Taysha (TSHA) Q4 2025 Earnings Call Transcript

Image source: The Motley Fool.

Date

Thursday, March 19, 2026 at 8:30 a.m. ET

Call participants

• Chief Executive Officer — Sean Nolan
• President and Head of R&D — Sukumar Nagendran
• Chief Financial Officer — Kamran Alam

Need a quote from a Motley Fool analyst? Email pr@fool.com

Takeaways

• REVEAL Phase 1/2 response rate -- 100% response rate in ten patients treated with TSHA‑102, across both low- and high-dose cohorts, as reported in Part A of the trial.
• Six-month high-dose response -- 83% response rate observed at six months, with five out of six high-dose patients gaining or regaining one or more developmental milestones.
• Average milestone gains -- Approximately nineteen developmental gains per patient, as captured by validated clinical assessments in Part A.
• FDA regulatory alignment -- Written FDA alignment obtained on both REVEAL pivotal and ASPIRE trial designs, enabling a potentially streamlined BLA submission pathway.
• Breakthrough therapy designation -- TSHA‑102 received this designation from the FDA during the reporting period.
• First patient dosed in pivotal trial -- Pivotal REVEAL trial initiated and first patient dosed; enrollment is advancing across multiple sites, with dosing completion targeted for 2026.
• ASPIRE trial initiation -- FDA cleared the safety-focused ASPIRE trial, which is enrolling patients aged two to less than four years, and is designed to support a broad label via BLA submission.
• No serious safety events -- As of the March 2026 data cutoff, no treatment-related serious adverse events or dose-limiting toxicities observed in the patients treated in the REVEAL Phase 1/2 and REVEAL pivotal trials.
• CMC and data pooling -- FDA agreed to allow pooling of data from REVEAL Phase 1/2, REVEAL pivotal, and ASPIRE trials for the BLA, based on comparability between clinical and commercial lots.
• BLA-enabling PPQ lots -- Process performance qualification (PPQ) lots for TSHA‑102 will be initiated in 2026, with completion expected by year end.
• Population and market opportunity -- Estimated 15,000 to 20,000 Rett syndrome patients across the U.S., EU, and UK, with 6,000 to 9,000 patients in the U.S. alone.
• Market research insights -- Caregivers emphasized that improvements in existing function, or the achievement of new functional gains, would be meaningful for individuals with Rett syndrome.
• Intrathecal administration benefits -- Intrathecal delivery for TSHA‑102 is routine, minimally invasive, and enables outpatient treatment, expanding access beyond major centers.
• Commercial infrastructure -- Brad Martin appointed as Senior Vice President of Market Access and Value to build commercialization capabilities.
• R&D expenses -- $86.4 million for the year ended December 31, 2025, up from $66 million in 2024, primarily driven by higher headcount and REVEAL study activities.
• General and administrative expenses -- $33.9 million for 2025, compared to $29 million in 2024, largely due to compensation, legal/professional fees, and debt-related costs.
• Net loss -- $109 million, or $0.34 per share for 2025, versus $89.3 million, or $0.36 per share, for 2024.
• Cash and cash equivalents -- $319.8 million as of December 31, 2025.
• ATM equity raise -- $50 million raised in gross proceeds in Q4 2025 through the at-the-market offering, supporting a planned commercial inventory build in 2027.
• Cash runway -- Management expects current cash resources to fund operations into 2028.

Summary

Taysha Gene Therapies (NASDAQ:TSHA) advanced TSHA‑102 to pivotal development for Rett syndrome, achieving regulatory milestones including Breakthrough Therapy designation and written FDA alignment supporting a streamlined BLA submission. Enrollment in the pivotal REVEAL trial progressed on schedule, complemented by initiation and FDA clearance of the ASPIRE trial for younger patients. Safety data show no treatment-related serious adverse events or dose-limiting toxicities in all clinical studies as of the current cutoff. Strategically, the company secured FDA agreement to pool data from REVEAL Phase 1/2, pivotal, and ASPIRE studies into its planned BLA, with commercial manufacturing processes deemed comparable to clinical lots. The current cash position and recent equity raise position Taysha Gene Therapies to fund operations through major regulatory and commercial milestones.

• Natural history data show that patients follow a common trajectory regarding the achievement of functional developmental skills, with the likelihood of spontaneous gain or regain of developmental milestones falling to approximately zero after six years of age.
• BLA submission timing scenarios depend on FDA receptivity to six- or twelve-month data in pivotal studies, with rolling submissions considered if additional durability data is requested.
• In the ASPIRE trial, efficacy data for two- to less than four-year-olds will be extrapolated from REVEAL pivotal trial results per FDA guidance.
• Management emphasized that intrathecal administration is preferred by caregivers and clinicians for its familiarity, and scalability to community and regional care settings.
• Approximately half of Rett syndrome patients interact with a center of excellence annually, illustrating the potential reach for outpatient administration.
• Pooling across datasets enables analyses by safety, efficacy, age distribution, and duration of effect, enhancing the regulatory submission package.
• Enrollment in the pivotal trial is advancing with active screening and dosing at multiple sites for the fifteen-patient target population.
• The internally developed Developmental Milestone Assessment (DMA) ensures standardized, rigorous collection of clinical outcomes, an element highly valued by the FDA.

Industry glossary

• BLA (Biologics License Application): A regulatory submission to the FDA seeking approval to market a biologic product in the United States.
• CMC (Chemistry, Manufacturing, and Controls): Section of regulatory submissions detailing manufacturing process, product comparability, and quality assurance data.
• PPQ (Process Performance Qualification): Manufacturing campaigns conducted to demonstrate process consistency and support validation for commercial production.
• REVEAL: The TSHA-102 clinical trial program, including Phase 1/2 and pivotal studies, for Rett syndrome.
• ASPIRE: A safety-focused clinical trial enrolling younger patients with Rett syndrome to supplement efficacy data for regulatory submissions.
• CGI (Clinical Global Impression): A clinician-rated assessment tool measuring symptom severity, global improvement, and efficacy of treatments.
• COA (Clinical Outcome Assessment): A type of measure used to determine how a patient feels or functions in clinical trials.
• ATM (At-the-market offering): A mechanism allowing a company to sell newly issued shares into the secondary market incrementally at prevailing market prices.
• Intrathecal administration: Delivery of medication directly into the spinal canal, allowing access to the central nervous system, commonly used for gene therapies targeting neurological diseases.

Full Conference Call Transcript

Hayleigh Collins: A copy of this press release is available on the company’s website and through our SEC filings. Joining me on today’s call are Sean Nolan, Taysha Gene Therapies, Inc.'s Chief Executive Officer; Sukumar Nagendran, President and Head of R&D; and Kamran Alam, Chief Financial Officer. We will hold a question-and-answer session following our prepared remarks.

On today’s call, we will be making forward-looking statements, including statements concerning the potential of TSHA-102, including the reproducibility and durability of any favorable results initially seen in patients dosed to date in clinical trials, including with respect to functional milestones, to positively impact quality of life and alter the course of disease in the patients we seek to treat; our research, development, and regulatory plans for our product candidates, including the timing of initiating additional trials, reporting data from our clinical trials, and making regulatory communications with the FDA on the regulatory pathway for TSHA-102; the potential for the product candidate to receive regulatory approval from the FDA or equivalent foreign regulatory agencies; our ability to realize the benefits of Breakthrough Therapy designation for TSHA-102; our ability to drive long-term value for stockholders; and the market opportunity for our programs.

This call may also contain forward-looking statements relating to Taysha Gene Therapies, Inc.'s growth, forecast cash runway and future operating results, discovery and development of product candidates, strategic alliances, and intellectual property, as well as matters that are not historical facts or information. Various risks may cause Taysha Gene Therapies, Inc.'s actual results to differ materially from those stated or implied in such forward-looking statements. For a list and description of the risks and uncertainties that we face, please see the reports we have filed with the SEC, including in our Annual Report on Form 10-K for the full year ended December 31, 2025, that we filed today.

This conference call contains time-sensitive information that is accurate only as of the date of this live broadcast, March 19, 2026. