

2023 

2024 

Total future lease 
payments 

Less: imputed 
interest 

Total 

Operating leases 

$ 

 107  

 36  

 143  

 (4) 

$ 

 139  

Rent expense was $0.1 million for the years ended December 31, 2022, 2021 and 2020. 

There were no right-of-use assets exchanged for operating lease liabilities during the years ended December 31, 2022 
and 2021. The Company recorded a right-of-use asset and lease liability of $316,000 as a result of the lease modification 
in September 2020. The Company utilized a discount rate of 3.25% for the modified lease to determine the present value 
of the future lease payments, which approximated the Company’s incremental borrowing rate in September 2020.  

Cash paid for operating lease liabilities totaled $155,000, $109,000 and $99,000 during the years ended December 31, 

2022, 2021 and 2020, respectively. 

Other Commitments 

The  Company  conducts  its  product  research  and  development  programs  through  a  combination  of  internal  and 
collaborative programs that include, among others, arrangements with universities, contract research organizations and 
clinical  research  sites.  It  has  contractual  arrangements  with  these  organizations  that  are  generally  cancelable.  The 
Company’s obligations under these contracts are largely based on services performed. 

The Company is dependent on contract development and manufacturing organizations for the manufacture of all our 

materials for clinical studies. 

102 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Note 11.  2020 Cash Incentive Bonus Plan 

In August 2020, the Board approved the Plan. The Plan was established to promote the long-term success of the 
Company by creating an “at-risk” cash bonus program that rewards Plan participants with additional cash compensation 
in lockstep with significant increases in the Company’s market capitalization. The Plan is considered “at-risk” because 
Plan  participants will not  receive  a  cash  bonus unless the  Company’s  market  capitalization  increases significantly 
and certain other conditions  specified  in  the  Plan are  met. Specifically,  Plan  participants will not be  paid any  cash 
bonuses unless (1) the Company completes a merger or acquisition transaction that constitutes a sale of ownership of the 
Company  or  its  assets  (a  Merger  Transaction)  or  (2)  the  Compensation  Committee  of  the  Board (the  Compensation 
Committee)  determines  the  Company  has  sufficient  cash  on  hand,  as  defined  in  the  Plan.  Because of  the  inherent 
discretion  and  uncertainty  regarding these requirements,  the  Company  has  concluded  that a Plan grant  date  has  not 
occurred as of December 31, 2022.  

Plan participants will be paid all earned cash bonuses in the event of a Merger Transaction. 

The  Company’s  market  capitalization  for  purposes  of  the  Plan is determined  based  on  either  (1)  the  Company’s 
closing price of one share on the Nasdaq Capital Market multiplied by the total issued and outstanding shares and options 
to purchase shares of the Company, or (2) the aggregate consideration payable to security holders of the Company in 
a Merger Transaction. This constitutes a market condition under applicable accounting guidance.    

The Plan triggers a potential cash bonus each time the Company’s market capitalization increases significantly, up 
to  a  maximum $5 billion  in  market  capitalization.  The  Plan  specifies  14 incremental amounts between $200 million 
and $5 billion (each  increment, a  “Valuation  Milestone”).  Each Valuation  Milestone triggers a  potential  cash  bonus 
award in a pre-set amount defined in the Plan. Each Valuation Milestone must be achieved and maintained for no less 
than 20 consecutive trading days for Plan participants to be eligible for a potential cash bonus award. Approximately 58% 
of  each cash  bonus  award associated  with  a  Valuation  Milestone is  subject  to adjustment  and approval by  the 
Compensation  Committee. Any  amounts not  awarded  by  the  Compensation  Committee are no  longer  available  for 
distribution. 

If  the  Company  were  to  exceed  a  $5 billion  market  capitalization for  no  less  than  20  consecutive  trading  days, 
all Valuation Milestones would be deemed achieved, in which case cash bonus awards would range from a minimum 
of $139.1 million up to a hypothetical maximum of $322.3 million. Payment of cash bonuses is deferred until such time 
as (1) the Company completes a Merger Transaction, or (2) the Compensation Committee determines the Company has 
sufficient  cash on  hand to  render  payment (each,  a  “Performance  Condition”), neither of  which  may  ever  occur. 
Accordingly, there can be no assurance that Plan participants will ever be paid a cash bonus that is awarded under the 
Plan, even if the Company’s market capitalization increases significantly. 

