Earnings Labs

Wave Life Sciences Ltd. (WVE)

Q3 2020 Earnings Call· Mon, Nov 9, 2020

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Transcript

Operator

Operator

Good morning, ladies and gentlemen, and welcome to the Wave Life Sciences Third Quarter 2020 Earnings Call. At this time, all participants are in a listen-only mode. Later, we will conduct a question-and-answer session, and instructions will follow at that time. [Operator Instructions] As a reminder, this conference call is being recorded. I would now like to turn the conference over to Graham Morrell, Investor Relations at Wave. Please go ahead.

Graham Morrell

Analyst

Thank you, Operator. Good morning, and thank you for joining us today to discuss our recent business progress and review Wave's third quarter 2020 financial results. This morning, we issued a news release detailing these results which is available in the Investors section of our Web site, www.wavelifesciences.com. The slide presentation that accompanies this webcast will also be available on our Web site following this call. Before we begin, I would like to remind you that discussions during this conference call will include forward-looking statements. These statements are subject to a number of risks and uncertainties that could cause our actual results to differ materially from those described in these forward-looking statements. The factors that could cause actual results to differ are discussed in the press release issued today and in our SEC filings, including our Annual Report on Form 10-K for the year ended December 31, 2019, and our quarterly report on Form 10-Q for the quarter ended September 30, 2020. We undertake no obligation to update or revise any forward-looking statements for any reason. I'd now like to turn the call over to Dr. Paul Bolno, President and CEO of Wave Life Sciences. Paul?

Paul Bolno

Analyst

Thank you, Graham. Good morning to everyone on the call, and thank you for joining us today. I hope you and families are staying healthy and safe during these challenging times. We are excited to share the latest on our progress, new programs, and future plans. I'll start us off this morning by providing an overview of recent achievements, a summary of the data that will be included in the readout for our PRECISION-HD clinical trial in the first quarter of 2021, a quick overview of our recently announced PN chemistry advancement, and then I'll talk about our first ADAR editing program. Our Chief Medical Officer, and Head of Therapeutics Discovery and Development, Dr. Mike Panzara, will then discuss our three upcoming clinical trial submissions, including our newly announced clinical trial in Duchenne muscular dystrophy. Finally, Dave Gaiero, our Interim Chief Financial Officer, will discuss Wave's third quarter financial results. Dr. Chandra Vargeese, our Chief Technology Officer, and Dr. Ken Rhodes, our Senior Vice President of Therapeutics Discovery will also be available during the Q&A portion of this call. This past quarter, we continued to make significant progress with our clinical and preclinical pipeline, as well as advances in expanding the potential of our innovative PRISM platform. Despite the challenges of COVID-19 around the world, our research and clinical teams made tremendous strides. As we look ahead to 2021, I believe we are ushering in a new and exciting phase for Wave. To start, we now anticipate having five clinical trials in 2021. This includes our two ongoing Phase 1b/2a PRECISION-HD studies in Huntington's disease, for which we continue to expect data in the first quarter of 2021, as well as our new first-in-human studies of WVE-003, and WVE-004. As a reminder, WVE-003 is our third allele-selective Huntington's disease candidate,…

Mike Panzara

Analyst

Thanks, Paul. This quarter has been highlighted by tremendous progress. We not only anticipate sharing data in the first quarter from PRECISION-HD1 and PRECISION-HD2 and their OLE as Paul already mentioned, but we're also preparing to file two CTAs before the end of the year, one for WVE-003, our third-allele selective candidate in Huntington's disease, and one for WVE-004, our variant selective financing candidate in ALS and FTD. In addition, in the first quarter of next year, we're planning to submit a CTA for WVE N531, our candidates for DMD patients with mutations amenable to exon 53 skipping; more on that later in my presentation. I'll start with a few words on Huntington's disease. Our work and the work of others in this area over the past few years have emboldened us in our belief that allele selectivity is critically important as a foundational concept in the treatment of HD, and that preserving as much wild-type huntingtin as possible, while lowering mutant Huntington is essential for not only proper function of the central nervous system, but systemically. In essence, this is balanced between these two proteins in a push-pull scenario, a tug of war of sorts between their opposing effects that over time leads to the invariable progression of disease, a process involving intense biological stress, where the beneficial effects of wild-type protein, maybe even more important, wild-type huntingtin carries out essential functions in both developing in adult brains, it protects neurons against various types of stress prevalent in cells with high metabolic activity, including excitotoxic, oxidative and protein misfolding stress. Wild-type huntingtin also plays a key role in trafficking synaptic proteins, and synaptic vesicles. This trafficking function has been shown to affect synaptic plasticity, which is important for learning and memory, as well as for supplying the essential growth…

