Commission File No. 001-36345
All references to “we,”
“us,” “our,” “the Company” and “our Company”, in this Annual Report on Form 20-F
(“our annual report)ˮ, are to Galmed Pharmaceuticals Ltd. and its subsidiaries, unless the context otherwise requires. All
references to “shares” or “ordinary shares” are to our ordinary shares, NIS 0.01 nominal par value per
share. All references to “Israel” are to the State of Israel. “U.S. GAAP” means the generally accepted
accounting principles of the United States. Unless otherwise stated, all of our financial information presented in this annual
report has been prepared in accordance with U.S. GAAP. Any discrepancies in any table between totals and sums of the amounts listed
are due to rounding. Unless otherwise indicated, or the context otherwise requires, references in this annual report to financial
and operational data for a particular year refer to the fiscal year of our company ended December 31 of that year.
Our reporting currency and
financial currency is the U.S. dollar. In this annual report, “NIS” means New Israeli Shekel, and “$,”
“US$” and “U.S. dollars” mean United States dollars.
This annual report contains
forward-looking statements about our expectations, beliefs or intentions regarding, among other things, our product development
efforts, business, financial condition, results of operations, strategies or prospects. In addition, from time to time, we or our
representatives have made or may make forward-looking statements, orally or in writing. Forward-looking statements can be identified
by the use of forward-looking words such as “believe,” “expect,” “intend,” “plan,”
“may,” “should,” “anticipate,” “could,” “might,” “seek,”
“target,” “will,” “project,” “forecast,” “continue” or their negatives
or variations of these words or other comparable words or by the fact that these statements do not relate strictly to historical
matters. These forward-looking statements may be included in, among other things, various filings made by us with the U.S. Securities
and Exchange Commission (the “SECˮ), press releases or oral statements made by or with the approval of one of our authorized
executive officers. Forward-looking statements relate to anticipated or expected events, activities, trends or results as of the
date they are made. Because forward-looking statements relate to matters that have not yet occurred, these statements are inherently
subject to risks and uncertainties that could cause our actual results to differ materially from any future results expressed or
implied by the forward-looking statements. Many factors could cause our actual activities or results to differ materially from
the activities and results anticipated in forward-looking statements, including, but not limited to, the factors summarized below:
We believe these forward-looking
statements are reasonable; however, these statements are only current predictions and are subject to known and unknown risks, uncertainties
and other factors that may cause our or our industry’s actual results, levels of activity, performance or achievements to
be materially different from those anticipated by the forward-looking statements. We discuss many of these risks in this annual
report in greater detail under the heading “Risk Factors” and elsewhere in this annual report. Given these uncertainties,
you should not rely upon forward-looking statements as predictions of future events.
All forward-looking statements
attributable to us or persons acting on our behalf speak only as of the date hereof and are expressly qualified in their entirety
by the cautionary statements included in this annual report. We undertake no obligations to update or revise forward-looking statements
to reflect events or circumstances that arise after the date made or to reflect the occurrence of unanticipated events. In evaluating
forward-looking statements, you should consider these risks and uncertainties.
Market data and certain
industry data and forecasts used throughout this annual report were obtained from internal company surveys, market research, consultant
surveys commissioned by the Company, publicly available information, reports of governmental agencies and industry publications
and surveys. Industry surveys, publications, consultant surveys commissioned by the Company and forecasts generally state that
the information contained therein has been obtained from sources believed to be reliable. However, this information may prove to
be inaccurate because of the method by which some of the data for the estimates is obtained or because this information cannot
always be verified with complete certainty due to the limits on the availability and reliability of raw data, the voluntary nature
of the data gathering process and other limitations and uncertainties. As a result, the market and industry data and forecasts
included or incorporated by reference in this annual report, and estimates and beliefs based on that data, may not be reliable.
We have relied on certain data from third-party sources, including internal surveys, industry forecasts and market research, which
we believe to be reliable based on our management’s knowledge of the industry. However, we have not ascertained the underlying
economic assumptions relied upon therein. Forecasts are particularly likely to be inaccurate, especially over long periods of time.
In addition, we do not necessarily know what assumptions regarding general economic growth were used in preparing the forecasts
we cite. Statements as to our market position are based to the best of our knowledge on the most currently available data. While
we are not aware of any misstatements regarding the industry data presented in this annual report, our estimates involve risks
and uncertainties and are subject to change based on various factors, including those discussed under the heading “Risk Factors”
in this annual report.
PART I
ITEM 1. Identity of Directors, Senior Management and Advisers.
Not applicable.
ITEM 2. Offer Statistics and Expected Timetable.
Not applicable.
ITEM 3. Key Information.
A. Selected
Financial Data.
The following table sets
forth our selected consolidated financial data for the periods ended and as of the dates indicated, which reflects the financial
data of the Company and the financial data of Galmed Holdings Inc., a holdings company incorporated in the British Virgin Islands
(“GHIˮ), our predecessor, prior to the Reorganization (as described below). The following selected consolidated financial
data for our Company should be read in conjunction with the financial information, “Item 5. Operating and Financial Review
and Prospects” and other information provided elsewhere in this annual report and our consolidated financial statements and
related notes. The selected consolidated financial data in this section is not intended to replace the consolidated financial statements
and is qualified in its entirety thereby. In the opinion of our management, our unaudited consolidated financial statements contain
all adjustments, consisting only of normal recurring adjustments, necessary for a fair presentation of our financial position,
results of operations and cash flows as of and for the periods indicated therein.
The selected consolidated statement of operations data for the years ended December 31, 2015, 2016 and
2017, and the selected consolidated balance sheet data as of December 31, 2016 and 2017, have been derived from our audited consolidated
financial statements set forth elsewhere in this annual report on Form 20-F. The selected consolidated statement of operations
data for the years ended December 31, 2013 and 2014, and the selected consolidated balance sheet data as of December 31, 2013,
2014 and 2015, have been derived from our audited consolidated financial statements not included in this annual report on Form
20-F.
Consolidated Statement
of Operations Data
|
|
Year
ended December 31,
|
|
|
|
2013
|
|
|
2014
|
|
|
2015
|
|
|
2016
|
|
|
2017
|
|
|
|
(in thousands)
|
|
Revenue
|
|
|
-
|
|
|
|
-
|
|
|
|
-
|
|
|
$
|
(467
|
)
|
|
$
|
(1,085
|
)
|
Research
and development expenses
|
|
|
7,207
|
|
|
|
6,664
|
|
|
|
7,629
|
|
|
|
14,271
|
|
|
|
9,650
|
|
General
and administrative expenses
|
|
|
7,355
|
|
|
|
2,478
|
|
|
|
3,246
|
|
|
|
3,078
|
|
|
|
3,799
|
|
Capital
Loss
|
|
|
10
|
|
|
|
—
|
|
|
|
—
|
|
|
|
—
|
|
|
|
—
|
|
Operating
loss
|
|
|
14,572
|
|
|
|
9,142
|
|
|
|
10,875
|
|
|
|
16,882
|
|
|
|
12,364
|
|
Financial
expenses
|
|
|
2,912
|
|
|
|
10
|
|
|
|
180
|
|
|
|
372
|
|
|
|
232
|
|
Financial
Income
|
|
|
—
|
|
|
|
(50
|
)
|
|
|
(433
|
)
|
|
|
(407
|
)
|
|
|
(297
|
)
|
Taxes
on income
|
|
|
1
|
|
|
|
1
|
|
|
|
—
|
|
|
|
106
|
|
|
|
—
|
|
Net
loss
|
|
$
|
17,485
|
|
|
$
|
9,103
|
|
|
$
|
10,622
|
|
|
$
|
16,953
|
|
|
$
|
12,299
|
|
Comprehensive
loss
|
|
|
17,485
|
|
|
|
9,099
|
|
|
|
10,832
|
|
|
|
16,832
|
|
|
|
12,221
|
|
Diluted
net loss per ordinary
|
|
$
|
3.45
|
(*)
|
|
$
|
0.88
|
(*)
|
|
$
|
0.96
|
|
|
$
|
1.49
|
|
|
$
|
0.98
|
|
Weighted
number of ordinary shares used in computing loss per ordinary shares
|
|
|
5,096,466
|
(*)
|
|
|
10,323,686
|
(*)
|
|
|
11,101,453
|
|
|
|
11,374,653
|
|
|
|
12,487,349
|
|
(*) Retroactively adjusted to reflect the 729:1
share split, which occurred upon the consummation of the Reorganization (as defined below).
Consolidated Balance Sheet data:
|
|
As of December 31,
|
|
|
|
2013
|
|
|
2014
|
|
|
2015
|
|
|
2016
|
|
|
2017
|
|
|
|
(In thousands)
|
|
Cash and cash equivalents
|
|
$
|
137
|
|
|
$
|
23,736
|
|
|
$
|
4,156
|
|
|
$
|
3,097
|
|
|
$
|
13,021
|
|
Short-term deposits and marketable securities
|
|
|
—
|
|
|
|
8,250
|
|
|
|
18,845
|
|
|
|
12,351
|
|
|
|
5,976
|
|
Other receivables
|
|
|
16
|
|
|
|
165
|
|
|
|
379
|
|
|
|
284
|
|
|
|
155
|
|
Fixed assets
|
|
|
13
|
|
|
|
774
|
|
|
|
883
|
|
|
|
718
|
|
|
|
491
|
|
Total assets
|
|
|
166
|
|
|
|
32,925
|
|
|
|
24,263
|
|
|
|
16,450
|
|
|
|
19,643
|
|
Total liabilities
|
|
|
2,117
|
|
|
|
1,518
|
|
|
|
2,718
|
|
|
|
5,375
|
|
|
|
3,848
|
|
Total shareholders’ equity
|
|
|
(1,951
|
)
|
|
|
31,407
|
|
|
|
21,545
|
|
|
|
11,075
|
|
|
|
15,795
|
|
Number of ordinary shares issued and outstanding
|
|
|
7,099,731
|
(*)
|
|
|
11,100,453
|
|
|
|
11,100,453
|
|
|
|
12,149,226
|
|
|
|
14,435,161
|
|
(*) Retroactively adjusted to
reflect the 729:1 share split, which occurred upon the consummation of the Reorganization (as defined below).
Exchange Rate
We report our financial
results and balance sheet position in U.S. dollars. While our functional currency is U.S. dollars, we incur expenses in NIS. On
February 28, 2018, the latest practicable date for inclusion in this annual report, the exchange rate between New Israeli Shekels
and U.S. dollars as published by the Bank of Israel was 3.48 NIS.
The average exchange rates
for each of the five most recent fiscal years, calculated by using the average of the exchange rates on the last day of each month
during the period, are set forth below:
|
|
2017
|
|
|
2016
|
|
|
2015
|
|
|
2014
|
|
|
2013
|
|
Average
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1 US $ = NIS
|
|
|
3.59
|
|
|
|
3.84
|
|
|
|
3.88
|
|
|
|
3.58
|
|
|
|
3.61
|
|
The high and low exchange
rates for each month during the previous six months are set forth below:
|
|
September
2017
|
|
|
October
2017
|
|
|
November
2017
|
|
|
December
2017
|
|
|
January
2018
|
|
|
February
2018
|
|
High
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1 US $ = NIS
|
|
|
3.58
|
|
|
|
3.54
|
|
|
|
3.54
|
|
|
|
3.55
|
|
|
|
3.46
|
|
|
|
3.53
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Low
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1 US $ = NIS
|
|
|
3.50
|
|
|
|
3.49
|
|
|
|
3.49
|
|
|
|
3.48
|
|
|
|
3.39
|
|
|
|
3.43
|
|
B. Capitalization and Indebtedness.
Not applicable.
C. Reasons for the Offer and Use of Proceeds.
Not applicable.
D. Risk Factors.
Risks Related to Our
Financial Position and Capital Requirements
We are a clinical-stage
biopharmaceutical company with a history of operating losses. We expect to incur significant additional losses in the future and
may never be profitable.
We are a clinical-stage
biopharmaceutical company with an operating history limited to pre-clinical and clinical drug development and no approved products.
To date, we have focused nearly exclusively on developing our product candidate, Aramchol. In addition, we have limited operating
experience and have not yet demonstrated an ability to successfully overcome many of the risks and uncertainties frequently encountered
by companies in new and rapidly evolving fields, particularly in the pharmaceutical industry. We have funded our research and development
programs and operations to date primarily through proceeds from private placements and public offerings. We currently have no products
approved for marketing in the United States or any other jurisdiction and have not generated any revenue from product sales to
date, although we have generated revenue from our licensing agreement with Samil Pharm. We have incurred operating losses in each
year since the inception of our predecessor in 2000. Our loss attributable to holders of our ordinary shares for the years ended
December 31, 2015, 2016, and 2017 was approximately $10.6 million, $17.0 million, and $12.3 million, respectively. As of December
31, 2017, we had an accumulated deficit of $76.6 million. Substantially all of our operating losses resulted from costs incurred
in connection with our development program and from general and administrative costs associated with our operations.
Our ability to become profitable
depends upon our ability to generate revenue in excess of our expenses. To date, we have not generated any revenue, excluding the
licensing revenue we recorded in connection with that certain Samil Agreement (as defined below), as our product candidate, Aramchol,
is still in clinical development and has not been approved by the FDA, nor has any other product candidate. We do not know when,
or if, we will generate any revenue from sales of Aramchol and any future product candidates, if any. We do not expect to generate
revenue other than subsequent royalties and/or milestones that can be earned in connection with the Samil Agreement or other potential
license agreements, unless and until we, or an ultimate third-party licensor or acquirer, obtain regulatory and marketing approval
of, and commercialize, Aramchol, and any future product candidates. We will continue to incur research and development and general
and administrative expenses related to our operations. We expect to continue to incur losses for the foreseeable future, which
may be significant, and these losses will likely increase as we:
|
·
|
initiate and manage additional clinical trials in multiple indications for Aramchol and any future
product candidates and initiate additional research and development programs;
|
|
·
|
seek regulatory approvals for Aramchol and any future product candidates, if any;
|
|
·
|
implement internal systems and infrastructures, including, without limitation, hiring of additional
personnel as needed and developing sales and marketing functions if and when Aramchol and any future product candidates receives
applicable regulatory approval and we opt to commercialize it ourselves;
|
|
·
|
seek to in-license additional products or technologies to develop;
|
|
·
|
hire additional management and other personnel; and
|
|
·
|
move towards commercialization of Aramchol, and any future product candidates, if any.
|
We may out-license Aramchol,
including through a territorial license, a worldwide license, or a license for a particular indication, before it is approved by
any applicable regulatory agency, commercialized and/or generates revenue, depending on a number of factors, including, but not
limited to, our ability to:
|
·
|
demonstrate a compelling and/or novel, pre-clinical, unique mechanism of action of Aramchol;
|
|
·
|
obtain adequate clinical results from and progress from the clinical development of Aramchol;
|
|
·
|
develop and obtain regulatory approvals in the countries and for the uses we intend to pursue for
Aramchol;
|
|
·
|
contract for the manufacture of commercial quantities of Aramchol by a current good manufacturing
practice (“cGMPˮ), compliant manufacturing facility at acceptable cost levels if marketing approval is received; and
|
|
·
|
establish external, and potentially in the future, internal, sales and marketing capabilities to
effectively market and sell Aramchol in the United States and other countries.
|
Even if Aramchol is approved
for commercial sale for the treatment of NASH in patients who are overweight or obese and have pre diabetes or type II diabetes
mellitus, or for any other indications, it may not gain market acceptance or achieve commercial success. In addition, we anticipate
incurring significant costs associated with seeking regulatory approval and commercialization. We may not achieve profitability
soon after generating product revenue, if ever. If we are unable to generate product revenue, we will not become profitable and
would be unable to continue operations without additional funding.
We expect our research
and development expenses to increase in connection with our planned clinical trials and initiation of clinical trials for other
indications. In addition, if we obtain marketing approval for Aramchol and opt to commercialize it ourselves, we will likely initially
incur significant expenses associated with outsourcing sales, marketing and manufacturing functions to third parties, as well as
continued research and development expenses. Furthermore, we expect to incur additional costs associated with operating as a public
company. As a result, we expect to continue to incur significant and increasing operating losses for the foreseeable future. Because
of the numerous risks and uncertainties associated with developing pharmaceutical products, we are unable to predict the extent
of any future losses or when we will become profitable, if at all.
Our limited operating
history makes it difficult to evaluate our business and prospects.
Our operating history is
limited to pre-clinical and clinical development of one product, and our operations to date have been limited primarily to research
and development, raising capital and recruiting scientific and management personnel and third-party partners. Therefore, it may
be difficult to evaluate our business and prospects. We have not yet demonstrated an ability to commercialize or obtain regulatory
approval for any product candidate. Consequently, any predictions about our future performance may not be accurate, and you may
not be able to fully assess our ability to complete development and/or commercialize Aramchol, and any future product candidates,
obtain regulatory approvals or achieve market acceptance or favorable pricing for Aramchol and any future product candidates.
We have not yet commercialized
any products and we may never be able to do so, and even if we do, the products may not gain market acceptance.
We have not yet commercialized
any products and we may never be able to do so. We do not know when or if we will complete Aramchol's and any future product candidates
development efforts, obtain regulatory approval for Aramchol and any future product candidates or successfully commercialize any
approved products. Even if we are successful in developing products that are approved for marketing, we will not be successful
unless these products gain market acceptance for appropriate indications at favorable reimbursement rates. The degree of market
acceptance for these products will depend on a number of factors, including:
|
·
|
the timing and scope of regulatory approvals in the countries we intend to pursue with respect
to the commercialization of Aramchol and any future product candidates, including the indications for which they are approved;
|
|
·
|
the competitive environment;
|
|
·
|
the ability for Aramchol and future product candidates to be manufactured, whether by us or third
parties, in compliance with applicable regulatory requirements, including cGMP;
|
|
·
|
our ability to effectively promote Aramchol and any future product candidates, whether directly
or using third parties, consistent with the approved indications and labeling in the countries in which we intend to pursue approval;
|
|
·
|
the acceptance by the medical community of the safety and clinical efficacy of Aramchol andr any
future product candidates and their potential advantages over other therapeutic products;
|
|
·
|
the development of a non-invasive method for diagnosing NASH as an alternative to the current gold
standard of liver biopsy, which we view as a rate-limiting factor to complete market uptake because of its expense and its risks
and discomfort to patients;
|
|
·
|
the adequacy and success of distribution, sales and marketing efforts, including through strategic
agreements with pharmaceutical and biotechnology companies; and
|
|
·
|
the pricing and reimbursement policies of government and third-party payors, such as insurance
companies, health maintenance organizations and other plan administrators.
|
Physicians, patients, third-party
payors or the medical community in general may be unwilling to accept, utilize or recommend, and in the case of third-party payors,
reimburse any of our planned future products. As a result, we are unable to predict the extent of future losses or the time required
to achieve profitability, if at all. Even if we successfully develop one or more products, we may not become profitable.
We will need substantial,
additional capital in the future. If additional capital is not available, we will have to delay, reduce or cease operations.
Based on our current
operating plan, we currently estimate that our cash position will support our current clinical trials and operations
through the end of 2019. We believe these funds will enable us to complete any preparatory clinical and non-clinical work, as
well as our Phase IIb ARREST Study (the “ARREST Study”). We will need to raise substantial, additional capital to
fund our operations and to develop Aramchol for, and beyond its current development stage for the NASH indication, as well as
additional indications, and ultimately commercialize it, if we opt to do so ourselves, for NASH or any other indication. In addition,
we may choose to expand our current research and development focus, or other clinical operations as well as the development of
a non-invasive biomarkers, which may also require additional capital. As of December 31, 2017, we had a net working capital of
$15.3 million, cash and cash equivalents of $13.0 million and marketable securities of $6.0 million. Our future capital requirements
may be substantial and will depend on many factors including:
|
·
|
adhering to patient recruitment in our clinical trials and sponsored trials;
|
|
·
|
our clinical trials and sponsored trials results;
|
|
·
|
developing
Aramchol for the treatment of other
conditions
or
indications beyond those being explored in the ARREST Study, or possible label
expansion of Aramchol once its approved, if at all, for the treatment of other conditions
or indications;
|
|
·
|
the cost of filing and prosecuting patent applications and the cost of defending our patents;
|
|
·
|
the cost of prosecuting infringement actions against third parties;
|
|
·
|
the cost, timing and outcomes of seeking marketing approval of Aramchol;
|
|
·
|
the costs associated with commercializing Aramchol if we receive marketing approval, and choose
to commercialize Aramchol ourselves, including the cost and timing of establishing external, and potentially in the future, internal,
sales and marketing capabilities to market and sell Aramchol;
|
|
·
|
subject to receipt of marketing approval, revenue received from sales of approved products, if
any, in the future;
|
|
·
|
the costs associated with any product liability or other lawsuits related to Aramchol and any future
product candidates, if any;
|
|
·
|
the costs associated with post-market compliance with regulatory requirements, and of addressing
any allegations of non-compliance by regulatory authorities in countries where we plan to market and sell Aramchol andr any future
product candidates;
|
|
·
|
the demand for Aramchol and any future product candidates;
|
|
·
|
the costs associated with developing and/or in-licensing other research and development programs;
|
|
·
|
the expenses needed to attract and retain skilled personnel; and
|
|
·
|
the costs associated with being a public company.
|
Changing
circumstances may cause us to consume capital significantly faster than we currently anticipate, such as losing our Small and Medium
Enterprise status at the EMA, which entitles us to significant fee reductions Because there are numerous risks and uncertainties
associated with the development and commercialization of Aramchol and any future product candidates, we are unable to estimate
the amount of increased capital outlays and operating expenditures associated with our anticipated clinical trials. We have no
committed external sources of funds. Additional financing may not be available when we need it or may not be available on terms
that are favorable to us and additional financing may cause significant dilution to our existing shareholders. If adequate funds
are not available to us on a timely basis, or at all, we may be required to terminate or delay planned or ongoing clinical trials
or other development activities for Aramchol.
Raising additional
capital may be costly or difficult to obtain and will dilute current shareholders’ ownership interests, potentially substantially.
Any debt, equity or structured
financing that we may need or desire may not be available on terms favorable to us, or at all. If we obtain funding through a strategic
collaboration or licensing arrangement, we may be required to relinquish our rights to certain of our technologies, products or
marketing territories. If we are unable to obtain required additional capital, we may have to curtail our growth plans or cut back
on existing business, and we may not be able to continue operating if we do not generate sufficient revenues from operations needed
to stay in business.
We may incur substantial
costs in pursuing future capital financing, including investment banking fees, legal fees, accounting fees, securities law compliance
fees, printing and distribution expenses and other costs. We may also be required to recognize non-cash expenses in connection
with certain securities we issue, such as convertible notes and warrants, which may adversely impact our capital structure, financial
condition and results of operations.
Any additional capital
raised through the sale of equity or equity-linked securities will dilute our current shareholders’ ownership in us, potentially
substantially, and could also result in a decrease in the market price of our ordinary shares. The terms and conditions of those
securities issued by us in future capital transactions may be more favorable to new investors and may include the issuance of warrants
or other derivative securities, which may have a further dilutive effect.
We are unable to estimate
our long-term capital requirements due to uncertainties associated with the development and commercialization of Aramchol. If we
fail to obtain necessary funds for our operations, we will be unable to develop and commercialize Aramchol and any future product
candidates.
Our long-term capital requirements
are expected to depend on many potential factors, including, among others:
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the number of product candidates in development;
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the size, duration and scope of existing and future clinical trials and pre-clinical studies;
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the regulatory path of Aramchol and any future product candidates;
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the results of our clinical trials, which are unpredictable in product candidate development;
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our ability to successfully commercialize Aramchol and any future product candidates, including
securing commercialization and out-licensing agreements with third parties and favorable pricing and market share;
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the progress, success and cost of our clinical trials and research and development programs, including
those associated with milestones and royalties;
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the costs, timing and outcome of regulatory review and obtaining regulatory approval of Aramchol
and any future product candidates and addressing regulatory and other issues that may arise post-approval;
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the breadth of the labeling, assuming that Aramchol and any future product candidates are approved
for commercialization by a relevant regulatory authority, which may not occur;
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our need, or decision, to acquire or in-license complementary technologies or new platform technologies
or product candidates;
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the costs of enforcing our issued patents and defending intellectual property-related claims;
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the costs of investigating patents that might block us from developing potential product candidates;
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the costs of recruiting and retaining qualified personnel;
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the costs associated with contracting with third parties to manufacture the product and to perform
other necessary services;
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our revenue, if any; and
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our consumption of available resources more rapidly than currently anticipated, resulting in the
need for additional funding sooner than anticipated.
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If we are unable to obtain
the funds necessary for our operations, we will be unable to develop and commercialize Aramchol, or other product candidates, which
would materially and adversely affect our business, liquidity and results of operations.
We may become subject
to the payment of taxes in connection with the Reorganization.
On February 2, 2014, we
underwent a reorganization (the “Reorganizationˮ), pursuant to which all of our current business (including our intellectual
property) was transferred to us. The Reorganization was effected by way of share transfers and asset transfers, as follows: First,
GHI, our predecessor, transferred the entire share capital of Galmed 2000 Inc., a holdings company incorporated in the British
Virgin Islands (“GTTI ˮ), to the Company; next, GTTI transferred the entire share capital of Galmed International Limited,
a company incorporated in Malta, a European Union (the “EUˮ), member state (“GILˮ), to the Company; then,
GIL transferred and assigned all of its intellectual property to Galmed Research and Development Ltd., a newly formed Israeli company
(“GRDˮ). GIL held all of the equity rights in and to Galmed Medical Research Ltd., an Israeli company (“GMRˮ).
In connection with the Reorganization, we obtained a tax pre-ruling (the “Tax Pre-Rulingˮ), from the Israeli Tax Authority.
The Tax Pre-Ruling confirms that the transfer of shares and assets resulting in the Company as the parent company and 100% equity-owner
of GRD, which holds all of the Group’s intellectual property, including the Company’s patent portfolio, GIL and GTTI,
is not taxable pursuant to the provisions of Sections 131 and 132 of the Income Tax Ordinance (New Version) — 1961
(the “Israeli Tax Ordinanceˮ), as long as certain requirements are met. However, we have not obtained a tax pre-ruling
from the tax authorities in the British Virgin Islands with respect to the transfer of the shares of GTTI and the transfer of the
shares of GIL to the Company, or from the tax authorities in Malta with respect to the transfer of the intellectual property of
GIL to GRD. We believe that such transfers of shares and assets are not taxable in the British Virgin Islands and Malta, respectively.
However, there can be no assurance that we will not become subject to the payment of taxes in the British Virgin Islands, with
respect to the transfers of shares as aforesaid, or in Malta, in connection with the transfer of the intellectual property as mentioned
above. See also “Item 4. Information on the Company—Historical Background and Corporate Structure” below.
Risks Related to Our
Business, Industry and Regulatory Requirements
We depend largely on
the success of our product candidate, Aramchol, and we may not obtain regulatory approval of Aramchol.
We have invested
almost all of our efforts and financial resources in the research and development (clinical and pre-clinical) of our product
candidate, Aramchol. We are currently in the final stages of our Phase IIb ARREST Study and expect top line results during
June 2018. As a result, our business is largely dependent on the success of the Phase IIb ARREST Study and our ability to
complete the development of, obtain regulatory approval for and successfully commercialize Aramchol in a timely manner. The
process to develop, obtain regulatory approval for and commercialize Aramchol is long, complex, costly and uncertain as to
its outcome.
The research, development,
testing, clinical trials, manufacturing, labeling, approval, sale, marketing and distribution of drugs are subject to extensive
regulation by the FDA and other regulatory agencies in other countries. These regulations differ from jurisdiction to jurisdiction.
We have not received marketing approval for Aramchol in any jurisdiction. We are not permitted to market Aramchol, or any other
product candidate, in the United States until we receive approval of a New Drug Application (“NDAˮ), from the FDA, or
in any foreign countries until we receive the requisite approval from the respective regulatory agencies in such countries., We
have not received regulatory authorization to conduct the clinical trials that are necessary to file an NDA with the FDA or comparable
applications to other regulatory authorities in other countries. The results of clinical trials may be unsatisfactory, and even
if we believe those clinical trials to be successful, the FDA, or other regulatory authorities, may not grant marketing authorization
should we be in a position to request it.
The requirements and length
of time for approval vary in different jurisdictions and could involve additional studies of Aramchol beyond those we currently
anticipate, including potentially post-approval studies. The time required to obtain approval in other countries might differ from
that required to obtain FDA approval in the United States. The marketing approval process in other countries may include all of
the risks detailed above regarding FDA approval as well as other risks. In particular, in many countries outside the United States,
it is required that a product receive pricing and reimbursement approval before the product can be commercialized. This can result
in substantial delays in such countries. In other countries, product approval depends on showing superiority to an approved therapy.
This can result in significant expense to conduct complex clinical trials. Finally, we do not have any products approved for sale
in any jurisdiction, including international markets, and we do not have experience in obtaining regulatory approval in international
markets. If we fail to comply with regulatory requirements in international markets or to obtain and maintain required approvals
or if regulatory approvals in international markets are delayed, our target market will be reduced and our ability to realize the
full market potential of Aramchol and any future product candidates will be harmed.
Marketing approval in one
jurisdiction does not ensure marketing approval in another, but a failure or delay in obtaining marketing approval in one jurisdiction
may have a negative effect on the regulatory process in others. Failure to obtain marketing approval in other countries or any
delay or setback in obtaining such approval would impair our ability to develop foreign markets for Aramchol. This would reduce
our target market and limit the full commercial potential of Aramchol.
We may be forced to
abandon development of Aramchol, or any future product candidates, which would have a material adverse effect on our business and may force us to cease operations.
Upon the completion
of any clinical or pre-clinical trial and/or tests, the results might not support the desired indications for use. Further,
success in earlier clinical trials does not ensure that later clinical trials will be successful, and the results of later
clinical trials may not replicate the results of prior clinical trials or pre-clinical testing. The clinical trial process
may fail to demonstrate that Aramchol is safe and/or effective for the indications we seek. Any such failure may cause us to
abandon Aramchol and may delay development of other potential product candidates. Any delay in, or termination or suspension
of, our clinical trials may delay the requisite filings with the FDA or other regulatory agencies and, ultimately, our
ability to commercialize Aramchol and any future product candidates and generate product revenues. We are currently in the
final stages of our Phase IIb ARREST Study and expect top line results during June 2018. If the results of the
ARREST Study are not successful, then the completion of development of Aramchol or any future product candidate may be
significantly delayed or abandoned which would have material adverse effect on our business, liquidity, operating results and financial
condition and may force us to cease operations.
If we acquire or in-license
additional technologies or product candidates, we may incur significant, incremental expenses, may have integration difficulties
and may experience other risks that could harm our business and results of operations.
We may acquire or in-license
additional product candidates and technologies. Any product candidate or technologies we in-license or acquire will likely require
additional development efforts prior to commercial sale, including extensive pre-clinical or clinical testing, or both, and approval
by the FDA and applicable foreign regulatory authorities, if any. All product candidates are prone to risks of failure inherent
in pharmaceutical product development, including the possibility that the product candidate, or product developed based on in-licensed
technology, will not be shown to be sufficiently safe and effective for approval by regulatory authorities. In addition, we cannot
assure that any product candidate that we develop based on acquired or in-licensed technology that is granted regulatory approval
will be manufactured or produced economically, successfully commercialized or widely accepted or competitive in the marketplace.
Moreover, integrating any newly acquired or in-licensed product candidates could be expensive and time-consuming. If we cannot
effectively manage these aspects of our business strategy, our business may not succeed.
The clinical trial
process is complex and expensive, and commencement and completion of clinical trials can be delayed or prevented for a number of
reasons.
We may not be able to complete
or commence the clinical trials that would support our submission of an NDA to the FDA, a Marketing Authorization Application (“MAAˮ),
to the EMA or any similar submission to regulatory authorities in other countries. Drug development is a long, expensive and uncertain
process, and delay or failure can occur at any stage of any of our clinical trials. The fact that the FDA, EMA or other regulatory
authorities permit a company to conduct human clinical trials is no assurance or guarantee that the trials will be successful.
On the contrary, most candidate drugs that begin clinical trials (including, but not limited to, Phase II trials, such as our ARREST
Study) do not prove to be successful and do not result in the filing of an NDA, MAA or similar filing. Drug candidates that successfully
complete one phase of clinical trials may prove unsuccessful at a subsequent phase. Human clinical trials are very expensive and
difficult to design and implement, in part because they are subject to rigorous regulatory requirements and in part because the
results of clinical trials are inherently uncertain and unpredictable. Regulatory authorities, such as the FDA, may decline to
permit a clinical trial to proceed or may suspend a clinical trial that it has previously permitted to proceed. Additionally, the
clinical trial process is time-consuming, and failure can occur at any stage of the trials. We may encounter problems that cause
us to abandon or repeat clinical trials. The commencement and completion of clinical trials may be delayed by several factors,
including:
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difficulties obtaining regulatory authorization to commence a clinical trial or complying with
regulatory requirements for clinical trials or with the conditions imposed by a regulatory authority regarding the scope or duration
of a clinical trial;
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delays in reaching or failing to reach agreement on acceptable terms with prospective contract
research organizations (“CROsˮ), and trial sites, the terms of which can be subject to extensive negotiation and may
vary significantly among different CROs and trial sites;
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insufficient or inadequate supply or quality of a product candidate or other materials necessary
to conduct our clinical trials;
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difficulties in obtaining institutional review board (“IRBˮ), approval to conduct a
clinical trial at a prospective site;
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delays resulting from a decision of the FDA not to designate Aramchol as a Breakthrough Therapy,
a designation that could, among other benefits, expedite the conduct of clinical trials;
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challenges in recruiting and enrolling patients to participate in clinical trials for a variety
of reasons, including size and nature of patient population, proximity of patients to clinical sites, eligibility and exclusion
criteria for the trial, nature of trial protocol, the availability of approved effective treatments for the relevant disease and
competition from other clinical trial programs for similar indications; and
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The ARREST Study may also
be terminated as a result of, but not limited to, safety signals. In addition, the ARREST Study or other clinical trials may be
suspended or terminated by us, the FDA or other regulatory authorities, the principal investigator at a site, the IRBs at the sites
where such boards are overseeing a trial or the data safety monitoring board (the “DSMBˮ), that is overseeing the clinical
trial at issue, or other regulatory authorities due to a number of factors, including:
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irregularities in conducting a clinical trial, including by way of example, failure to conduct
the clinical trial in accordance with regulatory requirements, in particular good clinical practice requirements (“GCPˮ),
or the FDA-authorized clinical protocols;
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negative findings upon inspection of the clinical trial operations or trial sites by the FDA or
other regulatory authorities;
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safety issues or lack of clinical drug activity or effectiveness; and
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lack of adequate funding to continue the clinical trials.
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To date, we have already
experienced material delays in the ARREST Study largely related to significantly slower than expected recruitment and the length
of time required to obtain regulatory authorizations to proceed with clinical trials, as well as the termination of a Phase IIA
trial of Aramchol for the treatment and dissolution of cholesterol gallstones. We may experience further delays in any or all of
our clinical trials, and there can be no assurance that we will not experience such risks in the future as we progress with our
planned clinical trials.
Furthermore, positive results
in previous clinical studies of Aramchol may not be predictive of similar results in future clinical trials. Also, interim results,
if at all, during a clinical trial do not necessarily predict final results. A number of companies in the pharmaceutical and biotechnology
industries have suffered significant setbacks in late-stage clinical trials even after achieving promising results in early- and
mid-stage development. Accordingly, the results from the completed pre-clinical studies and clinical trials for Aramchol may not
be predictive of the results we may obtain in later stage trials. Our clinical trials may produce negative or inconclusive results,
and we may decide, or regulators may require us, to conduct additional clinical and/or pre-clinical trials, or to even terminate
the development program entirely. Moreover, clinical data are often susceptible to varying interpretations and analyses, and many
companies that believed their product candidates performed satisfactorily in pre-clinical and clinical studies have nonetheless
failed to obtain FDA or EMA, or other regulatory agency, approval for their products.
In addition, we or regulatory
authorities may suspend our clinical trials at any time if it appears that we are exposing participants to unacceptable health
risks or if the regulatory authorities find deficiencies in our regulatory submissions or the conduct of such trials. Any suspension
of clinical trials will delay possible regulatory approval, if any, and adversely impact our ability to develop products and generate
revenue.
The lack of a reliable
non-invasive method for the diagnosis of NASH is likely to present a major challenge to Aramchol’s market penetration, if
ever commercialized.
Liver biopsy is the standard
approach for the diagnosis of inflammation and fibrosis associated with NASH. However, the procedure-related morbidity and, in
rare cases, mortality, sample errors, costs, patient discomfort and thus lack of patient interest in undergoing the procedure limit
its use. As such, only patients with a high risk of NASH, which includes patients with metabolic syndrome and an indication of
Non-Alcoholic Fatty Liver Disease (“NAFLDˮ), are generally sent for liver biopsy. Because NASH tends to be asymptomatic
until the disease progresses, many individuals with NASH remain undiagnosed until the disease has reached its late stages, if at
all. The lack of a reliable non-invasive method for the diagnosis of NASH is likely to present a major challenge to Aramchol’s
market penetration, as many practitioners and patients may not be aware that a patient suffers from NASH and requires treatment.
As such, use of Aramchol might not be as wide-spread as our actual target market and this may limit the commercial potential of
Aramchol.
A further challenge to
Aramchol’s market penetration is that currently a liver biopsy is the standard approach for measuring improvement in NASH
patients. Because it would be impractical to subject all patients that take Aramchol, when and if it approved, to regular and repeated
liver biopsies, it will be difficult to demonstrate Aramchol’s effectiveness to practitioners and patients unless and until
a reliable non-invasive method for the diagnosis and monitoring of NASH becomes available, as to which there can be no assurance.
While we, and other companies
in the industry are currently working on advancing non-invasive diagnostic approaches, none of these has been clinically validated,
and the timetable for commercial validation, if at all, is uncertain. Moreover, such diagnostics may also be subject to regulation
by FDA or other regulatory authorities as medical devices and may require premarket clearance or approval.
Obtaining approval
of an NDA, or other regulatory approval, even after clinical trials that are believed to be successful, is an uncertain process.
Even if we complete our
planned clinical trials and believe that the clinical data confirms that Aramchol is both safe and effective for its intended use
or uses, obtaining approval of an NDA, or similar regulatory application, is an extensive, lengthy, expensive and uncertain process,
and the FDA and other regulatory agencies may delay, limit or deny approval of Aramchol for many reasons, including, without limitation,
the fact that:
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we may not be able to demonstrate to the satisfaction of the applicable regulatory agencies that
Aramchol is safe and effective for treatment of NASH in patients who are overweight or obese and have pre diabetes or type II diabetes
mellitus or for any other indication;
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the results of clinical trials may not meet the level of statistical significance or clinical significance
required by the applicable regulatory agencies for approval;
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the applicable regulatory agencies may disagree with the number, design, size, conduct or implementation
of our clinical trials;
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the applicable regulatory agencies may not find the data from pre-clinical studies and clinical
trials sufficient to demonstrate that Aramchol’s clinical and other benefits outweigh its safety risks;
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the applicable regulatory agencies may disagree with our interpretation of data from pre-clinical
studies or clinical trials;
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the applicable regulatory agencies may not accept data generated at our clinical trial sites;
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the data collected from pre-clinical studies and clinical trials of Aramchol may not be sufficient
to support the submission of an NDA or similar regulatory application;
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the applicable regulatory agencies may not schedule an advisory committee meeting in a timely manner
or the advisory committee may recommend against approval of our application or may recommend that the applicable regulatory agencies
require, as a condition of approval, additional pre-clinical studies or clinical trials, limitations on approved labeling or distribution
and use restrictions;
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the applicable regulatory agencies may require development of a risk evaluation and mitigation
strategy (“REMSˮ), as a condition of approval;
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the applicable regulatory agencies may require simultaneous approval for both adults and children,
which would delay required approvals, or we may have successful clinical trial results for adults, but not children, or vice versa;
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the applicable regulatory agencies may change their approval policies or adopt new regulations
that may impede consideration or approval of our NDA, or similar regulatory application;
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the applicable regulatory agencies may identify deficiencies in the manufacturing processes or
facilities of third-party manufacturers, or suppliers of active pharmaceutical ingredients (“APIsˮ), with which we enter
into agreements for clinical and commercial supplies; and
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the applicable regulatory agencies may require post-marketing approval studies, such as Phase IV
clinical trials, in connection with Aramchol.
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Before we can submit an
NDA to the FDA or a similar approval application to other regulatory authorities, as applicable, we (or our commercialization partner,
as the case may be) must complete the ongoing ARREST Study and conduct one or more Phase III clinical trials that will be substantially
broader than our Phase IIb trial. We will also need to agree on a protocol with the FDA for any Phase III clinical trial(s) before
commencing that trial in the United States. Clinical trials frequently produce unsatisfactory results even though prior clinical
trials were successful. Therefore, the results of the ARREST Study or Phase III clinical trials that we may conduct may or may
not be successful. The applicable regulatory agencies may suspend all clinical trials or require that we conduct additional clinical,
pre-clinical, manufacturing, validation or drug product quality studies and submit data from these additional studies before considering
or reconsidering the NDA or similar regulatory application. Depending on the extent of these, or any other studies, approval of
any applications that we submit may be delayed by several years, or may require us to expend more resources than we have available.
It is also possible that additional studies, if performed and completed, may not be considered sufficient by the applicable regulatory
agencies to provide regulatory approval. If any of these outcomes occur, we would not receive approval for Aramchol and may be
forced to cease operations.
Even if we obtain regulatory
approval for Aramchol, the approval might contain significant limitations related to the indications for use for which the drug
is approved, use restrictions including, without limitation, for certain labeled populations, age groups, warnings, precautions
or contraindications, or may be subject to significant post-marketing studies or risk mitigation requirements. If we are unable
to successfully commercialize Aramchol, we may be forced to cease operations.
Aramchol may produce
undesirable side effects or have other properties that could delay or prevent its regulatory approval or result in significant
negative consequences following marketing approval, if any, which could substantially increase commercialization costs or even
force us to cease operations.
Undesirable side effects caused by Aramchol could cause us or regulatory authorities to interrupt, delay
or halt clinical trials and could result in a more restrictive label or the delay or denial of regulatory approval by the FDA or
applicable foreign regulatory authorities.
To date, we
have successfully completed four clinical trials of Aramchol, one proof of concept study in patient with gallstones, and a Phase
IIa, investigator initiated clinical trial. While no serious adverse events related to Aramchol have been reported in any of our
four completed clinical studies that we conducted, in which subjects have been administered doses up to 900 mg, at doses up to
600 mg administered once-daily for up to ten days and at doses up to 300 mg administered once-daily for up to three months, there
can be no assurance that there will continue to be an absence of serious adverse events related to Aramchol in any other clinical
trial, including the ARREST Study, or following marketing approval. Several non-serious adverse events were reported in our four
completed and fully analyzed clinical trials that we conducted. Those four studies enrolled a combined total of 234 patients.
In our Phase IA clinical
trial we enrolled 17 healthy volunteers. A total of 45 adverse events were reported in 13 subjects. All adverse events were mild
or moderate and transient and resolved without sequelae. There were no serious adverse events, deaths or other significant adverse
events observed in this study. In our Phase IB placebo-controlled clinical trial with 25 healthy and mildly overweight male volunteers
a total of 68 adverse events were reported by 80% of the subjects (placebo 89%; Aramchol 30mg 67%; Aramchol 300 mg 86%). All adverse
events were mild or moderate and resolved without sequelae. There were no serious adverse events, deaths or other significant
adverse events.
We completed a pharmacokinetic
(“PKˮ), and food effect study in 66 healthy male volunteers consisting of three parts. Overall, over the three parts
of the study, the vast majority of adverse events were mild and determined to be unrelated to Aramchol and all of the adverse events
were transient and gave no indication of target organ toxicity. No serious adverse events or deaths occurred during the study.
No clinically significant abnormalities related to any Aramchol dose were noted in electrocardiograms (“ECGsˮ), laboratory
results, vital signs or physical examinations.
In our Phase IIA placebo-controlled
trial with 60 subjects with steatosis due to NAFLD or NASH. A similar proportion of patients from each treatment group reported
adverse events (placebo 55%; Aramchol 100mg 40%, Aramchol 300mg 45%). Most adverse events were mild and transient. None of the
adverse events reported in the Aramchol groups were considered related to the investigational drug. Three adverse events were initially
considered to be related to the study drug; however, after un-blinding it turned out that they occurred in the placebo group. In
addition, one serious adverse events (acute appendicitis) was reported in the placebo group. There were no deaths or other significant
adverse events reported in this study.
In 2016, we performed a
pharmacokinetic study involving 66 Chinese subjects (the “Chinese PK Study”) who are domiciled in the United States,
consisting of two parts. Overall treatment with Aramchol 400 mg and 600 mg was well tolerated, all adverse events were mild, and
no safety signal was identified. No serious adverse events or deaths were reported. We deemed no changes were required in the enrollment
of Chinese patients into the ARREST Study
An additional Phase IIa,
proof of concept study in patients with gallstones was halted due to poor patient recruitment and change in company focus. The
primary end-point was to prove that Aramchol dissolves newly formed gallbladder gallstones following bariatric surgery. Patients
were to be assigned to one of three treatment arms; 400mg tablets, 600mg tablets and placebo. Only 9 patients were enrolled, and
7 patients completed the study (before it was halted). A similar proportion of subjects from each treatment group reported events;
7 in the placebo group, 9 in the 400 mg Aramchol group, and 5 in the 600 mg Aramchol group. One subject experienced 2 events of
severe cholecystitis in the Aramchol 600 mg group which were considered a serious adverse event and led to investigational product
discontinuation. It should be noted that to be included in this study the subject must have had a history of gall bladder disease
and gallstones, therefore the subject’s medical history is an important confounding factor.
Further, in the investigator initiated Phase IIa proof-of-concept ARRIVE study that evaluated the safety
and efficacy of Aramchol at 600mg/day versus placebo in 50 patients with HIV-associated lipodystrophy and NAFLD,
no serious adverse events
related to Aramchol were observed.
Although we have not seen
any evidence of these reactions causing a safety concern in our completed clinical trials, it is possible that the FDA may ask
for additional data regarding any adverse events seen in our trials. Results of our future trials could reveal a high and
unacceptable severity and prevalence of these or other side effects. In such an event, our trials could be suspended or terminated
and the FDA or applicable foreign regulatory authorities could order us to cease further development of or deny approval for Aramchol
for any or all targeted indications. The drug-related side effects could affect patient recruitment or the ability of enrolled
patients to complete future trials or result in potential product liability claims. Any of these occurrences may harm our business,
financial condition and prospects significantly.
Even if Aramchol receives
marketing approval, we or others may later identify undesirable side effects caused by the product. In such an event, regulatory
authorities may:
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suspend or withdraw their approval of the product;
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require the addition of labeling statements, such as warnings, so-called “black box warnings,”
contraindications or restrictions on the product’s intended use;
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require us to issue specific communications to healthcare professionals, such as “Dear Doctor”
letters;
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issue negative publicity regarding the affected product, including safety communications;
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impose a risk evaluation and mitigation strategy (REMS), in the case of FDA, or similar risk management
strategies in the case of foreign regulators;
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In addition to these potentially
significant negative consequences, we could be required to change the way the product is administered, conduct additional pre-clinical
studies or clinical trials or restrict or cease the distribution or use of the product, and/or be sued and held liable for harm
caused to patients. The foregoing or other events could prevent us from achieving or maintaining market acceptance of the affected
product candidate and could substantially increase commercialization costs or even force us to cease operations.
If we encounter difficulties
enrolling patients in our clinical trials, our clinical development activities could be delayed or otherwise adversely affected.
Patient enrollment, a significant
factor in the timing of clinical trials, is affected by many factors including the size and nature of the patient population, the
proximity of patients to clinical sites, the eligibility criteria for the trial, the design of the clinical trial, patient willingness
to undergo a liver biopsy in our NASH trials, competing clinical trials and clinicians’ and patients’ perceptions as
to the potential advantages and disadvantages of the product candidate being studied in relation to other available therapies,
including any new drugs that may be approved for the indications we are investigating. Potential patients for Aramchol may not
be adequately diagnosed or identified with the diseases which we are targeting or may not meet the entry criteria for our studies.
We will be required to
identify and enroll a sufficient number of patients in the U.S. with NASH for each of our ongoing and planned clinical trials of
Aramchol in this indication. We also may encounter difficulties in identifying and enrolling U.S. NASH patients who meet the eligibility
criteria for our planned clinical trials. We may not be able to initiate or continue clinical trials if we are unable to locate
a sufficient number of eligible patients to participate in the clinical trials required by the FDA or other foreign regulatory
agencies. In addition, the process of finding and diagnosing patients may prove costly. Our inability to enroll a sufficient number
of patients for any of our clinical trials would result in significant delays, additional expenses, or may require us to abandon
one or more clinical trials.
Changes in regulatory
requirements and guidance or unanticipated events during our clinical trials may occur, which may result in necessary changes to
clinical trial protocols, which could result in increased costs to us, delay our development timeline or reduce the likelihood
of successful completion of our clinical trials.
Changes in regulatory requirements
or guidance or unanticipated events during our clinical trials may result in the need for us to amend clinical trial protocols.
Amendments may require review and approval by regulators and/or IRBs, and re-consent subjects, which may adversely affect the cost,
timing or successful completion of a clinical trial. If we experience delays in the completion of, or if we terminate, any of our
clinical trials, the commercial prospects for Aramchol would be harmed and our ability to generate product revenue would be delayed,
possibly materially.
We cannot be certain
that the results of our potential Phase III clinical trials, even if all endpoints are met, will support definitive regulatory
approval of Aramchol for the treatment of NASH in patients who are overweight or obese and have pre diabetes or type II diabetes
mellitus.
Further, specific to us,
a number of issues still remain unclear with regard to the potential Phase III protocol, including, among other issues, the (i)
duration of study, (ii) number of subjects required, (iii) dosages, and (iv) approvable endpoints. These factors, among others,
would play a material role in determining the cost of such study(ies) and ultimate probability of success.
Even if Aramchol, or
any future product candidates that we may develop, receives marketing approval, we will continue to face extensive regulatory oversight
and requirements, and any such product may still face future regulatory risks or new requirements.
Even if we receive regulatory
approval to market a particular product candidate, any such product will remain subject to extensive regulatory requirements, including
requirements relating to manufacturing, labeling, packaging, adverse event reporting, storage, advertising, promotion, distribution
and recordkeeping. Even if regulatory approval of a product is granted, the approval may be subject to limitations on the uses
for which the product may be marketed or the conditions of approval, or may contain requirements for costly post-marketing testing
and surveillance to monitor the safety or efficacy of the product, which could negatively affect us by reducing revenues or increasing
expenses, and cause the approved product candidate not to be commercially viable. In addition, as clinical experience with a drug
expands after approval, typically because it is used by a greater number and more diverse group of patients after approval than
during clinical trials, side effects and other problems may be observed over time after approval that were not seen or anticipated
during pre-approval studies. Any adverse effects observed after the approval and marketing of a product candidate could result
in limitations on the use of the approved product, withdrawal of FDA approval of the previously approved product, or voluntary
withdrawal from the marketplace of the approved product. Absence of long-term safety data may also limit the approved uses of Aramchol
and any future product candidates, if any. If we fail to comply with the regulatory requirements of the FDA, and other applicable
U.S. and foreign regulatory authorities, or previously unknown problems with any approved commercial products, manufacturers or
manufacturing processes are discovered, we could be subject to administrative or judicially imposed sanctions or other setbacks,
including the following:
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suspension or imposition of restrictions on operations, including costly new manufacturing requirements;
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refusal to approve pending applications or supplements to applications;
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suspension of any ongoing clinical trials;
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suspension or withdrawal of marketing approval;
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an injunction or imposition of civil or criminal penalties or monetary fines;
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seizure or detainment of products;
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banning or restriction of imports and exports;
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issuance of warning letters or untitled letters;
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suspension or imposition of restrictions on operations, including costly new manufacturing requirements;
or
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refusal to approve pending applications or supplements to applications.
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In addition, various aspects
of our operations are subject to federal, state or local laws, rules and regulations, any of which may change from time to time.
Costs arising out of any regulatory developments could be time-consuming and expensive and could divert management resources and
attention and, consequently, could adversely affect our business operations and financial performance.
Delays in regulatory approval,
limitations in regulatory approval and withdrawals of regulatory approval may have a material adverse effect on the Company. If
we experience significant delays in testing or receiving approvals or sign-offs to conduct clinical trials, Aramchol and any future
product candidate's development costs will increase and our ability to out-license Aramchol and any future product candidates may
be impeded.
If we obtain approval
to commercialize Aramchol outside of the United States, a variety of risks associated with international operations could materially
adversely affect our business.
If Aramchol is approved
for commercialization outside the United States, we will likely enter into agreements with third parties to commercialize Aramchol
outside the United States. We expect that we will be subject to additional risks related to entering into or maintaining international
business relationships, including, without limitation:
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different regulatory requirements for drug approvals in foreign countries;
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differing U.S. and foreign drug import and export rules;
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reduced protection for intellectual property rights in foreign countries;
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unexpected changes in tariffs, trade barriers and regulatory requirements;
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different reimbursement systems;
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economic weakness, including inflation, or political instability in particular foreign economies
and markets;
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compliance with tax, employment, immigration and labor laws for employees living or traveling abroad;
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foreign currency fluctuations, which could result in increased operating expenses and reduced revenues,
and other obligations incident to doing business in another country;
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workforce uncertainty in countries where labor unrest is more common than in the United States;
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production shortages resulting from any events affecting raw material supply or manufacturing capabilities
abroad;
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potential liability resulting from development work conducted by these distributors;
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business interruptions resulting from geopolitical actions, including war and terrorism, or natural
disasters; and
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risks associated with clinical co-development agreements in other jurisdictions prior to or post-regulatory
approval.
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A failure to timely and
effectively address the additional risks related to entering into or maintaining international business relationships could have
a material adverse effect on our business, liquidity, operating results and financial condition.
If we receive marketing
approval for Aramchol, sales will be limited unless the product achieves broad market acceptance.
The commercial success
of Aramchol, or potentially any future product candidates for which we obtain marketing approval from the FDA, or other regulatory
authorities, will depend on the breadth of its approved labeling and upon the acceptance of the product by the medical community,
including physicians, patients and healthcare payors. The degree of market acceptance of any approved product will depend on a
number of factors, including, without limitation:
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demonstration of clinical safety and efficacy compared to other products;
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ability of physicians to accurately diagnose NASH in its early stages;
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the relative convenience and ease of administration;
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the prevalence and severity of any adverse side effects;
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limitations, warnings or contraindications contained in the product’s approved labeling;
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distribution and use restrictions imposed by the FDA, or other regulatory agencies, or agreed to
by us as part of a mandatory or voluntary REMS;
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availability of alternative treatments, including, in the case of Aramchol, a number of competitive
products already approved or expected to be commercially launched in the near future;
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pricing and cost effectiveness;
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the effectiveness of our, or any future collaborators’, sales and marketing strategies;
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our ability to obtain sufficient third-party coverage or reimbursement; and
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the willingness of patients to pay for drugs out of pocket in the absence of third-party coverage.
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If Aramchol is approved,
but does not achieve an adequate level of acceptance by physicians, healthcare payors and patients, we may not generate sufficient
revenue from the product, and we may not become profitable. In addition, our efforts to educate the medical community and third-party
payors on the benefits of the product may require significant resources and may never be successful.
The FDA and other regulatory
agencies actively enforce the laws and regulations prohibiting the promotion of off-label uses. If we are found to have improperly
promoted off-label uses, we may become subject to significant liability.
The FDA and other regulatory
agencies strictly regulate the promotional claims that may be made about prescription products. In particular, a product may not
be promoted for uses that are inconsistent with the FDA-approved indications and other conditions or restrictions contained in
the approved labeling, including the prescribing information, for the product. In particular, any labeling approved by FDA or other
foreign regulatory agencies for Aramchol necessarily limits its use for certain conditions in certain patient populations. Also,
regulatory agencies may impose further requirements or restrictions on the distribution or use of Aramchol as part of a mandatory
plan, such as limiting prescribing to certain physicians or medical centers that have undergone specialized training, limiting
treatment to patients who meet certain safe-use criteria and requiring treated patients to enroll in a registry. If we receive
marketing approval for Aramchol, physicians may nevertheless prescribe Aramchol to their patients in a manner that is inconsistent
with the approved labeling, which is commonly known as “off label” use. If we are found to have promoted Aramchol or
any future product candidates for such “off label” uses, we may become subject to significant liability under a variety
of statutory theories typically alleged by U.S. regulatory authorities. In particular, the U.S. federal government has levied large
civil and criminal fines against companies for alleged improper promotion, has enjoined several companies from engaging in off-label
promotion, and has requested that companies enter into consent decrees or permanent injunctions under which specified promotional
conduct is changed or curtailed.
Our business and operations may be materially adversely
affected in the event of computer system failures or security breaches.
Despite the implementation of security measures,
our internal computer systems, and those of our CROs and other third parties on which we rely, are vulnerable to damage from computer
viruses, unauthorized access, cyber-attacks, natural disasters, fire, terrorism, war, and telecommunication and electrical failures. If
such an event were to occur and interrupt our operations, it could result in a material disruption of our drug development programs. For
example, the loss of clinical trial data from ongoing or planned clinical trials could result in delays in our regulatory approval
efforts and significantly increase our costs to recover or reproduce the data. To the extent that any disruption or
security breach results in a loss of or damage to our data or applications, loss of trade secrets or inappropriate disclosure of
confidential or proprietary information, including protected health information or personal data of employees or former employees,
access to our clinical data, or disruption of the manufacturing process, we could incur liability and the further development of
our drug candidates could be delayed. We may also be vulnerable to cyber-attacks by hackers or other malfeasance. This
type of breach of our cybersecurity may compromise our confidential information and/or our financial information and adversely
affect our business or result in legal proceedings. Further, these cybersecurity breaches may inflict reputational harm
upon us that may result in decreased market value and erode public trust.
We may be subject to
extensive environmental, health and safety, and other laws and regulations in multiple jurisdictions.
Our business involves the
controlled use, through our service providers, of hazardous materials, various biological compounds and chemicals, and as such,
we, our agents and our service providers may be subject to various environmental, health and safety laws and regulations, including
those governing air emissions, water and wastewater discharges, noise emissions, the use, management and disposal of hazardous,
radioactive and biological materials and wastes and the cleanup of contaminated sites. The risk of accidental contamination or
injury from these materials cannot be eliminated. If an accident, spill or release of any regulated chemicals or substances occurs,
we could be held liable for resulting damages, including for investigation, remediation and monitoring of the contamination, including
natural resource damages, the costs of which could be substantial. We may incur substantial capital costs and operating expenses
and may be required to obtain consents to comply with any environmental and health laws or regulations and the terms and conditions
of any permits required pursuant to such laws and regulations, including costs incurred by us to install new or updated pollution
control equipment for our service providers, modify our operations or perform other corrective actions at our facilities or the
facilities of our service providers. In addition, fines and penalties may be imposed on us, our agents and/or our service providers
for noncompliance with environmental, health and safety and other laws and regulations or for the failure to have, or comply with
the terms and conditions of, required environmental or other permits or consents.