The  Plan  is  accounted  for  as  a  liability  award. The  fair  value  of  each Valuation Milestone award will 
be determined once a grant date occurs and will be remeasured each reporting period. Compensation expense associated 
with the Plan will be recognized over the expected achievement period for each of the 14 Valuation Milestones, when a 
Performance Condition is considered probable of being met.    

In  October  2020, 

the  Compensation 
Committee approved a  potential  cash  bonus award of $7.3 million in  total for all  Plan  participants,  subject  to  future 
satisfaction of a Performance Condition. 

first Valuation Milestone. Subsequently, 

the  Company achieved the 

During the year ended December 31, 2021, the Company achieved 11 additional Valuation Milestones triggering 
potential Company obligations to all Plan participants from a minimum of $93.7 million up to a hypothetical maximum 
of  $225.0 million,  to  be  determined  by  the  Compensation  Committee  and  contingent  upon  future  satisfaction  of  a 
Performance  Condition.  However, no compensation  expense  has  been  recorded since  no grant  date  has  occurred  and 
no Performance Conditions are considered probable of being met. There is no continuing service requirement for Plan 
participants once the Compensation Committee approves a cash bonus award. No Valuation Milestones were achieved 
during the year ended December 31, 2022. 

No actual cash payments were authorized or made to participants under the Plan through December 31, 2022. 

103 

 
 
 
 
 
 
 
 
 
 
12. Contingencies 

Securities Class Actions and Shareholder Derivative Actions 

Between August 27, 2021 and October 26, 2021, four putative class action lawsuits were filed alleging violations of the 
federal  securities  laws  by  the  Company  and  certain  named  officers.  The  complaints  rely  on  allegations  contained  in 
Citizen Petitions submitted to FDA, and allege that various statements made by the defendants regarding simufilam were 
rendered materially false and misleading. The Citizen Petitions were all subsequently denied by FDA. These actions were 
filed in the U.S. District Court for the Western District of Texas. The complaints seek unspecified compensatory damages 
and other relief on behalf of a purported class of purchasers.  

On June  30, 2022, a federal judge  consolidated the  four class action lawsuits into  one case and appointed a lead 
plaintiff and a lead counsel. Lead plaintiff filed a consolidated amended complaint on August 18, 2022 on behalf of a 
putative class of purchasers of our securities between September 14, 2020 and July 26, 2022. Briefing on defendants’ 
motion to dismiss was completed on January 23, 2023. The Company believes the claims are without merit and intend to 
defend against these lawsuits vigorously. The Company is unable to estimate the possible loss or range of loss, if any, 
associated with these lawsuits. 

On November 4, 2021, a related shareholder derivative action was filed, purportedly on behalf of the Company, in 
the U.S. District Court for the Western District of Texas, asserting claims under the U.S. securities laws and state fiduciary 
duty laws against certain named officers and the members of the Company’s board of directors. This complaint relies on 
allegations made in Citizen Petitions that were submitted to (and subsequently denied by) FDA. The complaint alleges, 
among  other  things,  that  the  individual  defendants  exposed  the  Company  to  unspecified  damages  and  securities  law 
liability by causing it to make materially false and misleading statements, in violation of the U.S. securities laws and in 
breach of their fiduciary duties to the Company. The derivative case seeks, among other things, to recover unspecified 
compensatory damages on behalf of the Company arising out of the individual defendant’s alleged wrongful conduct. 
Although  the  plaintiff  in  this  derivative  case  does  not  seek  relief  against  the  Company,  the  Company  has  certain 
indemnification obligations to the individual defendants. Since November 4, 2021, three additional shareholder derivative 
actions were filed alleging substantially similar claims, two in the U.S. District Court for the Western District of Texas, 
and one in Texas state court (Travis County District Court). All four actions have been stayed pending the resolution of 
the motions to dismiss in the securities class actions. On July 5, 2022, the three federal court actions were consolidated 
into a single action. 

