CelLBxHealth plc (CLBX.L) Earnings Call Transcript & Summary

February 6, 2024

London Stock Exchange GB Health Care Health Care Equipment and Supplies special 37 min

Earnings Call Speaker Segments

Andrew David Newland

executive
#1

Good evening, everybody. It's a pleasure to speak to you all. And congratulations with filling the room so well and I feel sorry for you guys who have been standing for so long. And I realize that I am the gap between you and the bar and a break. But I'm very much hoping that you will find this presentation as interesting as some of the earlier ones, which I certainly found very interesting. What we're going to be talking about is cancer, how cancer develops and how we believe that our company, ANGLE plc, is going to make a difference to the entire world in terms of how cancer is diagnosed and treated in the future. And the reason I say that is because the way that cancer progresses and spreads is via the blood system. The cancer might start as breast cancer or prostate cancer or lung cancer. But ultimately, if it's going to progress, it will spread into other organs. So for example, breast cancer will spread to the bones and the brain and the lungs and the liver as common metastatic sites. The way it gets there is via the blood circulation system. So it starts as -- I'm giving you examples on breast, but this is exactly the same for all solid tumors. It starts in the breast, and then the breast cancer will drop cancer cells into the bloodstream, and they will circulate, where they're known as circulating tumor cells. If they land somewhere else, they can start growing. So they are seeds of metastasis. And when they grow, that's when the prognosis becomes very poor. And in fact, well over 90% of people who die from cancer die from this metastatic spread of the disease. So if you could learn about how that was happening, then you might be able to start to reduce it. In fact, I find it extremely shocking that when patients are treated for cancer, the doctors do a tissue biopsy, which is absolutely standard of care to find out what's happening with the cancer and that guides their treatment decisions. But the cancer changes over time and later in the cancer treatment when the cancer is progressing, and it's even more important to know what's happening, they have no new information, and therefore, the decisions are more or less guesses towards the end. We want to change that by enabling repeat biopsies, by sampling the blood, whether these very important cancer cells that are spreading the disease, recovering them so that they can be analyzed. So that means you can have a repeat biopsy and repeat biopsy can then mean that patients can get treatments, which are better for them, and we can reduce a lot of money that is wasted on drugs. So another statistics for you, immunotherapy drugs, which are the latest bastion of new drugs cost roughly GBP 150,000 per patient, but they only work for 1 in 5 patients. So think how much money is wasted and what a high proportion of patients don't get a benefit from drugs when they desperately need it. That's what we're trying to address with our Parsortix system. We've actually made a lot of progress over the last few years, such that we have something called an FDA product clearance. So this is the American government's regulatory system, the Food and Drug Administration. And we're the only company in the world that has an FDA product clearance for recovery in cancer cells from blood for subsequent analysis. And that has now been followed recently by the expansion of our product sales activities and the establishment of a variety of distributors to drive sales for the company. It's also been followed at the beginning of this year -- first week of January, we announced some very important data on DNA mutation analysis, which I'll explain a little bit later in the presentation. So we've got a lot of momentum behind the company. We've also announced in first week of January, the first large, large pharmaceutical company that we signed as a customer, and I'll talk about why that's important. But we're building out many different areas for the business right now. So we're in the commercial phase. And what I'm expecting in 2024, is an expansion of our sales activity to give us a greater level of performance, wider use in pharma clinical trials and also we're targeting getting clinical tests being offered from the ANGLE laboratory for treating patients by the end of this year. In addition, we're generating clinical data in prostate cancer and ovarian cancer. So there's lots of different things happening in ANGLE, in a very large market that we're operating in. So just to emphasize about the FDA product clearance. This is driven by a machine and a consumable. So that's the Parsortix instrument. That's quite a small bit of kit that sits on top of a laptop