Dave Gaiero

Analyst

Thanks, Mike. Wave ended the third quarter of 2020 with approximately $216.4 million in cash and cash equivalents compared to $147.2 million as of December 31, 2019. During the third quarter of 2020, we substantially extended our cash runway by raising $93.7 million in net proceeds from our September 2020 public offering and $48 million in net proceeds from our at-the-market equity program and receiving $16.8 million in refundable tax credits. Now I would like to review our income statement for the quarter. For the third quarter of 2020, Wave reported a net loss of $33.1 million compared to $50.7 million for the same period in 2019. Research and development expenses were $28.3 million in the third quarter of 2020 compared to $44.6 million for the same period in the prior year. The decrease in research and development expenses in the third quarter was primarily due to external expenses related to suvodirsen due to our December 2019 decision to discontinue to program, as well as decreased headcount and other external expenses driven by our February 2020 cost reduction plan, partially offset by increased external expenses related to our clinical and preclinical activities related to our HD programs and our C9orf72 program for ALS and FTD. General and administrative expenses were $9.6 million in the third quarter of 2020, compared to $12.5 million in the same period in 2019. The decrease in general and administrative expenses in the third quarter of 2020 was primarily due to the February 2020 cost reduction plan, which included workforce reduction. We expect that our existing cash and cash equivalents, together with expected and committed cash from our existing collaboration will enable us to fund our operating and capital expenditure requirements into the second quarter of 2023. As a reminder, we did not include potential milestones and other uncommitted payments related to our Takeda collaboration in our cash runway. I will now turn the call back over to Paul for closing remarks. Paul?

Paul Bolno

Analyst

Thanks, Dave. I hope you all are sharing in our excitement for what we expect to be a catalyst-rich year ahead, driven mostly by the five clinical trials that we expect will be ongoing in 2021. To recap, this quarter, we expect to submit the CTAs for WVE-003 and WVE-004. In the first quarter of 2021, we plan to submit a third CTA for WVE-N531. Also in the first quarter, we expect to report data from all cohorts of the PRECISION-HD studies as well as initial OLE data. Finally, we plan to share updates on our AATD program, including data in the humanized model, and I expect we'll have other ADAR editing updates to share as we continue to build this novel platform capability. We are well-capitalized to advance our pipeline of potentially transformational programs, and realize the value of our platform. And with that, we'll open up the call for questions. Operator?

Operator

Operator

[Operator Instructions] Your first question is from the line of Joon Lee with Truist Securities.

Joon Lee

Analyst

Hi, guys, and thanks for the questions and the updates. I have a couple of questions. For your ADAR program, for the antitrypsin program, number one, what percent editing would you need to have a therapeutic effect and could you explain in what way your approach is better or different than the knockdown approach being taken by Alnylam and Dicerna? And for the DMD program, can you remind us again how your PN chemistry is able to overcome the tissue access from the patients of your prior chemistry, of backbone chemistry? Thank you.

Paul Bolno

Analyst

Thank you, Joon, and we'll divide this into two parts; I'll bring Chandra in a second. As it relates to ADAR, we're excited about the differentiation, as we laid out, for brining an editing approach or a correction approach forward over silencing, and while there's been a lot of excitement around silencing, and we don't discount that on knocking down or the mutated protein within the liver. I think when we think of and approached the alpha-1 antitrypsin deficiency we really approached it from the area of correction. So that is, how do we fix this point mutation such that we restore the physiologic balance of the protein, enabling it to treat both the pulmonary as well as the hepatic complications of the liver and lung. So this is a key driver for us to drive down the correction arm. As we talk about the heterozygosity of these patients, we do know that if a patient is heterozygous, so a 50% correction or restoration, it doesn't manifest the disease. So we think about where the correction needs to be with the physiologic protein between that up to 50%, but you don't -- by no means [anything to] [ph] 100% correction in terms of restoring normal physiology. Chandra, is there anything you want to add to the ADAR question?