On August 19, 2022, a shareholder derivative action was filed, purportedly on behalf of the Company, in the Delaware 
Court of Chancery, asserting claims under state fiduciary duty laws against certain named officers and members of the 
Company’s board of directors. The complaint alleges, among other things, that the individual defendants breached their 
fiduciary duties by approving the 2020 Cash Incentive Bonus Plan in August 2020. The complaints seek unspecified 
compensatory damages and other relief. On  January 6, 2023, the plaintiffs filed an amended complaint. Although the 
plaintiffs  in  this  derivative  case  do  not  seek  relief  against  the  Company,  the  Company  has  certain  indemnification 
obligations to the individual defendants.  

The Company is unable to estimate the possible loss or range of loss, if any, associated with these lawsuits. 

104 

 
 
 
 
 
 
 
 
 
 
 
Item 9.    Changes in and Disagreements with Accountants on Accounting and Financial Disclosure 

None.  

Item 9A.    Controls and Procedures 

Evaluation of disclosure controls and procedures. 

Our management, with the participation of our Chief Executive Officer and our Chief Financial Officer, evaluated 
the effectiveness of our disclosure controls and procedures as of the end of the period covered by this Annual Report on 
Form 10-K. Based on this evaluation, our Chief Executive Officer and our Chief Financial Officer have concluded that 
our disclosure controls and procedures were effective to ensure that information we are required to disclose in reports that 
we  file  or  submit  under  the  Exchange  Act  is  recorded,  processed,  summarized  and  reported  within  the  time  periods 
specified in the Securities and Exchange Commission, or SEC, rules and forms and that such information is accumulated 
and communicated to management as appropriate to allow timely decisions regarding required disclosures. 

Management’s  annual  report  on  internal  control  over  financial  reporting.  Our  management  is  responsible  for 
establishing and maintaining adequate internal control over our financial reporting. Our management has assessed the 
effectiveness of internal control over financial reporting as of December 31, 2022. Our assessment was based on criteria 
set forth by the Committee of Sponsoring Organizations of the Treadway Commission, or COSO, in Internal Control-
Integrated Framework (2013 Framework).  

Our internal control over financial reporting is a process designed to provide reasonable assurance regarding the 
reliability  of  financial  reporting  and  the  preparation  of  consolidated  financial  statements  for  external  purposes  in 
accordance with generally accepted accounting principles. Our internal control over financial reporting includes those 
policies and procedures that: 

(1)  pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflect our transactions and 

dispositions of our assets;  

(2)  provide reasonable assurance that transactions are recorded as necessary to permit preparation of  consolidated 
financial  statements  in  accordance  with  generally  accepted  accounting  principles,  and  that  our  receipts  and 
expenditures are being made only in accordance with authorizations of our management and board of directors; 
and  

(3)  provide  reasonable  assurance  regarding  prevention  or  timely  detection  of  unauthorized  acquisition,  use,  or 

disposition of our assets that could have a material effect on the consolidated financial statements. 

Because of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements. 
Also, projections of any evaluation of effectiveness to future periods are subject to the risk that controls may become 
inadequate  because  of  changes  in  conditions,  or  that  the  degree  of  compliance  with  the  policies  or  procedures  may 
deteriorate. 

Based on the COSO criteria, we believe our internal control over financial reporting as of December 31, 2022 was 

effective. 

Changes in internal control over financial reporting. 

There  was  no  change  in  our  internal  control  over  financial  reporting  that  occurred  during  the  quarter  ended 
December 31,  2022 that  has  materially  affected,  or  is  reasonably  likely  to  materially  affect,  our  internal  control  over 
financial reporting. 

The effectiveness of our internal control over financial reporting as of December 31, 2022 has been audited by Ernst 

& Young LLP, an independent registered public accounting firm, as stated in their report which is included herein. 

105 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Report of Independent Registered Public Accounting Firm 

To the Stockholders and the Board of Directors of Cassava Sciences, Inc. 

Opinion on Internal Control Over Financial Reporting 

We have audited Cassava Sciences, Inc.’s internal control over financial reporting as of December 31, 2022, based on 
criteria established in Internal Control—Integrated Framework issued by the Committee of Sponsoring Organizations of 
the Treadway Commission (2013 framework) (the COSO criteria). In our opinion, Cassava Sciences, Inc. (the Company) 
maintained, in all material respects, effective internal control over financial reporting as of December 31, 2022, based on 
the COSO criteria. 