bench, not taking up much space, about the same size as an inkjet printer. It's very easy to use. So in our labs, a single technician can actually run 20 machines at the same time because it's plug and play, you just attach the blood and then it runs. And it's all driven by a one-time use Parsortix cassette, which is essentially the razor blade of our model. So the customer -- every time they want to process a blood sample, they need one of these Parsortix cassettes. And that's what's been FDA cleared. Now the key part of this whole thing is getting the best possible sample to benefit the patient. So what we're recovering from the blood, despite it being in very rare numbers, so maybe one cancer cell in 1,000 million blood cells. Or taken another way, in a tube of blood of 10 milliliters, there might be 10 cancer cells, 1 cancer cell, 2 cancer cells or several hundred cancer cells, but they're very rare in number overall. But if you can get those cancer cells, you've got a sample, which is a living cancer cell for which you can do all sorts of analysis. You can do DNA, RNA, you can do a morphological analysis under a microscope. You can look at proteins, all the things that doctors would like to know to guide their treatment decisions. So we're now in the commercial phase, and there are lots of different things happening. So we've secured Eisai, major Japanese pharmaceutical company as a big customer for us. They have GBP 4 billion in revenue. We're in an important program with them. We've got other similar contract discussions in progress, and I'm hopeful we'll be able to sign some other very large household name pharma companies fairly soon. We're building product revenue. So we're selling this instrument, and we're selling the consumables. And to drive that, we've actually got a new product kit to make it easier for our customers to use, which I'll describe. We announced at the beginning of the year, very, very good molecular results with the Illumina platform, the Illumina are the leading next-generation sequencing platform company in the United States. We're also working with other platforms, including Thermo Fisher, who are the leaders in the rest of the world. And so we're hopeful we're going to get some good data coming out from that as well. In the meantime, we have undertaken some ovarian and prostate cancer studies where we have processed samples with our Parsortix system, and these samples are waiting to be analyzed with an appropriate molecular platform which is currently under evaluation at the moment. So later this year, we're hopeful that we're going to get some results on the detection and assessment of ovarian and prostate cancers. And in the meantime, we're working towards getting the ANGLE clinical labs, which are based on the Surrey Research Park near Guildford, so about 40 miles from here. Accredited both in the U.K. and Europe and in the United States so that we'll be able to do patient samples, which would be a very big step forward for us. So this lady, Dr. Julie Lang, who's Head of Breast Surgery at the Cleveland Clinic in the United States, is one of the U.S. leading cancer centers. She did some fantastic work, which did an RNA gene expression comparison of cancer cells from Parsortix blood test with cancer cells from metastatic breast cancer patients and tissue biopsies, which she found basically similar information. It's in the guidelines in the United States that breast cancer patients should have a tissue biopsy of their secondary cancer sites. So if it's spread to the liver, they have some of the liver cut out. This is notwithstanding the fact that they're extremely sick. And in fact, over half of the patients are not able to have a successful biopsies. These patients get nothing. Even the ones who do get a biopsy only have one additional biopsy. When in reality, you'd like to have a blood test every 3 months or every month to test exactly what's happened with the cancer. So I'll be quite quick about this. But the way that the system works is blood flows inside the Parsortix cassette. The channels closed at the end, so it has to go left or right. And what that does is it takes it up a series of steps. This is all patented. And the cancer cell won't go through the critical gap, whereas the red and white blood cells in the plasma liquid will flow through. So by doing that, we've separated the cancer cells. And we've solved a problem which scientists have been trying to solve for 50 years and yet not been able to. So I think I've said enough about the actual instrument. It's very easy to use. Now this is a animation of what's happening inside our Parsortix cassette. So the blood flows in the inlet, it flows down the channel. You can see the channel is closed at the other end. It then goes up the staircase and the blood cells flow away over the top, the cancer cells are held at