Financial Performance and Losses - Net loss for the three and nine months ended September 30, 2024 was 2.7millionand4.6 million, respectively, with a 7.5 million non-cash R&D expense related to the Varian asset acquisition and a 14.6 million gain on debt extinguishment[236] - The company reported a net loss of 4.55millionfortheninemonthsendedSeptember30,2024,comparedtoanetlossof15.14 million in the same period in 2023[268] - A gain on debt extinguishment of 14.59millionwasrecordedfortheninemonthsendedSeptember30,2024[268]−Thecompanyrecognizeda14.5 million non-cash gain on debt extinguishment related to the Exchange and Termination Agreement with Deerfield Management Company L.P.[284] - The company recognized a 14.5millionnon−cashgainondebtextinguishmentduringthethreemonthsendedSeptember30,2024,relatedtotheExchangeandTerminationAgreementwithDeerfield[320]AccumulatedDeficitandFinancing−AccumulateddeficitasofSeptember30,2024was848.8 million, with financing primarily through private placements, public offerings, and borrowings[236] - The company expects to continue to incur operating losses for at least the next several years and had an accumulated deficit of 848.8millionasofSeptember30,2024[293]−Managementhasconcludedsubstantialdoubtexistsaboutthecompany′sabilitytocontinueasagoingconcernforatleast12months,withplanstosecureadditionalcapitalthroughpublicorprivatesecuritiesofferings,convertibledebtfinancings,andstrategictransactions[296]ResearchandDevelopmentExpenses−ResearchanddevelopmentexpensesfortheninemonthsendedSeptember30,2024,increasedby8.8 million compared to the same period in 2023[268] - Research and development expenses for the nine months ended September 30, 2024 increased by 8.8millionto14.1 million, primarily due to a 7.5 million non-cash charge related to the acquired IPR&D from the Varian asset purchase[270] - The istaroxime – cardiogenic shock program costs increased by 2.1 million for the nine months ended September 30, 2024 compared to the same period in 2023, driven by trial execution costs for the SEISMiC Extension study and start-up procedures for the SEISMiC C study[273] - Total direct clinical and preclinical programs expenses increased by 2.2millionfortheninemonthsendedSeptember30,2024comparedtothesameperiodin2023,primarilyduetotheistaroxime–cardiogenicshockprogram[272]ClinicalTrialsandStudies−IstaroximedemonstratedsignificantimprovementinsystolicbloodpressureandcardiacfunctionintheSEISMiCExtensionstudy,withenrollmentfortheSEISMiCCstudyexpectedtocompletebylate2025[230][241][242]−TheSEISMiCCstudyisexpectedtoenrollupto100subjectswithSCAIStageCcardiogenicshock,withanunblindedreviewofdatafromthefirst20subjectsplannedforearlyQ22025[230][242]−RostafuroxindemonstratedefficacyinCaucasianpatientsinaPhase2btrialfortreatment−naı¨vehypertension,butanadditionalPhase2trialisneededforAfricanAmericanpatientswithtreatment−resistanthypertension[246]StrategicPartnershipsandLicensing−Thecompanyispursuinglicensingarrangementsandstrategicpartnershipsforrostafuroxin,anovelproductcandidateforhypertensiontreatmentinpatientswithaspecificgeneticprofile[232]−ThecompanyhasregionallicensedpartnershipswithLee′sPharmaceutical(HK)Ltd.forthedevelopmentandcommercializationofistaroximeandothercardiovascularassetsinGreaterChina[233]−Thecompanyisactivelyexploringlicensingtransactions,researchpartnerships,orotherstrategicopportunitiestoadvanceSERCA2aactivatorcandidates[245]IntellectualPropertyandPatents−ThecompanyholdspatentsfordualmechanismandpureSERCA2aactivators,withprotectionextendinguntil2038and2039,respectively[245]−IntangibleassetsasofSeptember30,2024,included22.34 million for istaroxime and 2.91millionforrostafuroxin[259]PreclinicalandOncologyResearch−ThetopicalformulationofaPKCiinhibitor(VAR−101)showeddose−dependentanti−tumoractivityinmurineandhumanbasalcellcarcinoma(BCC)celllines,supportedbypreclinicaldatafromCancerResearchUK[247]−TheoralformulationofaPKCiinhibitor(VAR−102)demonstrateddose−dependentanti−tumoractivityinamousemodelofnon−smallcelllungcancer(NSCLC)[248]−ThecompanyplanstoadvanceinvestigationalnewdrugenablingactivitiesfortheaPKCiinhibitorplatformacquiredfromVarian,withpotentialapplicationsinoncologyandraremalignantdiseases[235]StockandFinancingActivities−Thecompanyimplementeda1−for−18reversestocksplitonApril19,2024,toregaincompliancewithNasdaq′sminimumbidpricerequirement[249][252]−ThecompanyregainedcompliancewithNasdaq′sRule5550(a)(2)onMay6,2024,followingthereversestocksplit[252]−Thecompanysold1.4millionsharesofCommonStockundertheELOCPurchaseAgreementfornetproceedsof3.1 million during the three months ended September 30, 2024[294] - The company completed two private placement transactions in July 2024 for aggregate gross proceeds of approximately 13.9million,withnetproceedsof2.3 million[294] - The company entered into the ELOC Purchase Agreement in June 2024, allowing it to sell up to 35millionofnewlyissuedsharesofcommonstockovera36−monthperiod[306]−ForthethreemonthsendedSeptember30,2024,thecompanysold1.4millionsharesofcommonstockundertheELOCPurchaseAgreementforgrossproceedsof4.4 million[307] - The company's April 2023 public offering resulted in gross proceeds of approximately 12.4million,withnetproceedsof10.8 million after deducting underwriting discounts and commissions[311][312] - During the nine months ended September 30, 2024, the company sold 143,120 shares of common stock under the 2023 ATM Program, resulting in aggregate gross and net proceeds of approximately 1.4million[317]CashFlowandLiabilities−NetcashusedinoperatingactivitiesfortheninemonthsendedSeptember30,2024was11.7 million, primarily driven by a net loss of 4.6millionanda14.6 million gain on debt extinguishment[299] - Net cash provided by financing activities for the nine months ended September 30, 2024 was 9.6million,including4.4 million from the ELOC Purchase Agreement and 3.9millionfromprivateplacements[302]−AsofSeptember30,2024,thecompanyhadcashandcashequivalentsof2.3 million and current liabilities of 14.4million,includingan8.6 million warrant liability[295] - The company financed 0.5millionofinsurancepremiumsinAugust2024ata7.9456,000 due through May 2025[318] Goodwill and Intangible Assets - Goodwill impairment losses totaled 3.1millionfortheninemonthsendedSeptember30,2023,withgoodwillwrittendowntozeroasofJune30,2023[258]−IntangibleassetsasofSeptember30,2024,included22.34 million for istaroxime and 2.91millionforrostafuroxin[259]GeneralandAdministrativeExpenses−Clinical,medical,andregulatoryoperationsexpensesdecreasedby0.8 million for the nine months ended September 30, 2024 compared to the same period in 2023, due to a 0.7milliondecreaseinpersonnelcostsanda0.1 million decrease in non-cash stock-based compensation[280] - General and administrative expenses decreased by $0.8 million for the nine months ended September 30, 2024 compared to the same period in 2023, driven by reductions in personnel costs, severance costs, non-cash stock-based compensation, and insurance costs[283] Off-Balance Sheet Arrangements - The company did not have any material off-balance sheet arrangements as of September 30, 2024 or 2023[322]