Chandra Vargeese

Analyst

No, I think that you pretty much covered.

Joon Lee

Analyst

Hey, Paul, just from that…

Paul Bolno

Analyst

Yes.

Joon Lee

Analyst

Just to finish up the ADAR question, assuming both the knockdown approach works as they expect will be, and then your approach works surely as you expect by editing, how would you envision these two approaches manifesting clinically differently? How would it be different clinically?

Paul Bolno

Analyst

Yes, I mean as we know now there's -- the initial therapies that are out in terms of the protein replacement to treat pulmonary complications. So there is this augmentation therapy that's there, and so there is a desire to kind of think about the interchangeability of protein replacement or of protein augmentation therapies as well as now liver correction with silencing. I think we stand to be able to work in both, therefore really correcting and restoring the normal protein, so the wild-type protein to restore physiologic balance, letting the body use the proteins as they need for both the lung and the liver. So they would really -- potentially wouldn't require the necessity of silencing or protein replacement therapy.

Joon Lee

Analyst

Yes, and the DMD…

Paul Bolno

Analyst

Yes, and as it relates to DMD, and I'll let Mike continue to answer the question, but subsequently, I mean as we shared on research day, there's a lot of excitement as we think about the in vivo data we're generating across cell uptake of PN chemistry, and we'll talk about this in the context of muscle, obviously, for DMD, but as we just shared today, one can see that transitioning across neurons and other aspects. Mike, do you want to answer the question on DMD?

Mike Panzara

Analyst

Sure. Sure, Paul, yes. So as Paul just said, I mean we're seeing something very different in terms of tissue access, distribution, and importantly durability when the PN backbones are added to identical PS/PO molecules. So DMD, where we are, why we're thinking this could address these issues, first of all, the in vivo model, it targets exon 23, but you see a clear difference in terms of tissue, in terms of clinical effects, in terms of what we're seeing in that model, the PS/PO versus a PN. So clearly we're seeing a difference there that is encouraging. The PN does seem, as Paul alluded to earlier, introduce a negative -- introduce neutral charges to the backbone which changes the overall potentially effect on how that molecule accesses tissues. And as I said, the durability here is clearly different. So maybe having it in the tissues longer at higher concentrations with better access could address this change we saw, this lack of access that we saw with suvodirsen. So the overall picture here is that there are a lot of characteristics of the molecule in the preclinical data that we are seeing that give us hope, but you can only take that so far with an exon targeting or with an ASO targeting a different exon and manual, and you just need to take it into a human study to really answer that question, and we can do that very efficiently as described.

Joon Lee

Analyst

Thank you.

Paul Bolno

Analyst

Yes, just to follow-up on that. I mean I think, Joon, one of the other -- yes, as Mike alluded to with the DKO mouse study and the comparison, I think the other -- the piece that was also important was that substantial reduction in dose. So really not just seeing that improvement, but seeing that improvement at 50% less than that PS/PO drug, so 75 milligrams per kilogram, and every other week, so not even weekly. So I think we see that as important. I think we also see good distribution in that model which is heavily sensitive across cardiac and pulmonary phenotype with distribution to heart and diaphragm. So we're pretty excited about the characteristics there. One other point just to bring back up to Alpha-1 antitrypsin deficiency is you were asking questions about protein augmentation, and it should be noted that that therapy is a weekly IV infusion. So in terms of just correcting, not just in terms of the hepatic, but also being able to restore the normal protein in a lung, being able to move patients off of weekly IV administration to real correction of the physiologic protein, that's something we're pretty excited about brining forward.

Joon Lee

Analyst

Great, thank you, and looking forward to the data updates. Thank you, guys.

Operator

Operator

Your next question is from the line of Mani Foroohar with SVB Leerink.

Rick Bienkowski

Analyst

Hi, good morning. This is Rick on the line for Mani. Congrats on all the progress. My first question is also on N531. So I was hoping you can elaborate a little bit more on what you're seeing in the preclinical studies with the PN chemistry? And I guess besides tissue access, would you expect to see any improvements in either tolerability or therapeutic window compared to suvodirsen?