the critical gap. And what this does is it very neatly extracts the cancer cells from the blood giving you access to the best sample for downstream analysis. Now this is a really interesting video, which is of an actual breast cancer patients' blood flowing in our cassette. So we've got billions of blood cells coming in here, red and white blood cells. That's the staircase looking down on top of it, those lines. So going up the staircase. And then the light color is single cell deep of blood cells flowing through the critical gap. And here, these are the blood cells flowing away down the outlet channel, so they will go to waste. And in a minute, and amongst all these billions of cells, you will see a cancer cell. And that is a captured cancer cell. That's probably also one there as well. So it flows without any blockage. It's very easy. There's no damage to the cell. There's no chemical intervention and actually 99% of these cancer cells come out alive, exactly in the form that they were in the patient. In fact, we've optimized the pressures and flow rates in the Parsortix system to make sure that these cells are not damaged. And consequently, we not only get a very good recovery of the cancer cells, we can also recover clusters of cancer cells, which have been shown to be very highly metastatic. So what I'm showing here is our efforts to sell this product. So obviously, we're a small U.K. company. We want to be much larger, of course, but we're a relatively small company. We've got about 130 staff, most of whom are in the U.K. We've got some in the U.S. But we need much more power to our arm in selling this. So we've been signing up distributors around the world. And we've so far trained 75 salespeople from these distributors. They're very well incentivized because they keep 30% of all revenues. So they can do very well by selling this. These people have really only just got their feet under the desk. So we're expecting to see this year quite a strong increase in product sales. We're anticipating, we said at least a 3x increase on last year on 2023. We don't just have a product business. We also have a services business. The idea of our services business is to provide a demonstration of what can be done with Parsortix and also to accelerate the commercialization and the revenue. So our clinical people can take blood samples from pharma companies and then they can process them and say, what cancer cells can we find in the patient's blood, also what do those cancer cells express. And this is an opportunity that the pharma people can't do. We can do repeat testing of a patient in a trial. So before they go into the trial, we do a baseline and then during the time that they're in the trial, we look to see if it's reduced the position, and then afterwards, we can monitor that. So that gives multiple time points for patients, whereas at the moment, cancer drug trials are all about having 2 groups, 1 group that have the drug, another group that have a placebo and then looking to see the survival rates of these 2 groups. You might have to wait several years sometimes to get the results of those trials, whereas we can immediately assess that by looking at what's happening in the patient blood. We've been successful with securing about 5 companies as customers at the moment. These are an example of 3 of them. The most recent one, Eisai, GBP 4 billion in revenues, we're in one particular drug trial that they're interested in. We're just doing initially a pilot that's worth $250,000 to us. It's only 50 patients with 2 time points. So we're making $2500 per blood tube that we process and it only cost us a couple of hundred dollars to do that. The reason they're doing that is because they have something called an antibody drug conjugate, which is -- it's basically a way of delivering cancer drugs direct to the cancer cells to avoid toxicity. So this drug conjugate will target HER2 expressing cancer cells and attach to them and then release the drug. So that is -- it's a brilliant new way of reducing the toxicities that one gets from chemotherapy, which is more of a general drug by targeting it. But the targeting only works if the cancer cells express the protein HER2. So with Eisai, we've developed a special way of looking at the cancer cells that come out of Parsortix and saying, "Do they express HER2. And if so, to what extent?" So this big company with GBP 4 billion in revenues, we're doing a pilot for them. Once that's done, we hope to get into a Phase II trial, which will be worth a couple of million dollars to us and then a Phase III trial, which may be worth maybe $5 million to us, all from one particular line. They've got 80 oncology trials. This is just one aspect that I'm talking about. So this customer could be a very large customer for us. And indeed, they would like to have a companion diagnostic, ultimately, determine