We expect the healthcare
industry to face increased limitations on reimbursement, rebates and other payments as a result of healthcare reform, which could
adversely affect third-party coverage of Aramchol and any future product candidates and how much or under what circumstances healthcare
providers will prescribe or administer Aramchol and any future product candidates.
In both the United States
and other countries, sales of Aramchol and any future product candidates will depend in part upon the availability of reimbursement
from third-party payors, which include governmental authorities, managed care organizations and other private health insurers.
Third-party payors are increasingly challenging the price and examining the cost effectiveness of medical products and services.
Increasing expenditures
for healthcare have been the subject of considerable public attention in the United States. Both private and government entities
are seeking ways to reduce or contain healthcare costs. Numerous proposals that would effect changes in the U.S. healthcare system
have been introduced or proposed in U.S. Congress, or Congress, and in some state legislatures, including reducing reimbursement
for prescription products and reducing the levels at which consumers and healthcare providers are reimbursed for purchases of pharmaceutical
products.
In the United States, the
Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (the “Modernization Act”), changed the way Medicare
covers and pays for most pharmaceutical products in a number of ways. Medicare is the single largest third-party payment program
and is administered by the Centers for Medicare & Medicaid Services (the “CMS”). Medicare traditionally covered
prescription drugs administered by physicians. The Modernization Act introduced a new reimbursement methodology based on average
sales prices for many of these drugs. The Modernization Act also established a new competitive acquisition program for the purchase
of Part B drugs. This program, when fully implemented, will likely reduce the prices of these drugs. While the Medicare provisions
of the Modernization Act apply only to drug benefits for Medicare beneficiaries, private payors often follow Medicare coverage
policy and payment limitations in setting their own reimbursement rates. Therefore, any reduction in reimbursement that results
from federal legislation or regulation may result in a similar reduction in payments from private payors.
Most notably, the Modernization
Act also expanded coverage through a new Part D to include ordinary self-administered outpatient drugs. Medicare part D though
operates through private insurers, and these insurers negotiate prices with pharmacies and with manufacturers. Intense negotiations
can result in reduced revenues to manufacturers.
Increasing expenditures
for healthcare have been the subject of considerable public attention in the United States. Both private and government entities
are seeking ways to reduce or contain healthcare costs. Numerous proposals that would effect changes in the U.S. healthcare system
have been introduced or proposed in U.S. Congress, and in some state legislatures, including reducing reimbursement for prescription
products and reducing the levels at which consumers and healthcare providers are reimbursed for purchases of pharmaceutical products.
In March 2010, President
Barack Obama signed into law the Patient Protection and Affordable Care Act and the Health Care and Education Affordability Reconciliation
Act of 2010 (the “Affordable Care Act”), a sweeping law intended to broaden access to health insurance, reduce or constrain
the growth of healthcare spending, enhance remedies against fraud and abuse, add new transparency requirements for healthcare and
health insurance industries, impose new taxes and fees on pharmaceutical and medical device manufacturers and impose additional
health policy reforms. The Affordable Care Act expanded manufacturers’ Medicaid rebate liability to include covered drugs
dispensed to individuals who are enrolled in Medicaid managed care organizations, increased the minimum rebate due for innovator
drugs from 15.1% of average manufacturer price (“AMP”), to 23.1% of AMP. The rebate on innovator drugs is the greater
of 23.1% of the AMP per unit or the difference between the AMP and the best price per unit and adjusted by the Consumer Price Index-Urban
(CPI-U) based on a launch date and current quarter AMP. The total rebate amount for innovator drugs is capped at 100.0% of AMP.
The Affordable Care Act and subsequent legislation also narrowed the definition of AMP. Furthermore, the Affordable Care Act imposes
a significant annual, nondeductible fee on companies that manufacture or import certain branded prescription drug products. Substantial
new provisions affecting compliance were also been enacted, which may affect our business practices with healthcare practitioners.
Although it is too early to determine the effect of the Affordable Care Act, it appears likely to continue to put pressure on pharmaceutical
pricing, especially under the Medicare and Medicaid programs, and may also increase our regulatory burdens and operating costs.
On January 20, 2017, President
Donald J. Trump was inaugurated as the President of the United States. President Trump has stated that he intends to “repeal
and replace” the Affordable Care Act, and Congress has taken initial steps to repeal the law. In December 2017, Congress
passed and the President signed into law tax reform legislation that made significant changes to the Affordable Care Act including
the repeal of the “individual mandate” that was in place to strongly encourage broad participation in the health insurance
markets. Given these changes and other statements of political leaders, we cannot predict the ultimate impact on the Affordable
Care Act and the subsequent effect on the pharmaceutical industry at this time.
In addition, other legislative
changes have been proposed and adopted since the Affordable Care Act was enacted. In August 2011, President Obama signed into law
the Budget Control Act of 2011, which, among other things, created the Joint Select Committee on Deficit Reduction to recommend
to Congress proposals in spending reductions. The Joint Select Committee did not achieve a targeted deficit reduction of an amount
greater than $1.2 trillion for the years 2013 through 2021, triggering the legislation’s automatic reduction to several government
programs. This includes aggregate reductions to Medicare payments to healthcare providers of up to 2.0% per fiscal year, starting
in 2013. In January 2013, President Obama signed into law the American Taxpayer Relief Act of 2012, which, among other things,
reduced Medicare payments to several categories of healthcare providers and increased the statute of limitations period for the
government to recover overpayments to providers from three to five years. If we ever obtain regulatory approval and commercialization
of Aramchol or any future product candidates, these laws may result in additional reductions in Medicare and other healthcare funding,
which could have a material adverse effect on our customers and accordingly, our financial operations. Legislative and regulatory
proposals have been made to expand post-approval requirements and restrict sales and promotional activities for pharmaceutical
products. We cannot be sure whether additional legislative changes will be enacted, or whether the FDA regulations, guidance or
interpretations will be changed, or what the impact of such changes on the marketing approvals of Aramchol or any future product
candidates may be. Further, the Deficit Reduction Act of 2010, directed CMS to contract a vendor to determine “retail survey
prices for covered outpatient drugs that represent a nationwide average of consumer purchase prices for such drugs, net of all
discounts and rebates (to the extent any information with respect to such discounts and rebates is available).” This survey
information can be used to determine the National Average Drug Acquisition Cost (“NADAC”). Some states have indicated
that they will reimburse based on the NADAC and this can result in further reductions in the prices paid for various outpatient
drugs.
Various states, such as
California, have also taken steps to consider and enact laws or regulations that are intended to increase the visibility of the
pricing of pharmaceutical products with the goal of reducing the prices at which pharmaceutical products are sold. Because these
various actual and proposed legislative changes are intended to operate on a state-by-state level rather than a national one, we
cannot predict what the full effect of these legislative activities may be on our business in the future.
Although we cannot predict
the full effect on our business of the implementation of existing legislation or the enactment of additional legislation pursuant
to healthcare and other legislative reform, we believe that legislation or regulations that would reduce reimbursement for, or
restrict coverage of, Aramchol or any future product candidates, could adversely affect how much or under what circumstances healthcare
providers will prescribe or administer our products. This could materially and adversely affect our business by reducing our ability
to generate revenue, raise capital, obtain additional collaborators and market Aramchol or any future product candidates. In addition,
we believe the increasing emphasis on managed care in the United States has and will continue to put pressure on the price and
usage of pharmaceutical products, which may adversely impact any future product sales.
It will be difficult
for us to profitably sell Aramchol if reimbursement for the product is limited by government authorities and third-party payor
policies.
In addition to any healthcare
reform measures that may affect reimbursement, the market acceptance and sales of Aramchol will depend on the reimbursement policies
of government authorities and third-party payors. It will be difficult for us to profitably sell Aramchol if reimbursement for
the product is limited by government authorities or third-party payors. Government authorities and third-party payors, such as
private health insurers and health maintenance organizations, decide which medications they will pay for and establish reimbursement
levels. A primary trend in the U.S. healthcare industry and elsewhere is cost containment. Government authorities and these third-party
payors have attempted to control costs by limiting coverage and the amount of reimbursement for particular medications. We cannot
be sure that coverage or reimbursement will be available for Aramchol and, if coverage and reimbursement are available, of the
extent of coverage and the level of reimbursement. Reimbursement may affect the demand for, or the price of, any product for which
we obtain marketing approval. In addition, third-party payors are likely to impose strict requirements for reimbursement in order
to limit off-label use of a higher priced drug. Reimbursement by a third-party payor may depend upon a number of factors including
the third-party payor’s determination that use of a product is:
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a covered benefit under its health plan;
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safe, effective and medically necessary;
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appropriate for the specific patient;
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neither experimental nor investigational.
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Obtaining coverage and
reimbursement approval for a product from a government or other third-party payor is a time-consuming and costly process that could
require us to provide supporting scientific, clinical and cost effectiveness data for the use of Aramchol and any future product
candidates to the payor. We may not be able to provide data sufficient to gain acceptance with respect to coverage and reimbursement.
We cannot be sure that coverage or adequate reimbursement will be available for Aramchol and any future product candidates. Also,
we cannot be sure that reimbursement amounts will not reduce the demand for, or the price of, Aramchol and any future product candidates.
If reimbursement is not available, or is available only to limited levels, we may not be able to commercialize Aramchol, or any
future product candidates, profitably, or at all, even if approved. In addition, if physicians, government agencies and other third-party
payors do not accept the use or efficacy of Aramchol or any future product candidates, we will not be able to generate significant
revenue, if any.
Governments outside
the United States tend to impose strict price controls, which may adversely affect our revenues, if any.
In some countries, particularly
the countries of the EU, the pricing of prescription pharmaceuticals is subject to governmental control. In these countries, pricing
negotiations with governmental authorities can take considerable time after the receipt of marketing approval for a product. To
obtain reimbursement or pricing approval in some countries, we may be required to conduct a clinical trial that compares the cost-effectiveness
of Aramchol to other available therapies. If reimbursement of our products is unavailable or limited in scope or amount, or if
pricing is set at unsatisfactory levels, our business could be harmed, possibly materially.
If
we or any of our independent contractors, consultants, collaborators, manufacturers, or service providers fail to comply with healthcare
and data privacy laws and regulations, we or they could be subject to enforcement actions, which could result in penalties and
affect our ability to develop, market and sell our product candidates and may harm our reputation.
We are or may in the future
be subject to federal, state, and foreign healthcare and data privacy laws and regulations pertaining to, among other things, fraud
and abuse of patients’ rights. These laws and regulations include:
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The federal Anti-Kickback Statute prohibits, among other things, knowingly and willfully
soliciting, offering, receiving, or paying any remuneration, directly or indirectly, in cash or in kind, to induce or reward
purchasing, ordering or arranging for or recommending the purchase or order of any item or service for which payment may be
made, in whole or in part, under a federal healthcare program such as Medicare and Medicaid. Liability may be established
without a person or entity having actual knowledge of the federal Anti-Kickback Statute or specific intent to violate it.
This statute has been interpreted to apply broadly to arrangements between pharmaceutical manufacturers on the one hand and
prescribers, patients, purchasers and formulary managers on the other. In addition, the Affordable Care Act amended the
Social Security Act to provide that the U.S. 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 federal
civil False Claims Act. A conviction for violation of the Anti-kickback Statute requires mandatory exclusion from
participation in federal health care programs. Although there are a number of statutory exemptions and regulatory safe
harbors protecting certain common activities from prosecution, the exemptions and safe harbors are drawn narrowly, and those
activities may be subject to scrutiny or penalty if they do not qualify for an exemption or safe harbor.
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The federal civil False Claims Act (“FCA”), prohibits, among other things, knowingly
presenting, or causing to be presented claims for payment of government funds that are false or fraudulent, or knowingly making,
using or causing to be made or used a false record or statement material to such a false or fraudulent claim, or knowingly concealing
or knowingly and improperly avoiding, decreasing, or concealing an obligation to pay money to the federal government. This statute
also permits a private individual acting as a “whistleblower” to bring actions on behalf of the federal government
alleging violations of the FCA and to share in any monetary recovery. The FCA prohibits anyone from knowingly presenting, conspiring
to present, making a false statement in order to present, or causing to be presented, for payment to federal programs (including
Medicare and Medicaid) claims for items or services, including drugs, that are false or fraudulent, claims for items or services
not provided as claimed, or claims for medically unnecessary items or services. This law also prohibits anyone from knowingly
underpaying an obligation owed to a federal program. Increasingly, U.S. federal agencies are requiring nonmonetary remedial measures,
such as corporate integrity agreements in FCA settlements. The U.S. Department of Justice announced in 2016 its intent to follow
the “Yates Memo,” taking a far more aggressive approach in pursuing individuals as FCA defendants in addition to the
corporations. FCA liability is potentially significant in the healthcare industry because the statute provides for treble damages
and mandatory penalties of $5,500 to $11,000 per false claim or statement ($10,781 to $21,563 per false claim or statement for
penalties assessed after August 1, 2016 for violations occurring after November 2, 2015, and $10,957 to $21,916 per false claim
or statement for penalties assessed after February 3, 2017 for violations occurring after November 2, 2015). Government enforcement
agencies and private whistleblowers have investigated pharmaceutical companies for or asserted liability under the FCA for a variety
of alleged promotional and marketing activities, such as providing free product to customers with the expectation that the customers
would bill federal programs for the product; providing consulting fees and other benefits to physicians to induce them to prescribe
products; engaging in promotion for “off-label” uses; and submitting inflated best price information to the Medicaid
Rebate Program.
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The federal False Statements Statute prohibits knowingly and willfully falsifying, concealing,
or covering up a material fact or making any materially false, fictitious or fraudulent statement or representation, or making
or using any false writing or document knowing the same to contain any materially false, fictitious or fraudulent statement or
entry, in connection with the delivery of or payment for healthcare benefits, items, or services.
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The federal Civil Monetary Penalties Law authorizes the imposition of substantial civil monetary
penalties against an entity, such as a pharmaceutical manufacturer, that engages in activities including, among others (1) knowingly
presenting, or causing to be presented, a claim for services not provided as claimed or that is otherwise false or fraudulent in
any way; (2) arranging for or contracting with an individual or entity that is excluded from participation in federal healthcare
programs to provide items or services reimbursable by a federal healthcare program; (3) violations of the federal Anti-Kickback
Statute; or (4) failing to report and return a known overpayment.
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The federal Health Insurance Portability and Accountability Act of 1996 (“HIPAA”),
imposes criminal and civil liability for knowingly and willfully executing, or attempting to execute, a scheme to defraud any healthcare
benefit program, or knowingly and willfully falsifying, concealing or covering up a material fact or making any materially false
statement in connection with the delivery of, or payment for, healthcare benefits, items or services; similar to the federal Anti-Kickback
Statute, 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.
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HIPAA, as amended by the Health Information Technology for Economic and Clinical Health Act (HITECH),
which imposes requirements on certain types of people and entities relating to the privacy, security, and transmission of individually
identifiable health information, and requires notification to affected individuals and regulatory authorities of certain breaches
of security of individually identifiable health information;
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The federal Physician Payment Sunshine Act, which requires certain manufacturers of drugs, devices,
biologics and medical supplies for which payment is available under Medicare, Medicaid, or the Children’s Health Insurance
Program, to report annually to the Centers for Medicare & Medicaid Services (CMS) information related to payments and
other transfers of value to physicians, other healthcare providers and teaching hospitals, and ownership and investment interests
held by physicians and other healthcare providers and their immediate family members, which is published in a searchable form on
an annual basis;
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State laws comparable to each of the above federal laws, such as, for example, anti-kickback and
false claims laws that may be broader in scope and also apply to commercial insurers and other non-federal;
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Payors requirements for mandatory corporate regulatory compliance programs, and laws relating to
patient data privacy and security. Other state laws require pharmaceutical companies to comply with the pharmaceutical industry’s
voluntary compliance guidelines and the relevant compliance guidance promulgated by the federal government; require drug manufacturers
to report information related to payments and other transfers of value to physicians and other healthcare providers or marketing
expenditures; and state and foreign laws govern the privacy and security of health information in some circumstances, many of which
differ from each other in significant ways and often are not preempted by HIPAA, thus complicating compliance efforts; and
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In the European Union, the General Data Protection Regulation
(“GDPR”)—Regulation EU 2016/679—which was adopted in May 2016 and will become applicable on
May 25, 2018. The GDPR is intended to harmonize data protection requirements across the European Union member
states by establishing new and expanded operational requirements for entities that collect, process or use personal data
generated in the European Union, including consent requirements for disclosing the way personal information will be used,
information retention requirements, and notification requirements in the event of a data breach.
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If our operations are found
to be in violation of any such health care laws and regulations, we may be subject to penalties, including administrative, civil
and criminal penalties, monetary damages, disgorgement, imprisonment, the curtailment or restructuring of our operations, loss
of eligibility to obtain approvals from the FDA or foreign regulatory authorities, or exclusion from participation in government
contracting, healthcare reimbursement or other government programs, including Medicare and Medicaid, any of which could adversely
our financial results. Any action against us for an alleged or suspected violation could cause
us to incur significant legal expenses and could divert our management’s attention from the operation of our business, even
if our defense is successful. In addition, achieving and sustaining compliance with applicable laws and regulations may be costly
to us in terms of money, time and resources.
If we or our manufacturers
fail to comply with manufacturing regulations, our financial results and financial condition could be adversely affected.
Before an NDA is approved,
and before we begin the commercial manufacture of Aramchol, contract manufacturers must register with FDA or foreign regulators
undergo regulatory inspection of their manufacturing facilities, processes and quality systems. In addition, pharmaceutical manufacturing
facilities are subject to periodic inspection by the FDA and foreign regulatory authorities after product approval. Due to the
complexity of the processes used to manufacture pharmaceutical products and product candidates, any potential third-party manufacturer
may be unable to meet local, federal, or international regulatory requirements either at the outset or on an ongoing basis, in
a cost effective manner, if at all.
We do not intend to engage
in the manufacture of Aramchol other than for pre-clinical and clinical studies, but we or our materials suppliers may face manufacturing
or quality control problems causing product production and shipment delays or a situation where we or the supplier may not be able
to maintain compliance with the FDA’s or foreign regulators’ requirements necessary to continue manufacturing Aramchol.
Drug manufacturers are subject to ongoing periodic unannounced inspections by the FDA and corresponding foreign regulators to ensure
continuing compliance with applicable requirements. Any failure to comply with FDA or foreign regulatory requirements could adversely
affect our clinical research activities and our ability to develop and market Aramchol and any future product candidates.
If a third-party manufacturer
with whom we contract is unable to comply with manufacturing requirements, we may be subject to fines, unanticipated compliance
expenses, recall or seizure of Aramchol or any future product candidates, total or partial suspension of production and/or enforcement
actions, including injunctions, and criminal or civil prosecution. These possible sanctions could adversely affect our financial
results and financial condition.
Our market is subject
to intense competition. If we are unable to compete effectively, Aramchol or any other potential product candidate that we develop
may be rendered suboptimal, noncompetitive or obsolete.
There are a number of products
in development for NASH, many of which are being developed by pharmaceutical companies that are far larger than us, with significantly
greater resources and more experience than us in all aspects of drug development and commercialization. Further, our industry is
highly competitive and subject to rapid and significant technological change. Our potential competitors include large, fully-integrated
pharmaceutical and biotechnology companies, specialty pharmaceutical and generic drug companies, academic institutions, government
agencies and research institutions. All of these competitors currently engage in, have engaged in or may engage in the future in
the development, manufacturing, marketing and commercialization of new pharmaceuticals, some of which may compete with Aramchol
or other product candidates. Smaller or early stage companies may also prove to be significant competitors, particularly through
collaborative arrangements with large, established companies. These companies may have products in development that are superior
to Aramchol. Key competitive factors affecting the commercial success of Aramchol and any future product candidates that we develop
are likely to be efficacy, time of onset, safety and tolerability profile, reliability, convenience of dosing, price and reimbursement.
Many of our potential competitors
have substantially greater financial, technical and human resources than we do and significantly greater experience in the discovery
and development of drug candidates, obtaining FDA and other regulatory approvals of products and the commercialization of those
products. Accordingly, our competitors may be more successful than us in obtaining FDA and other marketing approvals for drugs
and achieving widespread market acceptance. Our competitors’ drugs may be more effective, or more effectively marketed and
sold, than any drug we may commercialize and may render Aramchol or any other potential product candidates that we develop suboptimal,
obsolete or non-competitive before we can recover the expenses of developing and commercializing the product. We anticipate that
we will face intense and increasing competition as new drugs enter the market and advanced technologies become available. Finally,
the development of new treatment methods for the diseases we are targeting could render Aramchol, or any other product candidate
that we develop, non-competitive or obsolete. If we cannot successfully compete with new or existing products, our marketing and
sales will suffer and we may never be profitable.
Our competitors currently
include companies with marketed products and/or advanced clinical programs. The majority of our competitors include, but are not
limited to, Intercept Pharmaceuticals, Inc., Genfit S.A., Gilead Sciences, Inc., Allergan, Plc., Madrigal Pharmaceuticals Inc.,
Conatus Pharmaceuticals Inc., and Novartis, among others. See also “Item 4. Information on the Company—Competition.”
Moreover, several additional companies have reported the commencement of research projects and proof-of-concept trials related
to NASH, including those mentioned in the preceding sentence.
We face potential product
and other liability exposure, and, if claims are brought against us, we may incur substantial liability.
Aramchol and any future
product candidates could cause adverse events. These adverse events may not be observed in clinical trials, but may nonetheless
occur in the future. If any of these adverse events occur, they may render Aramchol and any future product candidates ineffective
or harmful in some patients, and our sales would suffer, materially adversely affecting our business, financial conditions and
results of operations.
In addition, potential
adverse events caused by Aramchol and any future product candidates, could lead to product liability claims. Product liability
claims might be brought against us by consumers, healthcare providers or others coming into contact with Aramchol and any future
product candidates. If we cannot successfully defend ourselves against product liability claims, we could incur substantial liabilities.
In addition, regardless of merit or eventual outcome, product liability claims may result in, among other things:
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decreased demand for Aramchol or any other product candidate for which we obtain marketing approval;
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impairment of our business reputation and exposure to adverse publicity;
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increased warnings on product labels or other regulatory actions;
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withdrawal of clinical trial participants;
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costs of related litigation;
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distraction of management’s attention from our primary business;
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substantial monetary awards to patients or other claimants;
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the inability to successfully commercialize Aramchol or any future product candidates, for which
we obtain marketing approval.
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If we are unable to obtain
adequate insurance with respect to our clinical trials against and from any losses or claims from third parties, our financial
condition could be adversely affected in the event of uninsured or inadequately insured loss or damage. We may not be able to obtain
insurance policies on terms affordable to us that would adequately cover loss or claims by third parties. To the extent our business
suffers any losses or claims by third parties, which are not covered, or adequately covered, by insurance, our financial condition
may be materially adversely affected.
If product liability
lawsuits are successfully brought against us, our insurance may be inadequate.
We have obtained insurance
coverage for our clinical trials in accordance with market standards and in compliance with applicable Israeli law. However, our
insurance coverage may not be sufficient to reimburse us for any expenses or losses we may suffer. Moreover, insurance coverage
is becoming increasingly expensive, and, in the future, 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. If and when we obtain marketing approval for Aramchol,
or any other product candidate, we intend to expand our insurance coverage to include the sale of commercial products; however,
we may be unable to obtain this product liability insurance on commercially reasonable terms. On occasion, large judgments have
been awarded in class action lawsuits based on drugs that had unanticipated side effects. The cost of any product liability litigation
or other proceedings, even if resolved in our favor, could be substantial. A successful product liability claim, or series of claims,
brought against us could cause our share price to decline and, if judgments exceed our insurance coverage, could decrease our cash
and adversely affect our business.
The product liability insurance
we will need to obtain in connection with the commercial sales of Aramchol and any future product candidates, if and when they
receive regulatory approval, may be unavailable in meaningful amounts or at a reasonable cost. If we are the subject of a successful
product liability claim that exceeds the limits of any insurance coverage we obtain, we would incur substantial charges that would
adversely affect our earnings and require the commitment of capital resources that might otherwise be available for the development
and commercial launch of Aramchol and any future product candidate's programs.
We manage our business
through a small number of senior executive officers. We depend on them even more than similarly- situated companies.
Because of the specialized
scientific and managerial nature of our business, we rely heavily on our ability to recruit, attract, retain, manage and motivate
qualified senior executive officers with adequate operational, scientific and technical experience. The loss of the services of
our senior executive officers, including our President and Chief Executive Officer, Chief Medical Officer, and Chief Scientific
Officer, or the inability to hire or retain experienced management personnel, could adversely affect our ability to execute our
business plan and harm our operating results. In particular, the loss of one or more of our senior executive officers could be
detrimental to us if we cannot recruit suitable replacements in a timely manner.
We do not currently carry
“key person” insurance on the lives of members of senior management. The competition for qualified personnel in the
pharmaceutical field is intense. Due to this intense competition, we may be unable to attract and retain qualified personnel necessary
for the development of our business or to recruit suitable replacement personnel. Additionally, our ability to effectively recruit
and retain qualified officers and directors could also be adversely affected if we experience difficulty in obtaining adequate
directors’ and officers’ liability insurance. We may be unable to maintain sufficient insurance as a public company
to cover liability claims made against our officers and directors. If we are unable to adequately insure our officers and directors,
we may not be able to retain or recruit qualified officers and directors to manage the Company.
Failure to build our
finance infrastructure and improve our accounting systems and controls could impair our ability to comply with the financial reporting
and internal control requirements for publicly traded companies.
As a public company, we
operate in an increasingly challenging regulatory environment which requires us to comply with the Sarbanes-Oxley Act of 2002 (the
“Sarbanes-Oxley Actˮ), and the related rules and regulations of the SEC and securities exchanges, expanded disclosures,
accelerated reporting requirements and more complex accounting rules. Company responsibilities required by the Sarbanes-Oxley Act
include establishing corporate oversight and adequate internal control over financial reporting and disclosure controls and procedures.
Effective internal controls are necessary for us to produce reliable financial reports and are important to help prevent financial
fraud. However, our independent registered public accounting firm will not be required to attest to the effectiveness of our internal
control over financial reporting pursuant to Section 404 of the Sarbanes-Oxley Act, or Section 404, until the date we are no longer
an “emerging growth company” as defined in the Jumpstart Our Business Startups Act of 2012 (the “JOBS Actˮ),
because we are taking advantage of the exemptions contained in the JOBS Act. We will remain an emerging growth company until, subject
to certain conditions, the earlier of (1) the last day of the fiscal year (a) following the fifth anniversary of the completion
of our initial public offering, (b) in which we have total annual gross revenue of at least $1.0 billion, or (c) in which we are
deemed to be a large accelerated filer, which means the market value of our ordinary shares that is held by non-affiliates exceeds
$700.0 million as of the prior June 30, and (2) the date on which we have issued more than $1.0 billion in non-convertible debt
during the prior three-year period.
To date, our independent
public accountant has never conducted a review of our internal control for the purpose of providing the reports required by these
rules. During the course of our review and testing, we may identify deficiencies and be unable to remediate them before we must
provide the required reports. Furthermore, if we have a material weakness in our internal controls over financial reporting, we
may not detect errors on a timely basis and our financial statements may be materially misstated. We or our independent registered
public accounting firm may not be able to conclude on an ongoing basis that we have effective internal control over financial reporting,
which could harm our operating results, cause investors to lose confidence in our reported financial information and cause the
trading price of our stock to fall.
To build our finance infrastructure,
we may need to improve our accounting systems, disclosure policies, procedures and controls. If we are unsuccessful in building
an appropriate accounting infrastructure, we may not be able to prepare and disclose, in a timely manner, our financial statements
and other required disclosures, or comply with existing or new reporting requirements. Any failure to report our financial results
on an accurate and timely basis could result in sanctions, lawsuits, delisting of our shares from the Nasdaq Capital Market or
other adverse consequences that would materially harm our business. If we cannot provide reliable financial reports or prevent
fraud, our business and results of operations could be harmed and investors could lose confidence in our reported financial information.
We will need to significantly
increase the size of our organization, and we may experience difficulties in managing growth.
We may experience rapid
and substantial growth in order to achieve our operating plans, which will place a strain on our human and capital resources. Successful
implementation of our business plan will require management of growth, which will result in an increase in the level of responsibility
for management personnel. We currently have a relatively small number of employees and, in the event we continue the clinical development
of Aramchol into Phase III pivotal study independently, we will need to substantially increase our operations, including expanding
our employee base of managerial, operational, clinical and financial personnel. Any future growth will impose significant added
responsibilities on members of management, including the need to identify, recruit, maintain and integrate additional employees.
To that end, we must be able to, among other things:
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manage our clinical trials and the regulatory process effectively;
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develop our administrative, accounting and management information systems and controls;
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hire and train additional qualified personnel; and
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integrate current and additional management, administrative, financial and sales and marketing
personnel.
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If we are unable to
establish, scale-up and implement improvements to our control systems in an efficient or timely manner, or if we encounter deficiencies
in existing systems and controls, investors may choose not to invest in us, which could cause our share price to decline and negatively
impact our ability to successfully commercialize Aramchol and any future product candidates.
Failure to attract
and retain sufficient numbers of talented employees will further strain our human resources and could impede our growth or result
in ineffective growth. If we are unable to manage our growth effectively, our losses could materially increase and it will have
a material adverse effect on our business, results of operations and financial condition.
Our business, including
our ability to raise capital, may be affected by macroeconomic conditions.
A deterioration in
global economic conditions and uncertainties may have an adverse effect on our business. For instance, interest rates, the liquidity
of the credit markets and the volatility of the capital markets could also affect the value of our investments, if any, and our
ability to liquidate such investments in order to fund our operations. Interest rates and the ability to access credit markets
could also adversely affect the ability of patients and distributors to purchase, pay for and effectively distribute Aramchol and
any future product candidates.
In addition, we rely
and intend to rely on third-parties, including our clinical research organizations, third-party manufacturers and second source
suppliers, and certain other important vendors and consultants. As a result of volatile and unpredictable global economic situations,
there may be a disruption or delay in the performance of our third-party contractors and suppliers. If such third-parties are unable
to satisfy their contractual commitments to us, our business could be severely adversely affected.
The Israeli Ministry
of Health permits the conduct of multiple biopsies under restricted conditions
On March 9, 2015, we announced that we had begun the enrollment stage of our Phase IIb ARREST Study of
Aramchol in 247 biopsy-diagnosed patients with NASH who are
overweight
or obese and have pre diabetes or type II diabetes mellitus. The primary endpoint of the study is a significant reduction of liver
fat, as measured by magnetic resonance spectroscopy (“MRSˮ), which is a noninvasive and sensitive method for quantification
the amount of fat in the liver. The main secondary endpoints of the ARREST Study include fibrosis improvement and resolution of
NASH in biopsies, which can be assessed only at the completion of the study and by repeated liver biopsy. We are conducting a portion
of our ARREST Study in Israel. Although the Israeli Ministry of Health has granted us approval to conduct our ARREST Study including
patients that underwent a liver biopsy independently and previously to the study (as warranted by their medical condition), it
has taken exception to the necessity of conducting a second biopsy at the end of the trial period, as specified by the trial protocol.
As this position is inconsistent with the already established guidance by the FDA and the EMA, it was unexpected. After conducting
a close dialogue with the Israeli Ministry of Health, in September 2016, the Israeli Ministry of health released a general guidance,
which allowed performance of biopsies as part of clinical trials conducted in Israel subject to compliance with met criteria. However,
26 patients from Israel, eligible for an end of study biopsy, did not perform the second biopsy. We have defined in our statistical
analysis plan (SAP) an analysis set for liver biopsy data which will not include Israeli participants that are lacking the pair
of biopsies due to regulatory limitation.
Additional clinical
trials may divert a significant amount of Company resources and may ultimately be unsuccessful.
In 2016, we announced
we entered into several agreements to expand our clinical operations for Aramchol to multiple other indications in order to expand
our pipeline, commercial potential and ultimately de-risk the Company for the success of any one given trial. However, to date
the initiation of the Vitamin D Study (as defined below) and the microbiome Research (as defined below) have been postponed.
Risks Related to
Our Reliance on Third Parties
We have no manufacturing
capacity and anticipate reliance on third-party manufacturers for Aramchol.
We do not currently
operate manufacturing facilities for the production of Aramchol or its API. We still have not, and may never, develop facilities
for the manufacture of product candidates or products for clinical trials or commercial purposes. We rely, and for the foreseeable
future, will continue to rely, on third-party manufacturers to produce bulk drug products required for our clinical trials. We
plan to initially rely upon contract manufacturers and, potentially, collaboration partners, to manufacture commercial quantities
of Aramchol and any future product candidates, if and when approved for marketing by the applicable regulatory authorities. Our
contract manufacturers have not completed process validation for Aramchol or the Aramchol API manufacturing processes. If our contract
manufacturers and their facilities, as applicable, are not approved by the FDA, or other applicable regulatory authorities, our
commercial supply of the drug substance will be significantly delayed and may result in significant additional costs. We purchase
finished Aramchol from a third-party under a clinical supply agreement. If we will be required to change the finished product manufacturer,
we may encounter significant delay and likely significant additional cost.
A failure by our contract
manufacturer to achieve and maintain high manufacturing standards, in accordance with applicable good manufacturing practices and
other applicable regulatory requirements could result in patient injury or death, product shortages, product recalls or withdrawals,
delays or failures in product testing or delivery, cost overruns or other problems that could seriously harm our business. Contract
manufacturers often encounter difficulties involving production yields, quality control and quality assurance, as well as shortages
of qualified personnel.
Our existing manufacturers
and any future contract manufacturers may not perform as agreed or may not remain in the contract manufacturing business. In the
event of a natural disaster, business failure, strike or other difficulty, we may be unable to replace a third-party manufacturer
in a timely manner and the production of Aramchol would be interrupted, resulting in delays and additional costs.
We intend to rely
primarily on third parties to market and sell Aramchol.
We have no sales or
distribution capabilities. To the extent we rely on third parties to commercialize Aramchol, if marketing approval is obtained,
we may receive less revenue than if we commercialize Aramchol ourselves. In addition, we would have less control over the sales
efforts of any third parties involved in our commercialization efforts. In the event we are unable to collaborate with a third-party
marketing and sales organization to commercialize Aramchol, particularly for broader patient populations, our ability to generate
revenue will be limited.
Although we may ultimately
develop a marketing and sales force with technical expertise and supporting distribution capabilities in the longer term, we do
not currently intend to do so and, as such, we will be unable to market Aramchol directly in the near future. To promote any of
our potential products through third parties, we will have to locate acceptable third parties for these functions and enter into
agreements with them on acceptable terms, and we may not be able to do so. Any third-party arrangements we are able to enter into
may result in lower revenues than we could achieve by directly marketing and selling our potential products. In addition, to the
extent that we depend on third parties for marketing and distribution, any revenues we receive will depend upon the efforts of
such third parties, as well as the terms of our agreements with such third parties, which cannot be predicted in most cases at
this time. As a result, we might not be able to market and sell Aramchol in the United States or overseas, which would have a material
adverse effect on us.
Any collaboration
arrangements that we may enter into in the future may not be successful, which could adversely affect our ability to develop and
commercialize our current and potential future product candidates.
We intend to seek collaboration
arrangements with pharmaceutical or biotechnology companies for the continued development and commercialization of our current
and potential future product candidates. We will face, to the extent that we decide to enter into collaboration agreements, significant
competition in seeking appropriate collaborators. Moreover, collaboration arrangements are complex and time consuming to negotiate,
document and implement. We may not be successful in our efforts to establish and implement collaborations or other alternative
arrangements. The terms of any collaborations or other arrangements that we may establish may not be favorable to us.
Any future collaborations
that we enter into may not be successful. The success of our collaboration arrangements will depend heavily on the efforts and
activities of our collaborators. Collaborators generally have significant discretion in determining the efforts and resources that
they will apply to these collaborations. Disagreements between parties to a collaboration arrangement regarding clinical development
and commercialization matters can lead to delays in the development process or commercializing the applicable product candidate
and, in some cases, termination of the collaboration arrangement. These disagreements can be difficult to resolve if neither of
the parties has final decision making authority. Moreover, collaborations with pharmaceutical or biotechnology companies and other
third parties are often terminated or allowed to expire by the other party. Any lack of effort or ability by our collaborators
or any such disagreement, termination or expiration could adversely affect us financially and could harm our business reputation.
We depend on third
parties to conduct our clinical trials.
We rely on third parties,
such as contract research organizations, medical institutions, clinical investigators and contract laboratories to oversee most
of the operations of our clinical trials and to perform data collection and analysis. As a result, we may face additional delays
outside of our control if these parties do not perform their obligations in a timely fashion or in accordance with regulatory requirements.
If these third parties do not successfully carry out their contractual duties or obligations and meet expected deadlines, if they
need to be replaced, or if the quality or accuracy of the clinical data they obtain is compromised due to the failure to adhere
to our clinical protocols or for other reasons, our financial results and the commercial prospects for Aramchol or any other potential
product candidates could be harmed, our costs could increase and our ability to obtain regulatory approval and commence product
sales could be delayed.
Risks Related to
Our Intellectual Property
The failure to
obtain or maintain patents, licensing agreements and other intellectual property rights that are sufficiently broad and protective
could impact our ability to compete effectively.
To compete effectively,
we must develop and maintain a proprietary position with regard to our own technologies, intellectual property, licensing agreements,
product candidates and business. Legal standards relating to the validity and scope of claims in the biotechnology and biopharmaceutical
fields are still evolving. We cannot predict the scope and extent of patent protection for Aramchol because the patent positions
of pharmaceutical products are complex and uncertain. Therefore, the degree of future protection for our proprietary rights in
our core technologies and any product candidates or products that might be developed using these technologies is also uncertain.
The risks and uncertainties that we face with respect to our patents and other proprietary rights include, but are not limited
to, the following:
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while the patents we own have been issued, pending patent applications we have filed may not result
in issued patents or may take longer than we expect to result in issued patents;
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we may be subject to interference, reexamination,
inter pares
review, or post-grant review
proceedings in the U.S.;
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we may be subject to opposition proceedings in certain foreign countries;
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any patents that are issued may not provide meaningful protection for any significant period of
time, if at all;
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any issued patents may not be broad or strong enough to prevent competition from other products
including identical or similar products;
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we may not be able to develop additional proprietary technologies that are patentable;
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there may be prior art of which we are not aware that may affect the validity or enforceability
of a patent claim;
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there may be other patents or pending patent applications existing in the patent landscape that
will affect our freedom to operate for Aramchol;
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other companies may challenge and invalidate patents licensed or issued to us or our customers;
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a court could determine that a competitor’s technology or product does not infringe our patents;
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other companies may independently develop similar or alternative technologies, or duplicate our
technologies;
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other companies may design around technologies we have licensed or developed;
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if we are not awarded patents or if issued patents expire or are declared invalid or not infringed,
there may be no protections against competitors making generic equivalents;
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enforcement of patents is complex, uncertain and expensive, and our patents may be found invalid
or enforceable;
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our patents could irretrievably lapse due to failure to pay fees or otherwise comply with regulations,
or could be subject to compulsory licensing; and
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if we encounter delays in our development or clinical trials, the period of time during which we
could market Aramchol under patent protection would be reduced.
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We cannot be certain
that patents will be issued as a result of any of our pending applications, and we cannot be certain that any of our issued patents,
whether issued pursuant to our pending applications or licensed from third parties, will give us adequate protection from competing
products. For example, issued patents may be circumvented or challenged, declared invalid or unenforceable, or narrowed in scope.
In addition, because publication of discoveries in the scientific or patent literature often lags behind actual discoveries, we
cannot be certain that we were the first to make our inventions or to file patent applications covering those inventions. If any
of our composition of matter patents, or pending applications, was subject to a successful challenge or failed to issue, our business
and competitive advantage could be significantly affected. Our current patents will expire or they may otherwise cease to provide
meaningful competitive advantage, and we may be unable to adequately develop new technologies and obtain future patent protection
to preserve our competitive advantage or avoid adverse effects on our business.
The composition of
matter patents pertaining to Aramchol will expire on March 25, 2019 worldwide outside of Israel and on April 8, 2018 in Israel.
We do not expect that we will be able to submit an NDA seeking approval of Aramchol prior to the composition of matter patents’
expiration date. However, because Aramchol is regarded as a new chemical entity (“NCEˮ), following approval of an NDA,
if we are the first applicant to obtain NDA approval, we may be entitled to up to five years of patent term extension in the United
States with respect to such NCE, and provided that the use patent with respect to Aramchol in the treatment of fatty liver will
still be in force when the approval of the NDA is received from the FDA. The non-extended patent term for such use patent, is due
to expire on April 15, 2022 worldwide and on April 17, 2021 in Israel. The U.S. patent was extended by a patent term adjustment
of 567 days, resulting in an effective expiration date in the U.S. of November 3, 2023. Analogous mechanisms for protecting the
interests of innovator drug companies to compensate for regulatory review and other hurdles they must overcome, of varying duration,
may be available in Europe and other foreign jurisdictions. In addition, a term of data exclusivity of up to 5 years will be available
for the first approved clinical use of this NCE in the U.S. and for longer periods in other jurisdictions, if Aramchol receives
regulatory approval. Although the Company believes that it may be able to protect its exclusivity in its field of activity through
such use patent portfolio and such period of exclusivity, the lack of composition of matter patent protection may diminish the
Company’s ability to maintain a proprietary position for its intended uses of Aramchol. Moreover, the Company cannot be certain
that it will be the first applicant to obtain an FDA approval for any indication of Aramchol and it cannot be certain that it will
be entitled to NCE exclusivity. Such diminution of Aramchol’s proprietary position could have a material adverse effect on
our business, results of operation and financial condition.
Others may obtain issued
patents that could prevent us from commercializing Aramchol and any future product candidates or require us to obtain licenses
requiring the payment of significant fees or royalties in order to enable us to conduct our business. As to those patents that
we have licensed, our rights depend on maintaining our obligations to the licensor under the applicable license agreement, and
we may be unable to do so.
In addition to patents
and patent applications, we depend upon trade secrets and proprietary know-how to protect our proprietary technology. We require
our employees, consultants, advisors and collaborators to enter into confidentiality agreements that prohibit the disclosure of
confidential information to any other parties. We also require our employees and consultants to disclose and assign to us their
ideas, developments, discoveries and inventions. These agreements may not, however, provide adequate protection for our trade secrets,
know-how or other proprietary information in the event of any unauthorized use or disclosure.
Our potential development
of Aramchol salts may not result in improved bioavailability compared to the existing form of Aramchol. Furthermore, although we
have submitted patent applications for our Aramchol salts in development, there is no assurance that we will receive any patents
for them, and even if we receive one or more patents for our Aramchol salts in development, they may be of little or no commercial
value.
As part of our research
and development studies, we have confirmed that several Aramchol salts have improved solubility as compared to the existing form
of Aramchol acid. In 2014, we submitted new patent applications to protect such salts. Should we decide to develop the formulations
of Aramchol salts, we will need to conduct an appropriate bioequivalence study, or studies, of the biological equivalence of two
proprietary preparations of a drug.
If we commence animal
PK studies and formulation development in order to test the bioavailability of the Aramchol salt compounds, the results might not
support the claims sought by us. Success in our earlier pre-formulation studies does not ensure that later studies will be successful,
and the results of later studies may not replicate the results of our prior pre-formation studies. Furthermore, either or both
of the animal PK and formulation development studies may fail to demonstrate that the Aramchol salts result in an improvement in
solubility and bioavailability. Any such failure may cause us to abandon the Aramchol salt compounds and may delay development
of other product candidates. If the animal PK studies do not support our claims, the completion of development of such potential
product candidates may be significantly delayed or abandoned, which will significantly impair our ability to generate revenues
and will materially adversely affect our results of operations.
There can be no assurance
that the U.S. Patent and Trademark Office (the “USPTOˮ), will issue any patents based on the patent applications that
we submitted to protect our Aramchol salts, nor, should the USPTO issue any patents to us with respect to the Aramchol salts, that
we will be provided with adequate protection against potentially competitive products. Furthermore, if the USPTO issues us one
or more patents for the Aramchol salts, there can be no assurance that the issued patents will be of any commercial value, or that
private parties or competitors will not successfully challenge these patents or circumvent these patents in the United States or
their counterparts abroad. In the absence of adequate patent protection, our business may be adversely affected by competitors
who develop comparable technology or products.
We may not be able
to enforce our intellectual property rights throughout the world. This risk is exacerbated for us because we expect Aramchol will
be manufactured and used in a number of foreign countries.
The laws of some foreign
countries do not protect intellectual property rights to the same extent as the laws of the United States. Many companies have
encountered significant problems in protecting and defending intellectual property rights in certain foreign jurisdictions. This
risk is exacerbated for us because we expect Aramchol will be manufactured and used in a number of foreign countries.
The legal systems of
some countries, particularly developing countries, do not favor the enforcement of patents and other intellectual property protection,
especially those relating to life sciences. This could make it difficult for us to stop the infringement of our other intellectual
property rights. For example, several foreign countries have compulsory licensing laws under which a patent owner must grant licenses
to third parties. In addition, some countries limit the enforceability of patents against third parties, including government agencies
or government contractors. In these countries, patents may provide limited or no benefit.
Although most jurisdictions
in which the Company has applied for, intends to apply for, or has been issued patents have patent protection laws similar to those
of the United States, some of them do not. For example, the Company expects to do business in South America, Eurasia, China and
Indochina in the future and the countries in these regions may not provide the same or similar protection as that provided in the
United States. Additionally, due to uncertainty in patent protection law, the Company has not filed applications in many countries
where significant markets exist, including South American countries, Eurasian countries, African countries and Taiwan.
Proceedings to enforce
our patent rights in foreign jurisdictions could result in substantial costs and divert our efforts and attention from other aspects
of our business. Accordingly, our efforts to protect our intellectual property rights in such countries may be inadequate. In addition,
changes in the law and legal decisions by courts in the United States and foreign countries may affect our ability to obtain adequate
protection for our technology and the enforcement of intellectual property.
We may be unable
to protect the intellectual property rights of third parties from whom we may license certain of our intellectual property or with
whom we have entered into other strategic relationships, which could have a material adverse effect on our business, results of
operations and financial condition.
Certain of our intellectual
property rights may be licensed from third parties, including universities and strategic partners. Such third parties may determine
not to or fail to protect the intellectual property rights that we license from them and we may be unable to defend such intellectual
property rights on our own or we may have to undertake costly litigation to defend the intellectual property rights of such third
parties. There can be no assurances that we will continue to have proprietary rights to any of the intellectual property that we
license from such third parties or otherwise have the right to use through similar strategic relationships. Any loss or limitations
on use with respect to such intellectual property licensed from third parties or otherwise obtained from third parties with whom
we have entered into strategic relationships could have a material adverse effect on our business, results of operations and financial
condition.
We may infringe
the intellectual property rights of others, which may prevent or delay
Aramchol or any future product candidate's
development
efforts and stop us from commercializing, or increase the costs of commercializing,
Aramchol or any future product candidates
.
Our commercial success
depends significantly on our ability to operate without infringing the patents and other intellectual property rights of third
parties. For example, there could be issued patents of which we are not aware that Aramchol infringe. There also could be patents
that we believe we do not infringe, but that we may ultimately be found to infringe. Moreover, patent applications are in some
cases maintained in secrecy until patents are issued. The publication of discoveries in the scientific or patent literature frequently
occurs substantially later than the date on which the underlying discoveries were made and patent applications were filed. Because
patents can take many years to issue, there may be currently pending applications of which we are unaware that may later result
in issued patents that Aramchol infringe. For example, pending applications may exist that provide support or can be amended to
provide support for a claim that results in an issued patent that Aramchol infringes.
Third parties may assert
that we are employing their proprietary technology without authorization. If a court held that any third-party patents are valid,
enforceable and cover Aramchol and any future product candidates or their use, the holders of any of these patents may be able
to block our ability to commercialize Aramchol and any future product candidates unless we obtained a license under the applicable
patents, or until the patents expire. In addition to litigation proceedings which may be filed against us, we may not be able to
enter into licensing arrangements or make other arrangements at a reasonable cost or on reasonable terms. Any inability to secure
licenses or alternative technology could result in delays in the introduction of Aramchol or any future product candidates or lead
to prohibition of the manufacture or sale of products by us.
We may be unable
to adequately prevent disclosure and unauthorized use of trade secrets and other proprietary information by third parties.
Our ability to obtain
and maintain patent protection and trade secret protection for our intellectual property and proprietary technologies, Aramchol
and any future product candidates and their uses is important to our commercial success. We rely on a combination of patent, copyright,
trademark and trade secret laws, non-disclosure and confidentiality agreements, licenses, assignment of inventions agreements and
other restrictions on disclosure and use to protect our intellectual property rights.
We also rely on trade
secrets to protect our proprietary know-how and technological advances, especially where we do not believe patent protection is
appropriate or obtainable. However, trade secrets are difficult to protect. We rely in part on confidentiality agreements with
our employees, consultants, outside scientific collaborators, sponsored researchers and other advisors to protect our trade secrets
and other proprietary information. These agreements may not effectively prevent disclosure of confidential information and may
not provide an adequate remedy in the event of unauthorized disclosure of confidential information. In addition, others may independently
discover our trade secrets and proprietary information. Costly and time-consuming litigation could be necessary to enforce and
determine the scope of our proprietary rights. Failure to obtain or maintain trade secret protection could enable competitors to
use our proprietary information to develop products that compete with Aramchol or any future product candidates or cause additional
material adverse effects upon our competitive business position.
We cannot be certain
that the steps that we have taken will prevent the misappropriation or other violation of our confidential information and other
intellectual property, particularly in foreign countries in which laws may not protect our proprietary rights as fully as in the
United States and other developed economies. Moreover, if we lose any key personnel, we may not be able to prevent the unauthorized
disclosure or use of our technical knowledge or other trade secrets by those former employees. If we are unable to maintain the
security of our proprietary technology, this could materially adversely affect our competitive advantage, business and results
of operations.
Under applicable
U.S. and Israeli law, we may not be able to enforce covenants not to compete and therefore may be unable to prevent our competitors
from benefiting from the expertise of some of our former employees. In addition, employees may be entitled to seek compensation
for their inventions irrespective of their agreements with us, which in turn could impact our future profitability.
We generally enter
into non-competition agreements with our employees and certain key consultants, or our employment and consulting agreements contain
non-competition provisions. These agreements, to the extent they are in place and in effect, prohibit our employees and certain
key consultants, if they cease working for us, from competing directly with us or working for our competitors or clients for a
limited period of time. We may be unable to enforce these agreements under the laws of the jurisdictions in which our employees
work and it may be difficult for us to restrict our competitors from benefitting from the expertise our former employees or consultants
developed while working for us. For example, Israeli courts have required employers seeking to enforce non-compete undertakings
of a former employee to demonstrate that the competitive activities of the former employee will harm one of a limited number of
material interests of the employer which have been recognized by the courts, such as the secrecy of a company’s confidential
commercial information or the protection of its intellectual property. If we cannot demonstrate that such interests will be harmed,
we may be unable to prevent our competitors from benefiting from the expertise of our former employees or consultants and our ability
to remain competitive may be diminished.
In addition, under
the Israeli Patent Law, 5727-1967 (the “Patent Lawˮ), inventions conceived by an employee in the course and as a result
of or arising from his or her employment with a company are regarded as “service inventions,” which belong to the employer,
absent a specific agreement between the employee and employer giving the employee service invention rights. The Patent Law also
provides that if there is no such agreement between an employer and an employee, the Israeli Compensation and Royalties Committee
(the “Committeeˮ), a body constituted under the Patent Law, shall determine whether the employee is entitled to remuneration
for his inventions. Recent case law clarifies that the right to receive consideration for “service inventions” can
be waived by the employee and that in certain circumstances, such waiver does not necessarily have to be explicit. The Committee
will examine, on a case-by-case basis, the general contractual framework between the parties, using interpretation rules of the
general Israeli contract laws. Further, the Committee has not yet determined one specific formula for calculating this remuneration
(but rather uses the criteria specified in the Patent Law). Although we generally enter into assignment-of-invention agreements
with our employees pursuant to which such individuals assign to us all rights to any inventions created in the scope of their employment
or engagement with us, we may face claims demanding remuneration in consideration for assigned inventions. As a consequence of
such claims, we could be required to pay additional remuneration or royalties to our current and former employees, or be forced
to litigate such claims, which could negatively affect our business.
Any lawsuits relating
to infringement of intellectual property rights necessary to defend ourselves or enforce our rights will be costly and time consuming.
We may be required
to initiate litigation to enforce our rights or defend our activities in response to alleged infringement of a third-party. In
addition, we may be sued by others who hold intellectual property rights and who claim that their rights are infringed by Aramchol
or any of our future products or product candidates. These lawsuits can be very time consuming and costly. There is a substantial
amount of litigation involving patent and other intellectual property rights in the biotechnology and pharmaceutical industries
generally.
A third-party may claim
that we are using inventions claimed by their patents and may go to court to stop us from engaging in our normal operations and
activities, such as research, development and the sale of any future products. Such lawsuits are expensive and would consume time
and other resources. There is a risk that such court will decide that we are infringing the third-party’s patents and will
order us to stop the activities claimed by the patents, redesign our products or processes to avoid infringement or obtain licenses,
which may not be available on commercially reasonable terms. In addition, there is a risk that a court will order us to pay the
other party damages for infringement.
Moreover, there is
no guarantee that any prevailing patent owner would offer us a license so that we could continue to engage in activities claimed
by the patent, or that such a license, if made available to us, could be acquired on commercially acceptable terms. In addition,
third parties may, in the future, assert other intellectual property infringement claims against us with respect to future product
candidates, technologies or other matters.
In addition, our patents
and patent applications could face challenges. Any of these challenges, if successful, could result in the invalidation of, or
in a narrowing of the scope of, any of our patents and patent applications subject to challenge. Any of these challenges, regardless
of their success, would likely be time consuming and expensive to defend and resolve and would divert our management’s time
and attention.
Changes in patent
law could diminish the value of patents in general, thereby impairing our ability to protect Aramchol or any future product candidates.
As is the case with
other pharmaceutical companies, our success is heavily dependent on intellectual property, particularly patents. Obtaining and
enforcing patents in the biopharmaceutical industry involve both technological and legal complexity. Therefore, obtaining and enforcing
pharmaceutical patents is costly, time-consuming and inherently uncertain. In particular, the United States has recently enacted,
and is currently implementing, wide-ranging patent reform legislation. The United States Supreme Court has ruled on several patent
cases in recent years, and could do so again in the future, either narrowing the scope of patent protection available in certain
circumstances or weakening the rights of patent owners in certain situations. In addition to increasing uncertainty with regard
to our ability to obtain patents in the future, this combination of events has created uncertainty with respect to the value of
patents, once obtained. Depending on decisions by applicable courts and legislatures in the countries in which we may pursue patent
protection, including those of the U.S. Congress, the federal courts and the USPTO, the laws and regulations governing patents
and the interpretations of such laws could change in unpredictable ways that would weaken our ability to obtain new patents or
to enforce our existing patents and patents that we might obtain in the future.
Obtaining and maintaining
our patent protection depends on compliance with various procedural, documentary, fee payment and other requirements imposed by
governmental patent agencies, and our patent protection could be reduced or eliminated for non-compliance with these requirements.
The USPTO and various
foreign governmental patent agencies require compliance with a number of procedural, documentary, fee payment and other provisions
during the patent process. There are situations in which noncompliance can result in abandonment or lapse of a patent or patent
application, resulting in partial or complete loss of patent rights in the relevant jurisdiction. In such an event, competitors
might be able to enter the market earlier than would otherwise have been the case.
Risks Related to
Ownership of Our Ordinary Shares
The market price
of our ordinary shares is volatile and you may sustain a complete loss of your investment.
Since our initial public
offering, the trading price of our ordinary shares has been volatile and is likely to continue to be volatile. In addition, the
trading volume is and has been volatile and oftentimes relatively illiquid. The following factors, some of which are beyond our
control, in addition to other risk factors described in this section, may have a significant impact on the market price and trading
volume of our ordinary shares:
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delays in existing clinical trials;
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inability to obtain the approvals necessary to commence further clinical trials;
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unsatisfactory or inconclusive results of clinical trials;
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termination of clinical trials;
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adverse events in our ongoing clinical trials;
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announcements of regulatory approval or the failure to obtain it, or specific label indications
or patient populations for its use, or changes or delays in the regulatory review process;
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announcements of therapeutic innovations or new products by us or our competitors;
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adverse actions taken by regulatory agencies with respect to our clinical trials, manufacturing
supply chain or sales and marketing activities;
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changes or developments in laws or regulations applicable to Aramchol;
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any adverse changes to our relationship with manufacturers or suppliers;
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any product liability actions or intellectual property infringement actions in which we may become
involved;
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announcements concerning our competitors or the pharmaceutical industry in general;
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achievement of expected product sales and profitability or our failure to meet expectations;
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our commencement of, or involvement in, litigation;
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any major changes in our board of directors (the “Boardˮ), management or other key personnel;
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legislation in the United States, Europe and other foreign countries relating to the sale or pricing
of pharmaceuticals;
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announcements by us of significant strategic partnerships, out-licensing, in-licensing, joint ventures,
acquisitions or capital commitments;
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expiration or terminations of licenses, research contracts or other collaboration agreements;
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public concern as to the safety of drugs we, our licensees or others develop;
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success of research and development projects;
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variations in our and our competitors’ results of operations;
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changes in earnings estimates, cash flow guidance, or recommendations by securities analysts;
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developments by our licensees, if any; and
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future issuances of ordinary shares or other securities.
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These factors and any
corresponding price fluctuations may materially and adversely affect the market price and trading volume of our ordinary shares
and result in substantial losses by our investors.
In addition, the stock
market in general, and the Nasdaq Capital Market and the market for biotechnology companies in particular, have experienced extreme
price and volume fluctuations that have often been unrelated or disproportionate to the operating performance of our Company and
that of small companies. Broad market and industry factors may negatively affect the market price of our ordinary shares, regardless
of our actual operating performance. Further, a systemic decline in the financial markets and related factors beyond our control
may cause our share price to decline rapidly and unexpectedly. Price volatility of our ordinary shares might be worse if the trading
volume of our ordinary shares is low. Following periods of market volatility or a material decrease in the value of our common
shares, shareholders may institute securities class action litigation. If we were involved in securities litigation, it could have
a substantial cost and divert resources and attention of management from our business, even if we are successful. Future sales
of our ordinary shares could also reduce the market price of such stock. Any adverse determination in litigation could also subject
us to significant liabilities.