We also have audited, in accordance with the standards of the Public Company Accounting Oversight Board (United 
States) (PCAOB), the consolidated balance sheets of Cassava Sciences, Inc. (the Company) as of December 31, 2022 and 
2021, the related consolidated statements of operations, stockholders' equity and cash flows for each of the three years in 
the  period  ended  December  31,  2022,  and  the  related  notes and  our  report  dated  February  28,  2023  expressed  an 
unqualified opinion thereon. 

Basis for Opinion 

The Company’s management is responsible for maintaining effective internal control over financial reporting and for its 
assessment of the effectiveness of internal control over financial reporting included in the accompanying Management's 
Annual  Report  on  Internal  Controls  over  Financial  Reporting.  Our  responsibility  is  to  express  an  opinion  on  the 
Company’s internal control over financial reporting based on our audit. We are a public accounting firm registered with 
the PCAOB and are required to be independent with respect to the Company in accordance with the U.S. federal securities 
laws and the applicable rules and regulations of the Securities and Exchange Commission and the PCAOB. 

We  conducted  our  audit  in  accordance  with  the  standards  of  the  PCAOB.  Those  standards  require  that  we  plan  and 
perform the audit to obtain reasonable assurance about whether effective internal control over financial reporting was 
maintained in all material respects.  

Our  audit  included  obtaining  an  understanding  of internal  control  over  financial  reporting,  assessing  the  risk  that  a 
material weakness exists, testing and evaluating the design and operating effectiveness of internal control based on the 
assessed risk, and performing such other procedures as we considered necessary  in the circumstances. We believe that 
our audit provides a reasonable basis for our opinion. 

Definition and Limitations of Internal Control Over Financial Reporting 

A company’s internal control over financial reporting is a process designed to provide reasonable assurance regarding the 
reliability  of  financial  reporting  and  the  preparation  of  financial  statements  for  external  purposes  in  accordance  with 
generally accepted accounting principles. A company’s internal control over financial reporting includes  those policies 
and procedures that (1) pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflect the 
transactions and dispositions of the assets of the company; (2) provide reasonable assurance that transactions are recorded 
as necessary to permit preparation of financial statements in accordance with generally accepted accounting principles, 
and that receipts and expenditures of the company are being made only in accordance with authorizations of management 
and  directors  of  the  company;  and  (3)  provide  reasonable  assurance  regarding  prevention  or  timely  detection  of 
unauthorized acquisition, use, or disposition of the company’s assets that could have a material effect on the financial 
statements. 

Because of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements. 
Also, projections of any evaluation of effectiveness to future periods are subject to the risk that controls may become 
inadequate because of changes in conditions, or that the degree of compliance with the policies or procedures may 
deteriorate. 

/s/ Ernst & Young LLP  

106 

 
 
 
 
 
 
 
 
Austin, Texas 
February 28, 2023 

107 

 
 
 
 
 
Item 9B.    Other Information 

None. 

Item 9C.    Disclosure Regarding Foreign Jurisdictions that Prevent Inspection 

None. 

PART III 

Item 10.    Directors and Executive Officers and Corporate Governance  

The information regarding our directors (other than the biographies below), executive officers, director nomination 
process and the audit committee of the Board is incorporated by reference from "Directors and Executive Officers" in our 
Proxy Statement for our 2023 Annual Meeting of Stockholders. 

Biographies of Directors and Executive Officers 

Remi Barbier, the Company’s founder, has served as President, Chief Executive Officer and Chairman of the Board 
of Directors since the Company’s inception in 1998. Prior to that time, Mr. Barbier helped in the growth or founding of 
Exelixis  Inc.,  a  publicly-traded  drug development  company,  ArQule,  Inc.,  a  drug development  company  acquired by 
Merck & Co., and EnzyMed, Inc., a chemistry company acquired by Albany Molecular Research, Inc. Mr. Barbier is a 
trustee emeritus of the Carnegie Institute of Washington, the Santa Fe Institute, the Advisory Board of the University of 
California Institute for Quantitative Biosciences and a life science incubator at the University of Arkansas for Medical 
Sciences. Mr. Barbier received his B.A. from Oberlin College and his M.B.A. from the University of Chicago. 