Paul Bolno

Analyst

I mean, I'm going to let Mike continue. I mean I think as we alluded, one, with the distribution we're seeing it's substantially less dose, so have the amount of drug at -- and expanding the time interval out longer. We're seeing that -- those changes in a mouse that has a phenotype, and I think that's really important to note, because often times we talk to -- people talk about MDx data where there isn't a phenotype that is purely around dystrophin. So I think what's exciting about this model for us is this model does have the phenotype that's being corrected with this exon 23 skipping compound, as Mike said, with the PN chemistry. So we're excited about that in terms of exposure distribution and being able to evaluate that in the model. Mike, do you have anything you want to add to that?

Mike Panzara

Analyst

Yes, and I would say we also expect the therapeutic window to be quite different. I mean we're seeing that lower doses given less frequently are leading to effects that suggest that there's clearly a difference in that therapeutic window, as well as supported by all of the other preclinical studies between the molecules. So we would anticipate there being a difference, but obviously until you test that hypothesis in humans you don't know, which is why we've decided that the best way to proceed here is to proceed with a study that can be focused, focusing on target engagement in a small number of patients, but definitive to give us enough information to make that determination whether there is this difference.

Rick Bienkowski

Analyst

All right, got it. Thanks for that, and I have a follow-up about the Huntington's program, so could you maybe discuss some of the learnings from PRECISION-HD1 and HD2 that you're brining with you into the dose escalation of WVE-003? And if you think you'll be able to start at a -- the escalation at a more clinically relevant dose than the earlier studies, or maybe could you escalate more rapidly than PRECISION-HD1 and HD2 in the newer study?

Paul Bolno

Analyst

Mike, do you want to take that question?

Mike Panzara

Analyst

Yes, sure, absolutely. So, I think we've learned a lot, obviously, from PRECISION-HD1 and 2. We've learned that how to run these studies, how to engage community, how to find patients. I think the important thing here is, as I mentioned earlier, is we're in a situation where we have in vivo data to help give us a bit more guidance on where we need to be. So we would anticipate therefore starting at dosing levels that would be more in that window where we would expect to engage target, and a dose escalation scenario driven by those in vivo data as well as the data that we're going to be generating in an ongoing fashion from the clinical study itself, and I think what's very important is this once -- once again, every molecule that comes out of the PRISM platform has a different pharmacology, has a different characteristics in vivo and in vitro, and that's what's going to guide how we approach the next study. So when you see the study you'll see there are elements we've adapted from our existing studies, and you'll also see some pretty meaningful differences that we have -- that have been driven by the pharmacology of the 003 molecule.

Paul Bolno

Analyst

I think the other thing just to add to that in terms of identifying patients is, with -- to your point, Rick, with the ability now to have ongoing studies where we're screening for SNP, the apparatus around the phasing, we're able to do that a lot more efficiently now with the practice around SNP1 and SNP2, and also by screening those patients having a good understanding of SNP3 and where those SNP3 patients are. So as we look at the totality of the SNP3 program beyond just the SNP3 characteristics of the medicine itself, the broader infrastructure for clinical trial operations is in place to do this.

Mike Panzara

Analyst

Absolutely.

Rick Bienkowski

Analyst

All right, great. Thanks for taking our questions.

Paul Bolno

Analyst

Thank you.

Mike Panzara

Analyst

Thank you.

Operator

Operator

Your next question is from the line of Salim Syed with Mizuho.

Salim Syed

Analyst

Great. Good morning, everybody, and thanks for the color, guys. Just three for me, if I can, Paul, on the PRECISION trials, in the second quarter call you had talked about site lockdowns in Australia given half of your sites are currently there. So wondering if you could just give us an update on what you're seeing with COVID-19 in Australia, are you still seeing the site lockdowns there or are you seeing new patients coming back on -- into those trials, the ones that you identified, and are you close to finishing enrollment? Number two, on the going higher than 32 milligrams, now that we're getting close to the end of the fourth quarter here, what is your framework here, to go potentially higher than 32 milligrams given you don't need all the data from that cohort? And will you disclose this to the Street if you decide to go higher, and how will you do that? And then just lastly on 531 DMD, if you can just give us some color as to whether you plan on keeping 100% of the economics there or partnering that program out? Thanks so much.