Moreover, the liquidity
of our ordinary shares is limited, not only in terms of the number of shares that can be bought and sold at a given price, but
by delays in the timing of transactions and reduction in security analysts’ and the media’s coverage of us, if any.
These factors may result in lower prices for our ordinary shares than might otherwise be obtained and could also result in a larger
spread between the bid and ask prices for our ordinary shares. In addition, without a large float, our ordinary shares are less
liquid than the stock of companies with broader public ownership and, as a result, the trading prices of our ordinary shares are
more volatile. In the absence of an active public trading market, an investor may be unable to liquidate its investment in our
ordinary shares. Trading of a relatively small volume of our ordinary shares may have a greater impact on the trading price of
our stock than would be the case if our public float were larger. We cannot predict the prices at which our ordinary shares will
trade in the future.
Our ordinary shares
are listed on the Nasdaq Capital Market. As such, we must meet the Nasdaq Capital Market’s continued listing requirements
and other Nasdaq rules, or we may risk delisting. Delisting could negatively affect the price of our ordinary shares, which could
make it more difficult for us to sell securities in a financing and for you to sell your ordinary shares.
Our ordinary shares
are listed on the Nasdaq Capital Market. As such, we are required to meet the continued listing requirements of the Nasdaq Capital
Market and other Nasdaq rules, including those regarding director independence and independent committee requirements, minimum
shareholders’ equity, minimum share price and certain other corporate governance requirements. In particular, we are required
to maintain a minimum bid price for our listed ordinary shares of $1.00 per share. If we do not meet these continued listing requirements,
our ordinary shares could be delisted. Delisting of our ordinary shares from the Nasdaq Capital Market would cause us to pursue
eligibility for trading on other markets or exchanges, or on the pink sheets. In such case, our shareholders’ ability to
trade, or obtain quotations of the market value of, our ordinary shares would be severely limited because of lower trading volumes
and transaction delays. These factors could contribute to lower prices and larger spreads in the bid and ask prices for our securities.
There can be no assurance that our ordinary shares, if delisted from the Nasdaq Capital Market in the future, would be listed on
a national securities exchange, a national quotation service, the Over-The-Counter Markets or the pink sheets. Delisting from the
Nasdaq Capital Market, or even the issuance of a notice of potential delisting, would also result in negative publicity, make it
more difficult for us to raise additional capital, adversely affect the market liquidity of our ordinary shares, reduce security
analysts’ coverage of us and diminish investor, supplier and employee confidence. Additionally, the threat of delisting or
a delisting of our ordinary shares from the Nasdaq Capital Market, could reduce the number of investors willing to hold or acquire
our ordinary shares, thereby further restricting our ability to obtain equity financing, and it could reduce our ability to
retain, attract and motivate our directors, officers and employees. In addition, as a consequence of any such delisting, our share
price could be negatively affected and our shareholders would likely find it more difficult to sell, or to obtain accurate quotations
as to the prices of, our ordinary shares.
Our President and
Chief Executive Officer along with our Chairman of the Board, or our principal shareholders, currently beneficially own approximately
35.1% of our outstanding ordinary shares. Therefore, our principal shareholders will be able to exert significant control over
matters submitted to our shareholders for approval.
Our President and Chief
Executive Officer along with our Chairman of the Board, or our principal shareholders, currently beneficially own approximately
35.1% of our outstanding ordinary shares. Therefore, our principal shareholders will be able to exert significant control over
matters submitted to our shareholders for approval. As a result, these shareholders, if they acted together, could significantly
influence or even unilaterally approve matters requiring approval by our shareholders, including the election of directors and
the approval of mergers or other business combination transactions. The interests of these shareholders may not always coincide
with our interests or the interests of other shareholders. This significant concentration of share ownership may adversely affect
the trading price for our ordinary shares because investors often perceive disadvantages in owning stock in companies with controlling
shareholders.
Sales of a substantial
number of our ordinary shares in the public market could cause our share price to fall.
Sales of a substantial
number of our ordinary shares in the public market, or the perception that these sales might occur, could depress the market price
of our ordinary shares and could impair our ability to raise capital through the sale of additional equity securities. We are unable
to predict the effect that sales may have on the prevailing market price of our ordinary shares. Prior to the consummation of our
initial public offering and in accordance with the terms of the Tax Pre-Ruling, the holders of substantially all of our then-outstanding
approximately seven million ordinary shares and options agreed not to sell or dispose of our ordinary shares for a period of two
years following the consummation of the Reorganization, subject to certain exceptions. To date, the lock-up period has expired
and substantially all of our outstanding shares are eligible for unrestricted sale. Sales of shares by these shareholders would
likely result in the supply of our ordinary shares far exceeding the demand for our ordinary shares and could have a material adverse
effect on the trading price of our ordinary shares.
Raising additional
capital would cause dilution to our existing shareholders, and may restrict our operations or require us to relinquish rights.
We may seek additional
capital through a combination of private and public equity offerings, “at-the-market” issuances, equity-linked and
structured transactions, debt (straight, convertible, or otherwise) financings, collaborations and licensing arrangements. Under
our existing “at the market” equity offering program (the “ATM Offering”), as of December 31,
2017, we may sell, from time to time, up to approximately $29.0 million of additional ordinary shares. To the extent that we raise
additional capital through the sale of equity or convertible debt securities, your ownership interest will be diluted, and the
terms may include liquidation or other preferences that adversely affect your rights as a shareholder. Debt financing, if available,
would result in increased fixed payment obligations and may involve agreements that include covenants limiting or restricting our
ability to take specific actions such as incurring debt, making capital expenditures or declaring dividends. If we raise additional
funds through collaboration, strategic alliance and licensing arrangements with third parties, we may have to relinquish valuable
rights to our technologies, future revenue streams or product candidates, or grant licenses on terms that are not favorable to
us. Depending upon market liquidity at the time, additional sales of shares registered at any given time could cause the trading
price of our ordinary shares to decline.
Our U.S. shareholders
may suffer adverse tax consequences due to our classification as a passive foreign investment company).
Generally, if for any
taxable year 75% or more of our gross income is passive income, or at least 50% of our assets are held for the production of, or
produce, passive income, we would be characterized as a passive foreign investment company (“PFICˮ), for U.S. federal
income tax purposes. Based upon our review of our financial data, we believe that we were not a PFIC for our 2017 taxable year
and do not expect to be a PFIC for the 2018 taxable year. Because the PFIC determination is highly fact intensive, there can be
no assurance that we will not be a PFIC in 2018 or for any other taxable year. If we were to be characterized as a PFIC for U.S.
federal income tax purposes in any taxable year during which a U.S. Holder (as defined below) owns ordinary shares, such U.S. Holder
could face adverse U.S. federal income tax consequences. For example, such U.S. Holder could be subject to additional taxes and
interest charges upon certain distributions by us and any gain recognized on a sale, exchange or other disposition of our shares,
whether or not we continue to be characterized as a PFIC. One way in which certain of the adverse consequences of PFIC status can
be mitigated is for a U.S. Holder to make an election to treat us as a qualified electing fund (“QEFˮ). A shareholder
making the QEF election is required for each taxable year to include in income a pro rata share of the ordinary earnings and net
capital gain of the QEF, subject to a separate election to defer payment of taxes, which deferral is subject to an interest charge.
An election to treat us as a QEF will not be available if we do not provide the information necessary to make such an election.
It is not expected that a U.S. Holder will be able to make a QEF election because we do not intend to provide U.S. Holders with
the information necessary to make a QEF election. See also “Item 10. Additional Information—E. Taxation— Certain
U.S. Federal Income Tax Considerations.”
If we are unable
to satisfy the requirements of Section 404 as they apply to a foreign private issuer and emerging growth company, or our internal
controls over financial reporting are not effective, the reliability of our financial statements may be questioned and our share
price may suffer.
We became subject to
the requirements of the Sarbanes-Oxley Act when our ordinary shares were listed on the Nasdaq Capital Market. Section 404 requires
companies subject to the reporting requirements of the U.S. securities laws to do a comprehensive evaluation of its and its subsidiaries’
internal controls over financial reporting. To comply with this statute, we will be required to document and test our internal
control procedures and our management will be required to assess and issue a report concerning our internal controls over financial
reporting. Pursuant to the JOBS Act, we will be classified as an “emerging growth company.” Under the JOBS Act, emerging
growth companies are exempt from certain reporting requirements, including the auditor attestation requirements of Section 404(b)
of the Sarbanes-Oxley Act. Under this exemption, our auditor will not be required to attest to and report on management’s
assessment of our internal controls over financial reporting during a five year transition period. We will need to prepare for
compliance with Section 404 by strengthening, assessing and testing our system of internal controls to provide the basis for our
report. However, the continuous process of strengthening our internal controls and complying with Section 404 is complicated and
time-consuming. Furthermore, as our business continues to grow both domestically and internationally, our internal controls will
become more complex and will require significantly more resources and attention to ensure our internal controls remain effective
overall. During the course of its testing, our management may identify material weaknesses or significant deficiencies, which may
not be remedied in a timely manner to meet the deadline imposed by the Sarbanes-Oxley Act. If our management cannot favorably assess
the effectiveness of our internal controls over financial reporting, or our independent registered public accounting firm identifies
material weaknesses in our internal controls, investor confidence in our financial results may weaken, and the market price of
our securities may suffer. Nevertheless, as a foreign private issuer that is an emerging growth company, we are not required to
comply with the auditor attestation requirements of Section 404 for up to five fiscal years after the date of our initial public
offering. See “Item 5. Operating and Financial Review and Prospects—Jumpstart Our Business Startups Act of 2012”
for more detail regarding our status as an emerging growth company.
To date, our independent
public accountant has never conducted a review of our internal control for the purpose of providing the reports required by these
rules. During the course of our review and testing, we may identify deficiencies and be unable to remediate them before we must
provide the required reports. Furthermore, if we have a material weakness in our internal controls over financial reporting, we
may not detect errors on a timely basis and our financial statements may be materially misstated. We or our independent registered
public accounting firm may not be able to conclude on an ongoing basis that we have effective internal control over financial reporting,
which could harm our operating results, cause investors to lose confidence in our reported financial information and cause the
trading price of our stock to fall.
If the securities
analysts that currently cover our stock, or will do so in the future, or industry analysts do not publish or cease publishing research
or reports about us, our business or our market, or if they adversely change their recommendations or publish negative reports
regarding our business or our shares, our share price and trading volume could be negatively impacted.
The trading market
for our ordinary shares is influenced by the research and reports that industry or securities analysts may publish about us, our
business, our market or our competitors. We do not have any control over these analysts and we cannot provide any assurance that
analysts will cover us or provide favorable coverage. If any of the analysts who do cover, or may cover us in the future, adversely
change their recommendation regarding our shares, or provide more favorable relative recommendations about our competitors, our
share price would likely decline. If any analyst who cover us to cease coverage of our company or fail to regularly publish reports
on us, we could lose visibility in the financial markets, which in turn could negatively impact our share price or trading volume.
Because we do not
intend to declare cash dividends on our ordinary shares in the foreseeable future, shareholders must rely on appreciation of the
value of our ordinary shares for any return on their investment.
We have never declared
or paid cash dividends on our ordinary shares. We currently anticipate that we will retain future earnings for the development,
operation and expansion of our business and do not anticipate declaring or paying any cash dividends in the foreseeable future.
Moreover, the Israeli Companies Law, 5759-1999, as amended (the “Companies Lawˮ), imposes certain restrictions on our
ability to declare and pay dividends. See “Item 8. Financial Information—Consolidated Financial Statements and Other
Financial Information—Dividend Policy” for additional information.
The requirements
associated with being a public company require significant company resources and management attention.
We are subject to the
reporting requirements of the Securities Exchange Act of 1934 (the “Exchange Actˮ), the Sarbanes-Oxley Act, the listing
requirements of the Nasdaq Capital Market, on which our ordinary shares are traded, and other applicable securities rules and regulations.
The Exchange Act requires that we file periodic reports with respect to our business and financial condition and maintain effective
disclosure controls and procedures and internal control over financial reporting. In addition, subsequent rules implemented by
the SEC and the Nasdaq Capital Market may also impose various additional requirements on public companies. As a result, we incurred
and will continue to incur additional legal, accounting and other expenses that we did not incur as a privately-held company, particularly
after we are no longer considered an “emerging growth company” as defined in the JOBS Act. Further, the need to establish
the corporate infrastructure demanded of a public company may divert management’s attention from implementing our development
plans. We have made and will continue to make changes to our corporate governance standards, compensation policy, disclosure controls
and financial reporting and accounting systems to meet our reporting obligations and applicable law. The measures we take, however,
may not be sufficient to satisfy our obligations as a public company, which could subject us to delisting of our ordinary shares,
fines, sanctions and other regulatory action and potentially civil litigation.
The JOBS Act will
allow us to postpone the date by which we must comply with some of the laws and regulations intended to protect investors and to
reduce the amount of information we provide in our reports filed with the SEC, which could undermine investor confidence in our
company and adversely affect the market price of our ordinary shares.
For so long as we remain
an “emerging growth company” as defined in the JOBS Act, we intend to take advantage of certain exemptions from various
requirements that are applicable to public companies that are not “emerging growth companies” including:
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the provisions of the Sarbanes-Oxley Act requiring that our independent registered public accounting
firm provide an attestation report on the effectiveness of our internal control over financial reporting;
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the “say on pay” provisions of the Dodd-Frank Wall Street Reform and Consumer Protection
Act of 2010 (the “Dodd-Frank Actˮ), requiring a non-binding shareholder vote to approve compensation of certain executive
officers, and the Dodd-Frank Act’s “say on golden parachute” provisions requiring a non-binding shareholder vote
to approve golden parachute arrangements for certain executive officers in connection with mergers and certain other business combinations
and some of the disclosure requirements of the Dodd-Frank Act relating to compensation of our President and Chief Executive Officer;
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any rules that may be adopted by the Public Company Accounting Oversight Board (the “PCAOBˮ),
requiring mandatory audit firm rotation or a supplement to the auditor’s report on the financial statements; and
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our ability to furnish two rather than three years of income statements and statements of cash
flows in various required filings.
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We cannot predict if
investors will find our ordinary shares less attractive because we may rely on these exemptions. If some investors find our ordinary
shares less attractive as a result, there may be a less active trading market for our ordinary shares, and our share price may
become more volatile and decline.
As a “foreign
private issuer,” we are permitted to and currently do follow certain home country corporate governance practices instead
of otherwise applicable SEC and Nasdaq Capital Market requirements, which may result in less protection than is accorded to investors
under rules applicable to domestic U.S. issuers.
As a “foreign
private issuer,” we are permitted to, and currently do, follow certain home country corporate governance practices instead
of those otherwise required under the Listing Rules of the Nasdaq Capital Market (the “Nasdaq Listing Rulesˮ), for domestic
U.S. issuers. For instance, we currently follow home country practice in Israel with regard to, among other things, director nomination
procedure and approval of compensation of officers. In addition, we may follow our home country law instead of the Nasdaq Listing
Rules that require that we obtain shareholder approval for certain dilutive events, such as the establishment or amendment of certain
equity based compensation plans, an issuance that will result in a change of control of the company, certain transactions other
than a public offering involving issuances of a 20% or greater interest in the company, and certain acquisitions of the stock or
assets of another company. Following our home country governance practices as opposed to the requirements that would otherwise
apply to a U.S. company listed on the Nasdaq Capital Market may provide less protection to you than what is accorded to investors
under the Nasdaq Listing Rules applicable to domestic U.S. issuers. See “Item 16G. Corporate Governance.”
In addition, as a “foreign
private issuer,” we are exempt from the rules and regulations under the Exchange Act related to the furnishing and content
of proxy statements and certain individual executive compensation information, and our officers, directors and principal shareholders
are exempt from the reporting and short-swing profit recovery provisions contained in Section 16 of the Exchange Act. Furthermore,
as a “foreign private issuer,” we are also not subject to the requirements of Regulation FD (Fair Disclosure) promulgated
under the Exchange Act. These exemptions and leniencies reduce the frequency and scope of information and protections to which
you are entitled as an investor.
Because our ordinary
shares may be a “penny stock,” it may be more difficult for investors to sell their ordinary shares, and the market
price of our ordinary shares may be adversely affected.
Our ordinary shares
may be a “penny stock” if, among other things, the share price is below $5.00 per share, we are not listed on a national
securities exchange or we have not met certain net tangible asset or average revenue requirements. Broker-dealers who sell penny
stocks must provide purchasers of these stocks with a standardized risk-disclosure document prepared by the SEC. This document
provides information about penny stocks and the nature and level of risks involved in investing in the penny-stock market. A broker
must also give a purchaser, orally or in writing, bid and offer quotations and information regarding broker and salesperson compensation,
make a written determination that the penny stock is a suitable investment for the purchaser, and obtain the purchaser’s
written agreement to the purchase. Broker-dealers must also provide customers that hold penny stock in their accounts with such
broker-dealer a monthly statement containing price and market information relating to the penny stock. If a penny stock is sold
to an investor in violation of the penny stock rules, the investor may be able to cancel its purchase and get its money back.
If applicable, the
penny stock rules may make it difficult for investors to sell their ordinary shares. Because of the rules and restrictions applicable
to a penny stock, there is less trading in penny stocks and the market price of our ordinary shares may be adversely affected.
Also, many brokers choose not to participate in penny stock transactions. Accordingly, investors may not always be able to resell
their ordinary shares publicly at times and prices that they feel are appropriate and the market price of our ordinary shares may
be adversely affected.
Risks Related to
Israeli Law and Our Operations in Israel
Our headquarters
and other significant operations are located in Israel and, therefore, our results may be adversely affected by political, economic
and military instability in Israel.
Our executive offices
are located in Tel Aviv, Israel. In addition, the majority of our officers and directors are residents of Israel. Accordingly,
political, economic and military conditions in Israel may directly affect our business. Since the establishment of the State of
Israel in 1948, a number of armed conflicts have taken place between Israel and its neighboring countries. Any hostilities involving
Israel or the interruption or curtailment of trade between Israel and its trading partners could adversely affect our operations
and results of operations. In recent years, these have included hostilities between Israel and Hezbollah in Lebanon and Hamas in
the Gaza strip, both of which resulted in rockets being fired into Israel, causing casualties and disruption of economic activities.
In addition, Israel faces threats from more distant neighbors, in particular, Iran.
Since February 2011,
riots and uprisings in several countries in the Middle East and neighboring regions have led to severe political instability in
several neighboring states and to a decline in the regional security situation. Such instability may affect the local and global
economy, could negatively affect business conditions and, therefore, could adversely affect our operations. To date, these matters
have not had any material effect on our business and results of operations; however, the regional security situation and worldwide
perceptions of it are outside our control, and there can be no assurance that these matters will not negatively affect us in the
future. In addition, the political and security situation in Israel may result in parties with whom we have agreements involving
performance in Israel claiming that they are not obligated to perform their commitments under those agreements pursuant to force
majeure provisions in such agreements.
Our commercial insurance
does not cover losses that may occur as a result of an event associated with the security situation in the Middle East. Although
the Israeli government is currently committed to covering the reinstatement value of direct damages that are caused by terrorist
attacks or acts of war, we cannot assure you that this government coverage will be maintained, or if maintained, will be sufficient
to compensate us fully for damages incurred. Any losses or damages incurred by us could have a material adverse effect on our business.
Any armed conflicts or political instability in the region would likely negatively affect business conditions generally and could
harm our results of operations.
Further, in the past,
the State of Israel and Israeli companies have been subjects of economic boycotts. Several countries still restrict business with
the State of Israel and with Israeli companies. These restrictive laws and policies may have an adverse impact on our operating
results, financial condition or the expansion of our business.
Our operations
may be disrupted as a result of the obligation of Israeli citizens to perform military service.
Many Israeli citizens
are obligated to perform several days, and in some cases more, of annual military reserve duty until they reach the age of 40 (or
older, for reservists who are officers or who have certain occupations) and, in the event of a military conflict, may be called
to active duty. In response to increases in terrorist activity, there have been periods of significant call-ups of military reservists.
It is possible that there will be military reserve duty call-ups in the future. Our operations could be disrupted by such call-
ups, which may include the call-up of our employees or the employees of our Israeli business partners. Such disruption could materially
adversely affect our business, financial condition and results of operations.
Exchange rate fluctuations
between the U.S. dollar, Euro and the New Israeli Shekel currencies may negatively affect our earnings.
Our functional currency
is the U.S. dollar. We incur expenses in U.S. dollars, Euros and New Israeli Shekels (“NISˮ). As a result, we are exposed
to the risks that the Euro and the NIS may appreciate relative to the U.S. dollar, or, if either the Euro and the NIS devalue relative
to the U.S. dollar, that the inflation rate in the EU and in Israel may exceed such rate of devaluation of the Euro and the NIS,
or that the timing of such devaluation may lag behind inflation in the EU and in Israel. In any such event, the U.S. dollar cost
of our operations in the EU and in Israel would increase and our U.S. dollar-denominated results of operations would be adversely
affected. The average exchange rate for the year ended December 31, 2017 was $1.00 = Euro 0.89 and $1.00 = NIS 3.6. We cannot predict
any future trends in the rate of inflation in the EU and in Israel or the rate of devaluation, if any, of either the Euro or the
NIS against the U.S. dollar. As of the date hereof, neither the inflation rate in the EU nor in Israel has exceeded the rate of
devaluation of the Euro or the NIS, respectively, during the calendar years, 2014, 2015, 2016 or 2017.
Provisions of Israeli
law and our articles of association (
“
Articlesˮ), may delay, prevent or otherwise impede a merger with, or an
acquisition of, our company, which could prevent a change of control, even when the terms of such a transaction are favorable to
us and our shareholders.
The Companies Law regulates,
among others, mergers, requires tender offers for acquisitions of shares above specified thresholds, requires special approvals
for transactions involving directors, officers or significant shareholders and regulates other matters that may be relevant to
such types of transactions. See “Item 10. Additional Information—B. —Mergers and Acquisitions under Israeli Law”
for additional information.
Furthermore, Israeli
tax considerations may make potential transactions unappealing to us or to our shareholders whose country of residence does not
have a tax treaty with Israel exempting such shareholders from Israeli tax. See “Item 10. Additional Information—E.
Taxation—Certain Israeli Tax Considerations” for additional information.
Moreover, the classification
of our Board into three classes with terms of approximately three years each, per our Articles, the requirement of affirmative
vote of at least 75% of the voting rights represented personally or by proxy and voting thereon at a general meeting in order to
amend or replace our Articles and the requirement under the Companies Law to have at least two external directors who cannot readily
be removed from office, together with the other provisions of the Articles and Israeli law, could deter or delay potential future
merger, acquisition, tender or takeover offers, proxy contests or changes in control or management of the Company.
It may be difficult
to enforce a judgment of a United States court against us, our officers, directors and the Israeli experts named in this annual
report in Israel or the United States, to assert United States securities laws claims in Israel or to serve process on our officers,
directors and these experts.
We were and continue
to be organized in Israel. Substantially all of our executive officers and directors reside outside of the United States, and all
of our assets and most of the assets of these persons are located outside of the United States. Therefore, a judgment obtained
against us, or any of these persons, including a judgment based on the civil liability provisions of the U.S. federal securities
laws, may not be collectible in the United States and may not necessarily be enforced by an Israeli court. It also may be difficult
to effect service of process on these persons in the United States or to assert U.S. securities law claims in original actions
instituted in Israel. Additionally, it may be difficult for an investor, or any other person or entity, to initiate an action with
respect to United States securities laws in Israel. Israeli courts may refuse to hear a claim based on an alleged violation of
United States securities laws reasoning that Israel is not the most appropriate forum in which to bring such a claim. In addition,
even if an Israeli court agrees to hear a claim, it may determine that Israeli law and not United States law is applicable to the
claim. If United States law is found to be applicable, the content of applicable United States law must be proven as a fact by
expert witnesses, which can be a time consuming and costly process. Certain matters of procedure will also be governed by Israeli
law. There is little binding case law in Israel that addresses the matters described above. As a result of the difficulty associated
with enforcing a judgment against us in Israel, our shareholders may not be able to collect any damages awarded by either a United
States or foreign court.
Your rights, liabilities
and responsibilities as a shareholder will be governed by Israeli law and differ in some material respects from those under U.S.
law.
Because we are an Israeli
company, the rights and responsibilities of our shareholders are governed by our Articles and Israeli law. These rights, liabilities
and responsibilities differ in some material respects from the rights, liabilities and responsibilities of shareholders in a U.S.
corporation. In particular, a shareholder of an Israeli company has a duty to act in good faith towards the company and other shareholders
and to refrain from abusing his, her or its power in the company, including, among other things, when voting at the general meeting
of shareholders on certain matters. Israeli law provides that these duties are applicable to shareholder votes on, among other
things, amendments to a company’s articles of association, increases in a company’s authorized share capital, mergers
and interested party transactions requiring shareholder approval. In addition, a controlling shareholder, a shareholder who knows
that it possesses the power to determine the outcome of a shareholders’ vote or a shareholder who has the power to appoint
or prevent the appointment of a director or executive officer in the company, has a duty of fairness towards the company. However,
Israeli law does not define the substance of this duty of fairness. There is little case law available to assist in understanding
the implications of these provisions that govern shareholder behavior. These provisions may be interpreted to impose additional
obligations and liabilities on holders of our ordinary shares that are not typically imposed on shareholders of U.S. corporations.
See “Item 10. Additional Information—B Memorandum and Articles of Association—Shareholder Duties” for additional
information
Any of the risk
factors referred to above could significantly and negatively affect our business, results of operations or financial condition,
which may reduce our ability to pay dividends and lower the trading price of our ordinary shares. The risks referred to above are
not the only ones that may exist. Additional risks not currently known by us or that we deem immaterial may also impair our business
operations.
ITEM 4. Information on the Company.
|
A.
|
Historical
Background and Corporate Structure
|
Our Company, Galmed
Pharmaceuticals Ltd., was incorporated in Israel on July 31, 2013 as a privately held company and is governed by the Companies
Law. However, our business has been operating since 2000 under a different group of companies established in the same year (the
“Groupˮ). Originally, we operated under the parent company, GHI. GHI held all of the equity rights in and to GTTI. GTTI
held all of the equity rights in and to GIL (other than 0.1% of the share capital held by GHI). GIL held all of the equity rights
in and to GMR. Our intellectual property was held by GIL. The research and development was conducted by GMR as a service to GIL
on a cost plus basis. GIL was responsible for all product development.
On February 2, 2014,
we underwent the Reorganization, pursuant to which all of our intangible assets (including our intellectual property) were transferred
from GIL to GRD. The Reorganization was effectuated by share transfers and asset transfers, resulting in the Company as the parent
company and 100% equity-owner of the following companies: (1) GRD, which holds all the Group’s intellectual property, including
the Company’s patent portfolio; (2) GIL, which is an inactive company; and (3) GTTI, which was liquidated in 2017. GIL holds
GMR, which became an inactive company in 2015. The Reorganization was conducted in order to simplify our capital structure, reduce
our operating cost and to improve our ability to raise funds. Immediately prior to the Reorganization, all our shareholders collectively
held 9,739 ordinary shares of GHI. In connection with the Reorganization, and in accordance with the Tax Pre-Ruling, we issued
to all such shareholders ordinary shares of the Company, such that upon the Reorganization all our shareholders collectively held
7,099,731 ordinary shares of the Company, in the same proportion among all shareholders, which reflected a ratio of 729 ordinary
shares of the Company for each ordinary share of GHI.
The following is a diagram
of our corporate structure (following GTTI's liquidation):
On March 18, 2014,
we completed our initial public offering and since then have been listed on the Nasdaq Capital Market under the symbol “GLMD”.
Our principal executive
offices and registered office in Israel are located at 16 Tiomkin Street, Tel Aviv, Israel, 6578317 and our telephone number is
+972-3-693-8448. Our website address is http://www.galmedpharma.com. The information contained on, or that can be accessed through,
our website is neither a part of nor incorporated into this annual report. We have included our website address in this annual
report solely as an inactive textual reference. Puglisi & Associates (“Puglisiˮ), serves as our authorized representative
in the United States for matters concerning our IPO, our registration statement filing on Form S-8, our Form F-3, 2016 Agreement
and the Sales Agreement. Puglisi’s address is 850 Library Avenue, Newark, Delaware 19711.
We use our website
(
http://www.galmedpharma.com
)
as a channel of distribution of Company information. The information we post through this channel may be deemed material. Accordingly,
investors should monitor our website, in addition to following our press releases, SEC filings and public conference calls and
webcasts. The contents of our website are not, however, a part of this annual report.
Other than as described
in “Item 5. Operating and Financial Review and Prospects—Contractual Obligations”, we have not had any material
commitments for capital expenditures, including any anticipated material acquisition of plant and equipment or interests in other
companies, since January 1, 2014. Additionally, we have not had any material capital divestitures since January 1, 2014.
We are a clinical-stage
biopharmaceutical company focused on the development of the liver targeted stearoyl-coenzyme A desaturase-1 (“SCD1ˮ) modulator Aramchol, a first in class, novel, once-daily,
oral therapy for the treatment of NASH for variable populations, as well as other liver associated disorders. We believe that our
product candidate, Aramchol, has the potential to be a disease modifying treatment for fatty liver disorders, including NASH, which
is a chronic disease that constitutes a large unmet medical need.
Aramchol is a synthetic
conjugate of cholic acid, or a type of bile acid, and arachidic acid, or a type of saturated fatty acid, both of which, in their
non-synthetic forms, are naturally occurring. The conjugated molecule acts upon important metabolic pathways, reducing fat accumulation
in the liver, improving fatty acid oxidation and regulating the transport of cholesterol. The ability of Aramchol to decrease liver
fat content may also reduce the inflammation and fibrosis in the liver and the risk of cardiovascular complications associated
with NASH. Pre-clinical studies suggest Aramchol effect on fibrosis is also direct via collagen production from human hepatic stellate
cells. We believe that Aramchol’s ability to reduce liver fat and liver fibrosis and the safety profile observed to date
will enable it to be a safe and effective treatment for all stages of NASH in patients who are overweight or obese and have pre
diabetes or type II diabetes mellitus and prevent the hepatic complications associated therewith.
On February 1, 2015,
we began our ARREST Study, a multi-center, randomized, double-blind, placebo-controlled, dose-ranging Phase IIb clinical trial
of Aramchol, in 247 patients who are overweight or obese and have pre diabetes or type II diabetes mellitus and who have been biopsy-diagnosed
as having NASH. We have initiated this study in Israel, Europe, Latin America, China and the United States (pursuant to an IND
authorized by FDA). Our ARREST Study for Aramchol in OD NASH patients is in accordance with the study design recommended by the
Medicines and Healthcare Products Regulatory Agency (“MHRAˮ), and has been deemed acceptable by Bundesinstitut für
Arzneimittel und Medizinprodukte, a German medical agency (“BfArMˮ), and deemed satisfactory by Agence nationale de
sécurité du médicament, a French medical agency (“ANSMˮ). The BfArM and ANSM also confirmed, in
minutes of each of their respective scientific advisory meetings, that if successful, the ARREST Study may serve as a basis for
Phase III pivotal trials of Aramchol. The FDA and MHRA invited us to discuss the next steps in the development of Aramchol after
we analyze the results of the ARREST Study. If the Phase III trial(s) are successful, we intend to submit an NDA to the FDA and
an MAA to the EMA for the approval of Aramchol for the treatment of NASH in the United States and Europe. More information about
the ARREST Study may be found on ClinicalTrials.gov identifier: NCT02279524.
Originally, we intended
to perform a ‘futility analysis’ as part of the ‘interim analysis.’ The futility analysis would have reviewed
the data both for safety signals and determined whether subjects receiving Aramchol showed an observable reduction in liver fat
concentration, as measured by MRS. The independent DSMB would have then made a “go/no go” decision based on the MRS
data at six months. The absence of significant MRS-related results at the six month point could have resulted in the termination
of the study based on the absence of clinical benefit in the interim review and was therefore considered a futility analysis.
However, in light of
the FDA and AASLD clinical guidance for the development of diagnostic and therapeutic modalities for the treatment of NASH published
in early 2015, it has become increasingly clear that histological data (liver biopsy) will be absolutely required to seek regulatory
approval for NASH drugs, not merely MRS data. This conclusion was further supported by two Phase III protocols (the REGENERATE
Study, NCT02548351, and RESOLVE-IT study- NCT 02704403), which also require fibrosis improvement or resolution of NASH as measured
by histological data. As such, the entire twelve month dataset will be necessary to judge the viability of Aramchol, and potential
further development thereof.
Thus, the scope of
the interim analysis we conducted after 120 patients in our ARREST Study completed six months of treatment was limited to analysis
of safety related signals only, conducted by the DSMB. The interim analysis does not include review of the data with respect to
any efficacy endpoints. On February 8, 2017, the DSMB met in order to review the accumulated safety data in accordance with a protocol
defined safety interim review and has met periodically thereafter. Following its review of the data, the DSMB recommended continuation
of the ARREST Study without changes. The last DSMB meeting to date occurred on December 6, 2017 and the DSMB recommended continuation
of the study without changes.
We have completed
randomization into the ARREST Study with 247 randomized patients. Baseline histology of patients enrolled into the ARREST study
demonstrates a population with advanced disease, with 60% having stage 2 and 3 fibrosis at baseline and 70% have NAS
>
5
. Top line data from the ARREST Study are expected to be available during June 2018.
Non-Alcoholic Fatty
Liver Disease (NAFLD) / Non-Alcoholic Steato-Hepatitis (NASH)
It is estimated that
the global prevalence of Non-Alcoholic Fatty Liver Disease (NAFLD), the precondition to NASH, is approximately 25% in the general
population and much higher in certain high risk groups. This disease is also now recognized as one of the most common liver disorders,
and a significant growing public health problem. In the US alone, 80-100 million people are said to be affected by NAFLD, and its
prevalence is rapidly growing in parallel with metabolic syndromes, particularly obesity and diabetes.
NAFLD is characterized
by the accumulation of fat of 5% or greater in the liver of people who drink alcohol only in moderation, or not at all. There may
be numerous causes of NAFLD, however, the disease is mostly associated with a high fat, fructose-rich diet. Although NAFLD is generally
asymptomatic, it is a major risk factor for liver inflammation (NASH) and scarring (fibrosis and cirrhosis). In addition, NAFLD
is also associated with metabolic syndrome and cardiovascular disease. Currently, NAFLD can only be managed through lifestyle improvements,
such as weight reduction and physical activity.
NASH is an emerging
world crisis impacting an estimated 3% to 5% of the U.S. population and an estimated 2% to 4% globally, and is associated with
increased risk of liver cirrhosis, liver failure, hepatocellular cancer, as well as metabolic and cardiovascular diseases. The
major characteristics of NASH are elevated liver fat, inflammation, ballooning and fibrosis.
However, despite the
growing need, there are currently no approved therapeutic treatments for NASH. Modification of risk factors, such as obesity and
hyperlipidemia, and proper diabetic control is generally recommended for the treatment of NASH, and the standard of care includes
lifestyle changes to promote weight loss, including low-calorie, low-fat diets and physical activity. Although weight loss can
be potentially significant in delaying the progression of NASH, studies have shown that, for most individuals, it is generally
very difficult to maintain over the long-term, even following bariatric surgery.
There are currently
no drugs approved by regulatory authorities for the treatment of NASH. Even though certain drugs, such as insulin sensitizers and
antihyperlipidemic agents, are prescribed for some NASH patients, they are not approved for the treatment of NASH and their efficacy
has not been proven in adequate and well-controlled clinical studies.
Currently, it is impossible
to predict which of the NAFLD patients will deteriorate to NASH as it is unclear what causes NASH to develop. Researchers are now
focusing on several factors that may contribute to the development of NASH. Therefore lifestyle changes are recommended for all
patients with NAFLD.
In 2015, the FDA and
AASLD issued clinical guidance for the development of diagnostic and therapeutic modalities for the treatment of NASH based on
the joint workshop held on September 5-6, 2013. The guidance serves as a broad framework for discussions with different companies
and the requirements for pivotal studies for receiving regulatory approval are decided case-by-case depending on the products profile
and previous studies results. The current regulatory path may be inferred from the ongoing pivotal studies. To date, there are
several pivotal studies in NASH that are ongoing. These studies include a histology based interim after 48 or 72 weeks of treatment
which is intended for marketing approval while the study continues to a clinical end-point. The end-points in these studies are
either NASH resolution or fibrosis improvement.
There is an exceptionally
wide range of estimates regarding the potential commercial market for NASH. This uncertainty stems from (i) the overall size of
the patient population, (ii) the percentage of the addressable market that will be diagnosed and, subsequently, seek treatment,
(iii) the ultimate cost of the therapies, (iv) the number of approved drugs for NASH and their profile. Some of these factors cannot
be known until NASH drugs begin to hit the market, which based on analysts’ estimates, will likely be 2020 at the earliest
or biomarkers replacing the biopsy diagnosis are validated. Independent estimates generally estimate a commercial multi billion
market in developed countries, though we do not endorse any estimates, which are based on a number of different underlying assumptions.
Aramchol for NASH
Overview
Our product candidate,
Aramchol, is a first-in-class synthetic FABAC which we are developing for once-daily oral treatment for NASH in patients who are
overweight or obese and have prediabetes or type II diabetes mellitus.
Early in its development,
Aramchol’s ability to modulate hepatic lipid metabolism was observed and validated in numerous pre-clinical trials with different
animal species. Mice fed a high fat diet and treated with Aramchol did not develop fatty liver as compared to non-treated mice.
In these early studies, we also observed that the mechanism of this effect was not a result of malabsorption of fat in the intestines
because the FABAC-treated mice gained weight throughout the test periods to a similar degree to the control mice. This led us to
conclude that FABAC therapy triggers a beneficial modulation of intra-hepatic lipid metabolism and reduces liver fat content.
In
in-vitro
and in vivo studies, Aramchol down regulates the SCD1 enzyme, an enzyme recognized
as playing an important role in the metabolism of fatty acids. The SCD1 enzyme is essentially the gateway that regulates the use
and storage of fat in the body by converting saturated fatty acids to monounsaturated fatty acids. Experimental animal studies
showed that complete inhibition of the SCD1 enzyme protects against diet-induced obesity, hepatic steatosis, or fatty liver, and
insulin resistance by instructing the body to use, rather than store, all fatty acids. However, various animal studies have indicated
that such complete SCD1 enzyme inhibition has mechanism based serious side effects, such as atherosclerosis, and eye and skin disorders.
As observed by us in our pre-clinical and clinical
studies performed to date, and subsequently
published in the European Journal of Gastroenterology and Hepatology and Archives of Medical Research in 2008 and 2010 respectively,
one of Aramchol’s unique characteristics is that it down regulates the SCD1 enzyme but does not inhibit it completely –
a partial effect. To date, side effects that have been observed in animals with knock out of SCD1 have not been observed in our
toxicology and clinical studies.
Aramchol also has
the ability to up-regulate ABCA1 and thereby induce “reverse cholesterol transport” in animal models. ABCA1 is an ATP-binding
cassette transporter, also known as the cholesterol efflux regulatory protein (CERP), which is a regulator of cellular cholesterol and phospholipid homeostasis.
In every cell of the body, the LDL receptor enables entry of cholesterol into the cell and the ABCA1 transporter pumps cholesterol
out of the cell, where it is carried by high-density lipoprotein (“HDLˮ), to the liver to be excreted into the intestine.
This pathway of cholesterol from the cell to the liver is called reverse cholesterol transport and is essential for maintaining
cholesterol balance in the body. Excess LDL, or “bad,” cholesterol is deposited mainly in vascular walls, causing atherosclerosis,
a vascular disease in which an artery wall thickens as a result of the accumulation of calcium and fatty materials, such as cholesterol.
Activation of reverse cholesterol transport potentially reduces the bad cholesterol deposited in vascular walls and is therefore
beneficial. As published in the Biochemical Journal, the Archives of Medical Research and the Current Opinion in Lipidology in
2006, 2010 and 2014, respectively, in several experimental models in animals, Aramchol has been shown in independent studies to
increase ABCA1 activity by between 300% and 400%, thereby stimulating reverse cholesterol transport, reducing cholesterol levels
and preventing atherosclerosis. An article in the April 2014 issue of Biochimie further supports the importance of the regulation
of ABCA1-induced reverse cholesterol transport on the pathogenesis of NASH. Furthermore, in our recent non-clinical trials we identified
a unique mechanism of Aramchol by which it up regulates the glutathione levels, thereby facilitating an improved fatty liver oxidation
and reduction of reactive oxygen species (“ROS”) to better preserve normal redox homeostasis.
To better understand the role of Aramchol in NASH, we analyzed the effect of Aramchol in MCD diet model.
The aim of this study was to investigate Aramchol’s
mechanism of action and its effect on fibrosis using the methionine- and choline-deficient (MCD) diet model of NASH. We collected
liver and serum from mice fed a MCD diet containing 0.1% methionine (0.1MCD) for four weeks, which developed steatohepatitis and
fibrosis, as well as mice receiving a control diet; the metabolomes and proteomes were determined. 0.1MCD fed mice were given Aramchol
(5mg/kg/day for the last 2 weeks); liver samples were analyzed histologically. Aramchol administration was found to reduce features
of steatohepatitis and fibrosis in 0.1MCD fed mice. Aramchol downregulated the SCD1 enzyme, a key enzyme involved in triglyceride
biosynthesis whose loss enhances fatty acid β-oxidation. In addition, Aramchol increased the flux through the transsulfuration
pathway, leading to a rise in glutathione (GSH) and GSH/GSSG ratio, the main cellular antioxidant that maintains intracellular
redox status. Comparison of the serum metabolomic pattern between 0.1MCD-fed mice and patients with NAFLD showed a substantial
overlap. These findings were published in Hepatology Communications, Vol. 1, No. 9, 2017.
As the effect of Aramchol
on fibrosis was first reported we further analyzed the direct effect of Aramchol on collagen production and reported down regulation
of collagen production from the hepatic stellate cells (HSCs) by Aramchol. With that we could conclude that Aramchol has potential
direct effect on collagen production and therefore reduces fibrosis indirectly by down regulation of steatosis by reducing the
sequence of events but also directly affecting collagen producing cells. These findings were published in Hepatology Communications,
Vol. 1, No. 9, 2017.
These findings led us to further analyze the effect of Aramchol using the Thiocatemide (TAA) rat model.
TAA is the most commonly used toxic agents to induce liver fibrosis. Repeated IP injections of TAA leads to sever fibrosis / cirrhosis.
Among all models for fibrosis, the TAA model
share multiple
characteristics with human liver fibrosis and is considered to best predict efficacy in humans. Results demonstrated that treatment
with Aramchol 5mg/kg, significantly prevented TAA induced fibrosis in a dose dependent manner. These findings were presented at
EASL, Amsterdam in April 2017 (The anti Fibrotic effect of Aramchol on liver Fibrosis in TAA animal model).
Phase I Single and Multiple-Dose
Study of Aramchol in Healthy Male Volunteers (NCT00776841)
Aramchol was evaluated
in two Phase I clinical trials (under a single protocol) to study its safety, tolerability and PK profile in healthy volunteers,
in both single and multiple dose administrations. The first Phase I clinical trial was an escalating single-dose trial conducted
in 17 healthy subjects testing Aramchol doses ranging from 30 mg to 900 mg, performed in one center in Israel. The subsequent Phase
I clinical trial was a repeated-dose trial conducted over four days in 25 healthy subjects testing repeated daily doses of Aramchol
of 30 mg and 300 mg, performed in one center in Israel. The profiles for the groups were similar and the maximal plasma concentration
of Aramchol increased with the higher doses. The PK profile demonstrated that Aramchol is suitable at each dose for once-daily
administration and there were neither significant adverse events observed in either Phase I trial nor any notable changes in biochemical,
hematologic, cardiovascular or other safety parameters.
Phase IIA Trial: Aramchol Treatment
in NAFLD or NASH Patients (NCT01094158)
In January 2012, we
completed a 60 patient multi-center, randomized, double-blind, placebo-controlled Phase IIA clinical trial of Aramchol in patients
with NAFLD or NASH between the ages of 18 and 75 in 12 centers in Israel. The Phase IIA study results were published in July 2014
in the peer-reviewed Clinical Gastroenterology and Hepatology Journal. The trial was performed in patients with either NAFLD or
NASH, which design was deemed acceptable by the FDA in 2007 at a pre-IND scientific advisory meeting. The trial’s primary
efficacy endpoint was a reduction in liver fat content, and did not consider inflammation or fibrosis, which can be diagnosed only
by liver biopsy. We believe that the short study duration of three months of treatment followed by a one-month follow-up period
did not warrant repeated biopsies. The trial evaluated the effects on liver fat content of 100 mg and 300 mg once-daily doses of
Aramchol compared to a placebo. At the end of the three month treatment period, statistically significant reductions in liver fat
concentration as measured by MRS were observed in the 300 mg patient group. Specifically, a 12.57% mean liver fat content reduction
was observed in the 300 mg group, as compared to a mean reduction of 2.89% in the 100 mg group and a mean increase of 6.39% in
the placebo-treated patients. These results indicate that the effects of Aramchol are dose-dependent, as demonstrated in the graph
below, which presents the results with respect to the 57 patients who successfully completed the entire treatment period (three
patients were excluded from data analysis because of one protocol violation and two withdrawal consents).
Relative Change in
MRS from Baseline after Three Months of Treatment
The table above shows
that the primary endpoint of the study was attained. The study demonstrated a statistically significant, dose dependent reduction
in fat content in the livers of patients treated with Aramchol, with a 19% difference between the 300 mg dose group and the placebo
group, while the difference between the 100 mg dose group and the placebo group was not statistically significant. Notably, the
minimal effective dose of Aramchol has been defined.
A non-statistically
significant change of approximately 1 Kg in body weight was observed between the 300 mg dose group and the placebo group, suggesting
that weight-loss did not influence the observed reduction in liver fat content experienced in the Aramchol treated groups.
There
were no statistically signi
fi
cant
differences among the three treatment groups for any of the secondary end points. There was a nonsignificant trend of mild weight
reduction (
P=.1
) in the high dose Aramchol group. Serum adiponectin levels
increased (0.2 ± 1.7
µ
g/mL)
in the high-dose Aramchol group but decreased in the low-dose (-0.3 ± 1.5
µ
g/mL)
and placebo groups (-0.7 ±
_
1.3
µ
g/mL)
(
P=
0.88 for trend of dose-response relationship by linear regression)
.
FMD increased non signi
fi
cantly
by 1.28%
±
2.92% in the high-dose group, by 0.34%
±
3.54%
in the low-dose group, and by 0.46%
±
2.28% in the placebo group.
Adiponectin is a protein
that modulates metabolic processes, including the regulation of glucose levels and fatty acid breakdown in the body. Adiponectin
has an anti-inflammatory and antifibrotic effect on the liver. Adiponectin deficiency, or low amounts of adiponectin, results in
insulin resistance, glucose intolerance, abnormal levels of fat in the blood and vascular injury, all of which are characteristic
of metabolic syndrome. The graph below shows the change in serum adiponectin levels from baseline during treatment. At the end
of the three month treatment period, a non-statistically significant increase in serum adiponectin levels were observed in the
Aramchol treated patient groups, indicating that Aramchol may increases serum adiponectin levels in a dose dependent manner, suggesting
that Aramchol may act as a protective factor for the prevention of metabolic syndrome, as increased serum adiponectin is itself
such an independent protective factor.
Change in Serum Adiponectin
Levels from Baseline during Three Months of Treatment
The arterial endothelium
is a target for the atherosclerotic process. Atherosclerosis is associated with endothelial dysfunction in the very early stages
of the disease process. Several studies have shown that metabolic syndrome is associated with endothelial dysfunction as an early
pathogenic event. Thus, assessing endothelial function serves as an early marker for both metabolic syndrome and atherosclerosis.
In the present study, endothelial function was assessed using flow-mediated dilation, a noninvasive ultrasound-based method that
measures the ability of a large conduit artery to dilate in response to a shear stress stimulus, or an external force acting on
the blood vessel. At the end of the three month treatment period, a non-statistically significant improvement in endothelial function
was observed in the 300 mg Aramchol treated patient group. The improvement in endothelial function suggests a positive effect on
metabolic syndrome, specifically on vascular function.
The frequency of adverse events
was similar in all treatment groups, and none of them were considered to be related to the treatment. All adverse events were mild
or moderate and none were serious. None of the patients withdrew as a result of adverse events.
|
|
Aramchol
300 mg (n=20),
n (%)
|
|
Aramchol
100 mg (n=20),
n (%)
|
|
Placebo (n=20)
n (%)
|
Patients with adverse events
|
|
9 (45.0)
|
|
8 (40.0)
|
|
11 (55.0)
|
Preferred Term
|
|
|
|
|
|
|
Abdominal pain
|
|
1 (5.0)
|
|
1 (5.0)
|
|
2 (10.0)
|
Abdominal upper pain
|
|
|
|
2 (10.0)
|
|
1 (5.0)
|
Back pain
|
|
-
|
|
-
|
|
3 (15.0)
|
Constipation
|
|
-
|
|
-
|
|
2 (10.0)
|
Asthenia
|
|
-
|
|
-
|
|
2 (10.0)
|
Upper respiratory tract infection
|
|
2 (10.0)
|
|
-
|
|
-
|
The results of our
Phase IIA clinical trial of Aramchol in the peer-reviewed Clinical Gastroenterology and Hepatology Journal were published in December
2014. The trial manuscript, entitled “The Fatty Acid-Bile Acid Conjugate Aramchol Reduced Liver Fat Content in Patients with
Nonalcoholic Fatty Liver Disease,” provides the full report of the Phase IIA trial, which was completed in January 2012 and
presented at the 47
th
Annual Meeting of the European Association for the Study of the Liver in 2012. Based on this Phase
IIA proof-of-concept results, we established a development plan that we believe may confirm: (i) the good safety profile of Aramchol,
(ii) the optimal dose of Aramchol, and (iii) efficacy on steatosis as well as fibrosis in patients with NASH.
Pharmacokinetics of Single and Multiple
Escalating Doses of Aramchol and Food Effect in Healthy Volunteers (NCT02374437)
On April 28, 2014,
we commenced PK and food effect studies of Aramchol. In written correspondence from December 2013 regarding a requested pre- IND
meeting, the FDA recommended that we conduct such studies prior to commencing our Phase IIb ARREST Study.
We conducted the food
effect and PK study at the Sourasky Medical Center in Tel Aviv, Israel involving 66 healthy volunteers to evaluate the PK of Aramchol
following single and multiple escalating doses (200 mg, 400 mg and 600 mg), as well as to evaluate the effect of a high-fat, high-calorie
meal on the PK of Aramchol following a single dose in healthy volunteers.
The results showed
dose-related, but less than dose-proportional, increases in the mean Aramchol plasma concentrations (“Cmaxˮ), area under
the curve (“AUCˮ) (0-t), and AUC (inf) of 200 mg, 400 mg and 600 mg doses administered under fasting conditions or following
a light meal, both at single and repeated dose administration. Cmax and AUC are metrics used to indicate the significance of a
drug’s exposure. Steady-state was achieved by 144 hours (day seven). Administration of Aramchol after a high-fat, high-calorie
meal afforded a 2.6 fold increase in exposure, as measured by Cmax, AUC(0-t), and AUC(inf) compared to the fasting group.
No serious adverse
events or deaths occurred during the study. Adverse events were equally distributed between placebo and Aramchol doses, were mild
(with only one moderate adverse event) and the majority defined unrelated to Aramchol. The PK study provides additional safety
data to further support existing safety data from our pre-clinical studies and our Phase I and Phase IIA clinical trials of Aramchol.
Pharmacokinetics of Single and Multiple
Escalating Doses of Aramchol Administered under Fed Conditions in Healthy Chinese Volunteers (NCT 02803996)
In 2016, we performed
the Chinese PK Study involving Chinese patients who are domiciled in the United States. We enrolled 66 patients in this study,
consisting of two parts. In part A, 32 subjects received a single escalating dose; Part B enrolled 34 subjects which received a
multiple escalating dose. Dr. Evelyn Darius served as the Study Investigator. After repeat dosing with 400 mg daily, the mean exposure
over the dosing interval at steady state (AUC0-24) in Chinese was about 1.7-fold higher than in non-Chinese and at the 600 mg dose-level
the corresponding difference was about 1.5-fold. No safety signal was identified in this study and we deemed no changes were required
in the enrollment of Chinese patients into the ARREST Study. Moreover, having this Chinese PK Study data may give us a head start
in future licensing discussions with potential Chinese partners for the development of Aramchol in China.
Additional Pre-clinical
and Clinical Studies Required for Regulatory Submissions:
Toxicology Studies
Since the completion
of the Phase IIA study, pre-clinical toxicology studies have been conducted to support our ongoing clinical programs and regulatory
submissions. These studies were performed in compliance with the EMA’s ICH M3 (R2) guidelines by WIL Research, a global contract
research organization, at its facility in Holland. The toxicity program for Aramchol included repeat dose studies of up to six
months in rats and up to nine months in dogs by oral administration, the intended route of administration in the clinical trials
and beyond. The dose level of 1000 mg/kg/day in rats and 1500 mg/kg/day in dogs, which is the maximal feasible dose in both species
showed no-observed-adverse-effect-level (“NOAELˮ). There were no observations noted in the rat study. The findings in
the dog study were limited to changes in plasma lipids, including decreases in total blood cholesterol levels, LDL, HDL and phospholipids,
and a slight increase in the size of the adrenal glands, which were considered to be an extension of the primary pharmacology
of Aramchol and non-toxic effects, and skin scales from week 13 onwards in all Aramchol-treated groups, with a dose-related incidence.
After six months this was not accompanied by any microscopic alteration of the skin and therefore considered not toxicologically
relevant. Results from the study show that after nine months the presence of scales in all Aramchol-treated groups was accompanied
by minor test item-related microscopic findings in the skin: Hyperkeratosis of the epidermis, correlating to the scales, and keratin
plugs in the hair follicles (in males at 750/500 and 1500 mg/kg). After a 12-week treatment-free recovery period, fewer scales
were noted and microscopically there was partial recovery. As these findings were minor and no clinical symptoms like scratching
were noted, these findings were considered not adverse.
Aramchol was non-mutagenic
in vitro in the Ames test and chromosomal aberrations test, each of which is a test to determine whether the subject chemical can
cause mutations in the DNA of an organism. In addition, in bone marrow micronucleus test in male rats at a 2000 mg/kg oral dose
(the maximum recommended dose in accordance with ICH S2 (R1)), Aramchol was not clastogenic, meaning it did not give rise to or
induce disruption or breakages of chromosomes, nor was it aneugenic, meaning it did not cause the number of chromosomes in the
nucleus of a cell to not be an exact multiple of the monoploid number of a particular species.
Embryo-fetal development
toxicity was assessed in rats and rabbits. No maternal or fetal development toxicity was observed in either species. The NOAEL
for maternal and development toxicity was at least 1000 mg/kg in rats and 750 mg/kg in rabbits (the maximum feasible dose in both
species).
No maximum tolerated
doses were reached in the studies. Over 50-fold safety margin exposure was achieved in dogs but not in rats. However, for rats,
at least three of the four ICH M3(R2) safety margin criteria were met, and for dogs all four criteria were met. Blood tests revealed
a decrease in total blood cholesterol levels, including LDL, HDL and phospholipids, and there was a slight increase in the size
of the adrenal glands of the dogs, which WIL Research assessed as a physiologic compensatory response to the decrease in blood
cholesterol levels. WIL Research did not consider the decrease in blood cholesterol levels or the physiologic response of the adrenal
glands as a toxic effect, but rather as a pharmacodynamic effect, which is a biochemical and physiological effect of the drug on
the body. Based on the above, WIL Research concluded that the overall safety data for Aramchol is sufficient to support the proposed
Phase IIb clinical trial.
Our Phase IIb ARREST Study for Aramchol
We believe that Aramchol
will demonstrate effects on the three key pathologies of NASH: steatosis, inflammation and fibrosis.
We believe that Aramchol has a robust effect on lipid metabolism and fibrosis. The Phase IIa study confirmed
an effect on steatosis and the ARREST study is planned to repeat this finding in the targeted population. More importantly, the
ARREST Study includes histology based secondary end-points that are regulatory acceptable. Additionally, the ARREST Study is expected
to demonstrate the effect of Aramchol on the different components of NASH as well as fibrosis and allow the planning of a pivotal
phase.
In addition, we believe
that the minimal dose of Aramchol has been identified and hope the ARREST Study will define the maximal effective dose which should
allow a pivotal phase with only one dose.
We submitted an IND
application to FDA to initiate the ARREST Study, and hope to expand the scope of the IND in the future to conduct pivotal Phase
III clinical trial(s) for NASH in the United States. The FDA cleared our IND application, allowing us to conduct the Phase IIb
ARREST Study in the United States. In September 2014, the FDA granted Fast Track designation status to Aramchol for the treatment
of NASH. Fast Track designation may accelerate the development process and may expedite the review of drugs that show promise in
treating serious, life-threatening medical conditions for which no other drug either exists or is as effective.
We
are currently conducting our Phase IIb ARREST Study to evaluate the safety and effectiveness of two different doses of Aramchol
for the treatment NASH in patients who are overweight or obese and have pre diabetes or type II diabetes mellitus. In order to
be eligible to participate in our ARREST Study, patients must be affected by NASH, as diagnosed by a biopsy centrally read (steatosis
≥1 + inflammation ≥1 + ballooning ≥1; Total activity NAS score of 4 or more), be overweight or obese as measured by a
Body Mass Index between 25 and 40 or waist circumference between 88cm to 200cm for women, and between 102cm to 200cm for men,
and who are pre diabetic or type II diabetic. We targeted this specific population as it is at the greatest risk of developing
NASH and its complications. We have recently generated data from animal models that enable us to believe that Aramchol targets
all three pathologies of the disease: steatosis, inflammation and fibrosis. Since we have included patients with advanced fibrosis
in the ARREST Study, we hope to be able to identify these effects in the ARREST Study patients. Patients are randomized into one
of three trial groups taking either one of two different once-daily oral doses of Aramchol or a placebo. The treatment part of
the trial is designed to be 12 months in duration and patients completing this phase will be observed for a three month follow-up
period. This trial is designed to enroll 240 patients in a randomization ratio of 2:2:1 across approximately 70 clinical sites
in the United States, Europe, Latin America, China and Israel. In February 2017, we completed randomization of the ARREST Study
with 247 randomized patients. Baseline histology of patients enrolled into the ARREST study demonstrates a population with advanced
disease, with 60% having stage 2 and 3 fibrosis and 70% have NAS
>
5 at baseline.
The primary endpoint
of the 12-month double-blind portion of the trial is a statistically significant reduction in liver fat concentration as measured
by MRS, which is a surrogate endpoint that is generally accepted by the FDA with respect to Phase I and Phase II NASH studies.