R. Christopher Cook has served as Senior Vice President and General Counsel since October 2022.  He previously 
served, since 2017, as the Global Head of Litigation and Government Investigations for Alcon, a publicly traded medical 
device and pharmaceutical company, as well as the Vice President and division General Counsel for Walmart Central 
America in San Jose, Costa Rica. Chris also spent seventeen years at Jones Day, where he was a litigation partner in the 
firm's Washington, DC and Chicago offices. Chris served as an Assistant United States Attorney in Chicago and graduated 
from Harvard Law School. 

James W. Kupiec, M.D. has joined the Company in January 2021 as Chief Clinical Development Officer and has 
served as our Chief Medical Officer since December 2022. Dr. Kupiec joined the Company after three decades of drug 
development  experience  at  Pfizer,  Sanofi  and  Ciba-Geigy.  Dr.  Kupiec  previously  served  as  Vice  President,  Global 
Clinical  Leader  for  Parkinson’s  Disease  and  Clinical  Head  of  the  Neuroscience  Research  Unit  for  Pfizer,  Inc.,  in 
Cambridge, MA. He joined Pfizer in 2000 after seven years with Sanofi, and two years with Ciba-Geigy Pharmaceuticals. 
During his 17-year career at Pfizer, Dr. Kupiec had extensive governance, business development, alliance and leadership 
responsibilities. Dr. Kupiec earned his BS with Honors in Biochemistry at Stony Brook University and his MD from the 
Albert Einstein College of Medicine. He completed his residency training at the Strong Memorial Hospital, University 
of  Rochester  School  of  Medicine,  and  is  certified  by  the  American  Board  of  Internal  Medicine.  He  served  as  an 
investigator on many clinical trials before transitioning to the pharmaceutical industry. 

Eric Schoen has served as Chief Financial Officer since 2018. Prior to joining the Company, Mr. Schoen served in 
numerous financial leadership roles. Most recently, he served as Vice President, Senior Vice President, Finance and Chief 
Accounting  Officer  of  Aspira  Women’s  Health  Inc.  (formerly  Vermillion,  Inc.),  a  publicly-held  women’s  health 
company, from 2011 to 2017. Mr. Schoen also began his career and spent nine years with PricewaterhouseCoopers in the 
audit and assurance, transaction services and global capital markets practices. Mr. Schoen received his B.S. in Finance 
from Santa Clara University. 

Richard J. Barry has served as a director since June 2021. Since June 2015, Mr. Barry has also served as a director of 
Sarepta Therapeutics, Inc., (Nasdaq: SRPT). Mr. Barry has extensive experience in the investment management business. 
He was a founding member of Eastbourne Capital Management LLC, and served as a Managing General Partner and 
Portfolio Manager from 1999 to its close in 2010. Prior to Eastbourne, Mr. Barry was a Portfolio Manager and Managing 
Director of Robertson Stephens Investment Management. Mr. Barry holds a Bachelor of Arts from Pennsylvania State 
University.  

108 

 
 
 
 
 
 
 
 
 
 
Robert Z. Gussin, Ph.D. has served as a director since 2003. Dr. Gussin worked at Johnson & Johnson for 26 years, 
most recently as Chief Scientific Officer and Corporate Vice President, Science and Technology from 1986 through his 
retirement in 2000. Dr. Gussin served on the board of directors of Duquesne University and the advisory boards of the 
Duquesne University Pharmacy School and the University of Michigan Medical School Department of Pharmacology. 
Dr.  Gussin  received  his  B.S.  and  M.S.  degrees  and  D.Sc.  with  honors  from  Duquesne  University  and  his  Ph.D.  in 
Pharmacology from the University of Michigan, Ann Arbor. 

Michael J. O’Donnell, Esq. has served as a director since 1998. Mr. O’Donnell has been a partner in the law firm of 
Orrick, Herrington & Sutcliffe LLP since June 2021. Orrick, Herrington & Sutcliffe LLP is  the Company’s corporate 
counsel and provides legal services to the Company. Previously, Mr. O’Donnell was a member of Morrison & Foerster 
LLP from 2011 to 2021. Mr. O’Donnell serves as corporate counsel to numerous public and private biopharmaceutical 
and  life  sciences  companies.  Previously,  Mr.  O’Donnell  was  a  member  of  Wilson  Sonsini  Goodrich  &  Rosati.  Mr. 
O’Donnell received his J.D., cum laude, from Harvard University and his B.A. from Bucknell University, summa  cum 
laude.  