Paul Bolno

Analyst

Thank you, and I'll let Mike take the first two questions related to HD, and then I'll answer your last question on DMD. Mike, do you want to answer the questions on HD?

Mike Panzara

Analyst

Sure. So, first of all, focusing on the environment with COVID as we said at the last call, there were lockdowns that were clearly having differences along the way and impacting our ability to recruit. That is a moving target, but I can say that as sites have closed down, others have opened up as lockdowns end, sites open up again. So, we've been actually very fortunate that last time it was -- one of the big factors was Melbourne had just shutdown, Melbourne is up, and certainly cities and different places are opening and closing. I mean, this is an evolving landscape where -- but we're -- what's been great is that we have really good communication with the investigators, so we can anticipate when these things are happening and then redirect if necessary, but right now with the way we're headed, none of that has impacted our ability to have the data readout in the first quarter, which is what we're reaffirming we're going to have today. In terms of the framework to go higher with being one quarter away from the definitive multi-dose readout. At this point, we thought it may just make the most sense to wait to see that dataset in terms of degree of knockdown, in terms of the overall profile of the product before making that decision. I mean, as we've said previously, we have the therapeutic window. We have the ability to go higher from a preclinical perspective, but being so close to the definitive readout, we just thought it was best to wait for that at this time. So that's where we are with that, and I'll pass it back to Paul for the question about the partnering.

Paul Bolno

Analyst

And just, I mean, to wrap up on HD, I mean, we're excited at getting to this data readout. I mean, as you know, we provided updates. If there were any changes that impacted the updates to the readout timing and we remain on track for the first quarter of 2021 data readouts. As far as DMD and the percent of economic, I think this is something that we thought very carefully about around where and how to partner. I say you often partner, because you require the financial means to deliver on the data or you need to leverage some sort of operating capability or capacity to deliver that, and I think what the team has done and where we are is we can deliver this study that Mike laid out today within our runway, and therefore, I think it's important for us to continue to generate that data for both the platform and this particular program specifically, and for right now retain 100% of the economics as we push forward, but as anything, it's something that we'll continue to evaluate as we move that program forward.

Salim Syed

Analyst

Super helpful. Thanks so much, guys.

Operator

Operator

Your next question is from the line of Paul Matteis with Stifel.

Unidentified Analyst

Analyst

Hi, thanks for taking the question. This is Alex on per Paul. Just a couple on your AATD program, first, I was just curious if you could elaborate on how -- what proportion of the homozygous have that G-to-A mutation? And then along with that, I am curious if you can talk a little bit more about kind of the rationale for the ADAR strategy and its ability to allow for that physiologic regulation of AAT? Thanks so much.

Paul Bolno

Analyst

Yes, great question. It's something we focused in about 5% to 15%. I know that's a reasonable range, our patients who are amenable. So, our number on the 250,000 patients are the estimated patient populations worldwide, so 250,000 patients worldwide that are amenable to the correction of this mutation. I think we've stayed focused on this concept of correction around bringing kind of the concept around physiologic regulation, meaning restoring, and so, by correcting the transcript, therefore not knocking it out, but allowing for the production of a wild-type protein that then can be used as physiologically required. So, oftentimes it's known that since it's engaging [indiscernible] to the lung, which can result from injury in the lung to activating and acquiring this protein. By having that protein around that enables it to be responsive as it would be under normal circumstances. So I think the exciting aspect of bringing this program is really bringing a different way of thinking about the treatment of the disease, which is one around correction. So, not taking away a mutant protein and or requiring weekly IV protein augmentation therapy, but rather restoring physiologic balance through the correction of the transcript, which is really the hallmark of RNA editing. So we're excited about this space, and more broadly, we're excited about what it means as we think about different diseases in ADAR as a platform. So, we do look at this, obviously, AATD as initial therapeutic approach, but I think when we step back and say, what are we learning about ADAR, we're investing and building this proprietary model that will now let us be able to cross it with multiple diseases and look at the human ADAR enzyme in the context of disease, we build models for therapeutic program, I think we think much more broadly about the treatments that could be possible with Alpha-1 antitrypsin deficiency.