which patients will respond to their drug and which won't. If they want that, then they can work with ANGLE to get an extension of our FDA clearance to cover this specific application, which is why we did the FDA clearance in the first place is to enable this sort of thing. And then there's potential tens, if not hundreds of millions of dollars of revenue for ANGLE as a routine companion diagnostic for this drug, which will be a multibillion-dollar drug. So think about the risk profile of this. Obviously, developing a new drug, it may or may not get to market. But we are being paid and making money the whole way through the process. So if it stops, we get paid for everything that we've done, and we can go on to the next trial. Obviously, we hope that it won't stop. This other one -- this next one, Artios is a very successful private company in Cambridge. I think they've had several hundreds of millions of investment as a private company. They're working on a particular pathway in cancer called DNA damage response, and they paid ANGLE in our assay development business to develop the ability to look at two proteins for them, gamma-H2AX and PCaP1, the names are not really relevant. But the fact is we've earned GBP 250,000 to develop this assay. Now they're putting it into their Phase II trial. And not only that, we own the assay. So I was at a summit in Boston last week, which is a DDR Summit and was able to talk to lots of other pharma companies to say, "we've got this assay, do you guys want to use it?" and there was a lot of interest in that. I'll jump over to Crescendo and that's a very good company as well. We've developed a new product to go with Parsortix, which is called Portrait+ Antibody Staining Kit. And this helps our customer base to actually do immunofluorescent staining of the cancer cells for the identification. So by buying this kit, which we've optimized, they can follow our instructions, they can stain the cells and then they can work out that they are cancer cells, what type of cancer cells, et cetera, and look at them under their own microscopes. Until we did this, it was a bit of a hit and miss because the customers would make up their own home-brew if you like. So now we're standardizing it, making it reproducible, much easier for our customers to adopt the Parsortix system because we're making the whole process of what you do with it easier. We're working on a HER2 kit, which is just like I described with the antibody staining kit, but adding in HER2 protein evaluation, which is critical for breast cancer. So there were breast cancer drugs that target HER2 and actually 38% of patients HER2 status will change over time, and doctors don't know how it's changed. So when this kit comes out, we're expecting the clinical labs all over the world will want to use that. We're doing that in collaboration with another company, and hence, we're making money while we do the development. So we've been paid GBP 1.2 million and we've been paid about half of that so far and the rest of it to come through. On the development. So we get to have an asset at the end of it, but we make money during the process. Right. Okay. Now I'm going to talk about the DNA information, which has just come out. This is, I think, a game changer. So when we talk about DNA, we're talking about mutations and cancer mutates over time. And now there are increasing numbers of targeted therapies that go for specific DNA mutations. So it's a really important need to find out what are the DNA mutations of that cancer at a particular point in time. The whole world knows this, and there's been probably hundreds of billions, definitely tens of billions of dollars invested in trying to work out what is the patient's current DNA status because it's known that it will have changed from when they first were diagnosed. It changes over time. So what's happened? How do they do that now? Well, they're analyzing something called ctDNA. So ctDNA is also found in the blood and its fragments of dead cancer cells. So we've all got lots of cells in our body. They will die at a certain point and be replaced with new ones. When they die, they break into millions of pieces. They go in the blood, circulate a little bit and then half life is about an hour and a bit and then they get excreted. So we've all got this cell-free DNA in our blood at any time. But if you've got cancer, you might have some self-free bits from cancer. And that's what we mean by ctDNA, circulating tumor DNA. So the world has been analyzing this and getting DNA information, and there are big companies worth billions of dollars who have clinical labs just analyzing that. So we decided to take a gamble because we thought that actually the ctDNA analysis might not be giving a full picture of what's really happening in the cancer because it's not alive, it's dead. So by