Sanford R. Robertson has served as a director since 1998. Mr. Robertson has been a partner of Francisco Partners, a 
technology buyout fund, since 1999. Prior to founding Francisco Partners, Mr. Robertson was the founder and chairman 
of Robertson, Stephens & Company, a technology investment bank sold to BankBoston in 1998. Mr. Robertson is the 
lead  director  of  Salesforce.com,  a  publicly-held  provider  of  enterprise  cloud  computing  applications.  Mr.  Robertson 
received his B.A. and M.B.A. degrees with distinction from the University of Michigan. 

Patrick J. Scannon, M.D., Ph.D. has served as a director since 2007. Dr. Scannon is one of the founders of XOMA. 
From 2006 to 2016, Dr. Scannon was Executive Vice President, Chief Biotechnology Officer of XOMA. From 1993 to 
2006,  Dr.  Scannon  served  as Chief  Scientific  and  Medical  Officer  of  XOMA. Dr.  Scannon  retired  from  XOMA  and 
resigned  from  XOMA’s  board  of  directors  in  2016. Dr.  Scannon  received  his  Ph.D.  in  organic  chemistry  from  the 
University of California, Berkeley and his M.D. from the Medical College of Georgia.  

Section 16(a) Beneficial Ownership Reporting Compliance 

Section 16(a) of the Exchange Act requires our executive officers and directors and persons who own more than ten 
percent (10%) of a registered class of our equity securities to file reports of ownership and changes in ownership with the 
SEC. Executive officers, directors and greater than ten percent (10%) stockholders are required to furnish us with copies 
of all Section 16(a) forms they file. We believe all of our executive officers and directors complied with all applicable 
filing requirements during 2022. 

Code of Ethics  

We have adopted a Code of Ethics that applies to all of our directors, officers and employees, including our principal 
executive  officer  and  principal  financial  officer.  We  publicize  the  Code  of  Ethics  through  posting  the  policy  on  our 
website, http://www.cassavasciences.com. We will disclose on our website any waivers of, or amendments to, our Code 
of Ethics. 

Item 11.    Executive Compensation 

The information required by this Item is incorporated by reference from our definitive Proxy Statement referred to 

in Item 10 above where it appears under the heading "Executive Compensation and Other Matters." 

Item 12.  Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters 

The information required by this Item regarding security ownership of certain beneficial owners and management is 
incorporated by reference from our definitive Proxy Statement referred to in Item 10 above where it appears under the 
heading "Security Ownership of Certain Beneficial Owners and Management." 

109 

 
 
 
 
 
 
 
 
 
 
 
The  following  table  summarizes  the  securities  authorized  for  issuance  under  our  equity  compensation  plans  as 

of December 31, 2022: 

Equity compensation plans approved by stockholders 
Equity compensation plans not approved by stockholders  

Number of 
Securities to be 
Issued Upon 
Exercise of 
Outstanding 
Options, 
Warrants 
and Rights 
 2,536,590  (1) $ 

 —  

 2,536,590   $ 

Weighted Average 
Exercise Price of 
Outstanding 
Options, 
Warrants 
and Rights 

 12.10  (2) 
 —  
 12.10  

Number of Securities 
Remaining Available 
for Future Issuance 
Under Equity 
Compensation 
Plans 
 4,128,705  (3) 

 —  
 4,128,705  

(1)  Includes outstanding stock options and awards for 1,692,798 shares of our common stock under the 2008 Plan 

and 843,792 shares of our common stock under the 2018 Plan. 

(2)  Includes the weighted average stock price for outstanding stock options of $11.31 under the 2008 Plan and 

$13.78 for the 2018 Plan. 

(3)  Represents 4,070,688 shares of our common stock for the 2018 Plan and 58,017 for the Employee Stock Purchase 

Plan. No future awards shall occur under the 2008 Plan. 