Secondary endpoints
of the trial include: (1) fibrosis improvement without worsening of NASH, defined as a decrease in CRN fibrosis by at least 1 stage;
Worsening of NASH defined by an increase of Inflammation or Ballooning grades (2) improvement in NASH activity index, as measured
by NAS or SAF, without worsening fibrosis; Improvement in NAS as defined by at least two points improvement contributed by more
than one parameter; Improvement in SAF as defined by at least two points improvement in the SAF Activity score. Any stage increase
in fibrosis is considered fibrosis worsening; (3) NASH resolution without worsening of fibrosis defined as disappearance of ballooning
(score = 0) together with disappearance of inflammation or the persistence of mild inflammation (score= 0 or 1). Any stage increase
in fibrosis is considered fibrosis worsening.
In communications
received in response to our submission of an update to our IND in 2014, the FDA recommended that future clinical studies
should be discussed at an end-of-Phase II meeting, which could take place within three months from the date we complete the
analysis of the results of our ARREST Study, and at which time the trial results could be considered. The FDA communication
further noted that we must discuss with the FDA a methodology for our drug development. In light of the publication of the
FDA and AASLD joint workshop guidance, and based on the Phase III trial designs published to date by other companies drugs
for NASH, we currently believe that we will likely be approved based on a design that includes a histology based interim
after 48 or 72 weeks of treatment which is intended to seek marketing approval while the study continues to a clinical
end-point (predefined adverse liver-related clinical events, including progression to cirrhosis). The failure to successfully
complete any required post-market study could result in FDA withdrawing approval for Aramchol.
Potential Phase III Program for Aramchol
The
development work we have completed to date with regard to Aramchol was deemed appropriate for the initiation of a Phase IIb
study by the MHRA, BfArM and ANSM, in addition to FDA as noted above. Our ARREST Study design is in accordance with the study
design recommended by the MHRA, deemed acceptable by BfArM and deemed satisfactory by ANSM. BfArM and ANSM also confirmed,
in minutes of each of their respective scientific advisory meetings, that, if our ARREST Study is successful in reaching
its primary endpoint, we may proceed to pivotal randomized, double-blind, placebo-controlled, Phase III trial. We expect
the primary endpoints of such trials to be a histology endpoint based on NASH resolution and fibrosis improvement. Like
the FDA, as noted above, the MHRA invited us to discuss the next steps in the development of Aramchol after we complete
the analysis of the results of our ARREST Study, at which time the data from the study will be considered.
Aramchol for the Treatment
of Other Indications
In addition to the
ARREST Study, we are exploring other possible indications for the use of Aramchol.
We recently
announced topline results from our ARRIVE Study for HIV associated lipodystrophy and NAFLD patients. HIV patients have
advanced liver disease which is a major cause for morbidity and mortality. ARRIVE, a Phase IIa, investigator initiated
clinical trial conducted at the University of California San Diego by Professor Rohit Loomba was a randomized,
double-blinded, placebo-controlled, 12 weeks, proof-of-concept study that evaluated the safety and efficacy of Aramchol at
600mg/day versus placebo in 50 patients with HIV-associated lipodystrophy and NAFLD. The primary end point of successful
therapy was improvement in hepatic steatosis at 12 weeks, as measured by MRI-PDFF. Secondary endpoints were improvement in
total body fat, metabolic profile, and liver biochemistry. Liver biopsies were not included as part of the evaluation in this
pilot trial. The trial showed no difference between HIV patients receiving Aramchol for 12 weeks when compared with HIV
patients in the placebo arm. Aramchol showed a favorable safety and tolerability profile. Although the pathology (fatty liver) is similar to “garden variety” NASH, the pathogenesis
involved in the HIV lipodystrophy and NAFLD is different and multi factorial including the effect of the virus itself and the anti-HIV
medications. Further analysis of the data is ongoing.
On November 13, 2014,
we announced the first administration of Aramchol in a proof-of-concept Phase IIA clinical trial for the treatment of newly formed
cholesterol gallstones following bariatric surgery. The primary end-point was to prove that Aramchol dissolves newly formed gallbladder
gallstones following bariatric surgery. Patients were to be assigned to one of three treatment arms; 400mg tablets, 600mg tablets
and placebo. Only 9 patients were enrolled, and 7 patients completed the study. A similar proportion of subjects from each treatment
group reported events; 7 in the placebo group, 9 in the 400 mg Aramchol group, and 5 in the 600 mg Aramchol group. One subject
experienced 2 events of severe cholecystitis in the Aramchol 600 mg group which were considered a serious adverse event and led
to discontinuation from the study. It should be noted that to be included in this study the subject must have had a history of
gall bladder disease and gallstones, therefore the subject’s medical history is an important confounding factor. Due to poor
patient recruitment and change in Company focus, we decided to terminate the study on October 1, 2015. We currently believe that
it is unlikely that we will revive another study in cholesterol gallstones.
We
plan to conduct a Phase IIa, double blind Proof of Concept (PoC) Study to evaluate the safety and efficacy of Aramchol 600 mg
versus placebo in patients with Heart Failure with preserved Ejection Fraction (HFpEF). However, the decision to
initiate this study will depend, in part, on the complete results of the ARRIVE study and applicable regulatory approval.
Additionally, we may perform a Phase I-IIa Study, proof of concept study, with a primary objective of evaluating the safety
and PK of Aramchol, followed by the assessment of the safety and efficacy based on hepatic fat content as measured by
magnetic
resonance imaging-estimated proton density fat fraction
(MRI-PDFF) in juvenile patients with NAFLD. On September 22,
2016, we announced we entered into an investigator initiated clinical trial agreement with the Regents of the University of
California on behalf of its San Diego campus to perform such study. However, the decision to initiate the study has been
delayed until receipt of top line data of the ARREST Study. See “Item 4.B. Information on the Company—Business
Overview—Strategic Collaborations, Research Arrangements and Other Material Agreements—NAFLD Juvenile
Population.” for more information regarding the UCSD Agreement.
Topical Development
We selected to test
Steamchol, a synthetic FABAC, a conjugate of stearic acid (C18:0) and colic acid with similar properties of Aramchol, in proof
of concept studies through a cosmeceutical route of development. Accordingly, on October 13, 2015, Steamchol received a CAS (Chemical
Abstracts Service Registry) name and number to allow its cosmeceutical development.
On January 1, 2016,
Steamchol (formulated as topical cream) was successfully tested for safety assessment in 50 human subjects in a trial initially
lasting six weeks with two weeks of follow-up, by the Institute for Skin Research in Tel Aviv, Israel. Subsequently, on October
6, 2016, we initiated a proof-of-concept 20-week, double blind, controlled study to evaluate the efficacy and tolerance of Steamchol
in subjects with Acne Vulgaris. The study was conducted at the IRSI Institute (International Research Services Inc.) in Port Chester,
New York, US. A total of 68 subjects participated in the study. On July 2017, top line data was received which was determined to
be inconclusive. Due to poor data collection and higher-priority clinical programs, we decided not to pursue this indication. At
present, we believe that it is unlikely that we will revive another study in Acne Vulgaris.
Based on the results
of this proof-of-concept study, we will evaluate and decide whether to also advance Aramchol for topical clinical studies.
Our Competitive Strengths
We believe our competitive
strengths include our propriety family of molecules (FABACs) and our skilled, experienced, professional personnel, which enables
product development in an efficient and cost effective manner.
The competitive strengths
of Aramchol – our product candidate for NASH.
|
·
|
A once-daily oral drug that targets the main NASH pathology, steatosis, inflammation and fibrosis,
currently under development for NASH patients
. We believe that the mechanism of action of Aramchol, including its ability to
reduce liver fat content and its anti-fibrotic effects, shown in animal models for fibrosis, will translate to effects on steatosis,
inflammation and fibrosis in the ARREST clinical trial. We believe these effects will enable physicians to treat NASH patients
with moderate to severe fibrosis and in all stages of NASH. We believe that a simple and convenient delivery through once-daily
oral administration, a unique mode of action, targeting all aspects of NASH pathologies, and safety profile position it well against
the competition in the treatment of NASH. We believe that such characteristics may also lead to Aramchol’s acceptance and
adoption by the medical community and patients as an alternative to the medical treatments used today, which are not approved by
applicable regulatory authorities for treatment of NASH as their efficacy has not been proven in adequate and well-controlled clinical
studies. We believe Aramchol is well-positioned against drugs in development for NASH, some of which may require intravenous delivery
or may cause adverse events, such as itching or an increase in LDL, which can be highly inconvenient for patients with chronic
diseases, such as NASH, and may result in low patient compliance.
|
We recently discovered that Aramchol
has a dual mode of action and it targets both steatosis and fibrosis. We previously demonstrated that Aramchol down regulates SCD1
and therefore targets steatosis. Using animal models for NASH and fibrosis, we discovered that Aramchol targets also fatty acid
oxidation and fibrosis. We have good reasons to believe that Aramchol up regulates glutathione which is a well-known antioxidant
that mediates better oxidation of fatty acid in the mitochondria and cause significant reduction of ROS. This resulted in reduced
liver damage.
|
·
|
Extensive knowledge and expertise in the treatment of liver diseases, the development of FABACs
and working with lipid molecules
. We believe our management team, scientific advisors and personnel have extensive knowledge
and experience in the treatment of liver diseases, developing FABACs, such as Aramchol, for the treatment of liver diseases and
working with lipid molecules, which due to their special physiochemical characteristics, are difficult to synthesize, develop and
work with. We believe that such knowledge and expertise makes us competitive in the fields of metabolic and liver diseases.
|
Our Strategy
Our strategy is to
build a specialized biopharmaceutical company that develops, in a cost-effective manner, novel molecules from clinical stage to
Phase III readiness. We seek to create global partnerships with academic institutions and biotechnology or pharmaceutical companies
to effectively collaborate in developing a portfolio and ultimately out-license Aramchol. Through this approach, we have successfully
advanced Aramchol into various stages of clinical development. Key elements of our strategy include:
|
·
|
Continuing to advance the development of Aramchol for the treatment of NASH
. Our development
of Aramchol for treatment of NASH currently includes our ongoing Phase IIb ARREST Study. If this study is successful, the results
will serve as a basis for potential Phase III pivotal trial(s) in the United States, Latin America, Europe and Israel for the same
indication.
|
|
·
|
Exploring NASH sub populations and other indications for the use of Aramchol
, which includes
(i) a planned Phase I/II NAFLD juvenile population study and (ii) a Phase IIA proof of concept Heart Failure with Preserved Ejection
Fraction study, and potentially others.
|
|
·
|
Establishing a development and commercialization partnerships for Aramchol in different geographies.
We intend to out-license Aramchol to pharmaceutical companies that possess experience, resources and infrastructure to execute
pivotal trial(s), regulatory approval and/or market launch. As part of this strategy, in July 28, 2016, we signed a license agreement
with Samil Pharm Co., Ltd., for the commercialization of Aramchol in Korea. See “Item 4.B. Information on the Company—Business
Overview—Strategic Collaborations, Research Arrangements and Other Material Agreements—Samil Pharma. Co., Ltd.”
for more information regarding the Samil Agreement.
|
|
·
|
In-license, develop or acquire additional drug candidates
.
|
We believe that our
strategy will increase the likelihood of advancing clinical development and potential commercialization of Aramchol in multiple
indications. By activating our pipeline expansion strategy, we believe we could extrapolate additional commercial potential, as
well as de-risk our company through reducing our reliance on the success of any one given trial or indication.
Strategic Collaborations, Research Arrangements
and other Agreements
NAFLD Juvenile Population
On September 22, 2016, we entered into an investigator initiated clinical trial agreement, (the “UCSD
Agreement
ˮ), with the Regents of the University
of California on behalf of its San Diego campus, or UCSD, to conduct a Phase I/IIA study (the “ARTISAN Studyˮ), entitled:
“A Phase I-IIa Study to Assess Safety, Tolerability, Efficacy, and Pharmacokinetics of Aramchol in a NAFLD Juvenile Population”
(the “Protocol”). The ARTISAN Study (
AR
amchol
T
rial to
I
mprove
S
teatosis in
A
dolescent
N
AFLD) will be led by Jeffrey Schwimmer, MD, professor of pediatrics, UC San Diego School of Medicine and Director, Fatty
Liver Clinic, Rady Children’s Hospital, San Diego. The performance of the ARTISAN Study is subject to receipt of FDA IND
approval. There is no certainty that the FDA IND approval will be obtained. The decision to initiate the ARTISAN Study has been
delayed until receipt of top line data of the ARREST Study.
Pursuant to the terms
of the UCSD Agreement, we shall provide our proprietary drug product candidate Aramchol, without cost, to conduct the study as
required pursuant to the Protocol and shall provide funds to conduct the ARTISAN Study over the duration of the study.
Under the
UCSD
Agreement, UCSD has granted us a non-exclusive, royalty-free license to use any UCSD or joint invention and ARTISAN Study data
for our internal research and development purposes. Further, UCSD grants us a time-limited first right to negotiate a commercial,
royalty-bearing, exclusive license, to make, use, and sell any patentable UCSD or joint invention conceived and reduced to practice
in the performance of the research, for the term of any patent thereon.
All rights, title and
interest in ARTISAN Study data shall be the sole and exclusive property of UCSD; however, we shall be entitled to make use of such
ARTISAN Study data for legal purpose consistent with the informed consent, including publication and regulatory filings, after
the earlier of the publication of the ARTISAN Study data by UCSD or upon the expiration of a period of eighteen (18) months from
the completion of the ARTISAN Study. The Protocol and research design of the ARTISAN Study are the property of UCSD.
Either party may terminate
the
UCSD
Agreement (i) upon thirty (30) days prior written notice to the other Party,
in its sole discretion; (ii) upon written notice to the other Party, if the terminating Party determines that termination of the
ARTISAN Study is necessary for the safety of the ARTISAN Study subjects; or (iii) upon the other party’s material breach
if such party fails to cure such breach within thirty days after receiving written notice thereof. Upon receipt of notice of early
termination, UCSD will stop screening subjects for and enrolling subjects in the Study and will discuss in good faith a plan to
continue monitoring ARTISAN Study subjects as appropriate and determine an orderly winding down of the ARTISAN Study. Upon termination
or expiration of the
UCSD
Agreement, all CRFs outstanding must be completed and
copies returned to us together with completed ARTISAN Study Drug inventory and records, and all our confidential information. If
the
UCSD
Agreement is terminated before completion of the ARTISAN Study, the parties
shall negotiate in good faith on the phase-out for ARTISAN Study subjects and subsequent treatment of ARTISAN Study subjects.
The
UCSD
Agreement also includes customary indemnification provisions.
Samil Pharma. Co., Ltd.
On
July 28, 2016, we entered into a license agreement, referred to herein as the Samil Agreement, with Samil Pharma. Co., Ltd. (“Samil
ˮ
)
,
for the commercialization of Aramchol (with the option to manufacture) in the Republic of Korea (“the Territory
ˮ
).
Under
the terms of the Samil Agreement, the Company has granted Samil an exclusive licence (the “Samil License
ˮ
)
,
for fatty liver indications including NASH (the “Field of Use”) in the Republic of Korea (the “Territory”)
to such information concerning Aramchol as may be required to support Samil's applications for regulatory approvals (the “Licensed
Information”) and the patents for the import, marketing, use, sale, offer for sale, commercialisation and distribution (and,
if the option is exercised, manufacture) of Aramchol in tablet form, or any other physical form as may be produced or manufactured
by or on behalf of Galmed or by a third party for Galmed and, if the option set out below is exercised, any products within the
Field of Use, the development, manufacture or sale of which is based, in whole or in part, on, or involves the use of, the Licensed
Information or covered under any patent (the “Product”).
The Samil License shall
remain in force with respect to each Product (if the Samil Agreement is not early terminated) until the later of: (i) the date
of expiry in the Territory of the last of any patent covering such Product or any formulation, dosing or administration form thereof;
and (ii) the date of expiry of a period of 20 years commencing on the date of first commercial sale by Samil or a sublicensee of
such Product in the Territory.
Upon the signing of
the Samil Agreement, Samil paid the Company a gross upfront fee of approximately $2.1 million. Samil has also agreed to pay additional
clinical and regulatory-based milestone payments, which may aggregate to additional $6.0 million, as well as tiered, double-digit
royalties payable on sales (lower if sales of a generic equivalent commences in the Territory).
Pursuant to the terms
of the Samil Agreement, following the first achievement of US$25 million of net sales in any calendar year following the first
commercial sale of the Product in the Territory, Samil shall have the option to request that the Licensed Information include methods
for the formulation of Aramchol from its API, to allow for the manufacture of Aramchol by Samil; provided, however, that we shall
have the option, to widen the definition of the Licensed Information as aforesaid at any time.
We shall be entitled,
at our option: (i) to modify the Samil License with respect to any Product so that it is non-exclusive only; or (ii) to terminate
the Samil License hereunder, with respect to any Product if: (a) a first purchasing order from Samil for at least one Product shall
not have been placed by 6 months following the grant of the Korean Ministry of Food and Drug Safety new drug approval; or (b) commercial
sale of such Product having commenced and either (i) there shall be a period of 1 year during which no sales of any Product shall
take place, or (ii) within 1 year of such commencement, aggregate sales of Products shall not have reached a reasonable level,
as determined by the joint development committee, in each case, except as a result of force majeure or other factors beyond the
control of Samil. Further, we shall be entitled to terminate the Samil Agreement if Samil challenges the validity of any of the
patents. If any such challenge is unsuccessful, Samil shall (in addition to our right to terminate) pay us liquidated damages in
the amounts of US $8,000,000. Either party may terminate the Samil Agreement (i) upon the other party’s material breach
if such party fails to cure such breach within 30 days, or, in the case of failure by Samil to pay any amount due from Samil to
us pursuant to or in connection with the Samil Agreement 14 days after receiving written notice thereof, or (ii) upon customary
events such as the granting of a winding-up order if such order or act is not cancelled within 60 days.
In the event
that we do not achieve the primary endpoint as defined in the study protocol (the “Successful Completion”) of the ARREST
Study, we shall as soon as practicable notify Samil of the non-achievement of such Successful Completion, and within 60 days thereof,
notify Samil in writing either: (i) that we have decided not to develop the Licensed Information further for the Field of Use (“Cessation
Notice”), or (ii) that we intend to continue with such development notwithstanding the non-achievement of such Successful
Completion (“Licensor Continuation Notice”). Also, in the event that we do not achieve the Successful Completion of
the potential Phase III Study, we shall, as soon as practicable, notify Samil accordingly (“Notice of Non-Success”).
Samil shall thereafter have the option, by notice in writing served to us within 45 days of Samil's receipt of either a Cessation
Notice, a Licensor Continuation Notice or a Notice of Non-Success, as applicable, to indicate its intention either: (i) to terminate
the Samil License, or (ii) to continue research and development of the Licensed Information in the Field of Use in the Territory
(“Licensee Continuation Noticeˮ). In the event Samil shall serve a Licensee Continuation Notice following the service
of a Cessation Notice or a Notice of Non-Success, any such continuation by Samil shall be subject to the entry by Samil into a
written agreement with us as to the terms and conditions which would govern such continued research and development, which would
be carried out according to Samil's own development plan and at its sole expense. In the event Samil serves a Licensee Continuation
Notice following the service of a Licensor Continuation Notice (“Agreed Continuation”), the Samil Agreement shall continue
in accordance with its terms.
Additionally, following
the Successful Completion of the ARREST Study or Agreed Continuation following non-achievement of Successful Completion of the
ARREST Study, Samil shall, for a period of 90 days following the date of written notification to it by us of such Successful Completion
or following the date of Agreed Continuation following non-achievement of Successful Completion, have the option to require that
the Territory be extended to include Vietnam (the “Extension Optionˮ
)
.
In the event that Samil exercises its Extension Option, the parties shall conduct negotiations in good faith for up to 30 days
thereafter in order to agree on milestone payments which would replace those set out in the Samil Agreement. In the event that
agreement is not reached in such regard within such period, the Extension Option shall terminate.
Microbiome
On
June 30, 2016, we entered into a research and option agreement, referred to herein as the Yeda Agreement, with Yeda Research and
Development Co. Ltd (“Yedaˮ), the commercial arm of the Weizmann Institute of Science, to assess the effects of, Aramchol,
on the human gut microbiome for the treatment of fatty liver disease. The Research was to be performed in collaboration with Prof.
Eran Segal and Dr. Eran Elinav from the Weizmann Institute of Science. We had historically postponed the initiation of the microbiome
research and have since decided not to pursue this research.
Vitamin D
On May 3, 2016, we signed
an investigator initiated clinical trial agreement, referred to herein as the MS Agreement, with the Icahn School of Medicine at
Mount Sinai, or Mount Sinai, to conduct a Phase IIA Study entitled: “A Placebo-controlled Single-blinded Study of Aramchol
with Supplemental Vitamin D in Patients with Vitamin D Deficiency and Nonalcoholic Fatty Liver Disease (NAFLD) and Fibrosis.”
We had historically postponed the initiation of the Vitamin D research and have since decided not to pursue this research.
OWL
On July 8, 2015, we entered
into a Research, Option and License Agreement (the “OWL License Agreementˮ), with OWL, for the development of a non-invasive,
blood-based complimentary diagnostic tool, which we believe could increase the likelihood of success of our Phase III trials and
facilitate the market adoption of Aramchol. Pursuant to the terms of the OWL License Agreement, we have partially funded the research
and development of the diagnostic tool in the amount of Euro 437,000. Subject to development under the OWL License Agreement, we
have an option to exclusively license from OWL a complimentary diagnostic tool for NASH using Aramchol (the “OWL License
Agreement Optionˮ), in consideration for the payment of a 10% royalty to OWL on annual net sales of the complimentary diagnostic
product, exercisable by written notice to OWL at any time during the period commencing on July 8, 2015 and ending on the earlier
of (I) December 31, 2016; or (II) the completion of the ARREST Study (the “Option Period”). On June 22, 2017, we entered
into an amendment to the Agreement, which, inter alia, extended the Option Period until the lapse of six (6) months after the publication
of the results of the ARREST Study on clinicaltrials.gov.
In addition, if OWL develops
any other complimentary diagnostic tool for NASH not using Aramchol, it will pay us 10% royalties from revenues. Concurrently with
the OWL License Agreement, we have entered into a Share Purchase Agreement (the “OWL SPAˮ), pursuant to which we undertook
to invest Euro 175,000 in OWL, subject to certain specified milestones, in exchange for the issuance by OWL of such number of common
shares that result from dividing our investment amount by the price per share (the “Investment”). In addition, under
the OWL SPA, OWL has granted us an option which will allow us to invest up to €1,000,000 (the “First Option”)
at the higher of (i) the OWL company valuation in an equity financing (or series of related financings) of at least €1,000,000
that takes place at the same time as the exercise of the First Option; or (ii) a 15% premium to OWL's valuation in the most recent
equity investments of at least €1,000,000 (the “Baseline Valuation”). The First Option will expire at the earlier
of (i) an investment by a third party in OWL in excess of €1,000,000, or (ii) the completion of the ARREST Study in our reasonable
opinion. Furthermore, we have the option to purchase additional shares up to 19.9% of OWL (the “Second Option”) at
the higher of (x) the OWL company valuation in an equity financing (or series of related financings) of at least €2,500,000
that takes place at the same time as the exercise of the Second Option; (y) at a 15% premium to OWL's valuation in the most recent
equity investment of at least €2,500,000; or (z) the Baseline Valuation. The Second Option will expire at the earlier of (A)
the completion of a third party investment in OWL in excess of €2,500,000, or (B) one year following the successful completion
of the ARREST Study in our reasonable opinion. Moreover, pursuant to the OWL SPA, in the event OWL issues new common shares or
securities convertible into common shares, except in the event of customary curve outs (the “New Securities”), we have
an option to purchase up to our pro-rata share of the New Securities for the price and on the same terms as the most senior class
of participating shareholders, upon our notification to OWL within 21 days of OWL's notification of their intention to issue New
Securities (the “Preemptive Right”). This Preemptive Right shall survive termination of the OWL SPA, provided that
either the Investment or the exercise of the First option or the Second Option has taken place.
Upon exercise of the OWL
License Agreement Option, we will own all rights, title and interest in and to (i) the complimentary diagnostic tool for NASH using
Aramchol, excluding serum and plasma markers developed by OWL using proprietary methods and any of the OWL patents, OWL's know-how,
and any other results of whatsoever nature, which are discovered, developed or invented in the course of, or directly arising from,
the performance of the Research, excluding our technology (the “Research Results”) which is owned by OWL; (ii) the
complimentary diagnostic tool for NASH using Aramchol intellectual property; (iii) all results and intellectual property pertaining
to (a) our technology, (b) markers or other diagnostics for use in connection with liver diseases and/or cholesterol gallstones
and/or any other indications utilizing Aramchol and any future synthetic fatty-acid/bile conjugates or FABACs owned by us, (c)
metabolomics markers predicting therapeutics or safety response of Aramchol; or (iv) any additional markers improving NASH patient
selection for treatment with Aramchol that are generated, discovered, reduced to practice and/or arising in the course of and/or
from the performance of any research, services and/or development activities by or on behalf of or for us (including by OWL hereunder),
excluding research results, and including any regulatory filing or approval (if any) filed or obtained by us or any of our affiliates
in respect of the OWLiverGAL kit and any other product, kit, device, material, process, method, activities or service that incorporates,
uses, or is reliant upon the licensed technology (the “Licensed Technology Product”), and all communications with regulatory
authorities, and any data, information or document covered by data protection or data exclusivity, production processes, standard
operating procedures, subcontractors’ information and other technical information required for the sale and/or commercialization
of the Licensed Technology Products, test protocols and final reports of any testing or studies with respect to the Licensed Technology
Products.
Either party may terminate
the OWL License Agreement (i) upon the other party’s breach if such party fails to cure such breach within 60 days after
receiving written notice thereof; or (ii) upon customary events such as the granting of a winding up order or upon the appointment
of a temporary or permanent liquidator or receiver if such order or act is not cancelled within 60 days. We may terminate the OWL
License Agreement for any reason upon 30 days’ prior written notice. Further, OWL may terminate the OWL License Agreement
upon 30 days' prior written notice, in the event that within 18 months of receipt of the required regulatory approval to market
and sell the first Licensed Technology Product in the U.S, there has not been a first commercial sale, unless such failure or delay
is caused by (i) force majeure; or (ii) the requirements of a regulatory or other governmental authority, any contract manufacturer,
or due to any market shortage; or (iii) a significant technological and/or scientific barrier.
University of California, San Diego
In February 2015, we entered
into an Investigator Initiated Trial Agreement with the University of California, San Diego to conduct the ARRIVE Study, a Phase
IIa Study for the treatment of HIV-associated with Lipodystrophy and NAFLD. The ARRIVE Study principal investigator is Dr. Rohit
Loomba, a member of our scientific advisory board. The ARRIVE Study is a randomized, double-blinded, allocation-concealed, placebo-controlled,
proof-of-concept Phase IIA clinical trial. The study will evaluate 50 patients with HIV-associated lipodystrophy and NAFLD, with
either Aramchol at 600 mg or placebo for 12 weeks. Pre- and post-treatment MRI-measured liver fat content and total body fat via
DEXA will be compared. The primary end point of successful therapy will be an improvement in hepatic steatosis as measured by MRI.
Secondary endpoints will include an improvement in total body fat, metabolic profile, and liver biochemistry. On December 1, 2015,
we announced that the FDA has cleared our IND application for the ARRIVE Study. We recently announced topline results from the
ARRIVE Study. The trial did not achieve its primary endpoint and accordingly we do not intend to pursue further clinical trials
of Aramchol for this indication.
Perrigo API Ltd.
On January 28, 2015, the
Company entered into a Manufacturing Services Agreement (the “Perrigo Agreementˮ), with Perrigo API Ltd. (“Perrigoˮ),
a former subsidiary of Perrigo Company plc that was recently acquired by SK Capital Partners and had changed its name to Wavelength
Pharmaceuticals, for, among other things, the large-scale production of Aramchol API and the scale-up and manufacturing process
optimization for large-scale production of the Aramchol API. Pursuant to the Perrigo Agreement, Perrigo will provide manufacturing
process, optimization services for large-scale production of the Aramchol API, manufacture the Aramchol API pursuant to cGMPs and
perform additional development services regarding scale-up and manufacturing optimization for the Aramchol API. In consideration
for the services to be provided by Perrigo, the Company agreed to pay in accordance with the Perrigo Agreement a maximum aggregate
amount of approximately $3.6 million U.S. dollars to Perrigo. The Perrigo Agreement also provides Perrigo, under certain circumstances,
with the option to manufacture commercial supplies of the Aramchol API in the future. To date, Perrigo has manufactured 3 pilot
batches of approximately 60 kg of Aramchol API. However, while the material obtained was of appropriate quality and produced under
cGMP, it resulted in higher manufacturing costs than originally anticipated. Therefore, additional research and development work
pertaining to the scale-up and optimization of the process has been undertaken by two other CROs under cGMP and current Good Laboratory
Practices (“cGLPˮ), in order, inter alia, to simplify, increase yields and improve the volume capacity of the manufacturing
process in an attempt to achieve the target price. Recently, we decided to proceed with one of those other CROs which will complete
the scale up and optimization process. Based on the results of the additional scale up and optimization process, we will decide
how to progress with the future manufacture of Aramchol API.
Aventis Pharma Deutschland GmbH
In September 2002, we entered
into an agreement, which we refer to as the Aventis Agreement, with Aventis, which merged with and into Sanofi S.A., in connection
with the settlement of court proceedings regarding an invention covered by Israeli patent application 123998 and PCT/IL99/00173.
The invention relates to certain FABACs, pharmaceutical compositions containing FABACs and the use of FABACs for dissolving cholesterol
gallstones in bile and preventing the formation thereof, as well as for the prevention and reduction of atherosclerosis, or the
hardening of the arteries. Such court proceedings resulted from a claim filed by us and Prof. Tuvia Gilat, our founder, in the
Tel Aviv District Court seeking a declaratory judgment that Prof. Gilat was the sole inventor of the invention and the owner of
all rights in and to the invention and the patent application with respect thereto, and that neither Aventis nor anyone on its
behalf has any rights in or to the invention or such patent application. We filed the claim with Prof. Gilat based on assertions
by Aventis that it had certain rights to the invention as a result of the participation of one of its employees in the discovery
of the same. Under the Aventis Agreement, Aventis agreed that we had the exclusive worldwide right to commercialize the invention
and we agreed to pay Aventis a royalty of 10% in respect of all income that we or our affiliates may receive from the commercialization
of such invention for the prevention and treatment of cholesterol gallstones (less certain standard deductions, including taxes,
credits, allowances, rebates, freight and insurance costs), for as long as there is a valid patent or pending patent application
covering such invention. Once all our valid patents covering the invention expire, which will occur in 2018, and provided that
one of Aventis’ other patents that covers an aspect of the invention is still valid and has received marketing approval prior
to the expiration of all our patents covering the invention, the royalty will be reduced to 5%.
The Aventis Agreement does
not contain any diligence obligations that require us to exert any special efforts to develop a product for the prevention and
treatment of cholesterol gallstones, nor are we contractually required to meet any milestones in respect of the development or
commercialization of the invention. We have not yet paid, nor do we currently owe, any amounts to Aventis under the Aventis Agreement.
Additionally, after experiencing poor patient recruitment and due to higher-priority clinical programs, at this point in time we
have decided not to pursue the indications of cholesterol gallstones and we believe that it is unlikely that we will revive another
study in cholesterol gallstones.
Unipharm
On October 7, 2000, in
connection with a certain share subscription agreement, we sent a letter to Unipharm Ltd. (“Unipharmˮ), pursuant to
which we agreed to negotiate the grant of an exclusive license to Unipharm with respect to the use of patents within our first
patent family covering the composition of matter of Aramchol within Israel on to-be-agreed upon terms and conditions. The letter
stated that, if granted, such license would at all times be subject to our best interests, as determined in our sole discretion,
and all approvals and proceedings required by agreement or by law. As of the date hereof, no such definitive agreement has been
executed with regard to this matter and at this stage we have no intention to pursue such an agreement. The letter is silent as
to term, termination and whether or not it is binding.
Competition
The pharmaceutical industry
is characterized by rapidly evolving technology, intense competition and a highly risky, costly and lengthy research and development
process. Adequate protection of intellectual property, successful product development, adequate funding and retention of skilled,
experienced and professional personnel are among the many factors critical to success in the pharmaceutical industry.
Other companies, including,
Intercept Pharmaceuticals, Inc. Gilead Sciences, Inc., Allergan (through its acquisition of Tobira Therapeutics Inc.) and Genfit
S.A., have molecules currently in Phase III clinical development; Shire, Novartis (through the in-license of Conatus Pharmaceuticals
Inc.), Cirius, and Inventiva have molecules in Phase IIB clinical development for the treatment of NASH and the fibrosis associated
therewith. There are a host of other potential competitors in earlier stages of development relative to us for the treatment of
NASH including, but not limited to, Galectin Therapeutics Inc., AstraZeneca, Bristol-Myers Squibb, and Novartis.
Notwithstanding the foregoing,
see “Item 3. Key Information—Risk Factors—Risks Related to Our Business, Industry and Regulatory Requirements—Our
market is subject to intense competition. If we are unable to compete effectively, Aramchol or any other product candidate that
we develop may be rendered noncompetitive or obsolete.”
Intellectual Property and Patent Strategy
The proprietary nature
of, and protection for, Aramchol or any future product candidates and our discovery programs for new indications, processes and
know-how are important to our business. We own patent rights to Aramchol in various jurisdictions worldwide, including within and
outside of Israel. We have sought patent protection in the United States and internationally for Aramchol and our discovery programs,
and any other inventions to which we have rights, where available and when appropriate. The term of U.S. Patent No. 7,501,403,
covering the use of Aramchol for the treatment of fatty liver, has been extended due to patent term adjustments of 567 days, resulting
in an effective expiration date of November 3, 2023.
Our policy is to pursue,
maintain and defend patent rights, whether developed internally or licensed from third parties, and to protect the technology,
inventions and improvements that are commercially important to the development of our business. We also rely on trade secrets that
may be important to the development of our business.
Patent Portfolio for Aramchol (First-in-Class
Synthetic FABAC)
The patent
portfolio for Aramchol contains patents and pending patent applications directed to composition of matter, manufacturing
methods and methods of use. As of February 28, 2018, the latest practicable date for inclusion in this annual report, we own six
U.S. patents, and corresponding foreign patents and pending patent applications, as detailed below. We have also recently
filed a PCT patent application for second generation FABAC compounds.
The first patent family
discloses and claims FABACs, including Aramchol, as well as methods for preventing or dissolving cholesterol gallstones in bile
and reducing or preventing arteriosclerosis using FABACs. This patent family includes three issued U.S. patents and an issued European
patent that was validated in Austria, Belgium, Cyprus, Denmark, Finland, France, Germany Greece, Ireland, Italy, Latvia, Lithuania,
Luxembourg, Monaco, Netherlands, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland and the United Kingdom. Corresponding
patents have been granted in Australia, Brazil, Canada, China, Czech Republic, Belarus, Kazakhstan, Russian Federation, Hungary,
Indonesia, Israel, Japan, Korea, Mexico, New Zealand, Norway, Poland, Turkey and the Ukraine. If the appropriate maintenance, renewal,
annuity or other governmental fees are paid, the non-extended patent term for this patent family is due to expire on March 25,
2019, with the exception of the Israeli patent, which is due to expire on April 8, 2018.
The second patent family
discloses and claims additional FABACs with different conjugation moieties, as well as the use of these and the compounds disclosed
in the first patent family above, including Aramchol, in the treatment of fatty liver, reduction of serum cholesterol and treatment
of hyperglycemia and diabetes. This patent family includes a U.S. patent directed to the treatment of fatty liver a U.S. patent
directed to reduction of serum cholesterol by administering additional forms of FABACs, and a U.S. patent (Continuation-in-Part)
directed to the treatment of hyperglycemia and diabetes. This patent family also includes two European patents, one patent which
was validated in Austria, Belgium, Cyprus, Denmark, Finland, France, Germany Ireland, Italy, Luxembourg, Monaco, Netherlands, Portugal,
Spain, Sweden, Switzerland, Turkey and the United Kingdom, and the second patent which was validated in Belgium, Denmark, Finland,
France, Germany, Greece, Ireland, Italy, Netherlands, Spain, Sweden, Switzerland, Turkey and the United Kingdom. The family also
includes patents in Australia, Canada, China, Czech Republic, Azerbaijan, Belarus, Kyrgyzstan, Kazakhstan, Russian Federation,
Indonesia, Japan, Korea, Israel, Mexico, New Zealand, Norway, Poland, Hungary and the Ukraine. A foreign patent application is
pending in the Czech Republic. If the appropriate maintenance, renewal, annuity or other governmental fees are paid, the non-extended
patent term for this patent family is due to expire on April 15, 2022, with the exception of the Israeli patent, which is due to
expire on April 17, 2021. The terms of the U.S. patents in this family have been extended due to patent term adjustments of 567
days for U.S. Patent 7,501,403, which is directed to the treatment of fatty liver, and 24 days for U.S. Patent 8,110,564, which
is directed to reduction of serum cholesterol, and 356 days for U.S. Patent 8,975,246, which is directed to disorders associated
with altered glucose metabolism or insulin action.
A third patent family that
is due to expire on February 1, 2030, discloses the use of FABACs in the treatment, prevention and inhibition of progression of
Alzheimer’s Disease, cerebral amyloid angiopathy and other brain diseases characterized by amyloid plaque deposits. This
patent family includes an issued European patent that was validated in France, Germany, Switzerland and the United Kingdom.
A fourth patent family
discloses and claims second generation FABAC compounds. This patent family includes a pending U.S. patent application as well as
foreign patent applications in Australia, Brazil, Canada, China, Europe, Hong Kong, India, Israel, Japan and Korea.
A fifth patent family having
one U.S. patent application, discloses and claims compositions comprising second generation FABAC compounds.
The sixth and seventh patent
families, each including one Israeli patent application and one PCT patent application, and patent families eight to eleven, each
including one U.S. Provisional patent application, cover additional therapeutic uses of Aramchol.
Patent family thirteen,
including pending U.S. and foreign patent applications, is directed to topical uses of FABAC compounds.
It is possible that the
term of the patents issued in the United States within our first patent family, which includes the composition of matter patents,
may be extended up to five additional years under the provisions of the Drug Price Competition and Patent Term Restoration Act
of 1984 (the “Hatch-Waxman Actˮ) (the longest possible extended patent term being five years from November 3, 2023).
Patent term extension or supplementary protection certificates may be available in certain foreign countries upon regulatory approval.
Independent of patent term extensions, five years of data exclusivity will be provided for this patent in the United States automatically
from the day Aramchol receives regulatory approval, if it is approved, in the United States. The data exclusivity is solely for
the indication tested, in this case presumably NASH. If we pursue commercialization of Aramchol in other jurisdictions, longer
periods of data exclusivity may pertain.
Our commercial success
will depend in part on obtaining and maintaining patent protection and trade secret protection of our current and future product
candidates and the methods used to develop and manufacture them, as well as successfully defending these patents against third-party
challenges. Our ability to stop third parties from making, using, selling, offering to sell or importing our products depends on
the extent to which we have rights under valid and enforceable patents or trade secrets that cover these activities. We believe
that our patents provide broad and comprehensive coverage for the use of Aramchol for the treatment of certain liver diseases.
However, the patent positions of biopharmaceutical companies, such as ourselves, are generally uncertain and involve complex legal
and factual questions. Our ability to maintain and solidify our proprietary position for the technology will depend on our success
in obtaining effective claims and enforcing those claims once granted. There is no certainty that any of the Company’s pending
patent applications will result in the issuance of any patents. The issued patents and those that may be issued in the future,
may be challenged, narrowed, circumvented or found to be invalid or unenforceable, which could limit our ability to stop competitors
from marketing related products or the length of term of patent protection that we may have for our products. In addition, our
competitors may independently develop similar technologies or duplicate any technology developed by us, and the rights granted
under any issued or future patents may not provide us with any meaningful competitive advantages against these competitors. Furthermore,
because of the extensive time required for development, testing and regulatory review of a potential product, before any of our
products can be commercialized, any related patent may expire or remain in force for only a short period following commercialization,
thereby reducing any advantage of such patent. For more risks associated with the protection of our licensed intellectual property,
see “Item 3. Key Information—Risk Factors—Risks Related to Our Intellectual Property.”
Trade Secrets
In addition to patents,
we rely on trade secrets and know-how to develop and maintain our competitive position. Trade secrets and know-how can be difficult
to protect. We seek to protect our proprietary processes, in part, by confidentiality agreements and invention assignment agreements
with our employees, consultants, scientific advisors, contractors and commercial partners. These agreements are designed to protect
our proprietary information. We also seek to preserve the integrity and confidentiality of our data, trade secrets and know-how
by maintaining physical security of our premises and physical and electronic security of our information technology systems. While
we have confidence in these individuals, organizations and systems, such agreements or security measures may be breached, and we
may not have adequate remedies for any breach. In addition, our trade secrets may otherwise become known or be independently discovered
by competitors or others.
Seasonality
Our business and operations
are generally not affected by seasonal fluctuations or factors.
Raw Materials and Suppliers
We believe that the raw
materials that we require to manufacture Aramchol are readily available commodities commonly used in the pharmaceutical industry.
Manufacturing
We do not own or operate
manufacturing facilities for the production of Aramchol or any future product candidates, nor do we have plans to develop our own
manufacturing operations in the foreseeable future. We currently rely on third-party contract manufacturers for all of our required
raw materials, API and finished product for our non-clinical research and clinical trials, including our ARREST Study. We do not
have long term agreements with any of these third parties. We also do not have any current contractual relationships for the manufacture
of commercial supplies of Aramchol if it is approved; however, the Perrigo Agreement (as described herein) provides Perrigo with
the option to negotiate an exclusive commercial contract for the manufacture of commercial supplies of the Aramchol API in the
future for a minimum term of five years. If Aramchol or any future product candidates are approved by any regulatory agency, we
intend to enter into agreements with a third-party contract manufacturer or collaboration partner and one or more back-up manufacturers
for the commercial production of those products. Development and commercial quantities of any products that we develop will need
to be manufactured in facilities, and by processes, that comply with the requirements of the FDA and the regulatory agencies of
other jurisdictions in which we are seeking approval. We currently employ internal resources to manage our manufacturing contractors.
The relevant manufacturers of our drug substance and drug products for our current pre-clinical and clinical trials have advised
us that they are compliant with both cGMP and, cGLP.
There can be no assurance
that Aramchol, if approved, can be manufactured in sufficient commercial quantities, in compliance with regulatory requirements
and at an acceptable cost. We and our contract manufacturers are, and will be, subject to extensive governmental regulation in
connection with the manufacture of any pharmaceutical products or medical devices. We and our contract manufacturers must ensure
that all of the processes, methods and equipment are compliant with cGMP and cGLP for drugs on an ongoing basis, as mandated by
the FDA and other regulatory authorities, and conduct extensive audits of vendors, contract laboratories and suppliers.
On January 28, 2015, we
entered into the Perrigo Agreement with Perrigo, a former subsidiary of Perrigo Company plc that was recently acquired by SK Capital
Partners and had changed its name to Wavelength Pharmaceuticals, for, among other things, the large-scale production of Aramchol’s
API and the scale-up and manufacturing process optimization for large-scale production of the Aramchol API. To date, Perrigo has
manufactured three pilot batches of Aramchol API. The material obtained is of appropriate quality and was produced under GLP, but
has resulted in significant high manufacturing costs. Therefore, additional research and development work pertaining to the scale-up
and optimization of the process has been undertaken by two other CROs under cGMP and cGLP, in order, inter alia, to simplify, increase
yields and improve the volume capacity of the manufacturing process. Recently, we decided to proceed with one of those other CROs
which will complete the scale up and optimization process. Based on the results of the additional scale up and optimization process,
we will decide how to proceed with the future manufacture of Aramchol API. See “Item 4.B. Information on the Company—Business
Overview—Strategic Collaborations, Research Arrangements and Other Material Agreements—Perrigo API Ltd.” for
more information regarding the Perrigo Agreement.
Contract Research Organizations
We outsource certain clinical
trial activities to CROs. Our clinical CROs comply with guidelines from the International Conference on Harmonisation of Technical
Requirements for Registration of Pharmaceuticals for Human Use, which attempt to harmonize the FDA, the EMA, and the Pharmaceuticals
and Medical Devices Agency of Japan regulations and guidelines. We create and implement the drug development plans and manage the
CROs according to the specific requirements of the drug candidate under development. To the extent clinical research is overseen
by the CROs (or directly by us), compliance with certain federal regulations, including but not limited to 21 C.F.R. parts 50,
54, 56, 58 and 312, which pertain to, among other things, IRBs, informed consent, financial conflicts of interest by investigators,
correct administration of treatment, follow up of adverse events, good laboratory practices and submitting IND applications, may
be required.
Marketing, Sales and Commercialization
Given our stage of development,
we do not have any internal sales, marketing or distribution infrastructure or capabilities. In the event we receive regulatory
approval for Aramchol, we intend, where appropriate, to pursue commercialization relationships, including strategic alliances and
licensing, with pharmaceutical companies and other strategic partners, which are equipped to market and/or sell Aramchol or any
future product candidates, if any, through their well-developed sales, marketing and distribution organizations in order to gain
access to global markets. In addition, we may out-license some or all of our worldwide patent rights to more than one party to
achieve the fullest development, marketing and distribution of any products we develop. Over the longer term, we may consider ultimately
building an internal marketing, sales and commercial infrastructure. See “Item 4.B. Information on the Company—Business
Overview—Strategic Collaborations, Research Arrangements and other Material Agreements—Samil Pharm Co.” for information
regarding the license agreement we entered with Samil for the commercialization of Aramchol (with an option to manufacture) for
the treatment of fatty liver indications including NASH, in the Republic of Korea.
Environmental Matters
We, our agents and our
service providers, including our manufacturers, may be subject to various environmental, health and safety laws and regulations,
including those governing air emissions, water and wastewater discharges, noise emissions, the use, management and disposal of
hazardous, radioactive and biological materials and wastes and the cleanup of contaminated sites. We believe that our business,
operations and facilities, including, to our knowledge, those of our agents and service providers, are being operated in compliance
in all material respects with applicable environmental and health and safety laws and regulations. All information with respect
to any chemical substance is filed and stored as a Material Safety Data Sheet, as required by applicable environmental regulations.
Based on information currently available to us, we do not expect environmental costs and contingencies to have a material adverse
effect on us. However, significant expenditures could be required in the future if we, our agents or our service providers are
required to comply with new or more stringent environmental or health and safety laws, regulations or requirements.
Government Regulation and Product Approval
Governmental authorities
in the United States and in other countries extensively regulate, among other things, the research, development, testing, manufacture,
labeling, packaging, promotion, storage, advertising, distribution, marketing and export and import of products such as those we
are developing. Aramchol or any future product candidates must be approved by the FDA through the NDA process before they may be
legally marketed in the United States and by the Committee on Human Medicinal Products (“CHMPˮ), via the EMA and European
Commission through the MAA process before they may be legally marketed in Europe. Aramchol or any future product candidates will
be subject to similar requirements in other countries prior to marketing in those countries. The process of obtaining regulatory
approvals and the subsequent compliance with applicable federal, state, local and foreign statutes and regulations require the
expenditure of substantial time and financial resources.
We are conducting a global
development program for Aramchol for the treatment of NASH in patients who are overweight or obese and have pre diabetes or type
II diabetes mellitus, and we may make our submissions for regulatory approval in parallel; initially in Europe and in the United
States. Typically, approval time in the United States with the FDA for an NDA is faster than that within Europe with the EMA and
the European Commission for an MAA, especially when the novelty of the submission is considered. First in class, high medical need
and rare disease drugs can experience faster review. Nevertheless, marketing and pricing approval presents a further delay in many
countries that should be considered in addition to the regulatory approvals noted above.
United States Government Regulation
NDA Approval Processes
In the United States, the
FDA regulates drugs under the Federal Food, Drug, and Cosmetic Act (the “FDCAˮ), and implementing regulations and guidance
documents. Failure to comply with the applicable U.S. requirements at any time during the product development process or approval
process, or after approval, may subject an applicant to administrative or judicial sanctions, any of which could have a material
adverse effect on us. These sanctions could include refusal to approve pending applications, withdrawal of an approval, imposition
of a clinical hold, issuance of warning letters, product seizures, total or partial suspension of production or distribution, injunctions,
fines, disgorgement, and civil or criminal penalties.
The process required by
the FDA before a drug may be marketed in the United States generally involves the following:
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completion of pre-clinical laboratory tests, animal studies and formulation studies conducted according
to GLPs, or other applicable regulations;
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submission to the FDA of an IND application, which must become effective before human clinical
trials may begin;
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performance of adequate and well-controlled human clinical trials according to GCPs, to establish
the safety and efficacy of the proposed drug for its intended use;
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submission to the FDA of an NDA;
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satisfactory completion of an FDA inspection of the manufacturing facility or facilities at which
the product is produced to assess compliance with cGMPs to assure that the facilities, methods and controls are adequate to preserve
the drug’s identity, strength, quality and purity;
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satisfactory completion of FDA inspections of clinical sites and GLP toxicology studies; and
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FDA review and approval of the NDA.
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The testing and approval
process requires substantial time, effort and financial resources, and we cannot be certain that any approvals for Aramchol or
any future product candidates will be granted on a timely basis, if at all.
Once a product candidate
is identified for development, it enters the pre-clinical testing stage. Pre-clinical tests include laboratory evaluations of product
chemistry, toxicity and formulation, as well as animal studies. An IND sponsor must submit the results of the pre-clinical tests,
together with manufacturing information and analytical data, to the FDA as part of the IND. Some pre-clinical testing may continue
after the IND is submitted. In addition to including the results of the pre-clinical studies, the IND will also include a clinical
trial protocol detailing, among other things, the objectives of the clinical trial, the parameters to be used in monitoring safety
and, depending on the phase of the study, the effectiveness criteria to be evaluated. The IND automatically becomes effective 30
days after receipt by the FDA, unless the FDA, within the 30-day time period, places the IND on clinical hold. In such a case,
the IND sponsor and the FDA must resolve any outstanding concerns before clinical trials can begin. A clinical hold may occur at
any time during the life of an IND, due to safety concerns or non-compliance, and may affect one or more specific studies or all
studies conducted under the IND.
All clinical trials must
be conducted under the supervision of one or more qualified investigators in accordance with the FDA’s GCP regulations. These
regulations include the requirement that all research subjects provide informed consent. Further, an IRB must review and approve
the plan for any clinical trial, including the informed consent document, before it commences at any institution. An IRB considers,
among other things, whether the risks to individuals participating in the trials are minimized and are reasonable in relation to
anticipated benefits. The IRB also approves the investigator brochure and other information about the trial distributed by the
sponsor and the consent form that must be provided to each trial subject or his or her legal representative and must monitor the
study until completed. All clinical trials must be conducted under protocols detailing the objectives of the trial, dosing procedures,
research subject inclusion and exclusion criteria and the safety and effectiveness criteria to be evaluated. Each protocol must
be submitted to the FDA as part of the IND, and progress reports detailing the status of the clinical trials must be submitted
to the FDA annually. Sponsors must also report within set timeframes to FDA serious and unexpected adverse reactions, any clinically
important increase in the rate of a serious suspected adverse reaction over that listed in the protocol or investigation brochure,
or any findings from other studies or animal or in-vitro testing that suggest a significant risk in humans exposed to the drug.
Sponsors must also report to FDA certain amendments to the protocol and other essential information concerning the IND that does
not fall within the scope of other required reports.
Human clinical trials are
typically conducted in three sequential phases that may overlap or be combined:
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Phase I
. The drug is initially introduced into healthy human subjects and tested for safety,
dosage tolerance, absorption, metabolism, distribution and elimination. In the case of some products for severe or life-threatening
diseases, such as cancer, especially when the product may be inherently too toxic to ethically administer to healthy volunteers,
the initial human testing is often conducted in patients.
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Phase II
. Clinical trials are performed on a limited patient population intended to identify
possible adverse effects and risks, to preliminarily evaluate the efficacy of the product for specific targeted diseases and to
determine dosage tolerance and optimal dosage.
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Phase III
. Clinical trials are undertaken to further evaluate dosage, clinical efficacy
and safety in an expanded patient population at geographically dispersed clinical study sites. Phase III clinical trials are conducted
to provide sufficient data for the statistically valid evidence of safety and efficacy.
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Human clinical trials are
inherently uncertain and Phase I, Phase II and Phase III testing may not be successfully completed. The FDA or the sponsor may
suspend a clinical trial at any time for a variety of reasons, 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 trial at its institution
if the clinical trial is not being conducted in accordance with the IRB’s requirements or if the drug has been associated
with unexpected serious harm to patients.
During the development
of a new drug, sponsors are given opportunities to meet with the FDA at certain points. These points are typically prior to the
submission of an IND, at the end of Phase II and before an NDA is submitted. Meetings at other times may also be requested. These
meetings can provide an opportunity for the sponsor to share information about the data gathered to date and for the FDA to provide
advice on the next phase of development. Sponsors typically use the meeting at the end of Phase II to discuss their Phase II clinical
results and present their plans for the pivotal Phase III clinical trial that they believe will support the approval of the NDA.
If a Phase II clinical trial is the subject of discussion at the end of Phase II meeting with the FDA, a sponsor may be able to
request a Special Protocol Assessment (the “SPAˮ), the purpose of which is to reach agreement with the FDA on the Phase
III clinical trial protocol design and size that will form the primary basis for the demonstration of effectiveness in a marketing
application.
According to published
guidance on the SPA process, a sponsor which meets the prerequisites may make a specific request for an SPA and provide information
regarding the design and size of the proposed clinical trial. The FDA has a goal of completing the majority of SPA reviews within
45 days, although certain circumstances may result in a delay in FDA’s decision. An SPA request must be made before the proposed
trial begins, and all open issues must be resolved before the trial begins. If a written agreement is reached, it will be documented
and made part of the record. The agreement will be binding on the FDA and may not be changed by the sponsor or the FDA after the
trial begins except with the written agreement of the sponsor and the FDA or if the FDA determines that a substantial scientific
issue essential to determining the safety or efficacy of the drug was identified after the testing began. There is no indication
that we will be able to meet the requirements necessary for an SPA.
Concurrent with clinical
trials, sponsors usually complete any remaining animal safety studies and also develop additional information about the chemistry
and physical characteristics of the drug and finalize a process for manufacturing commercial quantities of the product in accordance
with cGMP requirements. The manufacturing process must be capable of consistently producing quality batches of the drug and the
manufacturer must develop methods for testing the quality, purity and potency of the drug. Additionally, appropriate packaging
must be selected and tested and stability studies must be conducted to demonstrate that the drug candidate does not undergo unacceptable
deterioration over its proposed shelf-life.
The results of product
development, pre-clinical studies and clinical trials, along with descriptions of the manufacturing process, analytical tests and
other control mechanisms, proposed labeling and other relevant information are submitted to the FDA as part of an NDA requesting
approval to market the product for one or more specified indications. The submission of an NDA is subject to the payment of an
application fee, but a waiver of such fees may be obtained under specified circumstances. We will seek a waiver of these fees as
a small business submitting its first human drug application to the FDA. If the waiver is granted it would not extend to establishment
or product fees. The FDA reviews all NDAs submitted to ensure that they are sufficiently complete for substantive review before
it accepts them for filing. It may request additional information rather than accept an NDA for filing. In this event, the NDA
must be resubmitted with the additional information. The resubmitted application also is subject to review before the FDA accepts
it for filing.
Once the submission is
accepted for filing, the FDA begins an in-depth review. The FDA may refuse to approve an NDA if the applicable statutory and regulatory
criteria are not satisfied or may require additional clinical or other data. Even if such data are submitted, the FDA may ultimately
decide that the NDA does not satisfy the criteria for approval. The FDA reviews an NDA to determine, among other things, whether
a product is safe and effective for its intended use and whether its manufacturing is cGMP-compliant. The FDA may refer the NDA
to an advisory committee for review and recommendation as to whether the application should be approved and under what conditions.
The FDA is not bound by the recommendation of an advisory committee, but it generally follows such recommendations. Before approving
an NDA, the FDA will typically inspect the facility or facilities where the product is manufactured and tested. The FDA will also
inspect selected clinical sites that participated in the clinical studies and may inspect the testing facilities that performed
the GLP toxicology studies cited in the NDA.
Expedited Review and
Approval
NDAs receive either standard
or expedited review. A drug representing a significant improvement in treatment, prevention or diagnosis of disease may receive
expedited review. The FDA has various specific programs, including Fast Track, Breakthrough Therapy, Priority Review, and Accelerated
Approval, which, in different ways, are each intended to expedite the process for reviewing and approving drugs. Even if a drug
qualifies for one or more of these programs, the FDA may later decide that the drug no longer meets the conditions for qualification
or that the time period for FDA review or approval will be shortened. Generally, drugs that are eligible for these programs are
those for serious or life-threatening conditions, those with the potential to address unmet medical needs and those that offer
meaningful benefits over existing treatments. For example, Fast Track is a process designed to facilitate the development and expedite
the review of drugs to treat serious or life-threatening diseases or conditions and fill unmet medical needs, and Breakthrough
Therapy designation is designed to expedite the development and review of drugs that are intended to treat a serious condition
where preliminary clinical evidence indicates that the drug may demonstrate substantial improvement over available therapy on a
clinically significant endpoint(s). Priority review is designed to give drugs that offer major advances in treatment or provide
a treatment where no adequate therapy exists an initial review within six months as compared to a standard review time of ten months.
Although Fast Track, Breakthrough Therapy designation and priority review do not affect the standards for approval, the FDA will
attempt to facilitate early and frequent meetings with a sponsor of a Fast Track or Breakthrough Therapy designated drug and expedite
review of the application for a drug designated for priority review. The FDA will also provide Breakthrough Therapy designated
drugs intensive guidance on an efficient drug development program and provide these drug developers with an organizational commitment
from the FDA involving senior managers. Since sponsors can design clinical trials in a number of ways, in providing its guidance
for drugs designated as breakthrough therapies, the FDA will seek to ensure that the sponsor of the product designated as a breakthrough
therapy receives timely advice and interactive communications in order to help the sponsor design and conduct a development program
as efficiently as possible. During these interactions, the FDA may suggest, or a sponsor can propose, alternative clinical trial
designs (e.g., adaptive designs, an enrichment strategy, use of historical controls) that may result in smaller trials or more
efficient trials that require less time to complete. Such trial designs could also help minimize the number of patients exposed
to a potentially less efficacious treatment (i.e., the control group treated with available therapy). On September 23, 2014, the
FDA granted Fast Track designation status to Aramchol for the treatment of patients who are overweight or obese and have pre diabetes
or type II diabetes mellitus with NASH.