Unidentified Analyst

Analyst

Thanks so much.

Operator

Operator

Your next question is from the line of Eun Yang with Jefferies Jefferies.

Eun Yang

Analyst

Thank you, I have more speculative questions. So on HD program, as we expect data in the first quarter of next year, hypothetically, if you see similar mutant HTT reduction at 32 milligram as what you saw as 16, would you make a go, no go decision at that point or still pursue a higher dose?

Paul Bolno

Analyst

I think that's exactly to Mike's point what we want to stay focused on in terms of analyzing the data. So being data driven, there's a variety of biomarkers to look at and ascertain at that point, do we believe going higher will be there? Are we at that dose as we think about that, that's the point, I think if we see a plateauing, there's a variety of other biomarkers to assess as part of that clinical data outcome, and we'll have to do that in the first quarter, once we have that data. Mike, any additional thoughts?

Mike Panzara

Analyst

No, nothing else there, Paul, I mean, we have a lot of things we're going to be looking at. So it's not the least of which is what's meaningful, in this setting, a very specific, knockdown as opposed to Pan selective, which is different, they have to be looked at differently, and that'll all be part of the conversation.

Paul Bolno

Analyst

But I think, Eun in terms of having tools for the Allele-selective therapy, it's one advantage of why we're not getting the SNP-3 WV-003 on that readout. So we're excited about driving that program forward independently because we do believe in this and this Allele-selective approach, the data that we're seeing in the literature continues to grow and wild-type sparing, and so, we'll have other programs to be able to assess that, but we'll have to look at the totality of the data in the first quarter.

Eun Yang

Analyst

Yes, that's informative, and a lot of questions on the DMD program exon 53 candidate, so in vitro model, you saw dose dependent increase in dystrophin production up to 70% of the normal, and I understand that we improve the durability and tissue penetration. I mean, can you extrapolate from this in vitro study data to what you could realistically expect in humans?

Paul Bolno

Analyst

I think we're going to reserve speculation from the in vitro study, I think we see substantial dystrophin production with the candidate that's going to be tested in the clinic, that gives us a lot of confidence on dystrophin production and the preclinical data supporting exposure, I think, coupling that with the DKO data, which is here you have a phenotype that you can correct and restore. I think that gives us confidence that, indeed, we are getting into dystrophic muscle and having an impact granted with the 23 molecule, but in vivo data at lower dose is less frequently, which give us confidence. I think the study that Mike laid out that we're going to be pursuing is measured for that exact reason. I think we're disciplined after our Suvodirsen experience that we do need to see what happens in the DMD poise, and we've had a lot of conversations with the community, having seen the data, who are extraordinarily supportive after this approach and the data that we've generated, but we need to generate that data, and we're excited to be able to do that. Mike, I don't know, you want to add to that?

Mike Panzara

Analyst

Yes, and the only thing I would add is, I think as you captured nicely, this entire DMD space is unfortunately lots of disappointment about what can translate preclinically to clinically, we have a lot of evidence that suggests that we have something here that could be different, but really the best way is to get it into human beings take a look judiciously at, we execute this study in a way that allows us to assess that profile and make determinations of next steps that we felt that was the most responsible way to proceed.

Eun Yang

Analyst

Okay, thank you very much.

Mike Panzara

Analyst

Thanks, Eun.

Operator

Operator

Your next question is from the line of Yaron Werber with Cowen.

Unidentified Analyst

Analyst

Hi guys, this is Brendan on for Yaron. Thanks very much for taking on the question. Just a couple quick ones from me, I guess. First in HD, I just wanted to check in on the wild-type huntingtin as and kind of see where this stands. I know in the past, there has been talk of maybe some updates to the assay, it felt just to make sure you're really able to see differences and kind of little sparing effect and just kind of -- I just wanted to check in on that. And then, for DMD, as we're kind of looking across the space, obviously, between the exon skippers and like gene therapy, for example, we're seeing kind of different, the five different mechanisms, just different results here. So, just kind of trying to get your thoughts on where your bar is for this Phase 1, are you really hoping to see level of protein restoration or maybe improve NSA that we've seen with gene therapy, or you're really aiming for the bar closer to where we stand with exon skipping ASS? Thanks.