definition of its dead, something killed it. It might have died of old age, but quite possibly, it's been killed by the immune system or it's been killed by the therapy. In which case is not telling you what's happening in the future. It's telling you what has happened. So we wanted to see what happens with living cancer cells, the circulating tumor cells. So we've pioneered the ability to analyze both things from the same tube of blood. So we get a tube of blood. We remove the plasma, which is the bit where the ctDNA is. That's really easy. That's the liquid bit. So you just spin the blood, take off the plasma. That's why everyone is doing this stuff because it's easy. But we can do the hard bit as well, which is we take the blood cells, put them into a saline liquid, put them through our Parsortix system, and we can get out of circulating tumor cells. So we sequenced the ctDNA in the same way the industry does, then we sequenced the CTC-DNA in exactly the same way. So to analyze from the same tube of blood, process it in an identical way. And the idea was, could we find anything in the living cancer cells, which was not present in the dead. So if it's in the living cells spreading the cancer, but not in the dead and you know the immune system has not killed it. You also know that the drug has not killed it. So this is what -- this is the Holy Grail really. This is the evolution of the cancer that the doctor doesn't know about. So if we can find that, that was a gamble that we went out with. And we've -- what we announced was we successfully completed a 47-patient study, match samples for all of them. And what we found is, actually, this hypothesis is correct and 70% of breast cancer patients had actionable DNA variance mutations in their blood, which were not detectable by ctDNA and were not known about by the doctors, therefore. 70% in lung, 60% in ovarian and 20% in prostate. So the answer is, yes, if you can get the living cancer cells out and you do DNA information, you will get additional information beyond the ctDNA. So that opens up the potential for us to talk towards the ctDNA labs and say, "Guys, why don't you extend what you're doing to also look at living cells. All you need to do is adopt our system you can run the same sequencing that you've already invested in the same process and get more information." The other thing is that the industry has repeatedly said that CTCs, you can't get them from many patients, and there's so few cells you can't do anything useful with them, et cetera. There's much more ctDNA available. That's also not true. So we found that in this patient cohort, 90% of the patients were positive for CTCs in breast and in lung and 70% in ovarian and prostate, compare that with ctDNA actually, it's a little bit better, not worse. So that, again, is a very important point in terms of the applicability of our technology. So examining the DNA variants that were present we found actionable DNA variants. These are all well known to the field. And they actually already have FDA-cleared drugs, which are cleared for finding those actionable variants in tissue. So if the tissue biopsy comes in, these companies, Novartis, AstraZeneca, Menarini, Genentech, Puma, Boehringer, these guys have already got multibillion-dollar drugs which are addressing these specific variants that we found in the blood. So they're now all targets for us because they could have more sales of their drug if they did a blood test with Parsortix and found that was -- that PIK3CA was there or EGFR was there and did a clinical study to show that patients benefit from that, then they could extend what they're doing. So we do think that this -- the reason our stock price moved -- it should have moved more really. It is because of the importance of these actionable DNA variants that you find in CTCs that you don't find in ctDNA. So I'm going to wrap up now. And Ian, if you want to come up for questions -- he's our CFO. But what I'd like to leave you with is a really important point, which is that in all these medical fields, it's not what I tell you as a company that's important. It's what the world tells you and what other third parties have said. And in our case, we've got 41 independent cancer centers, nothing to do with ANGLE, who have used our system, they've either bought it or we've provided loan equipment to them. They run their own studies, and they published 92 peer-reviewed publications. Most of those are on our website, freely available and it shows that our system works without modification in 24 different cancer types. So it's very well proven and there's a lot of different things going on. So thank you very much for your attention. We know that a number of you are ANGLE shareholders and interested parties already. So we're happy to take detailed questions or also take general questions, whatever you prefer.