Accelerated Approval, which
is described in 21 C.F.R. § 314.500
et seq
., provides for approval of a new drug that is intended to treat a serious
or life-threatening disease or condition and that fills an unmet medical need based on a surrogate endpoint. A surrogate endpoint
is a laboratory measurement or physical sign used as an indirect or substitute measurement representing a clinically meaningful
outcome. To be used in accelerated approval, a surrogate endpoint must be “reasonably likely, based on epidemiologic, therapeutic,
pathophysiologic, or other evidence to predict benefit on irreversible morbidity or mortality.” The term “reasonably
likely” implies that some uncertainty remains about the relationship of the surrogate to the clinical benefit to the patient.
Therefore, accelerated approval is typically contingent on a sponsor’s agreement to conduct additional post-approval studies
to verify and describe the drug’s clinical benefit. Accelerated Approval does not change the standards for approval, but
by allowing a demonstration of efficacy based on a surrogate endpoint may expedite the approval process.
Liver histology currently
offers the best short-term method for tracking the progression of NASH. Certain features on histopathology provide some prognostic
information regarding risk for progression. Steatohepatitis, not isolated fatty liver, is associated with a substantial increase
in the long-term risk of developing cirrhosis and liver-related outcomes (15, 35). This is believed to be related to the underlying
inflammation and activation of pro-fibrogenic pathways in NASH. Based on this current understanding of the pathogenesis of NASH,
one would expect that reversal of steatohepatitis would reduce the risk of developing cirrhosis. However, steatosis and inflammation
can decrease as fibrosis advances (37). Therefore, the reversal of steatohepatitis with no evidence of progression to advanced
fibrosis (stage 3 or 4), may be an acceptable surrogate endpoint suitable both for phase IIB and III trials that enroll patients
with NASH and evidence of early fibrosis.
In 2016, the U.S. Congress
enacted the 21
st
Century Cures Act. The law contains several provisions aimed at accelerating drug approval. In particular,
it directs FDA to implement a formal review pathway to qualify biomarkers and other drug development tools. It is unclear when
this new pathway will be implemented or whether using this pathway would have any impact on our clinical program.
Patent Term Restoration
and Marketing Exclusivity
Depending upon the timing,
duration and specifics of FDA approval of the use of Aramchol or any future product candidates, U.S. patents may be eligible for
limited patent term extension under the Hatch-Waxman Act. The Hatch-Waxman Act permits a patent restoration term of up to five
years as compensation for patent term lost during product development and the FDA regulatory review process. However, patent term
restoration cannot extend the remaining term of a patent beyond a total of 14 years from the product’s approval date. The
patent term restoration period is generally one-half the time between the effective date of an IND, and the submission date of
an NDA, plus the time between the submission date of an NDA and the approval of that application. Only one patent applicable to
an approved drug is eligible for the extension and the application for extension must be made prior to expiration of the patent.
The USPTO, in consultation with the FDA, reviews and approves the application for any patent term extension or restoration. In
the future, we intend to apply for restorations of patent term for some of our currently owned patents to add patent life beyond
their current expiration date, depending on the expected length of clinical trials and other factors involved in the submission
of the relevant NDA.
Market exclusivity provisions
under the FDCA also can delay the submission or the approval of certain applications. The FDCA provides a five year period of non-patent
marketing exclusivity within the United States to the first applicant to gain approval of an NDA for a new chemical entity. A drug
is a new chemical entity if the FDA has not previously approved any other new drug containing the same active moiety, which is
the molecule or ion responsible for the action of the drug substance. During the exclusivity period, the FDA may not accept for
review an abbreviated new drug application (“ANDAˮ), or a 505(b)(2) NDA submitted by another company for another version
of such drug where the applicant does not own or have a legal right of reference to all the data required for approval. However,
an application may be submitted after four years if it contains a certification of patent invalidity or non-infringement. The FDCA
also provides three years of marketing exclusivity for an NDA, 505(b)(2) NDA or supplement to an approved NDA if new clinical investigations,
other than bioavailability studies, that were conducted or sponsored by the applicant are deemed by the FDA to be essential to
the approval of the application, for example, for new indications, dosages or strengths of an existing drug. This three year exclusivity
covers only the conditions associated with the new clinical investigations and does not prohibit the FDA from approving ANDAs for
drugs containing the original active agent. Five year and three year exclusivity will not delay the submission or approval of a
full NDA; however, an applicant submitting a full NDA would be required to conduct or obtain a right of reference to all of the
pre-clinical studies and adequate and well-controlled clinical trials necessary to demonstrate safety and effectiveness.
Post-approval Requirements
Once an approval is granted,
the FDA, European authorities and other regulatory authorities may withdraw the approval if compliance with regulatory requirements
is not maintained or if problems occur after the product reaches the market. Later discovery of previously unknown problems with
a product may result in restrictions on the product or even complete withdrawal of the product from the market. After approval,
some types of changes to the approved product, such as adding new indications, manufacturing changes and additional labeling claims,
are subject to further regulatory authority review and approval. Some of these modifications, especially adding indications, would
likely require additional clinical studies. In addition, the FDA may require testing and surveillance programs to monitor the effect
of approved products that have been commercialized, and the FDA has the power to prevent or limit further marketing of a product
based on the results of these post-marketing programs.
Any drug product manufactured
or distributed by us pursuant to FDA approvals are subject to continuing regulation by the FDA, including, among other things record-keeping
requirements; cGMPs; reporting of adverse experiences with the drug; providing the FDA with updated safety and efficacy information;
drug sampling and distribution requirements; notifying the FDA and gaining its approval of specified manufacturing or labeling
changes; and complying with FDA promotion and advertising requirements.
Drug manufacturers and
other entities involved in the manufacture and distribution of approved drugs are required to register their establishments with
the FDA and certain state agencies, and are subject to periodic unannounced inspections by the FDA and some state agencies for
compliance with cGMP and other laws.
We rely, and expect to
continue to rely, on third parties for the production of clinical and commercial quantities of Aramchol. Future FDA and state inspections
may identify compliance issues at the facilities of our contract manufacturers that may disrupt production or distribution, or
require substantial resources to correct.
From time to time, legislation
is drafted, introduced and passed in Congress that could significantly change the statutory provisions governing the approval,
manufacturing and marketing of products regulated by the FDA. In addition, FDA regulations and guidance are often revised or reinterpreted
by the agency in ways that may significantly affect our business and our products. It is impossible to predict whether legislative
changes will be enacted, or FDA regulations, guidance or interpretations changed or what the impact of such changes, if any, may
be. In particular, it is unknown whether any of the provisions of the 2016 21
st
Century Cures Act that are intended
to accelerate drug approval will result in any change in the current approval pathway for Aramchol.
Pursuant to the Affordable
Care Act (discussed in greater detail below), the Centers for Medicare & Medicaid Services (CMS) is required to collect and
publish information reported by applicable manufacturers about payments and other transfers of value manufacturers have made to
physicians and teaching hospitals. Such a law, when applicable to our products, could increase the company’s regulatory liability
through the imposition of additional reporting and regulatory requirements. There are also an increasing number of state laws that
require manufacturers to make similar reports to states on pricing and marketing information.
Reimbursement
We face uncertainties over
the pricing of pharmaceutical products. Sales of Aramchol or any future product candidates will depend, in part, on the extent
to which the costs of Aramchol or any future product candidates will be covered by third-party payors, such as federal health programs,
commercial insurance and managed care organizations. These third-party payors are increasingly challenging the prices charged for
medical products and services. Additionally, the containment of healthcare costs has become a priority of federal and state governments
and the prices of drugs have been a focus in this effort. The U.S. government, state legislatures, foreign governments and third
party payors have shown significant interest in implementing cost-containment programs, including price controls, pricing transparency
disclosure obligations, restrictions on reimbursement and requirements for substitution of generic products. Adoption of price
controls and cost-containment measures, and adoption of more restrictive policies in jurisdictions with existing controls and measures,
could further limit our net revenue and results. If these third-party payors do not consider Aramchol or any future product candidates
to be cost-effective compared to other therapies, they may not cover Aramchol or any future product candidates after approved as
a benefit under their plans or, if they do, the level of payment may not be sufficient to allow us to sell Aramchol or any future
product candidates on a profitable basis.
The Medicare Modernization
Act imposed new requirements for the distribution and pricing of prescription drugs for Medicare beneficiaries under Part D. Under
Part D, Medicare beneficiaries may enroll in prescription drug plans offered by private entities that provide coverage of outpatient
prescription drugs. Part D prescription drug plan sponsors are not required to pay for all covered Part D drugs, and each drug
plan can develop its own drug formulary that identifies which drugs it will cover and at what tier or level. However, Part D prescription
drug formularies must include drugs within each therapeutic category and class of covered Part D drugs, though not necessarily
all the drugs in each category or class. The Centers for Medicare & Medicaid Services published a final rule in 2014 implementing
the Medicare Modernization Act. Contrary to the proposed rule, which would have enabled Part D plans to offer fewer drugs, the
final rule maintained the existing six protected classes of drug categories, but stated that some of the proposals not included
in the final rule could still be finalized in the future, which would impact payor formulary and coverage decisions.
The American Recovery and
Reinvestment Act of 2009 provides funding for the federal government to compare the effectiveness of different treatments for the
same illness. A plan for the research will be developed by the Department of Health and Human Services, the Agency for Healthcare
Research and Quality and the National Institutes for Health, and periodic reports on the status of the research and related expenditures
will be made to Congress. Although the results of the comparative effectiveness studies are not intended to mandate coverage policies
for public or private payors, it is not clear what effect, if any, the research will have on the sales of any product, if any such
product or the condition that it is intended to treat is the subject of a study. It is also possible that comparative effectiveness
research demonstrating benefits in a competitor’s product could adversely affect the sales of Aramchol or any future product
candidates. If third-party payors do not consider Aramchol or any future product candidates to be cost-effective compared to other
available therapies, they may not cover Aramchol or any future product candidates as a benefit under their plans or, if they do,
the level of payment may not be sufficient to allow us to sell Aramchol or any future product candidates on a profitable basis.
The Affordable Care Act,
enacted in March 2010, has had a significant impact on the health care industry. Some of the key changes made to date pursuant
to the Affordable Care Act include an expansion of coverage for the uninsured, the creation of insurance marketplaces and increased
protection of insureds with new benefits, rights and protections. With regard to pharmaceutical products, among other things, the
Affordable Care Act made major changes to the Medicare prescription drug program, which helped reduce drug costs for seniors and
increased rebates and other costs for the pharmaceutical industry.
On January 20, 2017, President
Donald J. Trump was inaugurated as the President of the United States. President Trump has stated that he intends to “repeal
and replace” the Affordable Care Act, and Congress has taken initial steps to repeal the law. In December 2017, Congress
passed and the President signed into law tax reform legislation that made significant changes to the Affordable Care Act including
the repeal of the “individual mandate” that was in place to strongly encourage broad participation in the health insurance
markets. Given these changes and other statements of political leaders, we cannot predict the ultimate impact on the Affordable
Care Act and the subsequent effect on the pharmaceutical industry at this time.
In addition, in some non-U.S.
jurisdictions, the proposed pricing for a drug must be approved before it may be lawfully marketed. The requirements governing
drug pricing vary widely from country to country. For example, the EU provides options for its member states to restrict the range
of medicinal products for which their national health insurance systems provide reimbursement and to control the prices of medicinal
products for human use. A member state may approve a specific price for the medicinal product or it may instead adopt a system
of direct or indirect controls on the profitability of the company placing the medicinal product on the market. There can be no
assurance that any country that has price controls or reimbursement limitations for pharmaceutical products will allow favorable
reimbursement and pricing arrangements for Aramchol or any future product candidates. Historically, products launched in the EU
do not follow price structures of the United States and generally tend to be significantly lower.
Healthcare Fraud and
Abuse Laws
In the U.S., the research,
development, testing, manufacturing, handling, storage, distribution, sale and promotion of drug products and medical devices are
potentially subject to regulation by various federal, state and local authorities in addition to the FDA, including the Centers
for Medicare & Medicaid Services, other divisions of the U.S. Department of Health and Human Services (e.g., the Office of
Inspector General), the U.S. Department of Justice, state Attorneys General, and other state and local government agencies. For
example, sales, marketing and scientific/educational grant programs must comply with the fraud and abuse provisions applicable
to pharmaceutical manufacturers, including the federal “Anti-Kickback Statute”, the Civil Monetary Penalty Statute,
the Stark Law, the federal False Claims Act, as amended, state and federal “Physician Payment Sunshine Act” laws and
regulations, the privacy regulations promulgated under the Health Insurance Portability and Accountability Act (“HIPAAˮ),
and similar state laws. Pricing and rebate programs must comply with the Medicaid Drug Rebate Program requirements of the Omnibus
Budget Reconciliation Act of 1990, as amended, and the Veterans Health Care Act of 1992, as amended. If products are made available
to authorized users of the Federal Supply Schedule of the General Services Administration, additional laws and requirements apply.
All of these activities are also potentially subject to federal and state consumer protection and unfair competition laws.
The Anti- Kickback Statute
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 the referral of business, including the purchase,
order, or prescription of a particular drug, for which payment may be made under a federal healthcare program, such as Medicare
or Medicaid.
The federal False Claims
Act prohibits anyone from knowingly presenting, conspiring to present, making a false statement in order to present, or causing
to be presented, for payment to federal programs (including Medicare and Medicaid) claims for items or services, including drugs,
that are false or fraudulent, claims for items or services not provided as claimed, or claims for medically unnecessary items or
services. This law also prohibits anyone from knowingly underpaying an obligation owed to a federal program. Increasingly, U.S.
federal agencies are requiring nonmonetary remedial measures, such as corporate integrity agreements in False Claims Act settlements.
The U.S. Department of Justice announced in 2016 its intent to follow the “Yates Memo,” taking a far more aggressive
approach in pursuing individuals as False Claims Act defendants in addition to the corporations.
The Physician Payment Sunshine
Act, enacted in 2010 as part of the Affordable Care Act, requires manufacturers of pharmaceuticals and medical devices to annually
report certain payments and other transfers of value to physicians and teaching hospitals, as well as investment interests held
by physicians and their immediate family members. In recent years, several states in the United States have also enacted legislation
requiring pharmaceutical companies to file periodic reports with the state, make periodic public disclosures on sales, marketing,
pricing, clinical trials and other activities, and/or register their sales representatives, as well as establish marketing compliance
programs. These laws may affect our sales, marketing, and other promotional activities by imposing administrative and compliance
burdens on us. Failure to meet these requirements, to the extent they are applicable to our activities, also could result in a
variety of governmental sanctions that could have a material adverse effect on our business.
European Economic Area
In addition to approval
in the United States, we currently intend to seek regulatory approval of Aramchol in the EU. As such, a summary of the EU regulatory
processes follows below.
A medicinal product may
only be placed on the market in the European Economic Area (the “EEAˮ), composed of the 28 EU member states, plus Norway,
Iceland and Lichtenstein, when a marketing authorization has been issued by the competent authority of a member state pursuant
to member states’ law based on Directive 2001/83/EC, or an authorization has been granted under the centralized procedure
in accordance with Regulation (EC) No. 726/2004 or its predecessor, Regulation 2309/93. There are essentially three community procedures
created under prevailing European pharmaceutical legislation that, if successfully completed, allow an applicant to place a medicinal
product on the market in the EEA.
Centralized Procedure
Regulation 726/2004/EC
governs the centralized procedure when a marketing authorization is granted by the European Commission, acting in its capacity
as the European Licensing Authority on the advice of the EMA. That authorization is valid throughout the entire community and directly
or (as to Norway, Iceland and Liechtenstein) indirectly allows the applicant to place the product on the market in all member states
of the EEA. The EMA is the administrative body responsible for coordinating the existing scientific resources available in the
member states for evaluation, supervision and pharmacovigilance of medicinal products. Certain medicinal products, as described
in the Annex to Regulation 726/2004, must be authorized centrally. These are products that are developed by means of certain biotechnological
processes in accordance with Paragraph 1 to the Annex to the Regulation. Medicinal products for human use containing a new active
substance for which the therapeutic indication is the treatment of acquired immune deficiency syndrome, or AIDS, cancer, neurodegenerative
disorder or diabetes, autoimmune diseases and other immune dysfunctions and viral diseases must also be authorized centrally. Finally,
all medicinal products that are designated as orphan medicinal products pursuant to Regulation 141/2000 and Advanced Therapy Medicinal
Products (ATMP) according to Reg. (EC) No. 1394/2007 and medicinal products for veterinary use that are used primarily as performance
enhancers must be authorized under the centralized procedure. An applicant may also opt for assessment through the centralized
procedure if the medicinal product contains a new active substance which was not authorized in the EU when Reg. (EC) No. 726/2004
entered into force, or if the applicant can show that the medicinal product constitutes a significant therapeutic, scientific or
technical innovation or that the granting of authorization centrally is in the interests of patients or animal health at the community
level. For each application submitted to the EMA for scientific assessment, the EMA is required to ensure that the opinion of the
Committee for Medicinal Products for Human Use, or CHMP, is given within 210 days after receipt of a valid application. This 210
days period does not include the time that the applicant needs to answer any questions raised during the application procedure,
the so-called ‘clock stop’ period. If the opinion is positive, the EMA is required to send the opinion to the European
Commission, which is responsible for preparing the draft decision granting a marketing authorization. This draft decision may differ
from the CHMP opinion, stating reasons for diverging from the CHMP opinion. The draft decision is sent to the applicant and the
member states, after which the European Commission takes a final decision. If the initial opinion of the CHMP is negative, the
applicant is afforded an opportunity to seek a re-examination of the opinion. The CHMP is required to re-examine its opinion within
60 days following receipt of the request by the applicant. All CHMP refusals and the reasons for refusal are made public on the
EMA website. Without a centralized marketing authorization it is prohibited to place a medicinal product that must be authorized
centrally on the market in the EU. Once a centralized marketing authorization has been granted by the European Commission, it is
valid in all EEA States for 5 years on a renewable basis.
Mutual Recognition and
Decentralized Procedures
With the exception of products
that are authorized centrally, the competent authorities of the member states are responsible for granting marketing authorizations
for medicinal products placed on their national markets. If the applicant for a marketing authorization intends to market the same
medicinal product in more than one member state, the applicant may seek an authorization progressively in the community under the
mutual recognition or decentralized procedure. Mutual recognition procedure (“MRP”) is used if the medicinal product
has already been authorized in a member state. In this case, the holder of this marketing authorization requests the member state
where the authorization has been granted to act as reference member state by preparing an updated assessment report that is then
used to facilitate mutual recognition of the existing authorization in the other member states in which approval is sought (the
so-called concerned member state(s)). The reference member state must prepare an updated assessment report within 90 days of receipt
of a valid application. This report together with the approved Summary of Product Characteristics (the “SmPCˮ) (which
sets out the conditions of use of the product), and a labeling and package leaflet are sent to the concerned member states for
their consideration. The concerned member states are required to approve the assessment report, the SmPC and the labeling and package
leaflet within 90 days of receipt of these documents. The total procedural time of the MRP is 180 days.
The decentralized procedure
(“DCP”) is used in cases where the medicinal product has not received a marketing authorization in the EU at the time
of application. The applicant requests a member state of its choice to act as reference member state to prepare an assessment report
that is then used to facilitate agreement with the concerned member states and the grant of a national marketing authorization
in all of these member states. In this procedure, the reference member state must prepare, for consideration by the concerned member
states, the draft assessment report, a draft SmPC and a draft of the labeling and package leaflet within 120 days after receipt
of a valid application. As in the case of mutual recognition, the concerned member states are required to approve these documents
within 90 days of their receipt, i.e. the total time of the DCP is 210 days.
For both MRP and DCP, if
a concerned member state objects to the grant of a marketing authorization on the grounds of a potential serious risk to public
health, it may raise a reasoned objection with the reference member state. The points of disagreement are in the first instance
referred to the Co-ordination Group on MRP and DCP to reach an agreement within 60 days of the communication of the points of disagreement.
If member states fail to reach an agreement, then the matter is referred to the EMA and CHMP for arbitration. The CHMP is required
to deliver a reasoned opinion within 60 days of the date on which the matter is referred. The scientific opinion adopted by the
CHMP forms the basis for a binding European Commission decision.
Irrespective of whether
the medicinal product is assessed centrally, de-centrally or through a process of mutual recognition, the medicinal product must
be manufactured in accordance with the principles of GMP as set out in Directive2001/83/EC and Directive 2003/94/EC, or, Directive
2017/1572/EU that will replace Directive 2003/94/EC expectedly by 2019.
Directive 2003/94/EC and
Volume 4 of the rules governing medicinal products govern GMP in the European community. Moreover, community law requires the clinical
results in support of clinical safety and efficacy based upon clinical trials conducted in the European community to be in compliance
with the requirements of Directive 2001/20/EC, which implements good clinical practice in the conduct of clinical trials on medicinal
products for human use. Clinical trials conducted outside the European community and used to support applications for marketing
within the EU must have been conducted in a way consistent with the principles set out in Directive 2001/20/EC. The conduct of
a clinical trial in the EU requires, pursuant to Directive 2001/20/EC, authorization by the relevant national competent authority
where a trial takes place, and an ethics committee to have issued a favorable opinion in relation to the arrangements for the trial.
It also requires that the sponsor of the trial, or a person authorized to act on his behalf in relation to the trial, be established
in the community. Directive 2001/20/EC will be replaced by Regulation (EU) No. 536/2014 on Clinical Trials in the near future.
Although the Regulation entered into force on 16 June 2014 the timing of its application depends on the development of a fully
functional EU clinical trials portal and database, which will be confirmed by an independent audit. The Regulation becomes applicable
six months after the European Commission publishes a notice of this confirmation. The entry into application of the Regulation
is currently estimated to occur in 2019. Once the new Regulation becomes applicable, clinical trials law in the EU will be further
harmonized.
National Procedure
This procedure is available
for medicinal products that do not fall within the scope of mandatory centralized authorization. Specific procedures and timelines
differ between member states, but the duration of the procedure without clock-stop time is generally 210 days and based on a risk/efficacy
assessment by the competent authority of the member state concerned, followed by determination of SmPC, package leaflet and label
text/layout and subsequently grant of the marketing authorization. Marketing authorizations granted on this basis are not mutually
recognized by other member states, but the national marketing authorization can later be used in an MRP to obtain marketing authorizations
in other member states.
There are various types
of applications for marketing authorizations:
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Full Applications
. A full application is one that is made under any of the community procedures
described above and that “stands alone” in the sense that it contains all of the particulars and information required
by Article 8(3) of Directive 2001/83 (as amended) to allow the competent authority to assess the quality, safety and efficacy of
the product and in particular the balance between benefit and risk. Article 8(3)(l) in particular refers to the need to present
the results of the applicant’s research on (i) pharmaceutical (physical-chemical, biological or microbiological) tests, (ii)
pre-clinical (toxicological and pharmacological) studies and (iii) clinical trials in humans. The nature of these tests, studies
and trials is explained in more detail in Annex I to Directive 2001/83/EC. Full applications would be required for products containing
new active substances not previously approved by the competent authority, but may also be made for other products.
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Abridged Applications
. Article 10 of Directive 2001/83/EC contains exemptions from the requirement
that the applicant has to provide the results of its own pre-clinical and clinical research. There are three regulatory routes
for an applicant to seek an exemption from providing such results, namely (i) cross-referral to an innovator’s results without
consent of the innovator, (ii) well established use according to published literature and (iii) consent to refer to an existing
dossier of research results filed by a previous applicant.
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Cross-referral to Innovator’s
Data
Articles 10(1) and 10(2)(b)
of Directive 2001/83/EC provide the legal basis for an applicant to seek a marketing authorization on the basis that its product
is a generic medicinal product (a copy) of a reference medicinal product that has already been authorized, in accordance with community
provisions. A reference product is, in principle, an original product granted an authorization on the basis of a full dossier of
particulars and information. This is the main exemption used by generic manufacturers for obtaining a marketing authorization for
a copy product. The generic applicant is not required to provide the results of pre-clinical studies and of clinical trials if
its product meets the definition of a generic medicinal product and the applicable regulatory results protection period for the
results submitted by the innovator has expired. A generic medicinal product is defined as a medicinal product:
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having the same qualitative and quantitative composition in active substance as the reference medicinal
product;
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having the same pharmaceutical form as the reference medicinal product; and
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whose bioequivalence with the reference medicinal product has been demonstrated by appropriate
bioavailability studies.
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Applications in respect
of a generic medicinal product cannot be made before the expiry of the protection period. Where the reference product was granted
a national marketing authorization pursuant to an application made before October 30, 2005, the protection period is either six
years or 10 years, depending upon the election of the particular member state concerned. Where the reference product was granted
a marketing authorization centrally, pursuant to an application made before November 20, 2005, the protection period is 10 years.
For applications made after these dates, Regulation 726/2004 and amendments to Directive 2001/83/EC provide for a harmonized protection
period regardless of the approval route utilized. The harmonized protection period is in total 10 years, including eight years
of research data protection and two years of marketing protection. The effect is that the originator’s results can be the
subject of a cross-referral application after eight years, but any resulting authorization cannot be exploited for a further two
years. The rationale of this procedure is that the relevant particulars can, if the research data protection period has expired,
be found on the originator’s file and used for assessment of the generic medicinal product. The 10 year protection period
can be extended to 11 years where, in the first eight years post-authorization, the holder of the authorization obtains approval
for a new indication assessed as offering a significant clinical benefit in comparison with existing products.
If the copy product does
not meet the definition of a generic medicinal product or if bioequivalence could not be demonstrated through bioavailability studies
or in case of certain types of changes in the active substance(s) or in the therapeutic indications, strength, pharmaceutical form
or route of administration in relation to the reference medicinal product, Article 10(3) of Directive 2001/83/EC provides that
the results of the appropriate pre-clinical studies or clinical trials must be provided by the applicant.
Well-established Medicinal
Use
Under Article 10a of Directive
2001/83/EC, an applicant may, in substitution for the results of its own pre-clinical and clinical research, present detailed references
to published literature demonstrating that the active substance(s) of a product have a well- established medicinal use within the
community for at least ten years with recognized efficacy and an acceptable level of safety in terms of the conditions set out
in Annex I of Directive 2001/83/EC. In that event, the test and trial results shall be replaced by appropriate scientific literature.
The applicant is entitled to refer to a variety of different types of literature, including reports of clinical trials with the
same active substance(s) and epidemiological studies that indicate that the constituent or constituents of the product have an
acceptable safety/efficacy profile for a particular indication. However, use of the published literature exemption is restricted
by stating that in no circumstances active substances be treated as having a well- established use if they have been used for less
than 10 years from the first systematic and documented use of the substance as a medicinal product in the EU. Even after 10 years’
systematic use, the threshold for well-established medicinal use might not be met. European pharmaceutical law requires the competent
authorities to consider among other factors the period over which a substance has been used, the amount of patient use of the substance,
the degree of scientific interest in the use of the substance (as reflected in the scientific literature) and the coherence (consistency)
of all the scientific assessments made in the literature. For this reason, different substances may reach the threshold for well-established
use after different periods, but the minimum period is 10 years. If the applicant seeks approval of an entirely new therapeutic
use compared with that to which the published literature refers, additional pre-clinical and/or clinical results would have to
be provided.
Authorization Holder’s
Consent
Under Article 10c of Directive
2001/83/EC, following the grant of a marketing authorization the holder of such authorization may consent to a competent authority
utilizing the pharmaceutical, pre-clinical and clinical documentation that it submitted to obtain approval for a medicinal product
to assess a subsequent application relating to a medicinal product possessing the same qualitative and quantitative composition
with respect to the active substances and the same pharmaceutical form.
Law Relating to Pediatric
Research
Regulation (EC) 1901/2006
(as amended by Regulation (EC) 1902/2006) was adopted on December 12, 2006. This Regulation governs the development of medicinal
products for human use in order to meet the specific therapeutic needs of the pediatric population. It requires any application
for marketing authorization made after July 26, 2008 in respect of a product not authorized in the European Community on January
26, 2007 (the time the Regulation entered into force), to include the results of all studies performed and details of all information
collected in compliance with a pediatric investigation plan agreed by the Pediatric Committee of the EMA, unless the product is
subject to an agreed waiver or deferral or unless the product is excluded from the scope of Regulation 1901/2006 (generics, hybrid
medicinal products, biosimilars, homeopathic and traditional (herbal) medicinal products and medicinal products containing one
or more active substances of well-established medicinal use) according to its Art. 9. Waivers can be granted in certain circumstances
where pediatric studies are not required or desirable. Deferrals can be granted in certain circumstances where the initiation or
completion of pediatric studies should be deferred until appropriate studies in adults have been performed. The EMA does not evaluate
an application for market authorization that is not exempt from Regulation (EC) 1901/2006 if there is no agreed PIP, deferral or
waiver. Moreover, this regulation imposes the same obligation from January 26, 2009 on an applicant seeking approval of a new indication,
pharmaceutical form or route of administration for a product already authorized and still protected by a supplementary protection
certificate granted under Regulation EC 469/2009 and its precursor Regulation (EEC) 1768/92 or by a patent that qualifies for the
granting of such a supplementary protection certificate. The pediatric Regulation (EC) 1901/2006 also provides, subject to certain
conditions, a reward for performing such pediatric studies, regardless of whether the pediatric results provided resulted in the
grant of a pediatric indication. This reward comes in the form of an extension of six months to the supplementary protection certificate
granted in respect of the product, unless the product is subject to orphan drug designation, in which case the 10 year market exclusivity
period for such an orphan product is extended to 12 years. If any of the non-centralized procedures for marketing authorization
have been used, the six month extension of the supplementary protection certificate is only granted if the medicinal product is
authorized in all member states.
Post-authorization Obligations
In the pre-authorization
phase the applicant must provide a detailed pharmacovigilance plan that it intends to implement post- authorization. An authorization
to market a medicinal product in the EU carries with it an obligation to comply with many post- authorization organizational and
behavioral regulations relating to the marketing and other activities of authorization holders. These include requirements relating
to post-authorization efficacy studies, post-authorization safety studies, adverse event reporting and other pharmacovigilance
requirements, advertising, packaging and labeling, patient package leaflets, distribution and wholesale dealing. The regulations
frequently operate within a criminal law framework and failure to comply with the requirements may not only affect the authorization,
but also can lead to financial and other sanctions levied on the company in question and responsible officers. EU pharmacovigilance
legislation has been significantly modified by the Pharmacovigilance Directive, Dir. 2010/84/EU which amended the legal framework
of pharmacovigilance for medicines marketed within the EU provided in Regulation (EC) No 726/2004 with respect to EU authorized
medicinal products and in Directive 2001/83/EC with respect to nationally authorized medicinal products (including those authorized
through the mutual recognition and decentralized systems). In addition, Commission Implementing Regulation (EU) No 520/2012 outlines
the practical details to be respected by marketing authorization holders, national competent authorities and the EMA, and Commission
Delegated Regulation (EU) No 357/2014 on post-authorization efficacy studies specifies the situations in which such studies may
be required. Furthermore, EU good pharmacovigilance practice (GPC) rules apply. With the amended pharmacovigilance requirements,
the financial and organizational burden on market authorization holders increased significantly, such as the obligation to maintain
a pharmacovigilance system master file that applies to all holders of marketing authorizations granted in accordance with Directive
2001/83/EC or Regulation (EC) No 726/2004. Marketing authorization holders must furthermore collect data on adverse events associated
with use of the authorized product outside the scope of the authorization. Pharmacovigilance for biological products and medicines
with a new active substance is strengthened by subjecting their authorization to additional monitoring activities.
Any authorization granted
by member state authorities, which within three years of its granting is not followed by the actual placing on the market of the
authorized product in the authorizing member state ceases to be valid (Art. 24 (4) and (5) Directive 2001/83/EC). When an authorized
product previously placed on the market in the authorizing member state is no longer actually present on the market for a period
of three consecutive years, the authorization for that product shall cease to be valid. The same two three year periods apply to
authorizations granted by the European Commission based on the centralized procedure (Art. 14 (4) and (5) Regulation (EC) 726/2004).
Israel
Clinical Testing in
Israel
In order to conduct clinical
testing on humans in Israel, special authorization must first be obtained from the ethics committee and
Chief
Executive Officer and Director
of the institution in which the clinical studies are scheduled to be conducted, or in certain
cases, the Head of Clinical Trials Department of the Ministry of Health, as required under the Guidelines for Clinical Trials in
Human Subjects implemented pursuant to the Israeli Public Health Regulations (Clinical Trials in Human Subjects), as amended from
time to time, and other applicable legislation. In addition, these regulations also require authorization from the Israeli Ministry
of Health, in the case of genetic trials, certain fertility trials and in such other matters as set forth by the Ministry of Health,
which also include our ARREST Study. The institutional ethics committee must, among other things, evaluate the anticipated benefits
that are likely to be derived from the project to determine if it justifies the risks and inconvenience to be inflicted on the
human subjects, and the committee must ensure that adequate protection exists for the rights and safety of the participants as
well as the accuracy of the information gathered in the course of the clinical testing. Because we perform a portion of the ARREST
Study on therapeutic candidates in Israel, we obtained authorization from the
Chief
Executive Officer and Director
of ethics committee of each institution in which we conduct our ARREST Trial, and from the
Israeli Ministry of Health. We will also seek such authorizations from the ethics committee and the Israeli Ministry of Health
concerning any of our other or future clinical trials to be conducted in Israel.
Israeli Ministry of
Health
Israel’s Ministry
of Health, which regulates medical testing, has adopted guidelines that correspond, generally, to those of the FDA and the EMA,
making it comparatively straightforward for studies conducted in Israel to satisfy FDA and the EMA requirements, thereby enabling
medical technologies subjected to clinical trials in Israel to reach U.S. and EU commercial markets in an expedited fashion. Many
members of Israel’s medical community have earned international prestige in their chosen fields of expertise and routinely
collaborate, teach and lecture at leading medical centers throughout the world.
Other Countries
In addition to regulations
in the United States, the EU and Israel, we are subject to a variety of other regulations governing clinical trials and commercial
sales and distribution of drugs in other countries. Whether or not Aramchol or any future product candidates receive approval from
the FDA, approval of such product candidates must be obtained by the comparable regulatory authorities of countries other than
the United States before we can commence clinical trials or marketing of the product in those countries. The approval process varies
from jurisdiction to jurisdiction, and the time may be longer or shorter than that required for FDA approval. The requirements
governing the conduct of clinical trials and product licensing vary greatly from country to country.
The requirements that we
and our collaborators must satisfy to obtain regulatory approval by government agencies in other countries prior to commercialization
of Aramchol or any future product candidates in such countries can be rigorous, costly and uncertain. In the European countries,
Canada and Australia, regulatory requirements and approval processes are similar in principle to those in the United States. Additionally,
depending on the type of drug for which approval is sought, there are currently two potential tracks for marketing approval in
the European countries: Mutual recognition and the centralized procedure. These review mechanisms may ultimately lead to approval
in all EU countries, but each method grants all participating countries some decision-making authority in product approval. Foreign
governments also have stringent post-approval requirements including those relating to manufacture, labeling, reporting, record
keeping and marketing. Failure to substantially comply with these on-going requirements could lead to government action against
the product, us and/or our representatives.
Related Matters
From time to time, legislation
is drafted, introduced and passed in governmental bodies that could significantly change the statutory provisions governing the
approval, manufacturing and marketing of products regulated by the FDA or EMA and other applicable regulatory bodies to which we
are subject. In addition, regulations and guidance are often revised or reinterpreted by the national agency in ways that may significantly
affect our business and our therapeutic candidates. It is impossible to predict whether such legislative changes will be enacted,
whether FDA or EMA regulations, guidance or interpretations will change, or what the impact of such changes, if any, may be. We
may need to adapt our business and therapeutic candidates and products to changes that occur in the future.
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C.
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Organizational Structure
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See “Item 4.
Information on the Company—Historical Background and Corporate Structure” above.
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D.
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Description
of Property and Facilities
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Our corporate headquarters
are located at 16 Tiomkin Street, Tel Aviv, Israel, 6578317 pursuant to a lease to occupy approximately 356 square meters of space.
GRD entered into the lease agreement on March 22, 2015 with Mintz K. Construction Company (the “Lease Agreement”),
following the termination of GRD’s previous lease agreement at 8 Shaul Hamelech Blvd., Amot Mishpat Bldg., Tel Aviv, Israel,
6473307. The term of the lease is for four years with an option, at the election of GRD, for two additional years. The aggregate
quarterly rental payment for four years, together with adjustments and the maintenance fees, is approximately NIS33,055 plus VAT.
On February 27, 2017, GRD entered into an addendum to the Lease Agreement pursuant to which GRD leased an additional 90 square
meters for a space adjacent to the current premises, totaling in 446 square meters. The fees for the additional space are payable
quarterly in an aggregate amount of NIS 17,700 plus VAT.
ITEM 4A. Unresolved Staff Comments.
Not applicable.
ITEM 5. Operating and Financial Review and Prospects.
The following discussion
and analysis of our financial condition and results of operations should be read in conjunction with “Item 3. Key Information—Selected
Financial Data” above and our financial statements and related notes that appear elsewhere in this annual report. In addition
to historical financial information, the following discussion contains forward-looking statements that reflect our plans, estimates
and beliefs. Our actual results could differ materially from those discussed in the forward-looking statements. Factors that could
cause or contribute to these differences include those discussed below and elsewhere in this prospectus, particularly in the sections
titled “Risk Factors” and “Cautionary Note Regarding Forward-Looking Statements.”
Overview
We are a clinical-stage
biopharmaceutical company focused on the development of Aramchol, a liver targeted SCD1 modulator, first in class, novel, once-daily,
oral therapy for the treatment of NASH for variable populations, as well as other liver associated disorders. We believe that our
product candidate, Aramchol, has the potential to be a disease modifying treatment for fatty liver disorders, including NASH, which
is a chronic disease that constitutes a large unmet medical need.
On February 1, 2015, we
began our ARREST Study, a multi-center, randomized, double-blind, placebo-controlled, dose-ranging Phase IIb clinical trial of
Aramchol in 247 patients who are overweight or obese and have pre diabetes or type II diabetes mellitus and who have been biopsy-diagnosed
as having NASH. Our ARREST Study is in accordance with the study design recommended by the MHRA and has been deemed acceptable
by the BfArM and deemed satisfactory by the ANSM. The study design has been confirmed by the FDA in a written pre-IND advice as
acceptable for a Phase IIb study. The BfArM and ANSM also confirmed, in minutes of each of their respective scientific advisory
meetings, that if successful, this ARREST Study may serve as a basis for Phase III pivotal trial of Aramchol. The FDA and MHRA
invited us to discuss the next steps in the development of Aramchol after we analyze the results of the ARREST Study. If the Phase
III trials are successful, we intend to submit an NDA to the FDA and an MAA to the EMA for the approval of Aramchol for the treatment
of NASH in the United States, Europe, as well as additional territories. We currently expect top line data from the ARREST Study
to be available during June 2018.
The interim analysis conducted
by the DSMB after 120 patients in our ARREST Study completed six months of treatment was limited to analysis of safety related
signals only. On February 8, 2017, the DSMB met in order to review the accumulated safety data in accordance with a protocol defined
safety interim review and has met periodically thereafter. Following its review of the data, the DSMB recommended continuation
of the ARREST Study without changes. The last DSMB meeting to date occurred on December 6, 2017 and the DSMB recommended continuation
of the study without changes.
We recently announced topline
results from our ARRIVE Study. ARRIVE, a Phase IIa, investigator initiated clinical trial conducted at the University of California
San Diego by Professor Rohit Loomba was a randomized, double-blinded, placebo-controlled, 12 weeks, proof-of-concept study that
evaluated the safety and efficacy of Aramchol at 600mg/day versus placebo in 50 patients with HIV-associated lipodystrophy and
NAFLD. The primary end point of successful therapy was improvement in hepatic steatosis at 12 weeks, as measured by MRI-PDFF. Secondary
endpoints were improvement in total body fat, metabolic profile, and liver biochemistry. Liver biopsies were not included as part
of the evaluation in this pilot trial. The trial showed no difference between HIV patients receiving Aramchol for 12 weeks when
compared with HIV patients in the placebo arm. Aramchol showed a favorable safety and tolerability profile. Further analysis of
the data is ongoing.
To date, we have successfully
completed four clinical trials of Aramchol, one proof of concept study in patient with gallstones which was stopped after only
9 patients were randomized, and a Phase IIa, investigator initiated clinical trial conducted at the University of California San
Diego by Professor Rohit Loomba, which did not achieve its primary endpoint. The first completed clinical trial was performed in
two parts: (a) a single dose, double-blind, placebo- controlled, Phase IA study with ascending doses of Aramchol in healthy volunteers
in one center in Israel, in which no serious adverse side effects were observed; and (b) a Phase IB repeated dose trial completed
on healthy volunteers in one center in Israel also showed that Aramchol has no serious adverse side effects and confirmed the suitability
of a once-daily dose of Aramchol. Thereafter, we commenced a multi-center, randomized, double-blind, placebo-controlled Phase IIA
trial of Aramchol in 60 NAFLD and NASH patients in 12 centers in Israel. This study, which design was deemed acceptable by the
FDA in 2007 at a pre-IND scientific advisory meeting, suggested that Aramchol reduced liver fat in a dose dependent manner, as
evidenced by a statistically significant reduction of liver fat over a three month treatment period of once-daily 300 mg doses
of Aramchol, and induces positive trends of changes in several metabolic parameters. Additionally, we performed a single-site,
randomized, partially double-blind, placebo-controlled PK and food effect study conducted in three parts. The first part of the
study assessed the PK, safety and tolerability of Aramchol tablets at single doses of either 200 mg or 400 mg under fasting
conditions. The second part of the study evaluated the effect of a high-calorie, high-fat meal on the bioavailability of a single
600 mg dose of Aramchol and assessed the safety and tolerability. The third part of the study assessed the PK and comparative bioavailability,
safety and tolerability of Aramchol tablets after repeated administrations of three different doses (200 mg, 400 mg and 600
mg) for ten consecutive days, with dosing occurring following the consumption of a light meal. No serious adverse events or deaths
occurred during the study. Adverse events were equally distributed between placebo and Aramchol doses, were mild (with only one
moderate adverse event) and the majority defined unrelated to Aramchol. Additionally, in 2016 we performed the Chinese PK Study
involving 66 healthy, Chinese volunteers, which consisted of two parts. Part A comprised of a single escalating dose to evaluate
the pharmacokinetics, safety and tolerability of Aramchol tablets at 400 mg and 600 mg. Part B was a randomised double blind study
evaluating the pharmacokinetics, safety and tolerability of Aramchol tablets at 400 mg and 600 mg dosed for ten consecutive days.
No safety signal was identified in this study and we deemed no changes were required in the enrollment of Chinese patients into
the ARREST Study.
To date, we have not generated
revenue from the sale of any product, excluding the licensing revenue we recorded in connection with the Samil Agreement, and we
do not expect to generate any significant revenue other than the amortization of the upfront payments under the license agreement
with Samil and of the subsequent royalties and/or milestones that may be earned in connection with the Samil Agreement or potential
other license Agreements, unless and until we commercialize Aramchol, or license the product to additional third parties. As of
December 31, 2017, the Company had an accumulated deficit of approximately $76.6 million
Our financing activities
are described below under “Liquidity and Capital Resources.” Obtaining approval of an NDA, MMA, or other similar application
is an extensive, lengthy, expensive and uncertain process, and the FDA, EMA and other regulatory agencies may delay, limit or deny
approval of Aramchol.
Financial Overview
To date, we have funded
our operations primarily through proceeds from private placements and public offerings. At December 31, 2017, we had current assets
$19.2 million, which is mainly comprised of cash and cash equivalents of $13.0 million and short-term investment securities of
$6.0 million. This compares with current assets of $15.7 million at December 31, 2016, which is mainly comprised of cash and cash
equivalents of $3.1 million and short-term investment securities of $12.4 million. We believe that such existing funds will be
sufficient to continue our business and operations as currently conducted through the end of 2019. However, we will
continue to incur operating losses, which may be substantial over the next several years, and we may need to obtain additional
funds to further develop our research and development programs.
Revenues
We
have entered into the Samil Agreement for the commercialization of Aramchol in Korea. Under the terms of the Samil Agreement, we
have received upfront payments of $2.1 million, and may be eligible to receive up to approximately $6.0 million in additional payments
for development and regulatory milestones for Aramchol in the licensed territories.
For
accounting purposes, the upfront payment has been recorded as deferred revenue. The deferred revenue is then amortized on a straight-line
basis over the contractual period and milestone payments are recognized once earned. Accordingly, during the year ended December
31, 2017, we recognized revenue of $1.1 million.
Costs and Operating Expenses
Our current costs and operating
expenses consist of two components: (i) research and development expenses; and (ii) general and administrative expenses.
Research and Development Expenses
Our research and development
expenses consist primarily of outsourced development expenses, salaries and related personnel expenses and fees paid to external
service providers, patent-related legal fees, costs of pre-clinical studies and clinical trials and drug and laboratory supplies.
We account for all research and development expenses as they are incurred. We expect our research and development expense to remain
our primary expense in the near future as we continue to develop Aramchol. Increases or decreases in research and development expenditures
are primarily attributable to the number and/or duration of the pre-clinical and clinical studies that we conduct.
We expect that a substantial
amount of our research and development expense in the future will be incurred in support of our current and anticipated pre-clinical
and clinical development projects. Due to the inherently unpredictable nature of pre-clinical and clinical development studies,
we are unable to estimate with any certainty the costs we will incur in the continued development of Aramchol for NASH and other
indications in our pipeline for potential partnering and/or commercialization. Clinical development timelines, the probability
of success and development costs can differ materially from expectations. We currently expect to continue testing Aramchol in pre-clinical
studies for toxicology, safety and efficacy, and to conduct additional clinical trials for Aramchol.
While we are currently
focused on advancing Aramchol's development, our future research and development expenses will depend on the clinical success of
Aramchol, as well as ongoing assessments of the Aramchol’s commercial potential. As we obtain results from clinical trials,
we may elect to discontinue or delay clinical trials for our product candidate in certain indications in order to focus our resources
on more promising indications for such product candidate. Completion of clinical trials may take several years or more, but the
length of time generally varies according to the type, complexity, novelty and intended use of a product candidate.
We expect our research
and development expenses to increase in the future from current levels as we continue to advance of our clinical product development
and, potentially, the in-licensing of additional product candidates.
The lengthy process of
completing clinical trials and seeking regulatory approval for Aramchol requires the expenditure of substantial resources. Any
failure or delay in completing clinical trials, or in obtaining regulatory approvals, could cause a delay in generating product
revenue and cause our research and development expenses to increase and, in turn, have a material adverse effect on our operations.
Because of the factors set forth above, we are not able to estimate with any certainty when we would recognize any net cash inflows
from our projects.
General and Administrative Expenses
General and administrative
expenses consist primarily of compensation for employees in executive and operational roles, including finance/accounting, legal
and other operating positions in connection with our activities. Our other significant general and administrative expenses include
non-cash stock-based compensation costs and facilities costs (including the rental expense for our offices in Tel Aviv, Israel),
professional fees for outside accounting and legal services, travel costs, investors relations, insurance premiums and depreciation.
Financial Income, Net
Our financial income consists
of interest income from marketable securities and our financial expense consists of fees associated with banking activities and
losses from realization of marketable securities.
Critical Accounting Policies and Estimate
We prepare our
financial statements in accordance with U.S. GAAP. In doing so, we must make estimates and assumptions that affect our
reported amounts of assets, liabilities and expenses, as well as related disclosure of contingent assets and liabilities. In
some cases, we could reasonably have used different accounting policies and estimates. Changes in the accounting estimates
are reasonably likely to occur from period to period. Accordingly, actual results could differ materially from our estimates.
To the extent that there are material differences between these estimates and actual results, our financial condition or
results of operations will be affected. Significant estimates include, but are not limited to, those related to deferred
revenue, revenue recognition and stock-based compensation.
For further significant accounting policies please see Note 2 to our audited consolidated financial statements of this annual
report. We believe that our accounting policies contained therein are critical in fully understanding and evaluating our
financial condition and operating results.
Jumpstart Our Business Startups Act of 2012
We are an emerging growth
company within the meaning of the rules under the Securities Act and we will utilize certain exemptions from various reporting
requirements that are applicable to public companies that are not emerging growth companies. We could remain an “emerging
growth company” for up to five years from the date of our first sale of common equity securities pursuant to an effective
registration statement under the Securities Act, or until the earliest of (a) the last day of the first fiscal year in which our
annual gross revenue exceeds $1 billion (as such amount is indexed for inflation every five years by the SEC to reflect the change
in the Consumer Price Index for All Urban Consumers published by the Bureau of Labor Statistics, setting the threshold to the nearest
$1.0 million) or more, (b) the date that we become a “large accelerated filer” as defined in Rule 12b-2 under the Exchange
Act, which would occur if the market value of our ordinary shares that is held by non-affiliates exceeds $700.0 million as of the
last business day of our most recently completed second fiscal quarter, or (c) the date on which we have issued more than $1 billion
in nonconvertible debt during the preceding three year period.
The JOBS Act also permits
us, as an “emerging growth company,” to take advantage of an extended transition period to comply with certain new
or revised accounting standards if such standards apply to companies that are not issuers. We are choosing to “opt out”
of this provision and, as a result, we will comply with new or revised accounting standards when they are required to be adopted
by issuers. This decision to opt out of the extended transition period under the JOBS Act is irrevocable.
Stock-Based Compensation and Fair Value
of Ordinary Shares
We apply ASC 718-10, “Share-Based
Payment,” which requires the measurement and recognition of compensation expense for all share-based payment awards made
to employees and directors, including employee stock options under the Company’s stock plans, based on estimated fair values.
ASC 718-10 requires companies to estimate the fair value of equity-based payment awards on the date of the grant using an option-pricing
model. The value of the portion of the award that is ultimately expected to vest is recognized as an expense over the requisite
service periods in the Company’s consolidated statement of operations. The foregoing estimates of fair value that the Company
has made are highly complex and subjective. The estimates of the fair value of the Company’s ordinary shares will not be
necessary to estimate the fair value of new awards as the shares started trading on the Nasdaq Capital Market as of March 2014.
We recognize compensation
expense for the value of non-employee awards, which have graded vesting, based on the accelerated attribution method over the requisite
service period of each award, net of estimated forfeitures. We recognize compensation expense for the value of employee awards
that have graded vesting, based on the straight-line method over the requisite service period of each of the awards, net of estimated
forfeitures.
In determining the fair
value of our ordinary shares that was used to value previous equity issuances, we relied upon previous offering valuations while
taking into account the clinical development of the Company’s product candidate. We believe that the fair value of our ordinary
shares has continuously increased since inception as the development of Aramchol has continuously progressed.
The valuations were performed
contemporaneously with the offerings of ordinary shares to which such valuations relate. Such valuations were conducted by us and
were directly observable in the marketplace. Such valuations were in accordance with the provisions of ASC 820-35 and based on
the purchase price paid by new external and independent investors with pharmaceutical or financial expertise, who purchased our
convertible notes contemporaneously with or around the time of our equity issuances. Increases in the Company’s valuations
were based upon the progress in the clinical development of Aramchol, submissions of new families of patent applications for new
potential indications and new formulations of Aramchol, an investment round and our initial public offering in March 2014.
The table below provides
our results of operations (which reflect the results of operations of the Company, post reorganization, as well as the financial
data of the GHI, our predecessor, prior to the Reorganization for the year ended December 31, 2017 as compared to the years ended
December 31, 2016 and 2015.
|
|
Year Ended December 31,
|
|
|
|
2015
|
|
|
2016
|
|
|
2017
|
|
|
|
(thousands)
|
|
Revenue
|
|
|
|
|
|
$
|
(467
|
)
|
|
$
|
(1,085
|
)
|
Research and development expenses
|
|
$
|
7,629
|
|
|
$
|
14,271
|
|
|
$
|
9,650
|
|
General and administrative expenses
|
|
|
3,246
|
|
|
|
3,078
|
|
|
|
3,799
|
|
Operating loss
|
|
|
10,875
|
|
|
|
16,882
|
|
|
|
12,364
|
|
Financial income, net
|
|
|
(253
|
)
|
|
|
(35
|
)
|
|
|
(65
|
)
|
Loss before income taxes
|
|
|
10,622
|
|
|
|
16,847
|
|
|
|
12,299
|
|
Income taxes
|
|
|
-
|
|
|
|
106
|
|
|
|
-
|
|
Net loss
|
|
$
|
10,622
|
|
|
$
|
16,953
|
|
|
$
|
12,299
|
|
Comprehensive loss
|
|
$
|
10,832
|
|
|
$
|
16,832
|
|
|
$
|
12,221
|
|
Basic and diluted net loss per share from continuing operations
|
|
$
|
0.96
|
|
|
$
|
1.49
|
|
|
$
|
0.98
|
|
Revenue
Licensing revenue amounted
to $1.1 million during the year ended December 31, 2017, compared to $0.5 million of revenue for the year ended December 31, 2016.
The above mentioned revenue resulted from the amortization of the upfront payments under the Samil Agreement.
Licensing revenue amounted
to $0.5 million during the year ended December 31, 2016, compared to no revenue for the year ended December 31, 2015. The above
mentioned revenue resulted from the amortization of the upfront payments under the Samil Agreement.
Research and Development Expenses
Our research and development
expenses amounted to approximately $9.7 million during the year ended December 31, 2017, representing a decrease of approximately
$4.6 million, or approximately 32%, compared to approximately $14.3 million for the year ended December 31, 2016. The decrease
primarily resulted from a decrease in research and development subcontractor expenses in connection with the ARREST Study of approximately
$2.4 million and other studies of an aggregate of approximately $1.0 million. The decrease in the research and development expenses
is also as a result of a decrease in drug development related expenses of approximately $1.0 million.
Our research and development
expenses amounted to approximately $14.3 million during the year ended December 31, 2016, representing an increase of approximately
$6.7 million, or approximately 87%, compared to approximately $7.6 million for the year ended December 31, 2015. The increase primarily
resulted from an increase in research and development subcontractor expenses in connection with the ARREST Study of approximately
$3.9 million and other studies of an aggregate of approximately $1.7 million. The increase in the research and development expenses
is also as a result of an increase in employee salaries and benefits, consisting of non-cash stock-based compensation of approximately
$0.6 million and salaries paid to employees in the amount of approximately $0.2
million.
General and Administrative Expenses
Our general and administrative
expenses amounted to approximately $3.8 million for the year ended December 31, 2017, representing an increase of approximately
$0.7 million, or 23%, compared to approximately $3.1 million for the year ended December 31, 2016. The increase primarily resulted
from an increase in salaries and benefits expenses of approximately $0.6 million as well an increase in investor relations and
business development expenses of approximately $0.2 million.
Our general and administrative
expenses amounted to approximately $3.1 million for the year ended December 31, 2016, representing a decrease of approximately
$0.2 million, or 5%, compared to approximately $3.2 million for the year ended December 31, 2015. The decrease primarily resulted
from a decrease in investor relations and business development expenses.
Operating Loss
As a result of the foregoing research and development and general and administrative expenses, as well
as our failure to generate substantial operating revenues, our operating loss for the year ended December 31,
2017
was approximately $12.4 million, representing a decrease in our operating loss of approximately $4.5 million, or approximately
27%, compared to approximately $16.9 million for the year ended December 31, 2016.
As a result of the foregoing
research and development and general and administrative expenses, as well as our failure to generate substantial operating revenues,
our operating loss for the year ended December 31, 2016 was approximately $16.9 million, representing an increase in our operating
loss of approximately $6.0 million, or approximately 55%, compared to approximately $10.9 million for the year ended December 31,
2015.
Financial Income (Expense), Net
Our financial income, net,
for the year ended December 31, 2017 was approximately $0.06 million, representing an increase of approximately $0.03 million,
or approximately 86%, compared to approximately $0.035million for the year ended December 31, 2016.
Our financial income,
net, for the year ended December 31, 2016 was approximately $0.035 million, representing a decrease of approximately $0.2
million, or approximately 86%, compared to approximately $0.3 million for the year ended December 31, 2015. The increase
primarily resulted from an increase in interest income from marketable securities and short-term deposit resulting from our
implementation of a cash management strategy during the year in an effort to generate revenues with excess liquidity.
Net Loss
Our net loss for the
year ended December 31, 201
7 was approximately
$12.3 million, representing a decrease of approximately $4.7 million, or approximately 27%, compared to approximately $17.0
million for the year ended December 31, 2016. The decrease primarily resulted from the above mentioned decrease in
research and development expenses.
Our net loss for the year
ended December 31, 2016 was approximately $17.0 million, representing an increase of approximately $6.4 million, or approximately
60%, compared to approximately $10.6 million for the year ended December 31, 2015. The increase primarily resulted from the above
mentioned increase in research and development expenses.
|
B.
|
Liquidity
and Capital Resources
|
Overview
To date, we have funded
our operations primarily through proceeds from private placements and public offerings. During the year ended December 31, 2017,
we raised net proceeds of approximately $2.7 million in a registered direct offering to existing investors and a concurrent private
placement and a further $12.4 million under and our existing and former ATM Offerings. Under our existing ATM Offering, as
of December 31, 2017, we may sell, from time to time, up to approximately $29.0 million of additional ordinary shares.
We have incurred substantial
losses since our inception. As of December 31, 2017, we had an accumulated deficit of approximately $76.6 million and working capital
(current assets less current liabilities) of approximately $15.3 million. Due to our expectation that we will continue to not generate
substantial revenues for the foreseeable future, we expect that losses will continue for the foreseeable future.
As of December 31, 2017,
we had cash and cash equivalents of approximately $13.0 million and marketable securities of approximately $6.0 million
invested
in accordance with our investment policy, totaling approximately $19.0 in highly-liquid assets,
as compared to approximately
$3.1 million and approximately $12.4 million as of December 31, 2016
totaling
approximately
$15.5 million in highly-liquid assets,
respectively. The increase is primarily attributable
to the net proceeds from our registered direct offering and concurrent private placement (approximately $2.7 million) and our existing
and former ATM Offerings (approximately $12.4 million); partially offset by our net loss of approximately $12.3 million.
As of December 31, 2016,
we had cash and cash equivalents of approximately $3.1 million and marketable securities of approximately $12.4 million
invested
in accordance with our investment policy, totaling approximately $15.5 in highly-liquid assets,
as compared to approximately
$4.2 million and approximately $18.8 million as of December 31, 2015,
totaling
approximately
$23.0 million in highly-liquid assets,
respectively. The decrease is primarily attributable
to our net loss of approximately $17.0 million for the year ended December 31, 2016, partially offset by approximately $4.5 million,
net of issuance expenses from our former ATM Offering and the upfront payment of approximately $2.1 million received from Samil.
Cash Flow from Operating Activities
We had negative cash flow
from operating activities of approximately $12.1 million for the year ended December 31, 2017 as compared to a negative cash flow
from operating activities of approximately $12.1 million for the year ended December 31, 2016. The negative cash flow from operating
activities for the year ended December 31, 2017 was mainly attributable to our net loss of approximately $12.3 million
We had negative cash flow
from operating activities of approximately $12.1 million for the year ended December 31, 2016 as compared to a negative cash flow
from operating activities of approximately $8.5 million for the year ended December 31, 2015. The negative cash flow from operating
activities for the year ended December 31, 2016 was mainly attributable to our net loss of approximately $17.0 million, offset
by a stock-based compensation expense of approximately $1.6 million and an increase of upfront payment for license fee of approximately
$1.6 million.
Cash Flow from Investing Activities
We had positive cash flow
from investing activities of approximately $6.4 million for the year ended December 31, 2017 as compared to a positive cash flow
from investing activities of approximately $6.3 million for the year ended December 31, 2016. The positive cash flow from investing
activities for the year ended December 31, 2017 was mainly due to maturity of marketable securities in the amount of approximately
$10.3 million, offset by investment in marketable securities in the amount of approximately $3.9 million.
We had positive cash flow
from investing activities of approximately $6.3 million for the year ended December 31, 2016 as compared to a negative cash flow
from investing activities of approximately $11.1 million for the year ended December 31, 2015. The positive cash flow from investing
activities for the year ended December 31, 2016 was mainly due to maturity of marketable securities in the amount of approximately
$14.0 million, offset by investment in marketable securities in the amount of approximately $7.6 million.
Cash Flow from Financing Activities
We had positive cash
flow from financing activities of approximately $15.5 million for the year ended December 31, 2017 as compared to a positive
cash flow from financing activities of $4.7 million for the year ended December 31, 2016. The positive cash flow from
financing activity for the year ended December 31, 2017 was mainly due the net proceeds from our registered direct offering
and concurrent private placement (approximately $2.7 million and our existing and former ATM Offerings (approximately
$12.4 million).
We had positive
cash flow from financing activity of approximately $4.7 million for the year ended December 31, 2016 as compared to no cash
flow from financing activities for the year ended December 31, 2015. The positive cash flow from financing activity for the
year ended December 31, 2016 was mainly due to net proceeds from our former ATM Offering in the amount of approximately $4.5
million, net of issuance expenses.
We believe that our
existing cash resources will be sufficient to fund our projected cash requirements through the end of 2019. Nevertheless,
we will require significant additional financing in the future to fund our operations if and when we progress into Phase III trials
of Aramchol and clinical trials for other indications and other research and development related activities.
Current Outlook
According to our current
financial forecast, if we are not successful in obtaining additional capital resources, there is substantial doubt that we will
be able to continue our activities beyond 2019. Even with the funds raised in our initial public offering and ATM Offering, we
believe that we will need to raise significant additional funds before we have any cash flow from operations, if at all.
Developing drugs,
conducting clinical and pre-clinical trials and commercializing products is expensive and we will need to raise substantial
additional funds to achieve our strategic objectives. Based on our current operating plan, we believe that our existing
cash resources will be sufficient to fund our projected cash requirements through the end of 2019. Nevertheless,
we will require significant additional financing in the future to fund our operations, including if and when we progress
into Phase III trials of Aramchol for the treatment of NASH in patients who are overweight or obese and have pre diabetes
or type II diabetes mellitus and clinical trials for other indications, obtain regulatory approval for Aramchol
and commercialize the drug. We currently anticipate that we will utilize approximately $12 million to support our research
and development activity and the related general and administrative expenses over the course of the next 12 months. Our
future capital requirements will depend on many factors, including:
|
·
|
the progress and costs of our pre-clinical studies, clinical trials and other research and development
activities;
|
|
·
|
the scope, prioritization and number of our clinical trials and other research and development
programs;
|
|
·
|
the amount of revenues and contributions we receive under future licensing, development and commercialization
arrangements with respect to Aramchol;
|
|
·
|
the costs of the development and expansion of our operational infrastructure;
|
|
·
|
the costs and timing of obtaining regulatory approval for Aramchol;
|
|
·
|
the ability of us, or our collaborators, to achieve development milestones, marketing approval
and other events or developments under our potential future licensing agreements;
|
|
·
|
the costs of filing, prosecuting, enforcing and defending patent claims and other intellectual
property rights;
|
|
·
|
the costs and timing of securing manufacturing arrangements for clinical or commercial production;
|
|
·
|
the costs of contracting with third parties to provide sales and marketing capabilities for us;
|
|
·
|
the costs of acquiring or undertaking development and commercialization efforts for any future
products, product candidates or platforms;
|
|
·
|
the magnitude of our general and administrative expenses; and
|
|
·
|
any cost that we may incur under future in- and out-licensing arrangements relating to Aramchol.
|
Until we can generate significant
recurring revenues, we expect to satisfy our future cash needs through the net proceeds from our initial public offering, debt
or equity financings (such as the ATM Offering) or by out-licensing applications of Aramchol. We cannot be certain that additional
funding will be available to us on acceptable terms, if at all. If funds are not available, we may be required to delay, reduce
the scope of or eliminate research or development plans for, or commercialization efforts with respect to, one or more applications
of Aramchol. This may raise substantial doubts about the Company’s ability to continue as a going concern.
|
C.
|
Research and Development,
Patents and Licenses
|
For information concerning
our research and development policies and a description of the amount spent during each of the last three fiscal years on company-sponsored
research and development activities, see “Item 5. Operating and Financial Review and Prospects—Results of Operations.”
We are a development stage
company and it is not possible for us to predict with any degree of accuracy the outcome of our research, development or commercialization
efforts. As such, it is not possible for us to predict with any degree of accuracy any known trends, uncertainties, demands, commitments
or events that are reasonably likely to have a material effect on our net sales or revenues, income from continuing operations,
profitability, liquidity or capital resources, or that would cause reported financial information to not necessarily be indicative
of future operating results or financial condition. However, to the extent possible, certain trends, uncertainties, demands, commitments
and events are in this “Operating and Financial Review and Prospects.”
|
E.
|
Off-Balance
Sheet Arrangements
|
The Company currently does
not have any off-balance sheet arrangements that have had, or are reasonably likely to have, a current or future effect on our
financial condition, changes in financial condition, revenues or expenses, results of operations, liquidity, capital expenditures
or capital resources that are material to investors.
|
F.
|
Contractual
Obligations
|
The following table summarizes
our significant contractual obligations at December 31, 2017.
|
|
Total
|
|
|
Less than 1 year
|
|
|
1 – 3 years
|
|
|
|
(in
thousands)
|
|
Facility leases (1)
|
|
$
|
128
|
|
|
$
|
104
|
|
|
$
|
24
|
|
Purchase Obligations
|
|
|
2,612
|
|
|
|
2,612
|
|
|
|
-
|
|
Total
|
|
$
|
2,740
|
|
|
$
|
2,716
|
|
|
$
|
24
|
|
|
(1)
|
For a more detailed description of the facility leases, see “Description of Property and
Facilities” above.
|
We
enter into contracts in the ordinary course of business with CROs for clinical trials and clinical supply manufacturing and with
vendors for pre-clinical research studies and other services and products for operating purposes, which generally provide for termination
within 30 days of notice, and therefore are cancelable contracts and not included in the Contractual Obligations table above. We
have included as purchase obligations our commitments under agreements to the extent they are quantifiable and are not cancelable.
Other than as described
above, we did not have any material commitments for capital expenditures, including any anticipated material acquisition of plant
and equipment or interests in other companies, as of December 31, 2017.
ITEM 6. Directors, Senior Management and Employees.
|
A.
|
Directors and Senior Management.
|
Set forth below is information
concerning the directors, senior management and executive officers of the Company as of February 28, 2018, the latest practicable
date for inclusion in this annual report. The business address for each of our directors, senior management and corporate officers
is c/o Galmed Pharmaceuticals Ltd., 16 Tiomkin St., Tel Aviv 6578317, Israel.
Name
|
|
Age
|
|
Position
|
Chaim Hurvitz
(1)(2)(6)
|
|
57
|
|
Chairman of the Board, Class III Director; Chairman of the R&D Committee
|
|
|
|
|
|
Allen Baharaff
|
|
53
|
|
President and Chief Executive Officer, Class II Director
|
|
|
|
|
|
Dr. Tali Gorfine
|
|
48
|
|
Chief Medical Officer
|
|
|
|
|
|
Dr. Liat Hayardeny
|
|
51
|
|
Chief Scientist Officer
|
|
|
|
|
|
Yohai Stenzler
|
|
35
|
|
Chief Financial Officer
|
|
|
|
|
|
Guy Nehemya
|
|
33
|
|
Vice President, Operations
|
|
|
|
|
|
Yael Hollander
|
|
35
|
|
Vice President, Legal Affairs and Strategy
|
|
|
|
|
|
William Marth
(1)(2)(6)
|
|
63
|
|
Class III Director, Chairman of our Nomination Committee
|
|
|
|
|
|
Shmuel Nir
(2)(3)(4)
|
|
55
|
|
Class I Director
|
|
|
|
|
|
Tali Yaron-Eldar
(2)(3)(4)(5)(6)
|
|
53
|
|
External Director; Chairman of our Audit Committee, Chairman of our Remuneration Committee
|
|
|
|
|
|
David Sidransky, M.D.
(1)(2)(3)(4)(5)(6)
|
|
56
|
|
External Director
|
|
|
|
|
|
Prof. Ran Oren, M.D.
|
|
66
|
|
Class II director
|
|
|
|
|
|
Carol L. Brosgart, M.D.
(2)
|
|
66
|
|
Class I Director
|
|
(1)
|
A member of our research & development committee.
|
|
(2)
|
Independent director under applicable Nasdaq Capital Market and SEC rules, as affirmatively determined
by our Board.
|
|
(3)
|
A member of our audit committee.
|
|
(4)
|
A member of our remuneration committee.
|
|
(5)
|
An external director under the Companies Law, approved by our shareholders.
|
|
(6)
|
A member of our nomination committee.
|
Chaim Hurvitz
, our
chairman of the Board and the Chairman of our R&D Committee joined our Board in 2011. Mr. Hurvitz currently serves as the Chief
Executive Officer of CH Health, a private venture capital firm, a position he has held since May 2011. Mr. Hurvitz served as a
member of the board of directors of Teva Pharmaceuticals Industries Ltd. from 2010 to 2014. Previously, he was a member of the
senior management of Teva Pharmaceuticals Industries Ltd., serving as the President of Teva International Group from 2002 until
2010, as President and Chief Executive Officer of Teva Pharmaceuticals Europe from 1992 to 1999 and as Vice President - Israeli
Pharmaceutical Sales from 1999 until 2002. Mr. Hurvitz presently serves as the chairman of Aerodentis and the Jaffa Institute,
and is a board member of Polypid and Cellixir. He is also a board member of the Manufacturers Association of Israel and chairs
its pharmaceutical branch. Mr. Hurvitz holds a Bachelor of Arts degree in political science and economics from Tel Aviv University,
which was awarded in 1985.
Allen Baharaff
,
our controlling shareholder, President and Chief Executive Officer and a member of our Board, co-founded the Group in 2000, served
as the Chief Financial Officer of GHI from 2000 until January 2015, and has served as our Chief Executive Officer since January
2012 and as our President since March 2015. Previously, he held a senior executive position at Isramex Projects Ltd., an energy
project financing company, and Managing Director of T+M Trusteeship & Management Services (Israel) Ltd., a subsidiary of a
Swiss company providing trust and similar services. Since 2005, Mr. Baharaff serves as a Director of the Rubin Museum. Mr. Baharaff
holds a Bachelor of Science degree in economics from the London School of Economics, University of London and LLB and MA degrees
from Cambridge University. Since 1993, Mr. Baharaff has been a member of the Israel Bar Association.
Dr. Tali Gorfine
,
our Chief Medical Officer since March 15, 2017, joined the Company in May 2016 as the Company's Senior Medical Director. In her
role as Senior Medical Director, Dr. Gorfine provided the Company with expertise regarding the Company's clinical development plan
and was the point of contact for all medical related issues. Prior to joining the Company, Dr. Gorfine served as “Senior
Clinical Program Leader” at Teva Pharmaceuticals global R&D devision, where she led the product strategy and clinical
development of Phase II and III assets. Dr. Gorfine holds a MD, PhD from Tel-Aviv University with a specialization in functional
magnetic resonance imaging (fMRI).
Dr. Liat Hayardeny
,
our Chief Scientific Officer (“CSO”), joined the Company in September 2016 bringing more than 16 years of experience
in drug development at all stages as part of Teva Pharmaceuticals’ global Resarch and Development Division. Prior to joining
Galmed, Dr. Hayardeny served as Teva’s Senior Director and Head of Research Scientific Affairs. In that capacity, Dr. Hayardeny
established the scientific positioning of Teva’s innovative compounds. Additionally, Dr. Hayardeny was responsible for Teva’s
relationship with institutions of higher education; managing Teva’s global research collaborations and publications. Dr.
Hayardeny holds a Ph.D. from Sackler School of Medicine and an MBA from Recanati Business School at Tel Aviv University.
Yohai Stenzler
,
our Chief Financial Officer, has served in such capacity since February 1, 2017. Mr. Stenzler joined the Company in June 2016 as
the company's corporate controller, and later on served as the Company's Director of Finance. Mr. Stenzler has six years of financial
management experience as an accountant at the real estate department at Ernst & Young LLP, where he was involved in financing,
taxes, auditing, advising and accounting of public and private companies, both domestic and international. Mr. Stenzler is a certified
CPA and holds a MBA in Finance from Recanati Business School at Tel Aviv University, and a BA in Economics and Accounting from
Ben-Gurion University of the Negev
.
Guy Nehemya
, our
Vice President, Operations, has served in such capacity since March 2017. Mr. Nehemya joined the Company in October 2013 as the
Company's Director of Operations, after completing his internship at Agmon, Rosenberg, HaCohen & Co. Law Offices. Mr. Nehemya
was a key member of management during the Company’s initial public offering and execution thereof. Mr. Nehemya, holds a LL.B.
from the College of Management and is currently completing his MBA degree at the IDC Herzliya. Mr. Nehemya has been a member of
the Israeli Bar Association since 2012.
Yael Hollander
,
our Vice President, Legal Affairs and Strategy, has served in such capacity since March 2017. Ms. Hollander, joined the Company
in July 2014 as the Company's General Counsel and Corporate Secretary. Ms. Hollander has five years of experience as a commercial
lawyer at Gross, Kleinhendler, Hodak, Halevy, Greenberg & Co. law offices, where she was involved in the representation of
both publicly-traded and private companies in connection with corporate finance, public offerings, mergers and acquisitions, commercial
transactions, corporate governance, and other securities, legal and business issues. Ms. Hollander holds a MBA in Finance from
Recanati Business School at Tel Aviv University, and a LL.B. and BA in Economics from the Hebrew University of Jerusalem. Ms. Hollander
has been a member of the Israeli Bar Association since 2010.
William Marth
, a
director of the Company since March 2014. Mr. Marth served as president and chief executive officer of Albany Molecular Research
Inc. since January 2014 until January 2018. Previously, Mr. Marth served as a Director of Albany Molecular Research Inc. and
as
chairman of its board of directors from June to December 2013
. Prior to this, he served as President and Chief Executive
Officer of Teva Pharmaceutical Industries Ltd. in the Americas from June 2010 to November 2012 and Chief Executive Officer of Teva
North America from January 2008 to June 2010 and CEO of Teva USA from January 2005 to January 2008. In addition, Mr.
Marth worked with several large equity firms providing guidance on their healthcare investments. He was a member of Teva’s
global executive management team from 2007 to 2012. From July 1999 to January 2002, he was the Executive Vice President and Vice
President of Sales and Marketing for Teva USA. Prior to joining Teva USA, he held various positions with the Apothecon division
of Bristol-Myers Squibb. Mr. Marth is a pharmacist and is currently a director at the University of Illinois at Chicago College
of Pharmacy (UIC). Previously, Mr. Marth served as the Chairman of the Board of Directors of Sorrento Therapeutics from 2014 to
July 2017, the Chairman of the Board of the Generic Pharmaceutical Association (GPhA) in 2008 and 2009 and the American Society
for Health-System Pharmacists (ASHP) in 2010, and various boards and committees, including the University of the Sciences
in Philadelphia and the Board of Ambassadors for John Hopkins’ Project RESTORE. Mr. Marth earned his B.Sc. in Pharmacy from
the University of Illinois in 1977 and his M.B.A. in 1989 from the Keller Graduate School of Management, DeVry University.
Shmuel Nir
, a director
of the Company since 2007, serves as President and Chief Executive Officer of Tushia Consulting Engineers Ltd., an investment and
management services company. From January 2001 to January 2016, Mr. Nir served as Chairman of the board of directors of Matan Digital
Printers Ltd. From March 1998 to January 2008, he served as President and Chief Executive Officer of Macpell Industries Ltd., a
leading industrial group. Between January 1991 and March 1998, Mr. Nir was an Executive Vice President of Operations at Macpell
Industries Ltd. and President and Chief Executive Officer of two of its subsidiaries, New Net Industries Ltd. and New Net Assets
Ltd. Prior to January 1991, Mr. Nir had held various positions with Intel Corporation in Jerusalem, Israel and Tefen Management
Consulting. Between 1999 and 2006, Mr. Nir served as managing partner at Spring Venture Capital Fund. Mr. Nir holds a B.Sc. in
Industrial Engineering and Management from the Technion - Israel Institute of Technology in Haifa, which was awarded in 1989.
Tali Yaron-Eldar
,
an external director and the chairman of our Audit Committee and Remuneration Committee, joined our Board in March 2014. Ms. Yaron-Eldar
is an Israeli attorney specializing in taxation and co-founded Yaron-Eldar, Paller, Schwartz & Co., Law Offices, in January
2013. Prior to January 2013, she was a partner at the law firm of Tadmor & Co. from March 2007 until December 2012 and a partner
at the law firm of Cohen, Yaron-Eldar & Co. from 2004 until March 2007. From January 2004 until January 2008, Ms. Yaron-Eldar
served as the Chief Executive Officer of Arazim Investment Company and she has also served in a variety of public positions, including
as the Chief Legal Advisor of the Customs and V.A.T department of the Finance Ministry of the State of Israel from 1998 to 2001
and as the Commissioner of Income Tax and Real Property Tax Authority of the State of Israel from 2002 to 2004. Ms. Yaron-Eldar
also serves as a director of a number of public companies, including Rossetta Genomics Ltd., Medtechnica Ltd., Magicjack Vocaltec
Ltd., Lodgia Rotex Investments Ltd., Arko Holdings Ltd., Greenergy Renewable Energy Ltd., GO.D.M Investments Ltd., and Tadea Technological
Development and Automation Ltd among others. Ms. Yaron-Eldar holds an M.B.A. specializing in finance from Tel Aviv University which
was awarded in 1995 and an LL.B. from Tel Aviv University which was awarded in 1987. Ms. Yaron-Eldar is also a member of the Israeli
Bar Association.
David
Sidransky, M.D.
, an external director and the chairman of our Nomination Committee, joined our Board in June 2014. Dr.
Sidransky is a renowned oncologist and research scientist named and profiled by TIME magazine in 2001 as one of the top
physicians and scientists in America, recognized for his work with early detection of cancer. He serves as the Director of
the Head and Neck Cancer Research Program at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University. He is
a Professor of Oncology, Otolaryngology, Cellular & Molecular Medicine, Urology, Genetics, and Pathology at John Hopkins
University and Hospital. Dr. Sidransky has written over 500 peer-reviewed publications, and has contributed to more than
60 cancer reviews and chapters. Dr. Sidransky is a founder of a number of biotechnology companies and holds numerous
biotechnology patents. He has been the recipient of many awards and honors, including the 1997 Sarstedt International
prize from the German Society of Clinical Chemistry, 1998 Alton Ochsner Award Relating Smoking and Health by the
American College of Chest Physicians and the 2004 Hinda Rosenthal Award and 2017 Team Award presented by the
American Association of Cancer Research. Dr. Sidransky has served as Vice Chairman of the Board of Directors of ImClone.
He is Chairman of the Board of Advaxis Inc., and Tamir Biotechnology and is a lead director at Champions Oncology
and on the board of directors of Orgenesis Inc. He is serving and has served on scientific advisory boards of
corporations and institutions, including Amgen, MedImmune, Roche and Veridex, LLC (a Johnson & Johnson
diagnostic company), among others. In addition, Dr. Sidransky served as Director of American Association for Cancer
Research from 2005 to 2008. Dr. Sidransky received his B.A. from Brandeis University and his M.D. from the Baylor
College of Medicine.
Prof. Ran Oren, M.D.
joined our Board in March, 2017 and has served as a member of our scientific advisory board since 2014, and as the Company's Chief
Medical Officer from August 1, 2016 to March 14, 2017. Prof. Oren is a Professor of Gastroenterology & Hepatology at the Faculty
of Medicine, Hebrew University of Jerusalem, Israel, and is the Head of the Institute of Gastroenterology and Liver Disease at
Hadassah Medical Center, Jerusalem, Israel. In addition, Prof. Oren serves as a member of the Scientific Advisory Board of Redhill
Biopharma Ltd., a member of the board of directors of the Boxenbaum – Netta Foundation Ltd. (CC), provides consultancy services
to MEDecide Ltd., advises Maccabi Healthcare in the field of liver and serves at the editorial board of the official journal of
the American Association for the study of liver diseases Hepatology. Prof. Oren published over the years in the fields of liver
fibrosis, thyroid hormone, effect on liver diseases and hepatocyte transplantation. In recent years his main research interests
are in the field of non-alcoholic fatty liver disease (NAFLD) – epidemiology, risk factors, diagnosis and treatment. Prof.
Oren has received numerous academic and professional awards in his field and holds several patents related to the prevention and
arresting of human liver disease. In 2000, Prof. Oren established the Liver Unit at the Tel Aviv Sourasky Medical Center, where
he served as Chief of Medicine from 2008 to 2010. Prof. Oren concurrently served as the President of the Israeli Association for
the Study of the Liver between 2007 and 2010.
Carol L. Brosgart,
M.D.
joined our Board on June 7, 2017. Dr. Brosgart served as a member of Tobira Therapeutics’s Board of Directors
from 2009 until it was acquired by Allergan in 2016. She is currently a member of the NASH council of Allergan and a consultant
to a number of biotechnology companies in the areas of liver disease and infectious disease. Dr. Brosgart currently serves
on the Steering Committee of the National Viral Hepatitis Roundtable, the Executive Committee of the Forum for Collaborative Research,
and the Steering Committee of the HBV Cure Group at the Forum as well as on the boards and committees of several other not-for-profit
health organizations. She is active in the public policy arena for AASLD and IDSA/HIVMA. Dr. Brosgart served as Senior Advisor
on Science and Policy to the Division of Viral Hepatitis, Centers for Disease Control, US Health and Human Services from 2011
to 2013. For the past three decades, Dr. Brosgart has also served as a member on the faculty of the School of Medicine at the
University of California, San Francisco where she is currently Clinical Professor of Medicine, Biostatistics and Epidemiology
in the Division of Global Health and Infectious Diseases. During 2011, Dr. Brosgart served as Chief Medical Officer at biotechnology
company Alios BioPharma, Inc. Prior to Alios, Dr. Brosgart served as Senior Vice President and Chief Medical Officer of Children’s
Hospital & Research Center in Oakland, California, from 2009 until February 2011. Previously, she served for eleven years,
from 1998 until 2009, at the biopharmaceutical company, Gilead Sciences, Inc., where she held a number of senior management roles,
most recently as Vice President, Public Health and Policy and earlier as Vice President, Clinical Research and Vice President,
Medical Affairs and Global Medical Director, Hepatitis. She led the clinical development of a number of agents at Gilead, including
Viread and Hepsera. Prior to Gilead, Dr. Brosgart worked for more than 20 years in clinical care, research and teaching at several
Bay Area medical centers. She was the founder and Medical Director of the East Bay AIDS Center at Alta Bates Medical Center in
Berkeley, California, from 1987 until 1998 and served as the Medical Director of Central Health Center, Oakland, California, of
the Alameda County Health Care Services Agency.
She is a board member of Abivax
,
and Chair of the Scientific Advisory Board for ContraVir Pharmaceuticals. Dr. Brosgart received a B.S. in Community Medicine from
the University of California, Berkeley and received an M.D. from the University of California, San Francisco. Her residency training
was in pediatrics, public health and preventive medicine at UCSF and UC Berkeley School of Public Health. She has published extensively
in the areas of HIV, HBV, CMV, and liver disease.
There
are no family relationships between any director or executive officer. There are no arrangements or understandings with major shareholders,
customers, suppliers or others, pursuant to which any director or executive officer was selected as a director or member of senior
management, as the case may be.
Scientific Advisory Board
We seek advice from our
Scientific Advisory Board generally on scientific and medical matters. Our Scientific Advisory Board includes: Professor Vlad Ratziu,
from the University Pierre et Marie Curie in Paris, France and coordinator of the EU FP7 FLIP consortium; Professor Scott Friedman
from the Icahn School of Medicine at Mount Sinai in New York, United States; Professor Arun Sanyal, from the Virginia Commonwealth
University in Richmond, Virginia; Professor Rohit Loomba, from the University of California San Diego School of Medicine in San
Diego, California; Professor Jose Mato, from CIC bioGUNE and CIC biomaGUNE, Spain; Professor Eric Gershwin, Chief, Division of Rheumatology
Allergy and Clinical Immunology of University of California at Davis, in Davis, California; and Professor Ran Oren from
Hadassah University Hospital in Ein Kerem, Jerusalem, Israel.
Certain Approvals Required
for Office Holders’ Compensation of the Companies Law
Pursuant to the Companies
Law, the Company is required to adopt a compensation policy regarding the terms of office and employment of its Office Holders
(as such terms are defined below), which includes exemption and release of the Office Holders from liability for breach of his
or her duty of care to the Company, an undertaking to indemnify the Office Holder, post factum indemnification or insurance; any
grant, payment, remuneration, compensation, or other benefit provided in connection with termination of service; and any benefit,
other payment or undertaking to provide any payment as aforesaid (the “Terms of Office and Employmentˮ). The Company’s
current compensation policy with respect to the Terms of Office and Employment of the Company’s Office Holders (the “Compensation
Policyˮ), was approved by the Board in April 2017 after considering the recommendations of the Remuneration Committee and
was adopted by the Company’s shareholders in June 2017.
The term ‘Office
Holder’ as defined in the Companies Law includes a general manager, chief business manager, deputy general manager, vice
general manager, any other person fulfilling or assuming the responsibilities of any of the foregoing positions without regard
to such person’s title, as well as a director, or a manager directly subordinate to the general manager or the chief executive
officer. As of February 28, 2018, the latest practicable date for inclusion in this annual report, in addition to the eight members
of the Board (including the Company's President and Chief Executive Officer), the Company considers five other individuals, including
its Chief Medical Officer, its Chief Scientist Officer, its Chief Financial Officer, its Vice President, Operations and its Vice
President, Legal Affairs and Strategy, to be Office Holders.
Pursuant to the Companies
Law, arrangements between the Company and its Office Holders must generally be approved by the Remuneration Committee and the Board,
and be consistent with the Compensation Policy. However, under certain circumstances, the Company may approve an arrangement that
is not consistent with the Compensation Policy, if such arrangement is approved by a majority of the Company’s shareholders,
provided that (i) such majority includes a majority of the votes cast by shareholders who are not controlling shareholders and
who do not have a personal interest in the matter, present and voting (abstentions are disregarded), or (ii) the votes cast by
shareholders who are not controlling shareholders and who do not have a personal interest in the matter who were present and voted
against the arrangement constitute two percent or less of the voting power of the company (the “Special Majorityˮ).
The terms of office and
employment of directors (including an officer who is a director but is not a controlling shareholder) further require the approval
of the shareholders by a simple majority in addition to the approval of the Compensation Committee and the Board, in that order,
and under certain circumstances, a Special Majority; with respect to a chief executive officer or an officer who is a controlling
shareholder, the approval of the shareholders must be made by the Special Majority. In addition, under certain circumstances, a
company may be exempt from receiving the shareholders’ approval with respect to the Terms of Office and Employment of a non-affiliated
candidate for chief executive officer.
Under certain circumstances,
if the terms of office and employment of Office Holders (who are not directors or controlling shareholders) are not approved by
the shareholders, where such approval is required, the Remuneration Committee and the Board may subsequently override the resolution
of the shareholders following a new discussion of the matter and for specified reasons. In addition, amendment of terms of office
and employment of Office Holders (who are not directors or controlling shareholders) requires the approval of the Remuneration
Committee only, if the Remuneration Committee determines that the amendment is not material.
Aggregate Executive
Compensation
The aggregate compensation,
including share-based compensation, paid by us to all of our Office Holders as a group, with respect to the year ended December
31, 2017, was approximately $3.4 million. This amount includes approximately $0.3 million set aside or accrued to provide pension,
severance, retirement, vacation or similar benefits or expenses, but does not include business travel, relocation, professional
and business association dues and expenses reimbursed to Office Holders, and other benefits commonly reimbursed or paid by companies
in our industry. In addition to the seven members of the Board (including the Company's President and Chief Executive Officer and
the Company's former Chief Medical Officer), the Company considers seven other individuals, namely its Chief Medical Officer, its
Chief Scientist Officer, its Chief Financial Officer, it's VP, Legal and strategy, its VP, Operations, its former Chief Financial
Officer, and its former VP, Clinical trials, to have been Office Holders in 2017.
As of December 31, 2017,
options to purchase 1,580,347 of our ordinary shares granted to our Office Holders as a group were outstanding, of which options
to purchase 1,249,054 of our ordinary shares were vested, with a weighted average exercise price of $2.22 per ordinary share.
As of December 31, 2017,
30,590 restricted stock units (RSUs) granted to our Office Holders as a group were outstanding. For outstanding equity-based awards
granted to our Office Holders, see below under “Item 6. Directors, Senior Management and Employees—E. Share Ownership—Certain
Information Concerning Equity Awards to Office Holders.”
Individual Compensation
of Covered Executives
The following table sets
forth the compensation granted to the five most highly compensated Office Holders during or with respect to the year ended December
31, 2017. All amounts reported in the table reflect the cost to the Company, as recognized in its financial statements for the
year ended December 31, 2017. The five individuals for whom disclosure is provided are referred to herein as “Covered Executives.”
Information Regarding the Covered Executives
|
|
Compensation for Services
(1)
|
|
Name and Principal Position
(1)
|
|
Base
Salary/consulting
fee($)
|
|
|
Benefits and
Perquisites
($)
(2)
|
|
|
Cash
Bonus
($)
(3)
|
|
|
Equity-Based
Compensation
($)
(4)
|
|
|
Other
($)
(5)
|
|
|
Total ($)
|
|
Allen Baharaff
(President and Chief Executive Officer and Director)
|
|
|
384,401
|
|
|
|
106,639
|
|
|
|
538,162
|
(6)
|
|
|
291,386
|
|
|
|
35,500
|
|
|
|
1,356,088
|
|
Dr.
Liat Hayardeny
(Chief
Scientific Officer)
|
|
|
127,019
|
|
|
|
32,479
|
|
|
|
20,891
|
|
|
|
53,947
|
|
|
|
-
|
|
|
|
234,338
|
|
Tali Gorfine
(Chief Medical Officer)
|
|
|
111,421
|
|
|
|
33,903
|
|
|
|
27,855
|
|
|
|
55,271
|
|
|
|
-
|
|
|
|
228,450
|
|
Yael Hollander
(Vice President, Legal Affairs and Strategy)
|
|
|
75,209
|
|
|
|
26,916
|
|
|
|
32,089
|
|
|
|
81,576
|
|
|
|
-
|
|
|
|
215,789
|
|
Guy Nehemya
(Vice President, Operations)
|
|
|
71,950
|
|
|
|
25,941
|
|
|
|
32,089
|
|
|
|
81,576
|
|
|
|
-
|
|
|
|
211,556
|
|
(1)
|
|
The above mentioned executives are all full-time employee
of the Company. Mr. Baharaff also serves as a member of our Board. Cash compensation amounts denominated in currencies other than
the Dollar were converted into Dollars at an exchange rate of NIS 3.60 = $1.00, which reflects the average conversion rate for
fiscal year ended December 31, 201
7.
|
(2)
|
|
Amounts reported in this column include benefits and perquisites, including those
mandated by applicable law. Such benefits and perquisites may include, to the extent applicable to the Covered Executives, payments,
contributions and/or allocations for savings funds, pension, severance, vacation, car allowance, medical insurances and benefits,
risk insurance (e.g., life, disability, accident), telephone, convalescence pay, relocation, payments for social security and
other benefits and perquisites consistent with the Company’s policies.
|
(3)
|
|
Amounts reported in this column refer to the cash bonuses provided by the Company
with respect to 2017, which have been provided for in the Company’s financial statements for the year ended December 31,
2017 (including if such bonuses were paid in 2018). They exclude bonuses paid in 2017 which were provided for in the Company’s
financial statements for previous years. Cash bonuses are paid in accordance with the Company’s 2017 Annual Cash Bonus Plan
and are intended to promote the Company’s work plan and business strategy by rewarding officers for achievement of the Company’s
business and financial goals through team work and collaboration. Key performance indicators which are factored into cash bonus
determinations are individual specific and may include: (i) major progress in research and development stages, (ii) the execution
of in/out-license transactions, (iii) the execution of strategic collaboration agreements, (iv) obtaining marketing approval of
a new product, and (v) raising funds throughout public offering or a private placement.
|
(4)
|
|
Amounts reported in this column represent the expense recorded in the
Company’s financial statements for the year ended December 31, 2017 with respect to equity-based compensation.
Assumptions and key variables used in the calculation of such amounts are discussed in Note 9 to the Financial Statements.
For outstanding equity-based awards granted to Covered Executives see below under “Item 6. Directors, Senior Management
and Employees—E. Share Ownership—Certain Information Concerning Equity Awards to Office Holders.”
|
(5)
|
|
Amounts reported in this column include payments made with respect to the year 2017
and recorded in the financial statements for the year ended December 31, 2017 relating to directors’ fees.
|
(6)
|
|
This cash bonus consists of: (i) an annual bonus; and (ii)
a special cash bonus for meeting certain goals.
|
Compensation of Directors
As approved by our shareholders
at our 2017 annual meeting of shareholders, in connection with their services as directors of the Company, each of our directors
from time to time, including external directors, is entitled to an annual payment of $40,000, plus value-added tax (“VATˮ),
if applicable, and with respect to an expert external director, $50,000 plus VAT, payable quarterly at the end of each quarter.
Our Board has determined that each of Mr. Nir, Ms. Yaron-Eldar and Mr. Sidransky are entitled to receive compensation as an ‘expert
external director’. The compensation of external directors is also subject to the provisions of the Israeli regulations promulgated
pursuant to the Companies Law governing the terms of compensation payable to external directors (the “Compensation Regulationsˮ),
which provide that such compensation will not be less than the Minimum Amount (as such term is defined in the Compensation Regulations).
See also “Item 6. Directors, Senior Management and Employees—C. Board Practices—External Directors & Financial
Experts” below.
For the outstanding equity-based
awards granted to our directors, see below under “Item 6. Directors, Senior Management and Employees—E. Share Ownership—Certain
Information Concerning Equity Awards to Office Holders.”
Employment Agreements
and Arrangements with Directors and Related Parties
We entered into written
employment agreements with each of our executive officers. These agreements provide for notice periods of varying duration for
termination of the agreement by us or by the relevant executive officer, during which time the executive officer will continue
to receive base salary and benefits. These agreements also contain customary provisions regarding non-competition, confidentiality
of information and assignment of inventions. However, the enforceability of the non-competition and assignment of inventions provisions
may be limited under applicable law. See “Item 3. Key Information—Risk Factors—Risks Related to Our Business,
Industry and Regulatory Requirements.”
Employment Agreement with Our President
and Chief Executive Officer
On December 30, 2013,
we entered into a personal employment agreement with our controlling shareholder, Mr. Allen Baharaff who serves as our
president, chief executive officer and as a member of our Board, as amended on March 15, 2016 and July 20, 2017, which
provides that Mr. Baharaff’s terms of office and employment are for an undefined term, subject to re-approval
under the Companies Law and termination in accordance with the terms of the employment agreement.
Under the terms of his
employment agreement, Mr. Baharaff is entitled to a gross monthly salary of NIS 115,000. In addition, Mr. Baharaff will be entitled
to the following cash bonuses based on achievement of qualitative and quantitative performance goals and objectives: (i) an annual
cash bonus in an amount of up to nine times his monthly base salary, to be determined based on the achievement of certain qualitative
and quantitative performance goals and objectives set by our Board and approved by our shareholders; (ii) upon execution of a Strategic
Agreement (as defined below), Mr. Baharaff will be entitled to receive, subject to the discretion of the Board, a cash bonus in
an amount of up to twelve times his monthly base salary. A “Strategic Agreement” means: a license agreement or any
other strategic agreement (i.e. research and development, manufacture, distribution, etc.) for the U.S., Europe, Japan or China;
(iii) upon consummation of a fund raising (excluding funds received from a Strategic Agreement), Mr. Baharaff will be entitled
to receive, subject to the discretion of the Board, a cash bonus in an amount of up to ten times his monthly base salary if the
funds received by the Company are between $8 Million to $10 million and up to twelve times his monthly base salary if the funds
received by the Company are $10 million or more; (iv) upon a Change of Control Event (as defined below), Mr. Baharaff will be entitled
to receive, subject to the discretion of the Board, a cash bonus in an amount of up to twelve times his monthly base salary. A
“Change of Control Event” means: (a) the acquisition of the Company by another entity or individual or group of individuals
by means of any transaction or series of related transactions (including, without limitation, any reorganization, merger, share
purchase or consolidation), unless the Company’s shareholders of record as constituted immediately prior to any such transaction
will, immediately after such transaction (by virtue of securities issued as consideration for the Company’s share capital,
assets or otherwise) hold more than 50% of the voting power of the surviving or acquiring entity; or (b) a sale of all or substantially
all of the assets of the Company.
Mr. Baharaff will also
be entitled to the following equity based compensation: (i) in the event that our options are cashed-out upon a Change of Control
Event, all unvested options granted to Mr. Baharaff will vest immediately prior to the consummation of the Change of Control Event;
(ii) if upon a Change of Control Event (a) Mr. Baharaff’s employment as chief executive officer of the Company or the surviving
entity is terminated within twelve months as of the Change of Control Event, and (b) unvested options are replaced for new options
of the surviving entity as part of the Change of Control Event with a vesting schedule and terms identical to the replaced options
(the “Replacement Options”), then (x) all unvested Replacement Options granted to Mr. Baharaff will vest immediately
prior to the termination of Mr. Baharaff’s employment, and (y) Mr. Baharaff’s Replacement Options will be exercisable
until the earlier of (a) two years from termination, and (b) expiration of the Replacement Options.
Mr. Baharaff will also
receive other benefits required under Israeli law or that are customary for senior executives in Israel such as confidentiality,
reimbursement of expenses, payment for absence days, sick leave, pension and/or a manager's insurance policy and study fund.
Mr. Baharaff’s employment
agreement is terminable by either party upon six months prior written notice ("Prior Notice Period"), and contains customary
provisions regarding noncompetition, confidentiality of information and assignment of inventions.
Upon
termination, provided such termination was not for cause, Mr. Baharaff shall be entitled, in addition to the Prior Notice Period,
to a payment
in an amount of up to twelve times his monthly base salary, to be paid in twelve equal monthly installments,
in exchange for
Mr. Baharaff’s undertaking not to compete with the Company
for
a period of twelve months
(“Non-Compete Grant”). Other than in case of resignation
by Mr. Baharaff, excluding resignation for a Good Reason Event (as defined below), or termination for cause: (i) all Mr. Baharaff’s
unvested options will vest upon termination; and (ii) unexercised options granted to Mr. Baharaff may be exercised until the earlier
of (a) two years from his termination, and (b) expiration of his options.
A “Good Reason Event” means: any of
the following events, provided that the event is effected by the Company without the written consent of Mr. Baharaff: (i) a material
reduction or adverse change in Mr. Baharaff’s authority, duties or responsibilities; (ii) a reduction in Mr. Baharaff’s
monthly base salary, other than a reduction of no more than 10% of his then current monthly base salary as part of an across the
board reduction in all salaries for employees of the Company; (iii) a material breach by the Company of Mr. Baharaff‘s employment
agreement or any other agreements pertaining directly to Mr. Baharaff’s compensation or employment or (iv) death, disability
or severe illness.
Upon termination for cause by the Company, Mr. Baharaff shall not be entitled
to any Prior Notice Period, Non-Compete Grant or any other payment, and any unvested outstanding equity awards shall terminate
immediately upon the date of such termination for cause.
For cash bonuses granted
to Mr. Baharaff see “Item 6. Directors, Senior Management and Employees— B. Compensation—Individual Compensation
of Covered Executives.” For outstanding equity-based awards granted to Mr. Baharaff see below under “Item 6. Directors,
Senior Management and Employees—E. Share Ownership—Certain Information Concerning Equity Awards to Office Holders.”
We are incorporated in
Israel, and, therefore, we are subject to various corporate governance practices under Israeli law relating to such matters as
external directors, independent directors, audit committees, remuneration committees and internal auditors. These Israeli law requirements
are in addition to the requirements of the Nasdaq Listing Rules and other relevant provisions of U.S. securities laws. Under such
Nasdaq Listing Rules, a foreign private issuer may generally follow its home country practices for corporate governance in lieu
of such comparable listing rules’ requirements, except for certain matters such as composition and responsibilities of the
audit committee and the SEC-mandated standards for the independence of its members. See below under “Item 16G. Corporate
Governance” for further information.
Membership of the Board
Our Articles provide that
the minimum number of members of the Board is three and the maximum number of members is eleven. The Board is presently comprised
of eight members, two of whom are external directors. The minimum and maximum number of directors may be changed, at any time and
from time to time, by a majority vote of our directors then in office, provided that no decrease in the number of directors shall
shorten the term of any incumbent director. Under our Articles, the Board consists of three classes of directors (not including
the two external directors, each of whom are not part of any class) which are appointed for fixed terms of office in accordance
with the Companies Law and our Articles, with one class being elected each year for a term of approximately three years by our
shareholders at our annual general meeting.
Directors so elected cannot
be removed from office by the shareholders until the expiration of their term of office. The directors do not receive any benefits
upon the expiration of their term of office.
The three classes of directors
are Class I Directors, Class II Directors and Class III Directors. Mr. Shmuel Nir and Dr. Carol Brosgart serve as our Class I Directors
until the close of the annual general meeting to be held in 2018; Mr. Allen Baharaff and Prof. Ran Oren serve as our Class II Directors
until the close of the annual general meeting to be held in 2019; and Mr. William Marth and Mr. Chaim Hurvitz serve as our Class
III Directors until the close of the annual general meeting to be held in 2020. In addition, our shareholders meeting held on June
7, 2017, resolved to re-elect Ms. Tali Yaron-Eldar and Dr. David Sidransky as the Company’s external directors for a term
of three years, commencing as of June 12, 2017.
In accordance with the
Articles, any vacancies on the Board of, including unfilled positions, may be filled by a vote of a majority of the directors then
in office, and each director chosen in this manner would hold office until the next annual general meeting of the Company (or until
the earlier termination of his or her appointment as provided for in the Companies Law or the Articles).
Any amendment of our Articles
regarding the election of directors, as described above, require the affirmative vote of at least 75% of the voting rights in the
Company. See “Item 6. Directors, Senior Management and Employees—C. Board Practices—External Directors”
for a description of the procedure for the election of external directors.
A nominee for service as
a director in a public company may not be elected without submitting a declaration to the company, prior to election, specifying
that he or she has the requisite qualifications to serve as a director, independent director or external director, as applicable,
and the ability to devote the appropriate time to performing his or her duties as such.
A director, including an
external director or an independent director, who ceases to meet the statutory requirements to serve as a director, external director
or independent director, as applicable, must notify the company to that effect immediately and his or her service as a director
will expire upon submission of such notice.
Alternate Directors
Our Articles provide, as
allowed by the Companies Law, that any director may, subject to the conditions set thereto, appoint a person as an alternate to
act in his place, to remove the alternate and appoint another in his place and to appoint an alternate in place of an alternate
whose office is vacated for any reason whatsoever. Under the Companies Law, a person who is not qualified to be appointed as a
director, a person who is already serving as a director or a person who is already serving as an alternate director for another
director, may not be appointed as an alternate director. Nevertheless, a director who is already serving as a director may be appointed
as an alternate director for a member of a committee of the board of directors so long as he or she is not already serving as a
member of such committee, and if the alternate director is to replace an external director, he or she is required to be an external
director and to have either “financial and accounting expertise” or “professional expertise,” depending
on the qualifications of the external director he or she is replacing. A person who does not have the requisite “financial
and accounting experience” or the “professional expertise,” depending on the qualifications of the external director
he or she is replacing, may not be appointed as an alternate director for an external director. A person who is not qualified to
be appointed as an independent director, pursuant to the Companies Law, may not be appointed as an alternate director of an independent
director qualified as such under the Companies Law. Unless the appointing director limits the time or scope of the appointment,
the appointment is effective for all purposes until the appointing director ceases to be a director or terminates the appointment.
External Directors
Under the Companies Law
and the regulations promulgated pursuant thereto, Israeli companies whose shares have been offered to the public, or that are publicly
traded outside of Israel, which we refer to as a public company, are required to appoint at least two natural persons as “external
directors.”
No person may be appointed
as an external director if such person is a relative of a controlling shareholder or if such person, a relative, partner or employer
of such person, or anyone to whom such person is directly or indirectly subordinate, or any entity under such person’s control,
has or had, on or within the two years preceding the date of such person’s appointment to serve as an external director,
any affiliation with the company to whose board of directors the external director is proposed to be appointed, with any controlling
shareholder of the company, with a relative of such controlling shareholder, or with any entity controlled, on the date of such
appointment or within the preceding two years, by the company or by a controlling shareholder of the company. If the company has
no controlling shareholder or a shareholder holding 25% or more of the company’s voting rights, a person may not serve as
an external director if the person has any affiliation, at the time of the appointment, to the chairman of the board of directors,
the chief executive officer or the most senior financial officer of the company, or to a shareholder holding 5% or more of the
outstanding shares or voting rights of the company.
The term “controlling
shareholder” means a shareholder with the ability to direct the activities of the company, other than by virtue of being
an office holder. A shareholder is presumed to have “control” of the company and thus to be a controlling shareholder
of the company if the shareholder holds 50% or more of the “means of control” of the company. “Means of control”
is defined as (1) the right to vote at a general meeting of a company or a corresponding body of another corporation; or (2) the
right to appoint directors of the corporation or its general manager.
The term “affiliation”
includes:
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an employment relationship;
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a business or professional relationship maintained on a regular basis;
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service as an office holder, excluding service as a director in a private company prior to the
first offering of its shares to the public if such director was appointed as a director of the private company in order to serve
as an external director following the initial public offering.
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The term “relative”
is defined as a spouse, sibling, parent, grandparent, descendant, spouse’s descendant, sibling and parent and the spouse
of each of the foregoing.
In addition, no person
may serve as an external director if: (i) the person’s other positions or other business activities create, or may create,
a conflict of interest with the person’s service as an external director or interfere with the person’s ability to
serve as an external director; (ii) at the time such person serves as a non-external director of another company on whose board
of directors a director of the reciprocal company serves as an external director; (iii) the person is an employee of the Israel
Securities Authority or of an Israeli stock exchange; (iv) such person or such person’s relative, partner, employer or anyone
to whom such person is directly or indirectly subordinate, or any entity under such person’s control, has business or professional
relations with any person or entity he or she should not be affiliated with, as described above, unless such relations are negligible;
or (v) such person received compensation, directly or indirectly, in connection with such person’s services as an external
director, other than as permitted under the Companies Law and the regulations promulgated thereunder. If, at the time of election
of an external director, all other directors who are not controlling shareholders of such company or their relatives, are of the
same gender, then the designated external director must be of the other gender.
Pursuant to the Companies
Law, an external director is required to have either financial and accounting expertise or professional qualifications according
to criteria set forth in regulations promulgated under the Companies Law, provided that at least one of the external directors
has financial and accounting expertise. However, if at least one of our other directors (1) meets the independence requirements
of the Exchange Act, (2) meets the Nasdaq requirements for membership on the audit committee and (3) has financial and accounting
expertise as defined in the Companies Law and applicable regulations, then neither of our external directors is required to possess
financial and accounting expertise as long as both possess other requisite professional qualifications as required under the Companies
Law and regulations promulgated thereunder.
The regulations promulgated
under the Companies Law define an external director with requisite professional qualifications as a director who satisfies one
of the following requirements: (1) the director holds an academic degree in either economics, business administration, accounting,
law or public administration, (2) the director either holds an academic degree in any other field or has completed another form
of higher education in the company’s primary field of business or in an area which is relevant to his or her office as an
external director in the company, or (3) the director has at least five years of experience serving in any one of the following
capacities, or at least five years of cumulative experience serving in two or more of the following capacities: (a) a senior business
management position in a company with a substantial scope of business, (b) a senior position in the company’s primary field
of business or (c) a senior position in public administration.
The board of directors
must make the determination as to the financial and accounting expertise, and as to the professional qualifications, of a director
taking into consideration those criteria and matters set forth in the regulations. A director with financial and accounting expertise
is a director who by virtue of his or her education, professional experience and skill, has a high level of proficiency in and
understanding of business accounting matters and financial statements so that he or she is able to fully understand our financial
statements and initiate debate regarding the manner in which the financial information is presented. In addition, the board of
directors of a public company is required to make a determination as to the minimum number of directors who must have such financial
and accounting expertise based on, among other things, the type of company, its size, the volume and complexity of the company’s
activities and the number of directors. Our Board has determined that the minimum number of directors with financial and accounting
expertise, in addition to the external director or directors who have such expertise, will be one, and that Mr. Marth qualifies
as such. The external director who qualifies to have such expertise is Ms. Yaron-Eldar. In addition, our Board has determined that
Ms. Yaron-Eldar qualifies as an audit committee financial expert pursuant to the applicable SEC rules, and accordingly as having
the necessary financial sophistication as required by the Nasdaq Capital Market rules.
Election and Dismissal of External
Directors
External directors are
elected for a term of three years at the general meeting of shareholders by a simple majority, provided that the majority includes
either:
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a majority of the shares that are voted at the meeting in favor of the election of the external
director, excluding abstentions, include at least a majority of the votes of shareholders who are not controlling shareholders
and who do not have a personal interest in the appointment (excluding a personal interest that did not result from the shareholder’s
relationship with the controlling shareholder), or
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the total number of shares held by the shareholders mentioned in the paragraph above that are voted
against the election of the external director does not exceed two percent of the aggregate voting rights in the company.
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External directors may
be re-elected for two additional terms of three years each, provided that with respect to the appointment for each such additional
three year term, one of the following has occurred:
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his/her service for each such additional term is recommended by one or more shareholders holding
at least 1% of the company’s voting rights and is approved at a shareholders’ meeting by a disinterested majority,
where the total number of shares held by non-controlling, disinterested shareholders voting for such reelection exceeds 2% of the
aggregate voting rights in the company, subject to additional restrictions set forth in the Companies Law with respect to the affiliation
of the external director nominee;
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the external director proposed his or her own nomination, and such nomination was approved in accordance
with the requirements described in the paragraph above; or
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the reappointment of the external director has been proposed by the board of directors and the
appointment was approved by the majority of shareholders required for the initial appointment of an external director.
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However, under regulations
promulgated pursuant to the Companies Law, companies whose shares are listed for trading on specified exchanges outside of Israel,
including the Nasdaq Capital Market, may elect external directors for additional terms that do not exceed three years each, beyond
the three year terms generally applicable, provided that, if an external director is being re-elected for an additional term or
terms beyond three year terms: (i) the audit committee and board of directors, in that order, must determine that, in light of
the external director’s expertise and special contribution to the board of directors and its committees, the re-election
for an additional term is to the company’s best interest; (ii) the external director must be re-elected by the required majority
of shareholders as described above; and (iii) the term during which the nominee has served as an external director and the reasons
given by the audit committee and board of directors for extending his or her term of office must be presented to the shareholders
prior to their approval.
Following termination of
service as an external director, a public company, a controlling shareholder thereof and any entity controlled by a controlling
shareholder, may not grant any benefit, directly or indirectly, to any person who served as an external director of such public
company, or to his or her spouse or child, including, not appointing such person, or his or her spouse or child, as an Office Holder
of such public company or of any entity controlled by a controlling shareholder of such public company, not employing such person
or his or her spouse or child and not receiving professional services for pay from such person, either directly or indirectly,
including through a corporation controlled by such person, all until the lapse of two years from termination of office with respect
to the external director, his or her spouse or child; and until the lapse of one year from termination of office with respect to
other relatives of the former external director.
Each committee of the Board
that is authorized to exercise powers of a company’s board of directors must include at least one external director. The
audit and remuneration committees of a company’s board of directors must include all of such company’s external directors.
Under the Companies Law,
an external director cannot be dismissed from office unless the board of directors has learned there is a concern that: the external
director no longer meets the statutory requirements for his appointment as an external director; or the external director is in
breach of his or her duty of loyalty to the company. The board of directors shall discuss the matter no later than in the first
board of directors meeting convened after the board had become aware of such circumstances. In the event the board of directors
has determined that an external director had ceased to comply with the requirements set forth under the Companies Law or that he
or she breached his or her duty of loyalty to the company, than the board of directors shall convene a general meeting of the shareholders
and will include on the agenda a resolution for the removal from office of such external director. The shareholders vote required
to removal of an external director from office is the same majority required for the appointment; provided, however, that the external
director has been given the opportunity to present his or her position. In addition, a court of law may determine, upon a request
of a director or a shareholder, to dismiss the external director after finding that such external director no longer meets the
statutory requirements of an external director set under the Companies Law or that the external director is in breach of his or
her duty of loyalty to the company.
In addition, under regulations
promulgated pursuant to the Companies Law, companies with no controlling shareholder whose shares are listed for trading on specified
exchanges outside of Israel, including the Nasdaq Capital Market, may adopt exemptions from various corporate governance requirements
of the Companies Law so long as the company satisfies the applicable foreign country laws and regulations, including applicable
stock exchange rules, that apply to companies organized in that country relating to the appointment of independent directors and
the composition of audit and compensation committees. Such exemptions include an exemption from the requirement to appoint external
directors and the requirement that an external director be a member of certain committees. We may use these exemptions in the future
if we do not have a controlling shareholder.
Ms. Yaron-Eldar and Dr.
Sidransky are the current external directors, appointed by our Board and approved by our shareholders to serve as such.
Independent Directors Under the
Companies Law
Under the Companies Law
an “independent director” is either an external director or a director appointed or classified as such who meets the
same non-affiliation criteria as an external director, as determined by the audit committee, and who has not served as a director
of the company for more than nine consecutive years. For these purposes, ceasing to serve as a director for a period of two years
or less would not be deemed to sever the consecutive nature of such director’s service.
Regulations promulgated
pursuant to the Companies Law provide that a director in a public company whose shares are listed for trading on specified exchanges
outside of Israel, including the Nasdaq Capital Market, such as the Company, who qualifies as an independent director under the
relevant non-Israeli rules relating to independence standards for audit committee membership and who meets certain non-affiliation
criteria, which are less stringent than those applicable to external directors, would be deemed an “independent” director
pursuant to the Companies Law provided: (i) he or she has not served as a director for more than nine consecutive years; (ii) he
or she has been approved as such by the audit committee; and (iii) his or her remuneration shall be in accordance with the Compensation
Regulations. For these purposes, ceasing to serve as a director for a period of two years or less would not be deemed to sever
the consecutive nature of such director’s service.
Furthermore, pursuant to
these regulations, such company may reappoint a person as an independent director for additional terms, beyond nine years, which
do not exceed three years each, if each of the audit committee and the board of directors determine, in that order, that in light
of the independent director’s expertise and special contribution to the board of directors and its committees, the reappointment
for an additional term is in the company’s best interest.
Committees of the Board
Our Articles also provide
that the Board may delegate any, or all, of its powers to one or more committees of the Board, and may entrust to and confer upon
a “managing director” such of its powers as it deems appropriate. However, the Companies Law provides that certain
powers and authorities (for example, the power to approve the financial statements) may not be delegated and may be exercised only
by the Board. Notwithstanding the foregoing, we currently do, and intend to continue to, comply with the corporate governance requirements
of the Nasdaq Capital Market, except to the extent indicated elsewhere in this annual report, including as set forth under “Item
16G. Corporate Governance” below. The Companies Law requires public companies such as the Company to appoint an audit committee
and a remuneration committee.
Audit Committee
The Companies Law requires
public companies to appoint an audit committee comprised of at least three directors, including all of the external directors,
the majority of whom must be independent directors under the Companies Law. The Companies Law further stipulates that the following
may not be members of the audit committee: (i) the chairman of the board of directors; (ii) any director employed by or providing
services on an ongoing basis to the company, to a controlling shareholder of the company or an entity controlled by a controlling
shareholder of the company; (iii) a director whose livelihood mainly depends on a controlling shareholder; and (iv) a controlling
shareholder or any relative of a controlling shareholder.
The Companies Law further
requires that: (i) the chairperson of the audit committee must be an external director; (ii) generally, any person who is not entitled
to be a member of the audit committee may not attend the audit committee’s meetings and voting sessions, unless such person
was invited by the chairperson of the committee for the purpose of presenting a specific subject matter thereof; and (iii) the
quorum required for the convening of meetings of the audit committee and for adopting resolutions by the audit committee is a majority
of the members of the audit committee, provided that the majority of the members present are independent directors and at least
one of them is an external director.
The responsibilities of
the audit committee under the Companies Law include: (i) identifying flaws in the management of a company’s business and
making recommendations to the board of directors as to how to correct them; (ii) with respect to certain actions involving conflicts
of interest and with respect to certain related party transactions, deciding whether such actions are material actions and whether
such transactions are extraordinary transactions, respectively, all for the purpose of approving such actions or transactions;
(iii) reviewing and deciding whether to approve certain related party transactions and certain actions involving conflicts of interest;
(iv) reviewing the internal auditor’s work program; (v) examining the company’s internal control structure and processes,
the performance of the internal auditor and whether the internal auditor has at his or her disposal the tools and resources required
to perform his or her duties, considering, inter alia, the special needs of the company and its size; (vi) examining the independent
auditor’s scope of work as well as the independent auditor’s fees and providing its recommendations to the appropriate
corporate organ; (vii) providing for arrangements as to the manner in which the company will deal with employee complaints with
respect to deficiencies in the management of the company’s business and the protection to be provided to such employees;
and (viii) with respect to related party transactions with a controlling shareholder, regardless of whether such transactions are
extraordinary transactions, that prior to entering into such transaction, to establish the requirement of having a competitive
process under the supervision of the audit committee or any individual, committee or body on its behalf and according to criteria
established by the audit committee and to determine procedures for approving certain related party transactions with a controlling
shareholder, which were determined by the audit committee to be non-extraordinary transactions, but which are not negligible transactions.