Item 13.    Certain Relationships and Related Transactions and Director Independence 

The information required by this Item is incorporated by reference from our definitive Proxy Statement referred to 

in Item 10 above where it appears under the heading "Certain Relationships and Related Transactions." 

Item 14.    Principal Accountant Fees and Services 

The information required by this Item is incorporated by reference from our definitive Proxy Statement referred to 

in Item 10 above where it appears under the heading “Principal Accountant Fees and Services.” 

110 

 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
  
 
 
 
PART IV 

Item 15.    Exhibits and Financial Statement Schedules 

(a)  The following documents are filed as part of this Form 10-K: 

(1)  Consolidated Financial Statements (included in Part II of this report): 

Report of Independent Registered Public Accounting Firm 
Consolidated Balance Sheets 
Consolidated Statements of Operations 
Consolidated Statements of Stockholders' Equity 
Consolidated Statements of Cash Flows 
Notes to Consolidated Financial Statements 

(2)  Consolidated Financial Statement Schedules: 

All consolidated financial statement schedules are omitted because the information is inapplicable or presented 
in the notes to the consolidated financial statements. 

(3)  Management Contracts, Compensatory Plans and Arrangements.  

Management contracts, compensatory plans and arrangements are indicated by the symbol 
“*” in the applicable exhibits listed in Item 15(b), below. 

(b)  Exhibits  

The exhibits listed below are filed as part of this Form 10-K other than Exhibit 32.1, which shall be deemed furnished. 

Exhibit 
No. 
3.1 
3.2 
3.3 
3.4 
4.1 
4.2 
10.1 

10.5*  * 

10.6 
10.7 
10.8 
10.9 

Filing 
Date 
7/29/2005 
5/8/2017 
3/29/2019 

  Incorporated by Reference    
Exhibit 
For
No. 
m 
  Description 
  Amended and Restated Certificate of Incorporation. 
  3.1 
 10-Q  
  Certificate of Amendment of Restated Certificate of Incorporation.    8-K   
  3.1 
  Certificate of Amendment of Restated Certificate of Incorporation.   10-K  
  3.3 
  Amended and Restated Bylaws of Cassava Sciences, Inc. 
  Specimen Common Stock Certificate. 
  Description of Registrant’s Securities. 
Form of Indemnification Agreement between Registrant and each of 
its directors and officers. 
Employment  Agreement,  dated  July 1,  1998  and  amended 
December 17, 2008, between Registrant and Remi Barbier. 
*  2000 Employee Stock Purchase Plan, as amended and restated. 
*  2008 Equity Incentive Plan. 
*  Amendment Number 1 to the 2008 Equity Incentive Plan. 
* 
Amendment  No.  2  to  Employment  Agreement  between  Registrant 
and Remi Barbier. 

7/29/2010 
5/29/2008 
8/1/2013 
8/1/2013 

8/12/2019 
3/26/2020 
3/1/2022 

 10-Q  
  8-K   
 10-Q  
10-Q  

  10.1 
  10.1 
  10.1 
  10.2 

 10-Q  
 10-K  
10-K  

  4.1 
  4.2 
  10.1 

2/13/2009 

  10.12   

10-K  

Filed 
Herewith 

  X 

10.10  *  2018 Omnibus Incentive Plan. 
10.11   

Sales  Agreement,  Dated  March 27,  2020,  between  Registrant  and 
SVB Leerink LLC. 

10.12  *  Cassava Sciences, Inc. 2020 Cash Incentive Bonus Plan 
10.13  * 

Employment  Agreement,  executed  on  October 9,  2018,  by  and 
between Registrant and Eric Schoen. 
Employment  Agreement,  executed  on  January 1,  2021,  by  and 
between Registrant and Dr. James Kupiec. 
Master  Services  Agreement  between  Cassava  Sciences,  Inc.  and 
Evonik Corporation, dated February 22, 2021. 
Master  Services  Agreement  between  Cassava  Sciences,  Inc.  and 
Premier Research International LLC, dated June 11, 2021 