Unknown Executive

executive
#2

Okay. Questions please, again wait for the microphone please before you ask your question. Everyone is a bit shy today. I'll start it off. A question here, please, Steve. Thank you, Chris.

Unknown Attendee

attendee
#3

That was a very fast flowing and very impressive presentation and one can only hope the respective of the business aspects to it that -- the health benefits that clearly are able to develop are picked up by those who can actively take them to market and maybe extend my life slightly. Looking at it from a businessmen's perspective, I'd be interested in the comments of your funding because if I just read very briefly, financial highlights. Revenues for the half year trebled to GBP 1.2 million, which is great. Trebling something is always good. Usually good, not cancer sales, presumably. On the other hand, you've burned through the thick end of GBP 10 million during that period of time. And that's not entirely comfortable positioned to read as a potential investor.

Ian Griffiths

executive
#4

That was planned investment. So investors, we raised money. We raised GBP 20 million back in sort of June '22. We're deploying the capital we raised on specific activities, clinical studies, generating the data that will get to customers. We're not just spending it willy-nilly. This is actually planned expenditure. And the medical industry, the nature of is you have to generate data to convince people, particularly when you're doing a pioneering activity such as the cells and particularly where people need to be convinced. And the way you do that is through data and through partnerships and collaborations. That costs money. You run a clinical study. It takes a number of years. We've got the only FDA-cleared product, right? That takes a lot of money. Most of our competitors can't do that. So we're not -- if you want a traditional organization, right, we're not a dividend, we're not a safe stock, but we are pioneering, we are developing, and we're deploying the capital that we raise. Now in terms of what that means going forward, we did give a trading update back out in November. So revenues for the sort of full year, we're saying GBP 2.2 million. So yes, it's modest at this stage. The money we've got will take us out to Q2 '25. We are aiming to be cash flow breakeven by the end of '25. So we do have a gap in terms of getting free to cash flow breakeven. We're seeking to fill that through either accelerating revenues further, if we can, getting in milestone payments or doing deals with large strategics or corporates to fill that through. But we're doing on a shoestring compared to our American cousins. But the nature of the industry in, you have to deploy capital to get that leadership position. We're the only company with the FDA clearance. We've got best-in-class results from our studies in ovarian, 95.4% area under the curve. All those things cost money, they don't happen by not spending money.

Unknown Attendee

attendee
#5

Is the -- is what I should draw from that, that if one invested, one would expect the [ rights issue ] somewhere in early '25?

Ian Griffiths

executive
#6

Well, as I've just explained, we are seeking to accelerate revenue growth or we're seeking to get milestone payments from strategic partners, that mean we don't have to do a capital raise. Now historically, we have done capital raises every year because we've been burning more. We were much earlier in the process of our commercialization. So and that's part of being a listed company is that you can raise capital. We, at the moment, are very tightly focusing our spend. So we're not doing -- we're a platform technology, but we're only working in a finite number of cancers. So we're not in a position -- we don't need to raise money immediately. Clearly, we will need some capital to fill that gap, whether it's through other partners or from the market, we'll just have to see when we get to that point.

Unknown Attendee

attendee
#7

Thank you very much. And I wish you every success in the venture.

Unknown Executive

executive
#8

Question here?

Unknown Attendee

attendee
#9

You mentioned the NCCN guidelines on doing secondary biopsies in metastatic breast cancer in the U.S., exactly sort of what sort of percent of patients with secondary metastatic breast cancer actually do the biopsies? And what percentage of those are currently conducted by on CTC's isolated by Parsortix?

Andrew David Newland

executive
#10

So what I was talking about there was the current standard of care in the United States. And the guidelines require a biopsy if it's possible. In reality, just under 50% of patients will get a biopsy. The remainder, they're either too sick for the operation or they elect not to have it. Some of them say, well, I just don't want to go through another operation. Or there's not enough material available. So if it's a lung biopsy, they can't get enough out or if it's in the bones. Obviously, if it's in the brain, they won't access it because that's too dangerous. And your question was what percentage of them are getting a CTC? Zero. This is what we're working to try and achieve, a groundswell change in the way that medical sciences is operated.

Unknown Attendee

attendee
#11

Do you suppose that some of the people who do have secondary biopsy might die as a result of the biopsy?

Andrew David Newland

executive
#12

Yes, some of them do, Yes.

Ian Griffiths

executive
#13

And also lots die from being given drugs that have side effects. They are not going to benefit from them. Even more die from that.

Unknown Executive

executive
#14

Question over here, please, and then we'll come back to you.

Unknown Attendee

attendee
#15

I mean I can see there has been an incredibly long accumulation of data that should create enough visibility for the world, for companies to see the potential. Why is this not stabilizing the share price? Please can you explain to me the correlation because there must be something done and response by the market?

Andrew David Newland

executive
#16

Yes, I couldn't agree more. But we don't control the supply and demand in the stock market. There's been massive, massive movements of capital away from growth stocks, and that's pushed down. There's been redemptions from funds for 28-months in a row where people have taken their money out of investment funds. This is not an ANGLE specific thing. Every single med tech stock in the -- pretty much in the world and certainly in the U.K., is heavily down. But I couldn't agree with you more. That's why we're doing these kind of meetings is to get more interest, more understanding because we're trying to do something new, people don't know about it. So we can sit in an ivory tower and assume they know, but they don't. So we have to get out and spread that message.

Unknown Attendee

attendee
#17

And is there an alternative to get more money in terms of not raising it. But doing an alternative way of funding that mitigates this instability?