Our Board has adopted an
audit committee charter setting forth the responsibilities of the Audit Committee consistent with the rules of the SEC and the
Nasdaq Listing Rules, as well as the requirements for such committee under the Companies Law, as described below.
Our Audit Committee oversees
the accounting and financial reporting processes of the Company. It also provides assistance to the Board in fulfilling its legal
and fiduciary obligations with respect to matters involving the accounting, auditing, financial reporting and internal control
functions of the Company. In carrying out its duties, our Audit Committee meets with management at least once a quarter, at which
time, among other things, it reviews, and either approves or disapproves, the financial results of the Company for the immediately
preceding calendar quarter and conveys its conclusions in this regard to the Board. Our Audit Committee also monitors generally
the services provided by the Company’s independent auditors to ensure their independence, and reviews all audit and non-audit
services provided by them.
Our Board has resolved
to delegate to the Audit Committee the power to pre-approve non-auditing services rendered by the Company’s independent auditors
without the need for further approval by our Board. As such, on March 6, 2018, our Audit Committee approved the adoption of a pre-approval
policy, such that the Chairman of the Audit Committee is authorized to pre-approve any engagement of our independent auditors during
a period of twelve months from the date of such approval, for the provision of non-auditing services, for fees not to exceed $20,000,
and any such engagement which exceeds $20,000 shall require a pre-approval by the entire Audit Committee. Once services have been
pre-approved, our management must then report to the Audit Committee on a periodic basis regarding the extent of services actually
provided in accordance with the pre-approval policy, and regarding the fees for the services performed. Such fees for 2017 were
pre-approved by the Audit Committee in accordance with the pre-approval policy.
The Company’s independent
and internal auditors also report regularly to our Audit Committee, and our Audit Committee discusses with the Company’s
independent auditors the quality, not just the acceptability, of the accounting principles, the reasonableness of significant judgments
and the clarity of disclosures in the Company’s financial statements, as and when it deems it appropriate to do so.
Under
the provisions of the Sarbanes-Oxley Act, the audit committee is directly responsible for the appointment, compensation and oversight
of the work of the company’s independent auditors. However, under Israeli law, the appointment of independent auditors and
their compensation require the approval of the shareholders of a public company. Pursuant to Israeli law, the shareholders may
delegate the authority to determine the compensation of the independent auditors to the board of directors. In addition, pursuant
to the Companies Law, the audit committee is required to examine the independent auditors’ fees and to provide its recommendations
with respect thereto to the appropriate corporate body. Accordingly, the appointment of our independent auditors is required to
be approved and recommended to the shareholders by our Audit Committee and Board and approved by the shareholders. The compensation
of the independent auditors for audit services is required to be approved and recommended to the Board by our Audit Committee and
approved by the Board. The Board has delegated its authority to approve the compensation of independent auditors for non-auditing
services to the Audit Committee.
Mr. Nir, Ms. Yaron-Eldar
and Dr. Sidransky are the current members of our Audit Committee, with Ms. Yaron-Eldar serving as chairperson. Each of our Audit
Committee members are “independent directors” in accordance with the Nasdaq Capital Market corporate governance requirements,
as affirmatively determined by our Board, and Ms. Yaron-Eldar and Dr. Sidransky also meet the qualifications for service as “external
directors” under the Companies Law and the regulations promulgated thereunder, also as affirmatively determined by our Board
and our shareholders. In addition, our Board has affirmatively determined that Ms. Yaron-Eldar also qualifies as an audit committee
financial expert pursuant to the applicable SEC rules, and accordingly has the necessary financial sophistication as required by
the Nasdaq Capital Market rules, and as a financial and accounting expert under the Companies Law.
Remuneration Committee
The Companies Law requires
public companies to appoint a remuneration committee comprised of at least three directors, including all of the external directors,
who must generally also constitute a majority of the members. All other members of the committee, who are not external directors,
must be directors who receive compensation consistent with that of external directors and that is in compliance with the Compensation
Regulations. In addition, the chairperson of the remuneration committee must be an external director.
The Companies Law further
stipulates that directors who are not qualified to serve on the audit committee, as described above, may not serve on the remuneration
committee either and that similar to the audit committee, generally, any person who is not entitled to be a member of the remuneration
committee may not attend the remuneration committee’s meetings. Our Board has adopted a remuneration committee charter setting
forth the responsibilities of our Remuneration Committee, as described below.
The responsibilities of
the remuneration committee under the Companies Law include: (i) making recommendations to the board of directors with respect to
the approval of the compensation policy and any extensions thereto; (ii) periodically reviewing the implementation of the compensation
policy and providing the board of directors with recommendations with respect to any amendments or updates thereto; (iii) reviewing
and resolving whether or not to approve transactions with respect to the terms of office and employment of Office Holders; and
(iv) resolving, under certain circumstances prescribed under the Companies Law, whether or not to exempt a transaction with a candidate
for chief executive officer who meets non-affiliation criteria from shareholder approval.
Our Remuneration Committee
also oversees the administration of the Company’s various compensation plans and arrangements, in particular, the incentive
compensation, deferred compensation and equity based plans of the Company (and to the extent appropriate, of the subsidiaries of
the Company) and assists the Board in fulfilling its responsibilities relating to the compensation of directors, the Chief Executive
Officer and other Office Holders of the Company. In carrying out these duties, our Remuneration Committee meets on an ad hoc basis.
Under the Companies Law, our Remuneration Committee may need to seek the approval of the Board and the shareholders for certain
compensation decisions as described above. Each member of our Remuneration Committee is an “independent director” in
accordance with the Nasdaq Capital Market corporate governance requirements, as affirmatively determined by our Board. Mr. Nir,
Ms. Yaron-Eldar and Dr. Sidransky are the current members of our Remuneration Committee, with Ms. Yaron-Eldar serving as chairperson.
Nominating Committee
The Nasdaq Capital Market
corporate governance requires each company adopting a nominating committee to certify that it has adopted a formal written charter
or board resolution, as applicable, addressing the nominations process and such related matters as may be required under U.S. federal
securities laws. Although not required as a foreign private issuer to adopt a nominating committee, we have decided to follow such
requirement.
Our Board has adopted a
nominating committee charter setting forth the responsibilities of the Nominating Committee consistent with the Nasdaq Listing
Rules.
The Nominating Committee
is responsible for identifying individuals qualified to be appointed as board members, and recommending to the Board of appropriate
director nominees for election at the general meeting of shareholders.
Independent director
oversight of nominations enhances investor confidence in the selection of well-qualified director nominees, as well as independent
nominees as required by the rules. The Nasdaq Capital Market listing rule is also intended to provide flexibility for a company
to choose an appropriate board structure and reduce resource burdens, while ensuring that independent directors approve all nominations.
Mr. Hurvitz, Ms. Yaron-Eldar,
Mr. Marth and Dr. Sidransky are the current members of our Nominating Committee, with Dr. Sidransky serving as chairperson. Nasdaq
Capital Market Listing Rule 5605(e) requires that our Nominating Committee be comprised solely of independent directors unless
the Nominating Committee is comprised of at least three members and the Board determines that such non-independent director’s
membership, which shall not be longer than two years, is required by the best interests of the Company and our shareholders.
R&D Committee
Our R&D Committee,
which was established by the Board on May 2014, advises and assists the Board in its oversight of our research and development
programs, including the rationale and timeline of clinical trials and other studies, as well as market surveys in connection therewith.
The R&D Committee operates in accordance with the purposes and objectives determined by the Board from time to time. Mr. Hurvitz,
Dr. Sidransky and Mr. Marth are the current members of our R&D Committee, with Mr. Hurvitz serving as chairperson.
Internal Auditor
Under the Companies Law,
the board of directors of an Israeli public company must appoint an internal auditor recommended by the audit committee and nominated
by the board of directors. The role of the internal auditor is to examine, among other things, our compliance with applicable law
and orderly business procedures. An internal auditor should comply with the requirements of the Companies Law and the Internal
Audit Law, 5752-1992, and may not be:
(a) a person (or a relative
of a person) who holds more than 5% of the Company’s outstanding shares or voting rights;
(b) a person (or a relative
of a person) who has the power to appoint a director or the general manager of the Company;
(c) an Office Holder, including
a director, of the Company (or a relative thereof); or
(d) a member of the Company’s
independent accounting firm, or anyone on his or her behalf.
Pursuant to Israeli law,
an internal auditor’s tenure cannot be terminated without his or her consent, nor can he or she be suspended from such position
unless the board of directors of the company has so resolved following the recommendations of the company’s audit committee
and, after providing the internal auditor with the opportunity to present his or her position to the board of directors of the
company and to the audit committee.
On January 31, 2017, our
Board re-appointed Mr. Alon Amit, CPA, from Raveh Ravid & Co. CPA, Tel Aviv, Israel, as the Company’s internal auditor,
effective as of January 1, 2017, for a period of two years.
Exculpation and Indemnification of Directors and Officers
Under the Companies Law,
a company may not exculpate an Office Holder from liability for a breach of the duty of loyalty. An Israeli company may exculpate
an Office Holder in advance from liability to the company, in whole or in part, for damages caused to the company as a result of
a breach of the duty of care but only if a provision authorizing such exculpation is included in its articles of association. Our
Articles include such a provision. The Company may not exculpate in advance a director from liability arising out of a prohibited
dividend or distribution to shareholders.
Under the Companies Law,
a company may indemnify, or undertake in advance to indemnify, an Office Holder for the following liabilities and expenses, imposed
on Office Holder or incurred by Office Holder due to acts performed by him or her as an Office Holder, provided its articles of
association include a provision authorizing such indemnification:
|
·
|
a monetary liability incurred by or imposed on him or her in favor of another person pursuant to
a judgment, including a settlement or arbitrator’s award approved by a court. However, if an undertaking to indemnify an
Office Holder with respect to such liability is provided in advance, then such an undertaking must be limited to events which,
in the opinion of the board of directors, can be foreseen based on the company’s activities when the undertaking to indemnify
is given, and to an amount or according to criteria determined by the board of directors as reasonable under the circumstances,
and such undertaking shall detail the abovementioned foreseen events and amount or criteria;
|
|
·
|
reasonable litigation expenses, including attorneys’ fees, incurred by the Office Holder
as a result of an investigation or proceeding instituted against him or her by an authority authorized to conduct such investigation
or proceeding, provided that (i) no indictment was filed against such Office Holder as a result of such investigation or proceeding;
and (ii) no financial liability was imposed upon him or her as a substitute for the criminal proceeding as a result of such investigation
or proceeding or, if such financial liability was imposed, it was imposed with respect to an offense that does not require proof
of criminal intent or as a monetary sanction;
|
|
·
|
a monetary liability imposed on him or her in favor of an injured party at an Administrative Procedure
(as defined below) pursuant to Section 52(54)(a)(1)(a) of the Securities Law;
|
|
·
|
expenses incurred by an office holder in connection with an Administrative Procedure under the
Securities Law, including reasonable litigation expenses and reasonable attorneys’ fees; and
|
|
·
|
reasonable litigation expenses, including attorneys’ fees, incurred by the Office Holder
or imposed by a court in proceedings instituted against him or her by the company, on its behalf, or by a third-party, or in connection
with criminal proceedings in which the Office Holder was acquitted, or as a result of a conviction for an offense that does not
require proof of criminal intent.
|
|
·
|
An “Administrative Procedure” is defined as a procedure pursuant to chapters H3 (Monetary
Sanction by the Israeli Securities Authority), H4 (Administrative Enforcement Procedures of the Administrative Enforcement Committee)
or I1 (Arrangement to prevent Procedures or Interruption of procedures subject to conditions) to the Securities Law.
|
Under the Companies Law,
a company may insure an Office Holder against the following liabilities incurred for acts performed by him or her as an Office
Holder if and to the extent provided in the company’s articles of association:
|
·
|
a breach of the duty of loyalty to the company, provided that the Office Holder acted in good faith
and had a reasonable basis to believe that such act would not prejudice the company;
|
|
·
|
a breach of the duty of care to the company or to a third-party;
|
|
·
|
a monetary liability imposed on the Office Holder in favor of a third-party;
|
|
·
|
a monetary liability imposed on the office holder in favor of an injured party at an Administrative
Procedure pursuant to Section 52(54)(a)(1)(a) of the Securities Law; and
|
|
·
|
expenses incurred by an office holder in connection with an Administrative Procedure, including
reasonable litigation expenses and reasonable attorneys’ fees.
|
Nevertheless, under the
Companies Law, a company may not indemnify, exculpate or insure an Office Holder against any of the following:
|
·
|
a breach of the duty of loyalty, except for indemnification and insurance for a breach of the duty
of loyalty to the company in the event Office Holder acted in good faith and had a reasonable basis to believe that the act would
not prejudice the company;
|
|
·
|
a breach of the duty of care committed intentionally or recklessly, excluding a breach arising
out of the negligent conduct of the Office Holder;
|
|
·
|
an act or omission committed with intent to derive unlawful personal benefit; or
|
|
·
|
a fine, monetary sanction, penalty or forfeit levied against the Office Holder.
|
Under the Companies Law,
exculpation, indemnification and insurance of Office Holders require the approval of the remuneration committee, board of directors
and, in certain circumstances, the shareholders, as described above under “Item 6
—
Directors, Senior Management
and Employees—B. Compensation.”
Our Articles permit us
to exculpate, indemnify and insure our Office Holders to the fullest extent permitted by the Companies Law. Each of our Office
Holders have entered into an indemnification agreement with us, exculpating them, to the fullest extent permitted by Israeli law,
from liability to us for damages caused to us as a result of a breach of the duty of care and undertaking to indemnify them to
the fullest extent permitted by Israeli law, including with respect to liabilities resulting from certain acts performed by such
Office Holders in their capacity as an Office Holder of the Company, our subsidiaries or our affiliates.
In the opinion of the SEC,
indemnification of directors and Office Holders for liabilities arising under the Securities Act, however, is against public policy
and therefore unenforceable.
Agreements with Directors
Other than a written agreement with our President and Chief
Executive Officer, as detailed in “Item 6. Directors, Senior Management and Employees—B. Compensation—Employment
Agreements and Arrangements with Directors and Related Parties—Employment Agreement with Our President and Chief Executive
Officer,” we do not have written agreements with any director providing for benefits upon the termination of his or her services
with our Company.
As of December 31, 2017,
we had 17 employees, of which 13 were full-time employees and four were part-time employees. Eleven of the Company’s employees
were involved in our clinical and product development operations and six served in general and administrative capacities. 16 of
our employees are located in Israel and one employee is located in the United Kingdom.
While none of our employees
are party to any collective bargaining agreements or represented by any labor unions, certain provisions of the Israeli labor laws
and certain collective bargaining agreements between the Histadrut (General Federation of Labor in Israel) and the Coordination
Bureau of Economic Organizations (including the Industrialists’ Associations) are applicable to our employees by order of
the Israel Ministry of Economics. These provisions primarily concern the length of the workday, minimum daily wages for professional
workers, pension fund benefits for all employees, insurance for work-related accidents, procedures for dismissing employees, determination
of severance pay and other conditions of employment. We generally provide our employees with benefits and working conditions beyond
the required minimums. We have never experienced any employment-related work stoppages and believe our relationship with our employees
is favorable.
Certain Information
Concerning Ordinary Shares Owned by Office Holders
The following table sets
forth information regarding beneficial ownership of our ordinary shares as of February 28, 2018, the latest practicable date for
inclusion in this annual report, held by our directors and executive officers, individually and as a group.
Beneficial ownership is
determined in accordance with the rules of the SEC and includes voting or investment power with respect to ordinary shares. Ordinary
shares issuable under share options, warrants or other conversion rights currently exercisable or that are exercisable within 60
days after February 28 2018 are deemed outstanding for the purpose of computing the percentage ownership of the person holding
the options, warrants or other conversion rights, but are not deemed outstanding for the purpose of computing the percentage ownership
of any other person. Percentage of shares beneficially owned is based on 14,472,414 ordinary shares outstanding on February 28,
2018.
|
|
As of February 28, 2018
|
|
|
|
Number of ordinary
shares beneficially
owned
(1)
|
|
|
Percentage of ordinary
shares beneficially
owned
|
|
Chaim Hurvitz
(2)
|
|
|
1,063,963
|
|
|
|
7.3
|
%
|
Allen Baharaff
(3)
|
|
|
4,253,797
|
|
|
|
27.8
|
%
|
Shmuel Nir
(4)
|
|
|
75,64
6
|
|
|
|
*
|
|
William Marth
(5)
|
|
|
5
7,595
|
|
|
|
*
|
|
Tali Yaron-Eldar
(6)
|
|
|
25,6
25
|
|
|
|
*
|
|
Dr. David Sidransky
(6)
|
|
|
2
5,625
|
|
|
|
*
|
|
Prof. Ran Oren
(7)
|
|
|
89,777
|
|
|
|
*
|
|
Dr. Carol L. Brosgart
(7)
|
|
|
20,000
|
|
|
|
*
|
|
Dr. Tali Gorfine
(7)
|
|
|
27,500
|
|
|
|
*
|
|
Dr. Liat Hayardeny
(7)
|
|
|
25,000
|
|
|
|
*
|
|
Yohai Stenzler
(8)
|
|
|
32,070
|
|
|
|
*
|
|
Yael Hollander
(9)
|
|
|
48,320
|
|
|
|
*
|
|
Guy Nehemya
(9)
|
|
|
48,320
|
|
|
|
*
|
|
All directors and executive officers as a group (13 persons)
|
|
|
5,
793,239
|
|
|
|
38.40
|
%
|
* Less than 1%.
(1)
|
|
All options included are either currently exercisable or will be exercisable within
60 days of February 28, 2018.
|
(2)
|
|
Consists of (i) 1,0
38,963 ordinary
shares, of which 811,596 ordinary shares are held through Shirat HaChaim Ltd., a company incorporated under the laws of the State
of Israel, of which Mr. Hurvitz is the controlling shareholder, president, chief executive officer and the chairman of its board
of directors and 227,367 ordinary shares held by Mr. Chaim Hurwitz; and (ii) 25,000 ordinary shares issuable upon the exercise
of options that are currently exercisable or will be exercisable within 60 days as of February 28, 2018.
|
(3)
|
|
Consists of (i) 3,420,822 ordinary shares, of which 3,416,822 are held through G.
Yarom Medical Research Ltd., a company incorporated under the laws of the State of Israel, of which Mr. Baharaff is the controlling
shareholder and the chairman of its board of directors and 4,000 ordinary shares held by Mr. Baharaff, which were purchased in
the open market; and (ii) options to purchase 832,975 ordinary shares that are currently exercisable within 60 days as of February
28, 2018. Of the 4,253,797 ordinary shares, Mr. Baharaff exercises sole voting and dispositive power over 836,975 shares beneficially
owned and shared voting and dispositive power with G. Yaron Medical Research Ltd. over 3,416,822 shares.
|
|
(4)
|
Consists of (i)
45,188 ordinary
shares, of which 41,438 ordinary shares are held through Tushia Consulting Engineers Ltd., of which Shmuel Nir is its controlling
shareholder and 3,750 ordinary shares held by Mr. Nir; and (ii) 30,458 ordinary shares issuable upon the exercise of options that
are currently exercisable or will be exercisable within 60 days as of February 28, 2018.
|
|
(5)
|
Consists of (i)
18,554
ordinary shares held by Mr. Marth; and (ii) 39,041 ordinary shares issuable upon the exercise of options that are currently exercisable
or will be exercisable within 60 days as of February 28, 2018.
|
|
(6)
|
Consists of (i)
3,750
ordinary shares held by the referenced person; and (ii) 21,875 ordinary shares issuable upon the exercise of options
that are currently exercisable or will be exercisable within 60
days as of February 28, 2018.
|
|
(7)
|
Represents ordinary shares issuable upon the exercise of options that are currently exercisable
or will be exercisable within 60 days as of February 28, 2018;
|
|
(8)
|
Consists of (i) 2
,812 ordinary
shares held by Mr. Stenzler; (ii) 28,906 ordinary shares issuable upon the exercise of options that are currently exercisable or
will be exercisable within 60 days as of February 28, 2018; and (iii) 352 ordinary shares issuable upon the vesting of restricted
stock units that are currently vested or will vest within 60 as of February 28, 2018.
|
|
(9)
|
Consists of (i) 2,812 ordinary shares held by the referenced person; (ii) 45,156 ordinary shares
issuable upon the exercise of options that are currently exercisable or will be exercisable within 60 days as of February 28, 2018;
and (iii) 352 ordinary shares issuable upon the vesting of restricted stock units that are currently vested or will vest within
60 as of February 28, 2018.
|
This table is based
upon information supplied by officers and directors and is believed to be accurate. Except as indicated in footnotes to this table,
we believe that the shareholders named in this table have sole voting and investment power with respect to all shares shown to
be beneficially owned by them, based on information provided to us by such shareholders. Unless otherwise noted below, each shareholder’s
address is: c/o Galmed Pharmaceuticals Ltd., 16 Tiomkin St., Tel Aviv, Israel 6578317.
To
our knowledge, as of February 28, 2018, we had 6 holders of record of our ordinary shares with a U.S. address, including Cede &
Co., the nominee of The Depository Trust Company. These holders held in the aggregate 9,842,254 ordinary shares, or 68% of our
outstanding ordinary shares as of February 28, 2018. The number of record holders in the United States is not representative of
the number of beneficial holders of our ordinary shares nor is it representative of where such beneficial holders are resident
since many of these ordinary shares were held by brokers or other nominees.
To our knowledge,
the only significant changes in the percentage ownership held by our major shareholders during the past three years have been
the following: From January 1, 2015 to February 28, 2018, the ownership percentage of Chaim Hurvitz decreased by 1.7% from 9.0%
to 7.3% and the ownership percentage of Allen Baharaff decreased by 7.2% from 35% to 27.8% during such period.
2013 Incentive Share Option Plan
We maintain one equity-based
incentive plan, our 2013 Incentive Share Option Plan (the “2013 Planˮ). As of February 28, 2018, the latest practicable
date for inclusion in this annual report, a total of 3,090,492 shares were reserved for issuance under our 2013 Plan, of which
(1) options to purchase 2,095,724 ordinary shares and 27,501 restricted stock units (“RSUsˮ), were issued and outstanding
thereunder (i.e., were granted but not canceled, expired or exercised); (2) options to purchase 739,078 ordinary shares were exercised
and 35,780 ordinary shares were issued upon vesting of RSUs, and (3) 187,253 shares remain unallocated for future equity awards
pursuant to our 2013 Plan.
Our 2013 Plan, which was
adopted by our Board on September 2, 2013, and approved by our shareholders in December 30, 2013 (as was amended by the Board and
our shareholders on March 30, 2015 and May 11, 2015, respectively), provides for the grant of options to purchase our ordinary
shares and the issuance of RSUs to our officers, directors, employees, service providers and consultants. Our 2013 Plan provides
for such equity-based compensation under various and different tax regimes, including those detailed below.
The 2013 Plan is administered
by our Board, which, on its own or upon the recommendation of our Remuneration Committee or any other similar committee of the
Board, shall determine, subject to applicable law, the identity of grantees of awards and various terms of the grant. Consistent
with our Compensation Policy, the 2013 Plan provides for granting options to purchase our ordinary shares pursuant to Section 102
of the Israeli Income Tax Ordinance (the “Ordinanceˮ), under the capital gains route, to directors, officers and employees
who are Israeli residents holding (or have a right to hold or to purchase) less than 10% of our total share capital and do not
have a right to receive 10% or more of the Company’s profits.
Section 102 of the Ordinance
allows Israeli employees, directors and officers, who are not controlling shareholders to receive favorable tax treatment for compensation
in the form of shares or options. However, under this route we are not allowed to deduct any expense with respect to the issuance
of the options or shares. Israeli non-employee service providers, consultants and shareholders who hold 10% or more of our total
share capital or are otherwise controlling shareholders, may be granted options pursuant to Section 3(i) of the Ordinance, which
does not provide for similar tax benefits. In order to comply with the terms of the capital gains route pursuant to Section 102
of the Ordinance, the granted options as well as the ordinary shares issued upon exercise of these options and other shares received
subsequently following any realization of rights with respect to such options (such as share dividends and share splits), must
be granted to a trustee for the benefit of the relevant grantee and should be held by the trustee for at least two years after
the date of the grant. If such options or shares are sold by the trustee or are transferred to the grantee before the end of the
two year period, then the grantee would be taxed at top marginal rates upon selling the shares.
For residents, or deemed
residents, of the United States, the 2013 Plan provides grants, which are pursuant to Section 422 of the Internal Revenue Code
of 1986, as amended (the “Codeˮ), as incentive stock options, or ISOs, and any other participants which do not qualify
for ISOs, as non-statutory stock options (“NSOsˮ), pursuant to the Code.
Section 422 of the Code
allows employees, directors and officers, who are non-controlling shareholders (e.g., less than 10% shareholders) and are considered
residents of the United States or those who are deemed to be residents of the United States for purposes of the payment of tax,
or are otherwise subject to taxation in the United States with respect to the grant of awards, to receive favorable tax treatment
for compensation in the form of shares or ISOs. 10% shareholders or persons which are not service providers will receive NSOs,
which do not entitle them to receive similar tax benefits. Section 422(b) of the Code provides for the ISO track such that the
individual does not have to pay ordinary income tax (nor employment taxes) on the difference between the exercise price and the
fair market value of the shares issued (however, the holder may have to pay U.S. alternative minimum tax instead). However, if
the shares are held for one year from the date of exercise and two years from the date of grant, then the profit (if any) made
on sale of the shares is taxed as long-term capital gain. Section 422 of the Code requires that any grant of awards shall not be
made at a price which is less than 100% of the fair market value of such awards on the date of the grant, all pursuant to the terms
of Section 409A of the Code. However, under this ISO track, we are not allowed to deduct any expense with respect to the issuance
of the options or shares. In order to comply with the terms of the ISO track, the option granted thereunder must meet the requirements
of Section 422 of the Code when granted and at all times until the exercise thereof.
Options and RSUs granted
under the 2013 Plan will vest in accordance with the vesting dates as determined by the Board following the recommendation of the
Remuneration Committee or any other similar committee of the Board with respect to each grant. Generally, options that are not
exercised within ten years from the grant date expire, unless otherwise determined by the Board and the Remuneration Committee,
as applicable, provided however, that, pursuant to our Compensation Policy, any equity-based awards to Office Holders must include
both a gradual vesting period of at least three years from the date of grant, and an exercise period of no more than ten years
from the date of grant.
Upon such date or dates
designated in the applicable award agreement, unless earlier forfeited, subject to the receipt of any approvals required from any
relevant tax authority, we shall settle each RSU upon vesting by delivering one ordinary share.
In case of termination
for reasons of disability or death, the grantee or his legal successor may exercise options that have vested prior to termination
within a period of twelve months from the date of disability or death. If we terminate a grantee’s employment or service
for cause, all of the grantee’s vested and unvested unexercised options will expire and terminate on the date of termination.
If a grantee’s employment or service is terminated for any other reason, the grantee may exercise his or her vested options
within 90 days of the date of termination or within a longer period under specified circumstances determined by our Board. Any
expired or unvested options shall return to the option pool reserved under the 2013 Plan for reissuance.
In the event of grantee’s
termination prior to a vesting date by reason of such grantee's death or disability, all of such grantee’s RSUs shall immediately
become vested as of the date of such termination. In the event of a grantee’s termination for cause prior to settlement,
all of such grantee’s RSUs shall immediately be forfeited for no consideration as of the date of such termination. If a grantee’s
employment or service is terminated for any other reason, (1) all vesting with respect to such grantee's RSUs shall cease,
(2) all of such grantee’s unvested RSUs shall immediately be forfeited for no consideration as of the date of such termination,
and (3) to the extent not already settled, all of such grantee’s vested RSUs shall be settled in accordance with the
settlement schedule set forth in the applicable award agreement.
In the event of a merger
or consolidation of our company subsequent to which we would no longer exist as a legal entity, or a sale of all, or substantially
all, of our ordinary shares or assets or other transaction having a similar effect on us, or a Transaction, any unexercised options
then outstanding will be cancelled. Notwithstanding the foregoing, the Board, or the relevant committee of the Board, may determine
that the options will not be cancelled but will be assumed or substituted for an appropriate number of the same type of shares
or other securities of the successor company as were distributed to the Company or the shareholders in connection with the Transaction.
In addition, the Board, or the relevant committee of the Board, may determine to include in certain option agreements either a
clause that provides for acceleration of vesting of all or part of the unvested options in the event of a Transaction or the occurrence
of another event or a clause which provides that if the optionee’s employment with the successor company is terminated by
the successor company without cause within a certain period, not to exceed two years from the closing of such Transaction, all
or part of the unvested options shall be accelerated.
Certain Information
Concerning Equity Awards to Office Holders
The following tables
set forth information, as of February 28, 2018, the latest practicable date for inclusion in this annual report, concerning all
outstanding equity awards to Office Holders.
Options
Name of
Office
Holder
|
|
Date of grant
|
|
Exercise
price per
share ($)
|
|
|
Shares subject
to the option
|
|
|
Shares
vested and
unexercised
|
|
|
Shares
unvested
|
|
|
Schedule
date of
expiration
|
Chaim Hurvitz
|
|
February 4, 2016
|
|
$
|
5.49
|
|
|
|
10,000
|
(1)
|
|
|
6,666
|
|
|
|
3,334
|
|
|
Feb-04-2026
|
|
|
February 4, 2016
|
|
$
|
5.94
|
|
|
|
30,000
|
|
|
|
15,000
|
|
|
|
15,000
|
|
|
Feb-04-2026
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Allen Baharaff
|
|
December 30, 2013
|
|
|
NIS0.01
|
|
|
|
115,437
|
|
|
|
115,437
|
|
|
|
0
|
|
|
Sep-2-2023
|
|
|
December 30, 2013
|
|
|
NIS0.01
|
|
|
|
266,085
|
|
|
|
266,085
|
|
|
|
0
|
|
|
Sep-2-2023
|
|
|
December 30, 2013
|
|
|
NIS0.01
|
|
|
|
150,174
|
|
|
|
150,174
|
|
|
|
0
|
|
|
Sep-2-2023
|
|
|
February 4, 2016
|
|
$
|
5.49
|
|
|
|
140,000
|
(1)
|
|
|
93,333
|
|
|
|
46,667
|
|
|
Feb-04-2026
|
|
|
February 4, 2016
|
|
$
|
5.94
|
|
|
|
170,000
|
|
|
|
85,000
|
|
|
|
85,000
|
|
|
Feb-04-2026
|
William Marth
|
|
March 18, 2014
|
|
$
|
3.57
|
|
|
|
17,166
|
|
|
|
17,166
|
|
|
|
0
|
|
|
Sep-02-2023
|
|
|
May 11, 2015
|
|
$
|
5.49
|
|
|
|
10,000
|
|
|
|
6,875
|
|
|
|
3,125
|
|
|
May-11-2025
|
|
|
February 4, 2016
|
|
$
|
5.94
|
|
|
|
30,000
|
|
|
|
15,000
|
|
|
|
15,000
|
|
|
Feb-04-2026
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Shmuel Nir
|
|
February 21, 2014
|
|
$
|
3.57
|
|
|
|
8,583
|
|
|
|
8,583
|
|
|
|
0
|
|
|
Sep-02-2023
|
|
|
May 11, 2015
|
|
$
|
5.49
|
|
|
|
10,000
|
|
|
|
6,875
|
|
|
|
3,125
|
|
|
May-11-2025
|
|
|
February 4, 2016
|
|
$
|
5.94
|
|
|
|
30,000
|
|
|
|
15,000
|
|
|
|
15,000
|
|
|
Feb-04-2026
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Tali Yaron-Eldar
|
|
May 11, 2015
|
|
$
|
5.49
|
|
|
|
10,000
|
|
|
|
6,875
|
|
|
|
3,125
|
|
|
May-11-2025
|
|
|
February 4, 2016
|
|
$
|
5.94
|
|
|
|
30,000
|
|
|
|
15,000
|
|
|
|
15,000
|
|
|
Feb-04-2026
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
David Sidransky
|
|
May 11, 2015
|
|
$
|
5.49
|
|
|
|
10,000
|
|
|
|
6,875
|
|
|
|
3,125
|
|
|
May-11-2025
|
|
|
February 4, 2016
|
|
$
|
5.94
|
|
|
|
30,000
|
|
|
|
15,000
|
|
|
|
15,000
|
|
|
Feb-04-2026
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Prof. Ran Oren
|
|
December 22, 2013
|
|
$
|
3.57
|
|
|
|
64,125
|
|
|
|
64,125
|
|
|
|
0
|
|
|
Sep-02-2023
|
|
|
January 3, 2016
|
|
$
|
7.61
|
|
|
|
30,000
|
|
|
|
15,000
|
|
|
|
15,000
|
|
|
Jan-03-2026
|
|
|
July 28, 2016
|
|
$
|
4.47
|
|
|
|
20,000
|
|
|
|
7,500
|
|
|
|
12,500
|
|
|
July-28-2026
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Dr. Tali Gorfine
|
|
July 28, 2016
|
|
$
|
4.47
|
|
|
|
40,000
|
|
|
|
15,000
|
|
|
|
25,000
|
|
|
July-28-2026
|
|
|
January 31, 2017
|
|
$
|
3.84
|
|
|
|
40,000
|
|
|
|
10,000
|
|
|
|
30,000
|
|
|
Jan-31-2026
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Dr. Liat Hayardeny
|
|
September 6, 2016
|
|
$
|
4.05
|
|
|
|
40,000
|
|
|
|
12,500
|
|
|
|
27,500
|
|
|
Sep-06-2026
|
|
|
January 31, 2017
|
|
$
|
3.84
|
|
|
|
40,000
|
|
|
|
10,000
|
|
|
|
30,000
|
|
|
Jan-31-2026
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Yohai Stenzler
|
|
December 30, 2014
|
|
$
|
5.49
|
|
|
|
20,000
|
|
|
|
15,000
|
|
|
|
5,000
|
|
|
Dec-30-2024
|
|
|
January 3, 2016
|
|
$
|
7.61
|
|
|
|
22,500
|
|
|
|
11,250
|
|
|
|
11,250
|
|
|
Jan-03-2026
|
|
|
November 7, 2017
|
|
$
|
7.48
|
|
|
|
20,000
|
|
|
|
0
|
|
|
|
20,000
|
|
|
Nov-07-2020
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Yael Hollander
|
|
December 30, 2014
|
|
$
|
5.49
|
|
|
|
40,000
|
|
|
|
30,000
|
|
|
|
10,000
|
|
|
Dec-30-2024
|
|
|
January 3, 2016
|
|
$
|
7.61
|
|
|
|
22,500
|
|
|
|
11,250
|
|
|
|
11,250
|
|
|
Jan-03-2026
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Guy Nehemya
|
|
December 30, 2014
|
|
$
|
5.49
|
|
|
|
40,000
|
|
|
|
30,000
|
|
|
|
10,000
|
|
|
Dec-30-2024
|
|
|
January 3, 2016
|
|
$
|
7.61
|
|
|
|
22,500
|
|
|
|
11,250
|
|
|
|
11,250
|
|
|
Jan-03-2026
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Carol L. Brosgart
|
|
April 25, 2017
|
|
$
|
4.87
|
|
|
|
20,000
|
|
|
|
15,000
|
|
|
|
5,000
|
|
|
A
pr-25-2027
|
RSUs
Name of
Office
Holder
|
|
Date of grant
|
|
Shares
subject to
the RSUs
|
|
|
Shares
vested
|
|
|
Shares
unvested
|
|
Chaim Hurvitz
|
|
Feb-04-2016
|
|
|
7,500
|
|
|
|
3,750
|
|
|
|
3,750
|
|
William Marth
|
|
Feb-04-2016
|
|
|
7,500
|
|
|
|
3,750
|
|
|
|
3,750
|
|
Shmuel Nir
|
|
Feb-04-2016
|
|
|
7,500
|
|
|
|
3,750
|
|
|
|
3,750
|
|
Tali Yaron-Eldar
|
|
Feb-04-2016
|
|
|
7,500
|
|
|
|
3,750
|
|
|
|
3,750
|
|
David Sidransky
|
|
Feb-04-2016
|
|
|
7,500
|
|
|
|
3,750
|
|
|
|
3,750
|
|
Yohai Stenzler
|
|
Jan-03-2016
|
|
|
5,625
|
|
|
|
2,812
|
|
|
|
2,813
|
|
Yael Hollander
|
|
Jan-03-2016
|
|
|
5,625
|
|
|
|
2,812
|
|
|
|
2,813
|
|
Guy Nehemya
|
|
Jan-03-2016
|
|
|
5,625
|
|
|
|
2,812
|
|
|
|
2,813
|
|
ITEM 7. Major Shareholders and Related
Party Transactions.
Except as set forth
in “Item 6. Directors, Senior Management and Employees—E. Share Ownership”, to the best of our knowledge, no
other person who we know beneficially owns 5.0% or more of the Company’s ordinary shares outstanding as of February 28, 2018,
the latest practicable date for inclusion in this annual report. None of our shareholders has different voting rights from other
shareholders. Other than as described herein, to the best of our knowledge, we are not owned or controlled, directly or indirectly,
by another corporation, by any foreign government or by any natural person or legal persons, severally or jointly, and we are not
aware of any arrangement that may, at a subsequent date, result in a change of control of our company.
|
B.
|
Related Party Transactions.
|
The following is a
summary description of the material terms of those transactions with related parties to which we, or our subsidiaries, are party
and which were in effect since January 1, 2017.
Financing Agreement with GRD
We have provided financing
to GRD from time to time, pursuant to which the Company and GRD have executed several capital notes for an aggregate outstanding
principal amount of $45.1 million. The par value of such notes is in NIS, and they bear no interest nor repayment date; provided,
however, that no repayment shall be made before the fifth anniversary from the issuance date of each note.
Concurrent Private Placement
In a concurrent private
placement to our registered direct offering of August 2017, on August 3, 2017, Shirat HaChaim Ltd, an entity controlled by Chaim
Hurvitz, our Chairman of the Board, and William Marth entered into a Securities Purchase Agreement with us to purchase an aggregate
of 49,295 of our ordinary shares at $7.10 per share. The Securities Purchase Agreement contained representations, warranties and
other provisions customary for a transaction of its nature. See also “Item 6.B. Compensation”.
Agreements with Directors and Officers
Employment and
Consulting Agreements
. We have entered into written employment or consulting agreements with certain of our Office Holders.
These agreements provide for notice periods of varying duration for termination of the agreement by us or by the relevant Office
Holder, during which time the Office Holder will continue to receive base salary and benefits. We have also entered into customary
non-competition, confidentiality of information and ownership of inventions arrangements with these Office Holders. However, the
enforceability of the noncompetition provisions may be limited under applicable law.
Options
.
Since our inception we have granted options to purchase our ordinary shares to certain of our Office Holders. Such option
agreements may contain acceleration provisions upon certain merger, acquisition, or change of control transactions. See also
“Item 6.E. Share Ownership”. We describe our 2013 Plan under “Item 6. Directors, Senior Management and
Employees—B. Compensation—2013 Incentive Share Option Plan.” If the relationship between us and an Office
Holder is terminated except for “cause” (as defined in the 2013 Plan and/or the applicable option award
agreement), options that are vested will generally remain exercisable for 90 days after such termination; provided, however,
that prior to the date of such termination, our Remuneration Committee may authorize an extension of the terms of all or part
of the vested options beyond the date of such termination for a period not to exceed the period during which the options by
their terms would otherwise have been exercisable, and provided further that the vested options may lose their status as
incentive stock options and/or approved 102 option if such extension extends beyond the maximum extension authorized by the
Ordinance or the Code, as applicable. Dr. Maya Halpern has ceased to serve as a director and Chief Medical Officer of the
Company effective as of April 9, 2016, and officially retired from the Company on May 15, 2016. In our 2016 annual meeting,
the shareholders approved an acceleration of the vesting dates of 30,000 of Dr. Halpern's unvested options and an extension
of the exercise period of all 60,000 vested options owned by Dr. Maya Halpern until the lapse of five years from the date of
Dr. Halpern's retirement date. Mr. George Tonelli has ceased to serve as the Company's VP, Clinical Operations effective as
of April 30, 2017 (the "Termination Date"). On April 2017, our Board approved an extension of the exercise period
of all 31,249 vested options owned by Mr. George Tonelli until the lapse of a period of 12 months following the Termination
Date.
RSUs.
We
have granted RSUs to certain of our Office Holders. Such award agreements may contain acceleration provisions upon certain
merger, acquisition, or change of control transactions. See also “Item 6.E. Share Ownership”. We describe our
2013 Plan under “Item 6. Directors, Senior Management and Employees—B. Compensation—2013 Incentive Share
Option Plan.” If the relationship between us and an Office Holder is terminated, RSUs that are vested shall be settled
in accordance with the settlement schedule set forth in the applicable award agreement.
|
C.
|
Interests of Experts and Counsel.
|
Not applicable.
ITEM 8. Financial Information.
|
A.
|
Consolidated Financial Statements and Other Financial Information.
|
See “Item 18.
Financial Statements” for a list of all financial statements filed as part of this annual report.
Legal Matters
We are neither party
to any legal or arbitration proceedings, including those relating to bankruptcy, receivership or similar proceedings and those
involving any third-party, nor any governmental proceedings pending or known to be contemplated, which may have, or have had in
the recent past, significant effects on the Company’s financial position or profitability.
Dividend Policy
We have never declared
or paid any cash dividends on our ordinary shares and do not anticipate paying any cash dividends in the foreseeable future. Payment
of cash dividends, if any, in the future will be at the discretion of our Board and will depend on then-existing conditions, including
our financial condition, operating results, contractual restrictions, capital requirements, business prospects and other factors
our Board may deem relevant.
Payment of dividends
may also be subject to Israeli withholding taxes. See “Item 10. Additional Information—E. Taxation—Certain Israeli
Tax Considerations” for additional information.
No significant changes
with respect to our consolidated financial statements have occurred since December 31, 2017.
ITEM 9. The Offer and Listing.
|
A.4
|
Offer and Listing Details
|
Our ordinary shares have
been listed on the Nasdaq Capital Market under the symbol “GLMD” since March 13, 2014. Prior to that date, there was
no public trading market for our ordinary shares. Our initial public offering was priced at $13.50 per share. The following table
sets forth for the periods indicated the high and low sales prices per ordinary share as reported on the NASDAQ Capital Market:
Annual Information:
|
|
Low
|
|
|
High
|
|
2014 (since March 13, 2014)
|
|
$
|
4.58
|
|
|
$
|
18.73
|
|
2015
|
|
$
|
5.54
|
|
|
$
|
13.50
|
|
2016
|
|
$
|
2.78
|
|
|
$
|
7.91
|
|
2017
|
|
$
|
3.43
|
|
|
$
|
9.78
|
|
Quarterly Information
|
|
|
|
|
|
|
|
|
First Quarter 2016
|
|
$
|
3.50
|
|
|
$
|
7.91
|
|
Second Quarter 2016
|
|
$
|
3.88
|
|
|
$
|
7.72
|
|
Third Quarter 2016
|
|
$
|
3.53
|
|
|
$
|
5.77
|
|
Fourth Quarter 2016
|
|
$
|
2.78
|
|
|
$
|
4.74
|
|
First Quarter 2017
|
|
$
|
3.43
|
|
|
$
|
5.79
|
|
Second Quarter 2017
|
|
$
|
4.40
|
|
|
$
|
7.09
|
|
Third Quarter 2017
|
|
$
|
6.20
|
|
|
$
|
9.39
|
|
Fourth Quarter 2017
|
|
$
|
6.55
|
|
|
$
|
9.78
|
|
Monthly Information:
|
|
|
|
|
|
|
|
|
September 2017
|
|
$
|
7.52
|
|
|
$
|
9.39
|
|
October 2017
|
|
$
|
7.16
|
|
|
$
|
9.59
|
|
November 2017
|
|
$
|
6.55
|
|
|
$
|
8.42
|
|
December 2017
|
|
$
|
7.84
|
|
|
$
|
9.78
|
|
January 2018
|
|
$
|
9.01
|
|
|
$
|
12.22
|
|
February 2018
|
|
$
|
3.61
|
|
|
$
|
10.79
|
|
Not applicable.
|
C.
|
Market for Ordinary Shares
|
Our ordinary shares have been quoted on
the NASDAQ Capital Market since March 18, 2014 under the symbol “GLMD.”
Not applicable.
Not applicable.
Not applicable.
ITEM 10. Additional Information.
Not applicable.
|
B.
|
Memorandum and Articles of Association.
|
Our original articles
of association were registered with the Israeli Registrar of Companies at the time of incorporation of the Company on July 31,
2013, under our registration number 51-495351-2. At the 2014 annual general meeting of shareholders, our shareholders adopted our
Articles, which became effective on the consummation of our initial public offering in the United States in March 2014, whereby
the Company became a public company under the Companies Law. Under Section 2 of our Articles, the purpose of the Company is to
engage in any lawful activity.
The following description
of our share capital and provisions of our Articles are summaries and do not purport to be complete and are qualified in their
entirety by the complete text of the Articles, which are filed as exhibits to this annual report and incorporated by reference
herein, and by Israeli law.
Election of Directors
Our Board consists
of three classes of directors (not including external directors who do not form part of any class), with one class being elected
each year by shareholders at the Company’s annual general meeting for a term of approximately three years. In accordance
with our Articles, directors so elected cannot be removed from office by the shareholders until the expiration of their term of
office. Ordinary shares do not have cumulative voting rights. As a result, the holders of ordinary shares that represent a simple
majority of the voting power represented at a shareholders’ meeting and voting at the meeting have the power to elect all
of the directors put forward for election, subject to specific requirements under the Companies Law with respect to the election
of external directors. For further information as to these appointments, see “Item 6
—
Directors, Senior Management
and Employees—C. Board Practices.”
Under our Articles,
a director shall vacate his or her office if that director dies; is declared bankrupt; is declared to be legally incompetent; resigns
such office by notice in writing given to the Company; is not re-elected by the shareholders upon expiration of his or her term
at the relevant annual general meeting of shareholders;
or otherwise as provided in the Companies
Law.
Our Articles provide
that a director may, by written notice to the Company, appoint another person to serve as an alternate director provided that such
appointment is approved by a majority of the directors then in office, and that such appointing director may remove such alternate
director. Any alternate director shall be entitled to notice of meetings of the Board and of relevant committees and to attend
and vote accordingly, except that the alternate has no standing at any meeting at which the appointing director is present or at
which the appointing director is not entitled to participate as provided in the Companies Law. A person who is not qualified to
be appointed as a director, or a person who already serves as a director or an alternate director, may not be appointed as an alternate
director.
Unless the appointing
director limits the time or scope of the appointment, the appointment is effective for all purposes until the earlier of (i) the
appointing director ceasing to be a director; (ii) the appointing director terminating the appointment; or (iii) the occurrence,
with respect to the alternate, of any of the circumstances under which a director shall vacate his or her office. The appointment
of an alternate director does not in itself diminish the responsibility of the appointing director as a director. An alternate
director is solely responsible for his or her actions and omissions and is not deemed an agent of the appointing director. Under
the Companies Law, external directors cannot generally appoint alternate directors, and a person who is not qualified to be appointed
as an “independent” director may not be appointed as an alternate to an independent director. See “Item 6
—
Directors,
Senior Management and Employees—C. Board Practices.” At present, there are no effective appointments of alternate directors
for our Board.
Borrowing Powers
Our Board may from
time to time, and at its reasonable discretion, borrow or secure the payment of any sum or sums of money for reasonable Company
purposes. The directors may raise or secure the repayment of such sum or sums in such manner, at such times and upon such terms
and conditions in all respects as they see fit and, in particular, by issuing bonds, perpetual or redeemable debentures, debenture
stock or any mortgages, charges or other securities on the undertaking of the whole or any part of the property of the Company,
both present and future, including current uncalled capital and called but unpaid capital.
For discussions relating
to certain compensation-related requirements of the Companies Law, external directors and financial experts, committees of the
Board, and exculpation and indemnification of directors and officers, see “Item 6 - Directors, Senior Management and Employees”.
Fiduciary Duties of Directors
and Executive Officers
The Companies Law codifies
the fiduciary duties that Office Holders owe to a company. Each person listed in the table under “Item 6. Directors, Senior
Management and Employees—A. Directors and Senior Management” is an Office Holder under the Companies Law.
An Office Holder’s
fiduciary duties consist of a duty of care and a duty of loyalty. The duty of care requires an Office Holder to act with the level
of care with which a reasonable Office Holder in the same position would have acted under the same circumstances. The duty of loyalty
requires that an Office Holder act in good faith and in the best interests of a company. The duty of care includes a duty to use
reasonable means to obtain:
|
·
|
information on the advisability of a given action brought for his or her approval or performed
by virtue of his or her position; and
|
|
·
|
all other important information pertaining to these actions.
|
The duty of loyalty
requires an Office Holder to act in good faith and for the benefit of a company, and includes a duty to:
|
·
|
refrain from any conflict of interest between the performance of his or her duties to the company
and his or her other duties or personal affairs;
|
|
·
|
refrain from any activity that is competitive with the company;
|
|
·
|
refrain from exploiting any business opportunity of the company to receive a personal gain for
himself or herself or others; and
|
|
·
|
disclose to the company any information or documents relating to the company’s affairs which
the Office Holder received as a result of his or her position as an Office Holder.
|
Disclosure of Personal Interests
of an Office Holder
The Companies Law requires
that an Office Holder promptly disclose to the board of directors any personal interest that he or she may have concerning any
existing or proposed transaction with a company, as well as any substantial information or document with respect thereof. An interested
Office Holder’s disclosure must be made promptly and in any event no later than the first meeting of the board of directors
at which the transaction is considered.
Under the Companies
Law, a “personal interestˮ includes an interest of any person in an action or transaction of a company, including a
personal interest of one’s relative or of a corporate body in which such person or a relative of such person is a 5% or greater
shareholder, director or general manager or in which he or she has the right to appoint at least one director or the general manager,
but excluding a personal interest stemming from one’s ownership of shares in a company. A personal interest furthermore includes
the personal interest of a person for whom the Office Holder holds a voting proxy or the interest of the Office Holder with respect
to his or her vote on behalf of the shareholder for whom he or she holds a proxy, even if such shareholder itself has no personal
interest in the approval of the matter. An Office Holder is not, however, obliged to disclose a personal interest if it derives
solely from the personal interest of a relative of such Office Holder in a transaction that is not considered an extraordinary
transaction.
Under the Companies
Law, an extraordinary transaction is defined as any of the following:
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a transaction other than in the ordinary course of business;
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a transaction that is not on market terms; or
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a transaction that may have a material impact on a company’s profitability, assets or liabilities.
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Approval Procedure
If an Office Holder
has a personal interest in a transaction, approval by the board of directors is required for the transaction, unless the articles
of association of a company provide for a different method of approval. Our Articles do not provide for any such different method
of approval. Further, so long as an Office Holder has disclosed his or her personal interest in a transaction, the board of directors
may approve an action by the Office Holder that would otherwise be deemed a breach of the duty of loyalty. However, a company may
not approve a transaction or action that is adverse to such company’s interest or that is not performed by the Office Holder
in good faith. Approval first by a company’s audit committee and subsequently by the board of directors is required for an
extraordinary transaction in which an Office Holder has a personal interest. Arrangements regarding the Office Holders’ terms
of office and employment (which includes compensation, indemnification or insurance) generally require the approval of the remuneration
committee, board of directors and, in certain circumstances, the shareholders, in that order, and must generally be consistent
with the Company’s Compensation Policy, as described under see “Item 6
—
Directors, Senior Management and
Employees—B. Compensation.”
Generally, a person
who has a personal interest in a matter which is considered at a meeting of the board of directors or the audit committee may not
be present at such a meeting or vote on that matter unless a majority of the directors or members of the audit committee have a
personal interest in the matter, or unless the chairman of the audit committee or board of directors (as applicable) determines
that he or she should be present in order to present the transaction that is subject to approval. Generally, if a majority of the
members of the audit committee and the board of directors (as applicable) has a personal interest in the approval of a transaction,
then all directors may participate in discussions of the audit committee and/or the board of directors on such transaction and
the voting on approval thereof, but shareholder approval is also required for such transaction.
Transactions with Controlling
Shareholders
Pursuant to Israeli
law, the disclosure requirements regarding personal interests that apply to directors and executive officers also apply to a controlling
shareholder of a public company. In the context of a transaction involving a controlling shareholder or an officer who is a controlling
shareholder of a company, a controlling shareholder also includes any shareholder who holds 25% or more of the voting rights if
no other shareholder holds more than 50% of the voting rights. Two or more shareholders with a personal interest in the approval
of the same transaction are deemed to be a single shareholder and may be deemed a controlling shareholder for the purpose of approving
such transaction.
Extraordinary Transactions,
including private placement transactions, with a controlling shareholder or in which a controlling shareholder has a personal interest,
and engagements with a controlling shareholder or his or her relative, directly or indirectly, including through a corporation
under his or her control, regarding the company’s receipt of services from the controlling shareholder, and if such controlling
shareholder is also an office holder or an employee of the company, regarding his or her terms of service or employment, require
the approval of the audit committee or remuneration committee, the board of directors and the shareholders of a company by a Special
Majority, in that order.
Arrangements regarding
the terms of office and employment of a controlling shareholder who is an Office Holder, and the terms of employment of a controlling
shareholder who is an employee of a company, require the approval of the remuneration committee, board of directors and the shareholders
by a Special Majority, in that order, as further described above under “Item 6
—
Directors, Senior Management
and Employees—B. Compensation” with respect to Office Holders’ compensation.
To the extent that
any such transaction with a controlling shareholder is for a period extending beyond three years, approval is required once every
three years, unless, with respect to extraordinary transactions with a controlling shareholder or in which a controlling shareholder
has a personal interest, the audit committee determines that the duration of the transaction is reasonable given the circumstances
related thereto.
Dividends and Dividend Policy
Dividends may be distributed
only out of profits available for dividends as determined by the Companies Law, provided that there is no reasonable concern that
the distribution will prevent the Company from being able to meet its existing and anticipated obligations when they become due.
Under the Companies Law, the distribution amount is further limited to the greater of retained earnings or earnings generated over
the two most recent years legally available for distribution. In the event that we do not have retained earnings or earnings generated
over the two most recent years legally available for distribution, we may seek the approval of the court in order to distribute
a dividend. The court may approve our request if it is convinced that there is no reasonable concern that the payment of a dividend
will prevent us from satisfying our existing and foreseeable obligations as they become due.
Generally, under the
Companies Law, the decision to distribute dividends and the amount to be distributed is made by a company’s board of directors.
The Articles provide that the Board may from time to time declare, and cause the Company to pay, such dividends as may appear to
it to be justified by the profits of the Company and that the Board has the authority to determine the time for payment of such
dividends and the record date for determining the shareholders entitled to receive such dividends, provided the date is not before
the date of the resolution to distribute the dividend. Declaration of dividends does not require shareholder approval.
Pursuant to Section
4(b) of the Company’s Articles, subject to the rights of holders of shares with limited or preferred rights, ordinary shares
shall confer upon the holders thereof equal rights to receive dividends and to participate in the distribution of the assets of
the Company upon its winding-up, in proportion to the amount paid up or credited as paid up on account of the nominal value of
the shares held by them respectively and in respect of which such dividends are being paid or such distribution is being made,
without regard to any premium paid in excess of the nominal value, if any.
We have never declared
or paid any cash dividends on our ordinary shares and do not anticipate paying any cash dividends in the foreseeable future. Payment
of cash dividends, if any, in the future will be at the discretion of our Board and will depend on then-existing conditions, including
our financial condition, operating results, contractual restrictions, capital requirements, business prospects and other factors
our Board may deem relevant.
Payment of dividends
may also be subject to Israeli withholding taxes. See “Taxation — Israeli Tax Considerations” for additional
information.
Transfer of Shares
Ordinary shares which
have been fully paid-up are transferable by submission of a proper instrument of transfer to the Company or its transfer agent
together with the certificate of the shares to be transferred and such other evidence, if any, as the directors may require to
prove the rights of the intending transferor in the transferred shares.
Our ordinary shares
that are fully paid for are issued in registered form and may be freely transferred under our Articles, unless the transfer is
restricted or prohibited by applicable law or the rules of a stock exchange on which the shares are traded. The ownership or voting
of our ordinary shares by non-residents of Israel is not restricted in any way by our Articles or the laws of the State of Israel,
except for ownership by nationals of some countries that are, or have been, declared as enemies of Israel.
Shareholder Meetings
Our Articles provide
that an annual general meeting must be held at least once in every calendar year, not later than 15 months after the last preceding
annual general meeting, at such time and place as may be determined by the Board. The Board may, in its discretion, convene additional
shareholder meetings and, pursuant to the Companies Law, must convene a meeting upon the demand of two directors or one quarter
of the directors then in office or upon the demand of the holder or holders of 5% of the Company’s issued share capital and
1% of its voting rights or upon the demand of the holder or holders of 5% of its voting rights. All demands for shareholder meetings
must set forth the items to be considered at that meeting. Pursuant to the Companies Law, the holder or holders of 1% of the Company’s
voting rights may request the inclusion of an item on the agenda of a future shareholder meeting, provided the item is appropriate
for discussion at a shareholder meeting.
The agenda for a shareholder
meeting is determined by the Board and must include matters in respect of which the convening of a shareholder meeting was demanded
and any matter requested to be included by holder(s) of 1% of the Company’s voting rights. According to regulations promulgated
pursuant to the Companies Law and governing the terms of notice and publication of shareholder meetings of public companies, or
the General Meeting Regulations, holder(s) of one percent or more of the Company’s voting rights may propose any matter appropriate
for deliberation at a shareholder meeting to be included on the agenda of a shareholder meeting, generally by submitting a proposal
within seven days of publicizing the convening of a shareholder meeting, or, if the Company publishes a preliminary notice at least
21 days prior to publicizing the convening of a meeting (stating its intention to convene such meeting and the agenda thereof),
within 14 days of such preliminary notice. Any such proposal must further comply with the information requirements under applicable
law and the Articles.
Pursuant to the Companies
Law and regulations promulgated thereunder with respect to the convening of general meetings in a public company, shareholder meetings
generally require prior notice of not less than 21 days, and for certain matters specified in the Companies Law, not less than
35 days. The function of the annual general meeting is to elect directors in accordance with the Articles, receive and consider
the profit and loss account, the balance sheet and the ordinary reports and accounts of the directors and auditors, appoint auditors
and fix their remuneration and transact any other business which under the Articles or applicable law may be transacted by the
shareholders of a company in general meeting.