10.14  * 

10.15+   

10.16+   

  8-K   
S-3   

  8-K   
8-K   

5/11/2018 
3/27/2020 

  10.1 
  1.1 

9/1/2020 
10/11/2018 

  10.1 
  10.1 

8-K   

1/6/2021 

  10.1 

8-K   

3/11/2021 

  10.1 

10-Q  

8/4/2021 

  10.3 

111 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
10.17+   

Agreement of Sale and Purchase Between DWF IV Lakewood, LP 
and Cassava Sciences, Inc. dated July 2, 2021 

10-Q  

11/15/2021 

  10.4 

 10-Q  
8-K   

10.18*    Amendment 1 to 2018 Omnibus Incentive Plan 
10.19*   

21.1 
23.1 
31.1 

31.2 

32.1 

Employment  Agreement,  executed  on  October  13,  2022,  by  and 
between Registrant and R. Christopher Cook 
  Subsidiaries of the Registrant. 
  Consent of Independent Registered Public Accounting Firm. 
Certification of Principal Executive Officer pursuant to Section 302 
of the Sarbanes-Oxley Act of 2002.  
Certification of Principal Financial Officer pursuant to Section 302 
of the Sarbanes-Oxley Act of 2002.  
Certifications of the Chief Executive Officer and the Chief Financial 
Officer pursuant to 18 U.S.C. Section 1350, as adopted pursuant to 
Section 906 of the Sarbanes-Oxley Act of 2002. 

XBRL Taxonomy Extension Schema Document. 

101.INS   XBRL Instance Document. 
101.SC
H 
101.CA
L 
101.DE
F 
101.LA
B 

XBRL Taxonomy Extension Calculation Linkbase Document. 

XBRL Taxonomy Extension Definition Linkbase Document. 

XBRL Taxonomy Extension Labels Linkbase Document. 

101.PRE   XBRL Taxonomy Extension Presentation Linkbase Document. 

104 

The cover page from the Company’s Annual Report on Form 10-K 
for  the  fiscal  year  ended  December  31,  2022,  formatted  in  Inline 
XBRL (included in Exhibit 101). 

* Management contract, compensatory plan or arrangement. 
+Confidential portions of this document have been  redacted as permitted by 
applicable regulations. 

(c)  Consolidated Financial Statement Schedules  

8/4/2022 
10/27/2022 

  10.1 
  10.1 

  X 
  X 

X 

X 

X 

  X 

X 

X 

X 

X 

  X 

X 

All consolidated financial statement schedules are omitted because the information is inapplicable or presented in 

the notes to the consolidated financial statements. 

Item 16.    Form 10-K Summary 

The Company has elected not to include summary information. 

112 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pursuant to the requirements of Section 13 or 15(d) of the Securities Exchange Act of 1934, the registrant has duly 

caused this report to be signed on its behalf by the undersigned, thereunto duly authorized. 

SIGNATURES 

(Principal Executive 

Dated: February 28, 2023 

Cassava Sciences, Inc. 
(Registrant) 

/s/ REMI BARBIER 
Remi Barbier, 
Chairman of the Board of Directors, 
President and Chief Executive Officer 

Pursuant  to  the  requirements  of  the  Securities  Exchange  Act  of  1934,  this  report  has  been  signed  below  by  the 

following persons on behalf of the registrant and in the capacities and on the dates indicated. 

Signature  

Title  

Date 

/s/  REMI BARBIER 

Remi Barbier 

President, Chief Executive Officer and    
Chairman of the Board of Directors 
(Principal Executive Officer) 

February 28, 2023 

/s/  ERIC J. SCHOEN 

Eric J. Schoen 

Chief Financial Officer 
(Principal Financial Officer and Principal 
Accounting Officer) 

February 28, 2023 

/s/  RICHARD J. BARRY 

Richard J. Barry 

/s/  ROBERT Z. GUSSIN, PH.D.  

Robert Z. Gussin, Ph.D. 

/s/  MICHAEL J. O'DONNELL, ESQ.  
Michael J. O'Donnell, Esq. 

/s/  SANFORD R. ROBERTSON 

Sanford R. Robertson 

/s/  PATRICK SCANNON, M.D., PH.D.  

Patrick Scannon, M.D., Ph.D. 

Director 

February 28, 2023 

Director 

February 28, 2023 

Director 

February 28, 2023 

Director 

February 28, 2023 

Director 

February 28, 2023 

113