Christopher Calhoun
Management
Yes. So currently, because the products are approved in Europe, physicians in Japan have the ability to bring that technology into Japan under a doctor's license. A few years ago, the government instituted some cell therapy guidelines for physicians even during translational work that they needed to get approval to do that, that anything with stem cells, through the Ministry of Health. And early on, we interpreted, along with a lot of the lead investigations in some of these translational centers, I'm talking about people at some of the leading hospitals across Japan, interpreted this. Our approach was not included in that Cell Therapy guidelines. While it's under review, it turns out we are, and so what we've done is we've taken all of those translational trials, received approval through the Ministry and have them up and running. But new trials, new things take a little time because you have to go through that application review period. So that's slowed down our revenues a little bit last year in terms of the translational sales which were a large part of our overall sales worldwide but also certainly in Japan. So -- but that's not the end goal there. The real avenue is going through the Ministry of Health as a device, much like we're doing on the rest of the world, and gaining specific indications. And on the breast reconstruction side, which is the one we're furthest along, we have an application in last year for breast reconstruction and the device. Subsequently, we've provided all of the data on the breast reconstruction trial called RESTORE 2 in Europe, to the Ministry, and they've reviewed that. We're now going back, reformatting that into a format they call the Japan's version of the Good Clinical Trial protocol format, their GCTP. And we think we're on track for that review. And hopefully, unless something new comes up, so that'll be enough to win our first approval in Japan with the indication of breast reconstruction. And then you probably know in Japan, reimbursement typically follows pretty quickly after approval and unlike other places in the world. So I think we can really get the imagers for market access fairly quickly in Japan, once we achieve that first goal of getting the approval. Looking forward, I think there are opportunities to bring several of our cardiac, one more of our cardiac programs into Japan, that wouldn't be multi-hundred patient studies but more satellite-type design trials that can mirror and echo and be supported by some of the larger international trials to expand those approvals in Japan, but based on smaller, clinical trials, which we expect to have to run in Japan.