Our Articles determine
that the quorum required for either an annual (regular) or an extraordinary (special) general meeting of shareholders consists
of at least two shareholders present in person or by proxy holding shares comprising in the aggregate more than 33.33% of the voting
rights of the Company. If a meeting is convened by the Board upon the demand of shareholders or upon the demand of less than 50%
of the directors then in office or directly by such shareholders or directors and no quorum is present within half an hour from
the time appointed, it shall be cancelled. If a meeting is otherwise called and no quorum is present within such time, the meeting
is adjourned to the same day one week later at the same time and place or at such other time and place as the Board may determine
and specify in the notice of the general meeting and it shall not be necessary to give notice of such adjournment. If a quorum
is not present within half an hour from the time stated for such adjourned meeting, any two shareholders present in person or by
proxy at such meeting shall constitute a quorum even if, between them, they represent shares conferring 33.33% or less of the voting
rights of the Company.
Generally, under the
Companies Law and the Articles, shareholder resolutions are deemed adopted if approved by the holders of a simple majority of the
voting rights represented at a meeting and voting unless a different majority is required by law or pursuant to the Articles. The
Companies Law provides that resolutions on certain matters, such as amending a company’s articles of association, assuming
the authority of the board of directors in certain circumstances, appointing auditors, appointing external directors, approving
certain transactions, increasing or decreasing the registered share capital and approving most mergers must be made by the shareholders
at a general meeting. A company may determine in its articles of association certain additional matters in respect of which resolutions
by the shareholders in a general meeting will be required.
Access to Corporate Records
Under the Companies
Law, all shareholders generally have the right to review minutes of our general meetings, our shareholder register and register
of significant shareholders (as defined in the Companies Law), our articles of association, our financial statements, other documents
as provided in the Companies Law, and any document we are required by law to file publicly with the Israeli Companies Registrar.
Any shareholder who specifies the purpose of its request may request to review any document in our possession that relates to:
(i) any action or transaction with a related party which requires shareholder approval under the Companies Law; or (ii) the approval,
by the board of directors, of an action in which an office holder has a personal interest. We may deny a request to review a document
if we determine that the request was not made in good faith, or if such denial is necessary to protect our interest or protect
a trade secret or patent.
Shareholder Duties
Pursuant to the Companies
Law, a shareholder has a duty to act in good faith and in a customary manner toward a company and other shareholders and to refrain
from abusing his or her power in the company, including, among other things, in voting at the general meeting of shareholders and
at class shareholder meetings with respect to the following matters:
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an amendment to the company’s articles of association;
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an increase of the company’s authorized share capital;
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approval of interested party transactions and acts of Office Holders that require shareholder approval.
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In addition, a shareholder
also has a general duty to refrain from discriminating against other shareholders.
Certain shareholders
have a further duty of fairness toward a company. These shareholders include any controlling shareholder, any shareholder who knows
that it has the power to determine the outcome of a shareholder vote or a shareholder class vote and any shareholder who has the
power to appoint or to prevent the appointment of an Office Holder of the company or other power towards the company. The Companies
Law does not define the substance of this duty of fairness, except to state that the remedies generally available upon a breach
of contract will also apply in the event of a breach of the duty to act with fairness, taking the shareholder’s position
in the company into account.
Mergers and Acquisitions under Israeli
Law
(i) Merger
The Companies Law permits
merger transactions if approved by each party’s board of directors, and, unless certain requirements described under the
Companies Law are met, a majority of each party’s shareholders, by a majority of each party’s shares that are voted
on the proposed merger at a shareholders’ meeting.
The board of directors
of a merging company is required pursuant to the Companies Law to discuss and determine whether in its opinion there exists a reasonable
concern that as a result of a proposed merger, the surviving company will not be able to satisfy its obligations towards its creditors,
taking into account the financial condition of the merging companies. If the board of directors has determined that such a concern
exists, it may not approve a proposed merger. Following the approval of the board of directors of each of the merging companies,
the boards of directors must jointly prepare a merger proposal for submission to the Israeli Registrar of Companies.
For purposes of the
shareholder vote, unless a court rules otherwise, the merger will not be deemed approved if a majority of the shares voting at
the shareholders meeting (excluding abstentions) that are held by parties other than the other party to the merger, any person
who holds 25% or more of the means of control of the other party to the merger or any one on their behalf including their relatives
or corporations controlled by any of them, vote against the merger. In addition, if the non-surviving entity of the merger has
more than one class of shares, the merger must be approved by each class of shareholders.
If the transaction
would have been approved but for the separate approval of each class of shares or the exclusion of the votes of certain shareholders
as provided above, a court may still rule that the company has approved the merger upon the request of holders of at least 25%
of the voting rights of a company, if the court holds that the merger is fair and reasonable, taking into account the appraisal
of the merging companies’ value and the consideration offered to the shareholders.
Under the Companies
Law, each merging company must send a copy of the proposed merger plan to its secured creditors. Unsecured creditors are entitled
to receive notice of the merger, as provided by the regulations promulgated under the Companies Law. Upon the request of a creditor
of either party to the proposed merger, the court may delay or prevent the merger if it concludes that there exists a reasonable
concern that, as a result of the merger, the surviving company will be unable to satisfy the obligations of the target company.
The court may also give instructions in order to secure the rights of creditors.
In addition, a merger
may not be completed unless at least 50 days have passed from the date that a proposal for approval of the merger was filed with
the Israeli Registrar of Companies and 30 days from the date that shareholder approval of both merging companies was obtained.
(ii) Special Tender Offer
The Companies Law provides
that an acquisition of shares of an Israeli public company must be made by means of a special tender offer if as a result of the
acquisition the purchaser would become a holder of 25% or more of the voting rights in the company. This rule does not apply if
there is already another holder of 25% or more of the voting rights in the company. Similarly, the Companies Law provides that
an acquisition of shares in a public company must be made by means of a special tender offer if as a result of the acquisition
the purchaser would become a holder of more than 45% of the voting rights in the company, if there is no other shareholder of the
company who holds more than 45% of the voting rights in the company.
These requirements
do not apply if the acquisition (i) occurs in the context of a private offering, on the condition that the shareholders’
meeting approved the acquisition as a private offering whose purpose is to give the acquirer at least 25% of the voting rights
in the company if there is no person who holds at least 25% of the voting rights in the company, or as a private offering whose
purpose is to give the acquirer 45% of the voting rights in the company, if there is no person who holds 45% of the voting rights
in the company; (ii) was from a shareholder holding at least 25% of the voting rights in the company and resulted in the acquirer
becoming a holder of at least 25% of the voting rights in the company; or (iii) was from a holder of more than 45% of the voting
rights in the company and resulted in the acquirer becoming a holder of more than 45% of the voting rights in the company.
The special tender
offer may be consummated only if (i) at least 5% of the voting power attached to the company’s outstanding shares will be
acquired by the offeror and (ii) the special tender offer is accepted by a majority of the votes of those offerees who gave notice
of their position in respect of the offer; in counting the votes of offerees, the votes of a holder of control in the offeror,
a person who has personal interest in acceptance of the special tender offer, a holder of at least 25% of the voting rights in
the company, or any person acting on their or on the offeror’s behalf, including their relatives or companies under their
control, are not taken into account.
In the event that a
special tender offer is made, a company’s board of directors is required to express its opinion on the advisability of the
offer or shall abstain from expressing any opinion if it is unable to do so, provided that it gives the reasons for its abstention.
In addition, the board of directors must disclose any personal interest each of member of the board of directors have in the offer
or stems therefrom.
An office holder in
a target company who, in his or her capacity as an office holder, performs an action the purpose of which is to cause the failure
of an existing or foreseeable special tender offer or is to impair the chances of its acceptance, is liable to the potential purchaser
and shareholders for damages resulting from his acts, unless such office holder acted in good faith and had reasonable grounds
to believe he or she was acting for the benefit of the company. However, office holders of the target company may negotiate with
the potential purchaser in order to improve the terms of the special tender offer, and may further negotiate with third parties
in order to obtain a competing offer.
If a special tender
offer was accepted by a majority of the shareholders who announced their stand on such offer, then shareholders who did not respond
to the special offer or had objected to the special tender offer may accept the offer within four days of the last day set for
the acceptance of the offer. In the event that a special tender offer is accepted, then the purchaser or any person or entity controlling
it and any corporation controlled by them shall refrain from making a subsequent tender offer for the purchase of shares of the
target company and may not execute a merger with the target company for a period of one year from the date of the offer, unless
the purchaser or such person or entity undertook to effect such an offer or merger in the initial special tender offer.
(iii) Full Tender Offer
Under the Companies
Law, a person may not acquire shares in a public company if, after the acquisition, he will hold more than 90% of the shares or
more than 90% of any class of shares of that company, unless a tender offer is made to purchase all of the shares or all of the
shares of the particular class. The Companies Law also provides, subject to certain exceptions, that as long as a shareholder in
a public company holds more than 90% of the company’s shares or of a class of shares, that shareholder shall be precluded
from purchasing any additional shares unless tendering an offer to purchase all of the outstanding shares of the company or the
applicable class of the shares. If the shareholders who do not respond to or accept the offer hold less than 5% of the issued and
outstanding share capital of the company or of the applicable class of the shares, and more than half of the shareholders who do
not have a personal interest in the offer accept the offer, all of the shares that the acquirer offered to purchase will be transferred
to the acquirer by operation of law. However, a tender offer will be accepted if the shareholders who do not accept it hold less
than 2% of the issued and outstanding share capital of the company or of the applicable class of the shares.
Upon a successful completion
of such a full tender offer, any shareholder that was an offeree in such tender offer, whether such shareholder accepted the tender
offer or not, has the right, within six months from the date of acceptance of the tender offer, to petition the court to determine
that the tender offer was for less than fair value and that the fair value should be paid as determined by the court. However,
under certain conditions, the purchaser may provide in its offer that an offeree who accepted the tender offer will not be entitled
to such rights.
If the conditions set
forth above are not met, the purchaser may not acquire additional shares of the company from shareholders who accepted the tender
offer to the extent that following such acquisition, the purchaser would own more than 90% of the company’s issued and outstanding
share capital.
Anti-Takeover Measures under Israeli
Law
The Companies Law allows
us to create and issue shares having rights different from those attached to our ordinary shares, including shares providing certain
preferred rights, distributions or other matters and shares having preemptive rights. As of the date hereof, no preferred shares
are authorized under our Articles. In the future, if we do authorize, create and issue a specific class of preferred shares, such
class of shares, depending on the specific rights that may be attached to it, may have the ability to frustrate or prevent a takeover
or otherwise prevent our shareholders from realizing a potential premium over the market value of their ordinary shares. The authorization
and designation of a class of preferred shares will require an amendment to our Articles, which requires the affirmative vote of
at least 75% of the voting rights of the Company represented personally or by proxy and voting thereon at a general meeting at
which a quorum is present. The convening of the general meeting, the shareholders entitled to participate and the majority vote
required to be obtained at such a meeting will be subject to the requirements set forth in the Articles and the Companies Law as
described above in “— Shareholder Meetings.”
In addition, certain
provisions of the Articles may have the effect of rendering more difficult or discouraging an acquisition of the Company deemed
undesirable by the Board. The classification of the Board into three classes with terms of approximately three years each, and
the requirement under Companies Law to have at least two external directors, who cannot readily be removed from office, may make
it more difficult for shareholders who oppose the policies of the Board to remove a majority of the then current directors from
office quickly. It may also, in some circumstances, together with the other provisions of the Articles and Israeli law, deter or
delay potential future merger, acquisition, tender or takeover offers, proxy contests or changes in control or management of the
Company.
Changes in Capital
The registered share
capital of the Company is NIS 500,000 divided into 50,000,000 ordinary shares, NIS 0.01 par value per share.
Our Articles enable
us to increase or reduce our share capital. Any such changes are subject to the provisions of the Companies Law and must be approved
by a resolution duly passed by our shareholders at a general meeting by voting on such change in the capital. In addition, transactions
that have the effect of reducing capital, such as the declaration and payment of dividends in the absence of sufficient retained
earnings or profits and an issuance of shares for less than their nominal value (under certain circumstances), require the approval
of both our Board and an Israeli court.
Changes in Shareholder
Rights
Pursuant to Section
6(a) of the Company’s Articles, if at any time the share capital is divided into different classes of shares, the Company
may by shareholder resolution, unless otherwise provided by the terms of issue of the shares of that class, modify, convert, broaden,
add or otherwise alter the rights, privileges, advantages, restrictions and provisions related or unrelated at that time to the
shares of any class with the sanction of a resolution passed by a simple majority of those present, personally or by proxy, and
voting thereon at a separate general meeting of the holders of the shares of that class. Such majority approval is consistent with
Israeli law.
For a description of
our material agreements relating to our strategic collaborations and research arrangements and other material agreements, please
refer to “Item 4.B. Information on the Company—Business Overview—Strategic Collaborations, Research Arrangements
and other Material Agreements.”
Employment Agreements
See “Item 6.
Directors, Senior Management and Employees—B. Compensation”.
There are no Israeli
government laws, decrees, regulations or other legislation that restrict or that affect our export or import of capital, including
the availability of cash and cash equivalents for use by us and our wholly owned subsidiaries, or the remittance of dividends,
interest or other payments to non-resident holders of our securities, except for ownership by nationals of certain countries that
are, or have been, declared as enemies of Israel or otherwise as set forth under “Item 10. Additional Information—E.
Taxation.”
The following description
is not intended to constitute a complete analysis of all tax consequences relating to the ownership or disposition of our ordinary
shares. You should consult your own tax advisor concerning the tax consequences of your particular situation, as well as any tax
consequences that may arise under the laws of any state, local, foreign, including Israel, or other taxing jurisdiction.
Certain Israeli Tax Considerations
The following is a
brief summary of the material Israeli income tax laws applicable to us. This section also contains a discussion of material Israeli
tax consequences concerning the ownership and disposition of our ordinary shares. This summary does not discuss all the aspects
of Israeli tax law that may be relevant to a particular investor in light of his or her personal investment circumstances or to
some types of investors subject to special treatment under Israeli law. Examples of this kind of investor include residents of
Israel or investors in securities who are subject to special tax regimes not covered in this discussion. To the extent that the
discussion is based on new tax legislation that has not yet been subject to judicial or administrative interpretation, we cannot
assure you that the appropriate tax authorities or the courts will accept the views expressed in this discussion. This summary
is based on laws and regulations in effect as of the date hereof and does not take into account possible future amendments which
may be under consideration.
General Corporate Tax Structure in
Israel
Israeli resident companies
(as defined below), such as the Company, are generally subject to corporate tax at the rate of 24% on their taxable income, as
of January 1, 2017 (25% in 2016), and 23% in 2018 and thereafter. However, the effective tax rate payable by a company that derives
income from a Preferred Enterprise or a Technology Enterprise, as discussed below, may be considerably less.
Capital gains derived
by an Israeli resident company are generally subject to tax at the same rate as the corporate tax rate. Under Israeli tax legislation,
a corporation will be considered an “Israeli resident” if it meets one of the following: (i) it was incorporated in
Israel; or (ii) the control and management of its business are exercised in Israel.
Law for the Encouragement of Industry
(Taxes), 5729-1969
The Law for the Encouragement
of Industry (Taxes), 5729-1969, which we refer to as the Industry Encouragement Law, provides several tax benefits for “Industrial
Companies,” which are defined as Israeli resident-companies which were incorporated in Israel, of which 90% or more of their
income in any tax year, other than income from certain government loans, is derived from an “Industrial Enterprise”
that it owns and located in Israel. An “Industrial Enterprise” is defined as an enterprise whose principal activity
in a given tax year is industrial production. Eligibility for benefits under the Industry Encouragement Law is not contingent upon
approval of any governmental authority.
The following tax benefits,
among others, are available to Industrial Companies:
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amortization over an eight year period of the cost of purchasing a patent, rights to use a patent and rights to know-how, which are used for the development or advancement of the company, commencing in the year in which such rights were first exercised;
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under limited conditions, an election to file consolidated tax returns with related Industrial Companies controlled by it; and
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deductions of expenses related to a public offering in equal amounts over a three year period commencing on the year of the offering.
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We believe that we
qualify as an “Industrial Company” within the meaning of the Industry Encouragement Law. There can be no assurance
that we will continue to qualify as an Industrial Company in the future or that the benefits described above will be available
to us at all.
Law for the Encouragement of Capital
Investments, 5719-1959
The Law for the Encouragement
of Capital Investments, 5719-1959, which we refer to as the Investment Law, provides certain incentives for capital investments
in production facilities (or other eligible assets). The Investment Law was significantly amended effective April 1, 2005, further
amended as of January 1, 2011 (the “2011 Amendmentˮ) and as of January 1, 2017 (the “2017 Amendment”). The
2011 Amendment introduced new benefits to replace those granted in accordance with the provisions of the Investment Law in effect
prior to the 2011 Amendment. The 2017 Amendment introduces new benefits for Technological Enterprises, alongside the existing tax
benefits.
Tax Benefits Under the 2011 Amendment
The 2011 Amendment
canceled the availability of the benefits granted to Industrial Companies under the Investment Law prior to 2011 and, instead,
introduced new benefits for income generated by a “Preferred Company” through its “Preferred Enterprise”
(as such terms are defined in the Investment Law) as of January 1, 2011.
The definition of a
Preferred Company includes a company incorporated in Israel that is not fully owned by a governmental entity, and that has, among
other things, a Preferred Enterprise and is controlled and managed from Israel. Under a recent amendment announced in August 2013
(the “2013 Amendment”), beginning in 2014 and in each year thereafter until 2016, a Preferred Company may only be entitled
to reduced corporate tax rates of 16%, unless the Preferred Enterprise is located in a specified development zone, in which case
the rate will be 9%. Pursuant to the 2017 Amendment, in 2017 and thereafter, the corporate tax rate for Preferred Enterprise which
is located in a specified development zone was reduced to 7.5%, while the reduced corporate tax rate for other development zones
remains 16%. Income derived by a Preferred Company from a “Special Preferred Enterprise” (as such term is defined in
the Investment Law) would be entitled, during a benefit period of ten years, to further reduced tax rates of 8%, or 5% if the Special
Preferred Enterprise is located in a certain development zone. As of January 1, 2017, the definition for ‘Special Preferred
Enterprise’ includes less stringent conditions.
As of January 1, 2014,
dividends paid out of income attributed to a Preferred Enterprise or to a Special Preferred Enterprise are subject to withholding
tax at source at the rate of 20% unless a lower tax rate is provided under an applicable tax treaty (subject to the receipt in
advance of a valid certificate from the Israel Tax Authority allowing for a reduced tax rate). However, if such dividends are paid
to an Israeli company, no tax is required to be withheld (although, if such dividends are subsequently distributed to individuals
or a non-Israeli company, withholding tax at a rate of 20% or such lower rate as may be provided in an applicable tax treaty will
apply). In 2017-2019 dividends paid out of preferred income attributed to a Special Preferred Enterprise, directly to a foreign
parent company, are subject to withholding tax at source at the rate of 5% (temporary provisions).
New Tax benefits under the 2017 Amendment
The 2017 Amendment
was enacted as part of the Economic Efficiency Law that was published on December 29, 2016, and is effective as of January 1, 2017.
The 2017 Amendment provides new tax benefits for two types of “Technology Enterprises”, as described below, and is
in addition to the other existing tax beneficial programs under the Investment Law.
The 2017 Amendment
provides that a technology company satisfying certain conditions will qualify as a “Preferred Technology Enterprise”
and will thereby enjoy a reduced corporate tax rate of 12% on income that qualifies as “Preferred Technology Income”,
as defined in the Investment Law. The tax rate is further reduced to 7.5% for a Preferred Technology Enterprise located in development
zone A. In addition, a Preferred Technology Company will enjoy a reduced corporate tax rate of 12% on capital gain derived from
the sale of certain “Benefitted Intangible Assets” (as defined in the Investment Law) to a related foreign company
if the Benefitted Intangible Assets were acquired from a foreign company on or after January 1, 2017 for at least NIS 200 million,
and the sale receives prior approval from the National Authority for Technological Innovation (referred to as NATI).
The 2017 Amendment
further provides that a technology company satisfying certain conditions will qualify as a “Special Preferred Technology
Enterprise” and will thereby enjoy a reduced corporate tax rate of 6% on “Preferred Technology Income” regardless
of the company’s geographic location within Israel. In addition, a Special Preferred Technology Enterprise will enjoy a reduced
corporate tax rate of 6% on capital gain derived from the sale of certain “Benefitted Intangible Assets” to a related
foreign company if the Benefitted Intangible Assets were either developed by an Israeli company or acquired from a foreign company
on or after January 1, 2017, and the sale received prior approval from NATI. A Special Preferred Technology Enterprise that acquires
Benefitted Intangible Assets from a foreign company for more than NIS 500 million will be eligible for these benefits for at least
ten years, subject to certain approvals as specified in the Investment Law.
Dividends distributed
by a Preferred Technology Enterprise or a Special Preferred Technology Enterprise, paid out of Preferred Technology Income, are
subject to withholding tax at source at the rate of 20%, or such lower rate as may be provided in an applicable tax treaty (subject
to the receipt in advance of a valid certificate from the Israel Tax Authority allowing for a reduced tax rate). However, if such
dividends are paid to an Israeli company, no tax is required to be withheld. If such dividends are distributed to a foreign company
and other conditions are met, the withholding tax rate will be 4%.
After examining the
impact of the 2017 Amendment, we submitted a request to receive a tax ruling from the Israel Tax Authority to be recognized as
a Preferred Technology Enterprise and recently we received a tax ruling from the Israel Tax Authority granting GRD a Preferred
Technology Enterprise status, subject to terms and conditions determined in the tax ruling.
Taxation of Our Israeli Individual
Shareholders on Receipt of Dividends
Israeli residents who
are individuals are generally subject to Israeli income tax for dividends paid on our ordinary shares (other than bonus shares
or share dividends) at a rate of 25%, or 30% if the recipient of such dividend is a Substantial Shareholder (as defined below)
at the time of distribution or at any time during the preceding 12 month period.
A “Substantial
Shareholder” is generally a person who alone, or together with his or her relative or another person who collaborates with
him or her on a regular basis, holds, directly or indirectly, at least 10% of any of the “means of control” of a corporation.
“Means of control” generally include the right to vote, receive profits, nominate a director or an officer, receive
assets upon liquidation or instruct someone who holds any of the aforesaid rights regarding the manner in which he or she is to
exercise such right(s), all regardless of the source of such right.
With respect to individuals,
the term “Israeli resident” is generally defined under Israeli tax legislation as a person whose center of life is
in Israel. The Israeli Tax Ordinance (as amended by Amendment Law No. 132 of 2002), states that in order to determine the center
of life of an individual, consideration will be given to the individual’s family, economic and social connections, including:
(i) place of permanent residence; (ii) place of residential dwelling of the individual and the individual’s immediate family;
(iii) place of the individual’s regular or permanent occupation or the place of his or her permanent employment; (iv) place
of the individual’s active and substantial economic interests; (v) place of the individual’s activities in organizations,
associations and other institutions. The center of life of an individual will be presumed to be in Israel if: (i) the individual
was present in Israel for 183 days or more in the tax year; or (ii) the individual was present in Israel for 30 days or more in
the tax year, and the total period of the individual’s presence in Israel in that tax year and the two previous tax years
is 425 days or more. Such presumption may be rebutted either by the individual or by the assessing officer.
Payers of dividends
on our ordinary shares, including the Israeli stockbroker effectuating the transaction, or the financial institution through which
the securities are held, are generally required, subject to any of the foregoing exemptions, reduced tax rates and the demonstration
of a shareholder regarding his, her or its foreign residency, to withhold tax upon the distribution of dividend at the rate of
25%, (whether the recipient is a Substantial Shareholder or not) so long as the shares are registered with a nominee company.
Taxation of Israeli Resident Corporations
on Payment of Dividends
Israeli resident corporations
are generally exempt from Israeli corporate income tax with respect to dividends paid on ordinary shares of Israeli resident corporations
as long as the profits out of which the dividends were paid were derived in Israel.
Capital Gains Taxes Applicable to
Israeli Resident Shareholders
The income tax rate
applicable to real capital gains derived by an Israeli individual resident from the sale of shares that were purchased after January
1, 2012, whether listed on a stock exchange or not, is 25%. However, if such shareholder is considered a Substantial Shareholder
at the time of sale or at any time during the preceding 12 month period and/or claims a deduction for interest and linkage differences
expenses in connection with the purchase and holding of such shares, such gain will be taxed at the rate of 30%.
Moreover, capital gains
derived by an individual shareholder who is a dealer or trader in securities, or to whom such income is otherwise taxable as ordinary
business income, are taxed in Israel at their marginal rates applicable to business income (up to 50% in 2017 and 2018, including
Excess Tax as detailed below).
At the sale of securities
traded on a stock exchange, a detailed return, including a computation of the tax due, must be filed and an advanced payment must
be paid on January 31 and July 31 of every tax year in respect of sales of securities made within the previous six months. However,
if all tax due was withheld at source according to applicable provisions of the Israeli Tax Ordinance and regulations promulgated
thereunder the aforementioned return is not required to be filed and no advance payment must be paid. Capital gain is also reportable
on the annual income tax return.
Taxation of Non-Israeli Shareholders
on Receipt of Dividends
Non-Israeli residents
are generally subject to Israeli income tax on the receipt of dividends paid on our ordinary shares at the rate of 25% (or 30%
for individuals, if such person is a Substantial Shareholder at the time he or she receives the dividend or on any date in the
12 months preceding such date), or 20% if the dividend is distributed from income attributed to Preferred Enterprise unless a lower
rate is provided under an applicable tax treaty between Israel and the shareholder’s country of residence and provided that
a certificate from the Israel Tax Authority allowing for a reduced withholding tax rate is obtained in advance.
A non-Israeli resident
who has dividend income derived from or accrued in Israel, from which the full amount of tax was withheld at source, is generally
exempt from the duty to file tax returns in Israel in respect of such income; provided that (i) such income was not derived from
a business conducted in Israel by the taxpayer and (ii) the taxpayer has no other taxable sources of income in Israel with respect
to which a tax return is required to be filed.
For example, under
the Convention Between the Government of the United States of America and the Government of Israel with Respect to Taxes on Income,
as amended, or the U.S.-Israel Tax Treaty, Israeli withholding tax on dividends paid to a U.S. resident for treaty purposes may
not, in general, exceed 25%, subject to certain conditions. Where the recipient is a U.S. corporation owning 10% or more of the
voting shares of the paying corporation during the part of the paying corporation’s taxable year which precedes the date
of payment of the dividend and during the entirety of its prior taxable year (if any), the Israeli tax withheld may not exceed
12.5%, subject to certain conditions.
Payers of dividends
on our ordinary shares, including the Israeli stockbroker effectuating the transaction, or the financial institution through which
the securities are held, are generally required, subject to any of the foregoing exemptions, reduced tax rates and the demonstration
of a shareholder regarding his, her or its foreign residency, to withhold tax upon the distribution of dividend at the rate of
25% (whether the recipient is a Substantial Shareholder or not), so long as the shares are registered with a nominee company.
Capital Gains Income Taxes Applicable
to Non-Israeli Shareholders
Non-Israeli resident
shareholders are generally exempt from Israeli capital gains tax on any gains derived from the sale, exchange or disposition of
our ordinary shares, provided that such shareholders did not acquire their shares prior to January 1, 2009 or acquired their shares
after the Company was listed for trading on NASDAQ and such gains were not derived from a permanent business or business activity
of such shareholders in Israel. These provisions dealing with capital gain are not applicable to a person whose gains from selling
or otherwise disposing of the shares are deemed to be business income. However, non-Israeli corporations will not be entitled to
the foregoing exemptions if an Israeli resident (i) has a controlling interest of more than 25% in such non-Israeli corporation
or (ii) is the beneficiary of or is entitled to 25% or more of the revenues or profits of such non-Israeli corporation, whether
directly or indirectly.
In addition, a sale
of securities by a non-Israeli resident may be exempt from Israeli capital gains tax under the provisions of an applicable tax
treaty. For example, under the U.S.-Israel Tax Treaty, the sale, exchange or disposition of our ordinary shares by a shareholder
who is a U.S. resident (for purposes of the U.S.-Israel Tax Treaty) holding the ordinary shares as a capital asset and is entitled
to claim the benefits afforded to such a resident by the U.S.-Israel Tax Treaty, or a Treaty U.S. Resident, is generally exempt
from Israeli capital gains tax unless: (i) such Treaty U.S. Resident is an individual and was present in Israel for 183 days or
more in the aggregate during the relevant taxable year; (ii) such Treaty U.S. Resident holds, directly or indirectly, shares representing
10% or more of our voting power of the Company during any part of the 12 month period preceding such sale, exchange or disposition,
subject to certain conditions; (iii) the capital gains arising from such sale, exchange or disposition are attributable to a permanent
establishment of the Treaty U.S. Resident maintained in Israel, subject to certain conditions; (iv) the capital gains arising from
such sale, exchange or disposition is attributed to real estate located in Israel; or (v) the capital gains arising from such sale,
exchange or disposition is attributed to royalties. In any such case, the sale, exchange or disposition of our ordinary shares
would be subject to Israeli tax, to the extent applicable. However, under the U.S.-Israel Tax Treaty, such Treaty U.S. Resident
would be permitted to claim a credit for such taxes against U.S. federal income tax imposed on any gain from such sale, exchange
or disposition, under the circumstances and subject to the limitations specified in the U.S.-Israel Income Tax Treaty.
Regardless of whether
shareholders may be liable for Israeli income tax on the sale of our ordinary shares, the payment of the consideration may be subject
to withholding of Israeli tax at the source. Accordingly, shareholders may be required to demonstrate that they are exempt from
tax on their capital gains in order to avoid withholding at source at the time of sale. Specifically, in transactions involving
a sale of all of the shares of an Israeli resident company, in the form of a merger or otherwise, the Israel Tax Authority may
require from shareholders who are not liable for Israeli tax to sign declarations in forms specified by this authority or obtain
a specific exemption from the Israel Tax Authority to confirm their status as non-Israeli resident, and, in the absence of such
declarations or exemptions, may require the purchaser of the shares to withhold taxes at source.
Excess Tax
Individuals who are
subject to tax in Israel are also subject to an additional tax at a rate of 2% (increased to 3% beginning in 2017 and thereafter)
on annual income exceeding a certain threshold (NIS 803,520 for 2016, and NIS 640,000 for 2017 and thereafter, which amount is
linked to the annual change in the Israeli consumer price index), including, but not limited to, dividends, interest and capital
gains.
Estate and Gift Tax
Israeli law presently
does not impose estate or gift taxes.
Pre-Ruling Regarding a Reorganization
of Our Corporate Structure
In connection with
the Reorganization, as detailed under “Item 4. Information on the Company—Historical Background and Corporate Structure”
above, we obtained a pre-ruling from the Israel Tax Authority. The Tax Pre-Ruling confirms that the transfer of shares and assets
resulting in the Company as the parent company and 100% equity-owner of GRD, which holds all the Group’s intellectual property,
including the Company’s patent portfolio and GIL, is not taxable pursuant to the provisions of the Israeli Tax Ordinance
as long as certain requirements are met. Pursuant to the Tax Pre-Ruling, certain restrictions under the Israeli tax laws were applied
to the Company and its subsidiaries, as well as to those shareholders and option holders and other holders of rights in the share
capital of the Company (on a diluted basis), who participated in the Reorganization and held such rights immediately after the
consummation of the Reorganization (the “Rights Holdersˮ). In this section, each of the terms “Rights” and/or
“share capital (on a diluted basis)” includes shares, options to purchase shares and any other “right”
in “a body of persons” as such term is defined in the Israeli Tax Ordinance. These restrictions generally restrict
these entities and Rights Holders from making any disposition of their Rights in the transferred assets and shares for a two year
period following the consummation of the Reorganization, which ended in February 2016 (the “Restriction Periodˮ). During
the Restriction Period, these restrictions included the following:
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Sale or otherwise disposition of our intellectual property, other than out-licensing in the ordinary course of business, was not permitted;
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the Rights Holders immediately following the Reorganization must not have changed. Notwithstanding this restriction, so long as the aggregate holdings of the Rights Holders, collectively, was 51% or more of the total share capital of the Company at any time during the Restriction Period, certain changes in the holding percentages of the Rights Holders might have been permitted during the Restriction Period under the Israeli Tax Ordinance and guidelines issued by the Israel Tax Authorities;
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the Rights Holders may not have sold or otherwise transfer or dispose of more than 10% of their respective Rights, subject to the exemptions and relief detailed below;
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Sale or otherwise transfer or disposition of any of our shares in GHI or GIL, was not permitted; and
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during the two tax years following the end of the year in which the Reorganization was completed we may not have offset losses (whether business or capital losses) incurred in the year in which the Reorganization was completed or in the years preceded that year up to the fair market value of the transferred asset.
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In addition, no deduction
for tax purposes is allowed in relation to the Reorganization.
If during the Restriction
Period, we or the Rights Holders committed a violation, the transfer of shares or other rights and/or assets in connection with
the Reorganization will become subject to taxation based on the greater of the transferred assets’ fair market value on the
day of such violation or taxes that, but for the Tax Pre-Ruling, would be payable in connection with the transfer of such assets
and shares at the time of the Reorganization, linked to the Israeli consumer price index linkage differentials and interest from
the day of the actual transfer of such assets and shares until the day of payment of such taxes, unless the Israel Tax Authority
is satisfied that such violation was a result of special circumstances beyond our control. The Restriction Period ended on February
2016, and to our knowledge, neither we nor any of the Right Holders has committed a violation during the Restriction Period pursuant
to the terms and conditions of the Tax Pre Ruling.
Certain U.S. Federal Income Tax Considerations
The following is a
general summary of certain material U.S. federal income tax consequences relating to the purchase, ownership and disposition of
our ordinary shares by U.S. Holders (as defined below). This summary is based on the the Code, the regulations of the U.S. Department
of the Treasury issued pursuant to the Code, or the Treasury Regulations, the income tax treaty between the United States and Israel,
or the U.S.-Israel Tax Treaty, and administrative and judicial interpretations thereof, all as in effect on the date hereof and
all of which are subject to change, possibly with retroactive effect, or to different interpretation. No ruling has been sought
from the IRS with respect to any U.S. federal income tax consequences described below, and there can be no assurance that the IRS
or a court will not take a contrary position. This summary is no substitute for consultation by prospective investors with their
own tax advisors and does not constitute tax advice. This summary applies only to U.S. Holders that hold our ordinary shares as
capital assets for U.S. federal income tax purposes (generally, property held for investment) and does not address all of the tax
considerations that may be relevant to specific U.S. Holders in light of their particular circumstances or to U.S. Holders subject
to special treatment under U.S. federal income tax law (including, without limitation, banks, insurance companies, tax-exempt entities,
retirement plans, regulated investment companies, partnerships, dealers in securities, brokers, real estate investment trusts,
certain former citizens or residents of the United States, persons who acquire our ordinary shares as part of a straddle, hedge,
conversion transaction or other integrated investment, persons who acquire our ordinary shares through the exercise or cancellation
of employee stock options or otherwise as compensation for their services, persons that have a “functional currency”
other than the U.S. dollar, persons that own (or are deemed to own, indirectly, or by attribution) 10% or more of our shares, or
persons that mark their securities to market for U.S. federal income tax purposes). This summary does not address any U.S. state
or local or non-U.S. tax considerations, any U.S. federal estate, gift or alternative minimum tax considerations, or any U.S. federal
tax consequences other than U.S. federal income tax consequences.
As used in this summary,
the term “U.S. Holder” means a beneficial owner of our ordinary shares that is, for U.S. federal income tax purposes,
(i) an individual citizen or resident of the United States, (ii) a corporation, or other entity taxable as a corporation for U.S.
federal income tax purposes, created or organized in or under the laws of the United States, any state thereof, or the District
of Columbia, (iii) an estate the income of which is subject to U.S. federal income tax regardless of its source, or (iv) a trust
with respect to which a court within the United States is able to exercise primary supervision over its administration and one
or more U.S. persons have the authority to control all of its substantial decisions, or that has a valid election in effect under
applicable Treasury Regulations to be treated as a “United States person.”
If an entity or arrangement
treated as a partnership for U.S. federal income tax purposes holds our ordinary shares, the tax treatment of such entity or arrangement
treated as a partnership and each person treated as a partner thereof generally will depend upon the status and activities of the
entity and such person. A holder that is treated as a partnership for U.S. federal income tax purposes should consult its own tax
advisor regarding the U.S. federal income tax considerations applicable to it and its partners of the purchase, ownership and disposition
of our ordinary shares.
Prospective investors should
be aware that this summary does not address the tax consequences to investors who are not U.S. Holders. Prospective investors should
consult their own tax advisors as to the particular tax considerations applicable to them relating to the purchase, ownership and
disposition of our ordinary shares, including the applicability of U.S. federal, state and local tax laws and non-U.S. tax laws.
Taxation of U.S. Holders
Distributions
. Subject
to the discussion below under “Passive Foreign Investment Company,” a U.S. Holder that receives a distribution with
respect to an ordinary share generally will be required to include the amount of such distribution in gross income as a dividend
(without reduction for any Israeli tax withheld from such distribution) when actually or constructively received to the extent
of the U.S. Holder’s pro rata share of our current and/or accumulated earnings and profits (as determined under U.S. federal
income tax principles). Any distributions in excess of our earnings and profits will be applied against and will reduce (but not
below zero) the U.S. Holder’s tax basis in its ordinary shares, and, to the extent they exceed that tax basis, will be treated
as gain from the sale or exchange of our ordinary shares. We do not intend to calculate our earnings and profits under U.S. federal
income tax principles. Therefore, a U.S. Holder should expect that a distribution will be treated as a dividend even if that distribution
would otherwise be treated as a non-taxable return of capital or as capital gain under the rules described above.
As noted above, we do not
anticipate paying any cash dividends in the foreseeable future. If we were to pay dividends, we expect to pay such dividends in
NIS. A dividend paid in NIS, including the amount of any Israeli taxes withheld, will be includible in a U.S. Holder’s income
at a U.S. dollar amount calculated by reference to the exchange rate in effect on the date such dividend is received, regardless
of whether the payment is in fact converted into U.S. dollars. If the dividend is converted to U.S. dollars on the date of receipt,
a U.S. Holder generally will not recognize a foreign currency gain or loss. However, if the U.S. Holder converts the NIS into U.S.
dollars on a later date, the U.S. Holder must include, in computing its income, any gain or loss resulting from any exchange rate
fluctuations. The gain or loss will be equal to the difference between (i) the U.S. dollar value of the amount included in income
when the dividend was received and (ii) the amount received on the conversion of the NIS into U.S. dollars. Such gain or loss generally
will be ordinary income or loss and will be U.S. source income or loss for U.S. foreign tax credit purposes. U.S. Holders should
consult their own tax advisors regarding the tax consequences to them if we pay dividends in NIS or any other non-U.S. currency.
Subject to certain significant
conditions and limitations, any Israeli taxes paid on or withheld from distributions from us and not refundable to a U.S. Holder
may be credited against the U.S. Holder’s U.S. federal income tax liability or, alternatively, may be deducted from the U.S.
Holder’s taxable income. The election to deduct, rather than credit, foreign taxes, is made on a year-by-year basis and applies
to all foreign taxes paid by a U.S. Holder or withheld from a U.S. Holder that year. Dividends paid on the ordinary shares generally
will constitute income from sources outside the United States and be categorized as “passive category income” or, in
the case of some U.S. Holders, as “general category income” for U.S. foreign tax credit purposes. Because the rules
governing foreign tax credits are complex, U.S. Holders should consult their own tax advisors regarding the availability of foreign
tax credits in their particular circumstances.
Dividends paid on the ordinary
shares will not be eligible for the “dividends-received” deduction generally allowed to corporate U.S. Holders with
respect to dividends received from U.S. corporations.
Certain distributions treated
as dividends that are received by an individual U.S. Holder from a “qualified foreign corporation” generally qualify
for a 20% reduced maximum tax rate so long as certain holding period and other requirements are met. A non-U.S. corporation (other
than a PFIC for the taxable year in which the dividend is paid or the preceding taxable year) generally will be considered to be
a qualified foreign corporation (i) if it is eligible for the benefits of a comprehensive tax treaty with the United States which
the Secretary of Treasury of the United States determines is satisfactory for purposes of this provision and which includes an
exchange of information program, or (ii) with respect to any dividend it pays on stock which is readily tradable on an established
securities market in the United States. Dividends paid by us in a taxable year in which we are not a PFIC and with respect to which
we were not a PFIC in the preceding taxable year are expected to be eligible for the 20% reduced maximum tax rate, although we
can offer no assurances in this regard. However, any dividend paid by us in a taxable year in which we are a PFIC or were a PFIC
in the preceding taxable year will be subject to tax at regular ordinary income rates (along with any applicable additional PFIC
tax liability, as discussed below). As discussed below under “Passive Foreign Investment Company,” we believe that
we were not a PFIC for our 2017 taxable year and do not expect to be a PFIC for the 2018 taxable year. Because the PFIC determination
is highly fact intensive, there can be no assurance that we will not be a PFIC in 2018 or for any other taxable year.
The additional 3.8% “net
investment income tax” (described below) may apply to dividends received by certain U.S. Holders who meet certain modified
adjusted gross income thresholds.
Sale, Exchange or Other
Taxable Disposition of Ordinary Shares
. Subject to the discussion under “Passive Foreign Investment Company” below,
a U.S. Holder generally will recognize capital gain or loss upon the sale, exchange, or other taxable disposition of our ordinary
shares in an amount equal to the difference between the amount realized on the sale, exchange, or other taxable disposition and
the U.S. Holder’s adjusted tax basis (determined under U.S. federal income tax rules) in such ordinary shares. This capital
gain or loss will be long-term capital gain or loss if the U.S. Holder’s holding period in our ordinary shares exceeds one
year. Preferential tax rates for long-term capital gain (currently, with a maximum rate of 20%) will apply to individual U.S. Holders.
The deductibility of capital losses is subject to limitations. The gain or loss generally will be income or loss from sources within
the United States for U.S. foreign tax credit purposes, subject to certain possible exceptions under the U.S.-Israel Tax Treaty.
The additional 3.8% “net investment income tax” (described below) may apply to gains recognized upon the sale, exchange,
or other taxable disposition of our ordinary shares by certain U.S. Holders who meet certain modified adjusted gross income thresholds.
U.S. Holders should consult
their own tax advisors regarding the U.S. federal income tax consequences of receiving currency other than U.S. dollars upon the
disposition of their ordinary shares.
Passive Foreign Investment
Company.
In general, a non-U.S. corporation will be treated as a PFIC for U.S. federal income tax purposes in any taxable year
in which either (i) at least 75% of its gross income is “passive income,” or (ii) on average at least 50% of its assets
by value produce passive income or are held for the production of passive income. Passive income for this purpose generally includes,
among other things, certain dividends, interest, royalties, rents and gains from commodities and securities transactions and from
the sale or exchange of property that gives rise to passive income. Passive income also includes amounts derived by reason of the
temporary investment of funds, including those raised in a public offering. Assets that produce or are held for the production
of passive income include cash, even if held as working capital or raised in a public offering, marketable securities and other
assets that may produce passive income. In determining whether a non-U.S. corporation is a PFIC, a proportionate share of the income
and assets of each corporation in which it owns, directly or indirectly, at least a 25% interest (by value) is taken into account.
A foreign corporation’s
PFIC status is an annual determination that is based on tests that are factual in nature, and our status for any year will depend
on our income, assets, and activities for such year. Based upon our review of our financial data, we believe that we were not a
PFIC for our 2017 taxable year and do not expect to be a PFIC for the 2018 taxable year. Because the PFIC determination is highly
fact intensive, there can be no assurance that we will not be a PFIC in 2018 or for any other taxable year.
U.S. Holders should be
aware of certain tax consequences of investing directly or indirectly in us due to our classification as a PFIC. A U.S. Holder
is subject to different rules depending on whether the U.S. Holder makes an election to treat us as a “qualified electing
fund,” referred to herein as a “QEF election,” for the first taxable year that the U.S. Holder holds ordinary
shares, makes a “mark-to-market” election with respect to the ordinary shares, or makes neither election. An election
to treat us as a QEF will not be available if we do not provide the information necessary to make such an election. It is not expected
that a U.S. Holder will be able to make a QEF election because we do not intend to provide U.S. Holders with the information necessary
to make a QEF election.
Default PFIC Rules
.
If we are a PFIC for any tax year, a U.S. Holder who does not make a timely “qualified electing fund” election, or
“QEF election” (as discussed below, we do not currently intend to prepare or provide the information that would enable
a U.S. Holder to make a QEF election), or a mark-to-market election (as described below), referred to in this summary as a “Non-Electing
U.S. Holder,” will be subject to special rules with respect to (i) any “excess distribution” (generally, the
portion of any distributions received by the Non-Electing U.S. Holder on the ordinary shares in a taxable year in excess of 125%
of the average annual distributions received by the Non-Electing U.S. Holder in the three preceding taxable years, or, if shorter,
the Non-Electing U.S. Holder’s holding period for the ordinary shares), and (ii) any gain realized on the sale or other disposition
of such ordinary shares. Under these rules:
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the excess distribution or gain would be allocated ratably over the Non-Electing U.S. Holder’s
holding period for such ordinary shares;
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the amount allocated to the current taxable year and any year prior to us becoming a PFIC would
be taxed as ordinary income; and
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the amount allocated to each of the other taxable years would be subject to tax at the highest
rate of tax in effect for the applicable class of taxpayer for that year, and an interest charge for the deemed deferral benefit
would be imposed with respect to the resulting tax attributable to each such other taxable year.
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If a Non-Electing U.S.
Holder who is an individual dies while owning our ordinary shares, the Non-Electing U.S. Holder’s successor would be ineligible
to receive a step-up in tax basis of such ordinary shares. Non-Electing U.S. Holders should consult their tax advisors regarding
the application of the “net investment income tax” (described below) to their specific situation.
To the extent a distribution
on our ordinary shares does not constitute an excess distribution to a Non-Electing U.S. Holder, such Non-Electing U.S. Holder
generally will be required to include the amount of such distribution in gross income as a dividend to the extent of our current
or accumulated earnings and profits (as determined for U.S. federal income tax purposes) that are not allocated to excess distributions.
The tax consequences of such distributions are discussed above under “Taxation of U.S. Holders—Distributions.”
Each U.S. Holder is encouraged to consult its own tax advisor with respect to the appropriate U.S. federal income tax treatment
of any distribution on our ordinary shares.
If we are treated as a
PFIC for any taxable year during the holding period of a Non-Electing U.S. Holder, we will continue to be treated as a PFIC for
all succeeding years during which the Non-Electing U.S. Holder is treated as a direct or indirect Non-Electing U.S. Holder even
if we are not a PFIC for such years. A U.S. Holder is encouraged to consult its tax advisor with respect to any available elections
that may be applicable in such a situation, including the “deemed sale” election of Code Section 1298(b)(1) (which
will be taxed under the adverse tax rules described above).
We may invest in the equity
of foreign corporations that are PFICs or may own subsidiaries that own PFICs. If we are classified as a PFIC, under attribution
rules, U.S. Holders will be subject to the PFIC rules with respect to their indirect ownership interests in such PFICs, such that
a disposition of the ordinary shares of the PFIC or receipt by us of a distribution from the PFIC generally will be treated as
a deemed disposition of such ordinary shares or the deemed receipt of such distribution by the U.S. Holder, subject to taxation
under the PFIC rules. There can be no assurance that a U.S. Holder will be able to make a QEF election or a mark-to-market election
with respect to PFICs in which we invest. Each U.S. Holder is encouraged to consult its own tax advisor with respect to tax consequences
of an investment by us in a corporation that is a PFIC.
Mark-to-Market Election
.
Alternatively, if our ordinary shares are treated as “marketable stock,” a U.S. Holder would be allowed to make a “mark-to-market”
election with respect to our ordinary shares, provided the U.S. Holder completes and files IRS Form 8621 in accordance with the
relevant instructions and related Treasury Regulations. If that election is made, the U.S. Holder generally would include as ordinary
income in each taxable year the excess, if any, of the fair market value of our ordinary shares at the end of the taxable year
over such holder’s adjusted tax basis in such ordinary shares. The U.S. Holder would also be permitted an ordinary loss in
respect of the excess, if any, of the U.S. Holder’s adjusted tax basis in our ordinary shares over their fair market value
at the end of the taxable year, but only to the extent of the net amount previously included in income as a result of the mark-to-
market election. A U.S. Holder’s tax basis in our ordinary shares would be adjusted to reflect any such income or loss amount.
Gain realized on the sale, exchange or other disposition of our ordinary shares would be treated as ordinary income, and any loss
realized on the sale, exchange or other disposition of our ordinary shares would be treated as ordinary loss to the extent that
such loss does not exceed the net mark-to-market gains previously included in income by the U.S. Holder, and any loss in excess
of such amount will be treated as capital loss. Amounts treated as ordinary income will not be eligible for the favorable tax rates
applicable to qualified dividend income or long-term capital gains.
Generally, stock will be
considered marketable stock if it is “regularly traded” on a “qualified exchange” within the meaning of
applicable Treasury Regulations. A class of stock is regularly traded on an exchange during any calendar year during which such
class of stock is traded, other than in de minimis quantities, on at least 15 days during each calendar quarter. To be marketable
stock, our ordinary shares must be regularly traded on a qualifying exchange (i) in the United States that is registered with the
SEC or a national market system established pursuant to the Exchange Act or (ii) outside the United States that is properly regulated
and meets certain trading, listing, financial disclosure and other requirements. Our ordinary shares are expected to constitute
“marketable stock” as long as they remain listed on the Nasdaq Capital Market and are regularly traded.
A mark-to-market election
will not apply to our ordinary shares held by a U.S. Holder for any taxable year during which we are not a PFIC, but will remain
in effect with respect to any subsequent taxable year in which we become a PFIC. Such election will not apply to any PFIC subsidiary
that we own. Each U.S. Holder is encouraged to consult its own tax advisor with respect to the availability and tax consequences
of a mark-to-market election with respect to our ordinary shares.
Each U.S. Holder should
consult its own tax adviser with respect to the applicability of the “net investment income tax” (discussed below)
where a mark-to-market election is in effect.
In addition, U.S. Holders
should consult their tax advisors regarding the IRS information reporting and filing obligations that may arise as a result of
the ownership of ordinary shares in a PFIC, including IRS Form 8621, Information Return by a Shareholder of a Passive Foreign Investment
Company or Qualified Electing Fund.
The U.S. federal income
tax rules relating to PFICs, QEF elections, and mark-to market elections are complex. U.S. Holders are urged to consult their own
tax advisors with respect to the purchase, ownership and disposition of our ordinary shares, any elections available with respect
to such ordinary shares and the IRS information reporting obligations with respect to the purchase, ownership and disposition of
our ordinary shares.
Certain Reporting Requirements
Certain U.S. Holders are
required to file IRS Form 926, Return by U.S. Transferor of Property to a Foreign Corporation, and certain U.S. Holders may be
required to file IRS Form 5471, Information Return of U.S. Persons With Respect to Certain Foreign Corporations, reporting transfers
of cash or other property to us and information relating to the U.S. Holder and us. Substantial penalties may be imposed upon a
U.S. Holder that fails to comply. See the discussion regarding Form 8621, Information Return by a Shareholder of a Passive Foreign
Investment Company or Qualified Electing Fund, above.
In addition, certain U.S.
Holders must report information on IRS Form 8938, Statement of Specified Foreign Financial Assets, with respect to their investments
in certain “foreign financial assets,” which would include an investment in our ordinary shares, if the aggregate value
of all of those assets exceeds $50,000 on the last day of the taxable year (and in some circumstances, a higher threshold). This
reporting requirement applies to individuals and certain U.S. entities.
U.S. Holders who fail to
report required information could become subject to substantial penalties. U.S. Holders should consult their tax advisors regarding
the possible implications of these reporting requirements arising from their investment in our ordinary shares.
Backup Withholding Tax and Information
Reporting Requirements
Generally, information
reporting requirements will apply to distributions on our ordinary shares or proceeds on the disposition of our ordinary shares
paid within the United States (and, in certain cases, outside the United States) to U.S. Holders other than certain exempt recipients,
such as corporations. Furthermore, backup withholding (currently at 28%) may apply to such amounts if the U.S. Holder fails to
(i) provide a correct taxpayer identification number, (ii) report interest and dividends required to be shown on its U.S. federal
income tax return, or (iii) make other appropriate certifications in the required manner. U.S. Holders who are required to establish
their exempt status generally must provide such certification on IRS Form W-9.
Backup withholding is not
an additional tax. Amounts withheld as backup withholding from a payment may be credited against a U.S. Holder’s U.S. federal
income tax liability and such U.S. Holder may obtain a refund of any excess amounts withheld by filing the appropriate claim for
refund with the IRS and furnishing any required information in a timely manner.
Medicare Tax on Investment Income
Certain U.S. persons, including
individuals, estates and trusts, will be subject to an additional 3.8% Medicare tax, or “net investment income tax,”
on unearned income. For individuals, the additional net investment income tax applies to the lesser of (i) “net investment
income” or (ii) the excess of “modified adjusted gross income” over $200,000 ($250,000 if married and filing
jointly or $125,000 if married and filing separately). “Net investment income” generally equals the taxpayer’s
gross investment income reduced by the deductions that are allocable to such income. Investment income generally includes, among
other things, passive income such as interest, dividends, annuities, royalties, rents, and capital gains. U.S. Holders are urged
to consult their own tax advisors regarding the implications of the additional net investment income tax resulting from their ownership
and disposition of our ordinary shares.
THE DISCUSSION ABOVE
IS A GENERAL SUMMARY. IT DOES NOT COVER ALL TAX MATTERS THAT MAY BE OF IMPORTANCE TO A PROSPECTIVE INVESTOR. EACH PROSPECTIVE INVESTOR
IS URGED TO CONSULT ITS OWN TAX ADVISOR ABOUT THE TAX CONSEQUENCES RELATING TO THE PURCHASE, OWNERSHIP AND DISPOSITION OF OUR ORDINARY
SHARES IN LIGHT OF THE INVESTOR’S OWN CIRCUMSTANCES, INCLUDING THE CONSEQUENCES OF ANY PROPOSED CHANGE IN APPLICABLE LAWS.
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F.
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Dividends and Paying Agents.
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Not applicable.
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G.
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Statements by Experts.
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Not applicable.
You may read and copy this
annual report, including the related exhibits and schedules, and any document we file with the SEC without charge at the SEC’s
public reference room at 100 F Street, N.E., Room 1580, Washington, DC 20549. You may also obtain copies of the documents at prescribed
rates by writing to the Public Reference Section of the SEC at 100 F Street, N.E., Room 1580, Washington, DC 20549. Please call
the SEC at 1-800-SEC-0330 for further information on the public reference room. The SEC also maintains an Internet website that
contains reports and other information regarding issuers that file electronically with the SEC. Our filings with the SEC are also
available to the public through the SEC’s website at
http://www.sec.gov.
As a “foreign private
issuer,” we are subject to the information reporting requirements of the Exchange Act that are applicable to foreign private
issuers, and under those requirements file reports with the SEC. Those other reports or other information may be inspected without
charge at the locations described above. As a “foreign private issuer,” we are exempt from the rules under the Exchange
Act related to the furnishing and content of proxy statements, and our officers, directors and principal shareholders will be exempt
from the reporting and “short-swing” profit recovery provisions contained in Section 16 of the Exchange Act with respect
to their purchases and sales of ordinary shares. Furthermore, as a “foreign private issuer,” we are also not subject
to the requirements of Regulation FD (Fair Disclosure) promulgated under the Exchange Act.
We maintain a corporate
website at http://www.galmedpharma.com. Information contained on, or that can be accessed through, our website is not incorporated
by reference into this annual report and does not constitute a part of this annual report. We have included our website address
in this annual report solely as an inactive textual reference.
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I.
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Subsidiary Information.
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Not applicable.
ITEM 11. Quantitative and Qualitative Disclosures About Market
Risk.
Quantitative and Qualitative Disclosure
About Market Risk
We are exposed to market
risks in the ordinary course of our business. Market risk represents the risk of loss that may impact our financial position, results
of operations or cash flows due to adverse changes in financial market prices and rates, including interest rates and foreign exchange
rates, of financial instruments.
Foreign Currency Exchange Risk
Our foreign currency
exposures give rise to market risk associated with exchange rate movements of the Euro and NIS mainly against the U.S. dollar because
a large portion of our expenses are denominated in Euros and NIS. Our Euro expenses consist principally of payments made to sub-contractors
and consultants for pre-clinical studies, clinical trials and other research and development activities. Our NIS expenses consist
principally of payments made to employees, subcontractors and consultants for pre-clinical studies, clinical trials, professional
services, other research and development activities and general and administrative activities. We anticipate that a large portion
of our expenses will continue to be denominated in currencies other than the U.S. dollar. Our financial position, results of operations
and cash flow are subject to fluctuations due to changes in foreign currency exchange rates. Our results of operations and cash
flow are, therefore, subject to fluctuations due to changes in foreign currency exchange rates and may be adversely affected in
the future due to changes in foreign exchange rates. Approximately 41% of our expected expenses are denominated in NIS. Changes
of 5% and 10% in the U.S. dollar to NIS exchange rate will increase/decrease our operation expenses by 2.05% and 4.1%, respectively.
Approximately 9% of our expected expenses are denominated in Euros. Changes of 5% and 10% in the U.S. dollar to Euro exchange rate
will increase/decrease our operation expenses by 0.45% and 0.9%, respectively. To date, fluctuations in the exchange rates have
not materially affected our results of operations or financial condition for the periods under review.
To date, we have not engaged
in hedging our foreign currency exchange risk. In the future, we may enter into formal currency hedging transactions to decrease
the risk of financial exposure from fluctuations in the exchange rates of our principal operating currencies. These measures,
however, may not adequately protect us from the material adverse effects of such fluctuations.
Interest
Rate Risk
Our
primary exposure to market risk is interest income sensitivity, which is affected by changes in the general level of U.S. interest
rates. We currently do not hedge interest rate exposure. Because of the short-term maturities of our cash equivalents and investment
securities, we do not believe that an increase in market rates would have any significant impact on the realized value of our investment
securities. If a 10% change in interest rates were to have occurred on December 31, 2017, this change would not have had a material
effect on the fair value of our investment portfolio as of that date.
Liquidity
We
do not believe that our cash and cash equivalents and available for sale investments have significant risk of default or illiquidity.
While we believe our cash, cash equivalents and available for sale investments do not contain excessive risk, we cannot provide
absolute assurance that in the future our investments will not be subject to adverse changes in market value. In addition, we maintain
significant amounts of cash and cash equivalents at one or more financial institutions that are in excess of federally insured
limits.
ITEM 12. Description of Securities Other Than Equity Securities.
Not applicable.
Not applicable.
Not applicable.
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D.
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American Depositary Shares.
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Not applicable.