Andrew David Newland

executive
#18

Yes. So if you go back to the slide I was showing just on one customer -- if I can get it to work. This one here, Eisai, I'm slightly standing in the light, but Eisai have got 80 clinical trials with 60,000 patients. The base cost -- the price that we quoted them was $4,600 for a tube of blood. We discounted that to $2,500 for the pilot. And the patients need to have at least -- in the trials need to have a minimum of 3 time points. So just as one company, there's 60,000 patients, 3 time points at $4,600 each. So there was a huge opportunity for building revenue. Now it took us the best part of a year to close the negotiation with Eisai including 6-months waiting for their trial to start. But now we're in. And last week, I went to New York, and I went to their headquarters and met their people and talked to them about this project and about other potential projects. And they understand it. So they want to see the data from the pilot. So we can't get ahead of ourselves. We've got to show them that we've got good data. But this is just literally one company. They are probably the 20th on the list of the top 20 companies. They're not the biggest. There's other big companies and they can benefit themselves financially and obviously, we can too. So my hope is that by working with these kinds of companies, they will take us the whole way to the market for a companion diagnostic. So they'll pay for us to get the extended FDA clearance. They'll pay for all the marketing. They'll probably be the customer that pays for it. So if you're selling a drug for $100,000, would you pay for a blood test for a couple of thousand? Of course, you would. If you can get $100,000 from selling the drug. So there are plenty of opportunities for us to actually even just do the companion diagnostic paid for by them.

Unknown Executive

executive
#19

We are a bit over time, again one final question, the gentleman here in the...

Unknown Attendee

attendee
#20

Cancer cells come from different tissues in the body. And the size of the cancer cells is interest in your filtering system, presume that by and large cancer cells are bigger than the red and white blood corpuscles. Do you have to calibrate your kit to track specific types of cancer? I mean, is a lung cancer cell going to be significantly bigger or different shapes from a breast cancer or prostate cancer?

Andrew David Newland

executive
#21

That's a great question. In reality, what we found is that the same equipment works fine for 24 different cancer types. In addition to -- you're rightly pointing out that the cancer cells are different between different types of cancer. They're also different in terms of their stage of the life cycle. So they sort of start at a medium size, get bigger, then they break into 2 and you get smaller. So you've got everything from relatively small to relatively large. And the red blood cells are way smaller. So they're not really part of it. The white blood cells also have a continuum. So you get very big white cells -- white blood cells, which will overlap with the small cancer cells. And we actually collect some of those. So there's particular immune cells called macrophages and megakaryocytes, et cetera, which we may collect as well, which also provide really useful information. But the big difference is the cancer cells are generally 2 to 3x bigger, and they're also less compressible. So if you think of the overlap of a squash ball and a golf ball, golf ball represents the cancer cells, so if you're pushing through a gap, that golf ball won't go through, but the squash ball will.

Ian Griffiths

executive
#22

I was just going to add 2 things. We do. So you can alter the pressure. We have standardized protocols, but you can alter the pressure so you can go through faster or slower. If you go through slightly slower, you can alter the capture rates, and we also have different critical gap sizes as well. But generally, what we found is because of that distribution, we're consistently reliably capturing cells, and the question is, so we may not capture 100%, but we typically capture 70% to 80%. But we're not too worried about those -- the outliers because you're seeing the mutations in the cells that you do catch.

Unknown Attendee

attendee
#23

So there might be a few other cells as well as well, like the large white...

Ian Griffiths

executive
#24

Yes. But that's because of the overlap of the cell size. But the white cells are increasingly seem to be producing useful information because of the body's immune response to them. So we think...

Unknown Attendee

attendee
#25

So you can analyze both.

Ian Griffiths

executive
#26

Yes. So you can analyze the cancer, i.e., which is the cells direct, but also the body's response to that as well.

Unknown Attendee

attendee
#27

So white cells will probably have some response to the...

Ian Griffiths

executive
#28

Yes, they may well do it. That's breaking area.

Unknown Executive

executive
#29

We are out of time. Thank you so much. Thank you.

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