Paul Bolno

Analyst

Excellent, I mean, the short answer on the first question is, we continue to do the work, as we alluded to earlier on the wild-type assay and we anticipate and we're working hard to deliver that with our data in the first quarter. We agree that's an important way of driving that assessment, as it relates to the bar, I think what we were excited about now is restoring dystrophin and having an impact, this study is initially anticipated, it is not a clinical outcome study, we're not right now looking at this in the context of that would be something that would follow-up, as you pointed out, the NSA and other metrics, that's something that we could continue to follow. I think the first question we want to ask is dystrophic muscle exposure, dystrophin production and safety, those are the key drivers to give us a sense moving forward, and we're excited about the prospects based on the preclinical work, but we also want to be really measured on where we are, I think if we see what we're seeing in the DKO mouse, which is these mice that should actually not be living, we're restoring a survival phenotype in them, and that's not just about skeletal muscle, and I think one nuance that we're excited about with the prospects of the addition of PN chemistry now is exposure to heart and diaphragm. So these might have, the full phenotypes and are dying from cardiac and respiratory complications. So the ability to access both those other tissues beyond skeletal muscle is really what excites us about this program and at the dosing intervals and doses that we're using. So I think there's a lot to be excited about to go forward, but again, this first study is about that measured approach to assessing that, and I'll pass to Mike, is there anything you want to add to either of those points?

Mike Panzara

Analyst

No, nothing to add to that. Thanks, Paul.

Unidentified Analyst

Analyst

Great. Thanks, guys.

Operator

Operator

Your next question is from the line of Luca Issi with RBC Capital.

Luca Issi

Analyst

Terrific. Thank you for taking my question, congratulation on all the progress here. Two quick one for me; one, it is my understanding that all five studies that are ongoing in 2021 will be actually ex-U.S. One, is that correct? Two, if so, are you planning to open an IND in the U.S. for any of the programs, and how should we think about timelines there, two, I think Ionis showed their initial data for SOD1-ALS was actually more impressive for fast progressors. I do suspect the same for C9 and if so, are you planning to enrich your trials for such patient? Thank you.

Paul Bolno

Analyst

Thank you for your questions. Mike, do you want to take the question?

Mike Panzara

Analyst

Sure. Yes, so regarding first question about where we're conducting the study, it's our intention for I mean as you know, PRECISION HD1, PRECISION HD2 we have some sites in the U.S., and we have some sites outside the U.S. So multidose is outside the U.S., as we've always talked about. So regarding other programs, we anticipate that these are going to be global studies, and we anticipate conducting these studies in the U.S., except for in N531, as we've already said will be just a small proof-of-concept study ex-U.S. So I would, so that is our intention. We're very optimistic that we'll be able to do that. Regarding the second question, which was again…

Luca Issi

Analyst

I was just wondering about SOD1, I think as Ionis for this study. Yes, go ahead.

Mike Panzara

Analyst

I'm sorry, yes, thank you. No, sorry about that. Yes, so we'll give more details of the study design early next year, but what I can say is that, I mean one thing about C9orf72 disease in ALS patients, it is a fairly rapidly progressive, they progress it a little more rapid rate than other groups of ALS patients. So, that's going to be something that will just be a factor of the population itself. The way we're approaching our C9orf72 program is really focusing on C9 disease, if you will, these are patients that could have ALS, they could have FTD, they can have the overlap condition, which is actually fairly, not unusual, and that we're really looking to target the disease itself at its origins in both population focusing on a biomarker readout that will allow us then to make those decisions on how we progress clinically. So that's how we're approaching it. Again, we're approaching it as a single, rapidly progressive thing focused on target engagement at the biomarker level.

Luca Issi

Analyst

Great, thanks guys.

Mike Panzara

Analyst

Thank you.

Operator

Operator

I'm showing no further questions at this time. I would now like to turn the conference back to Dr. Paul Bolno.

Paul Bolno

Analyst

Thanks everyone for joining the call this morning to review our third quarter update, and thanks to our employees for their hard work and commitment to patients. We look forward to speaking with you all again soon. Have a nice day. Thank you.

Operator

Operator

Ladies and gentlemen, this concludes today's conference. Thank you for your participation and have a wonderful day. You may all disconnect.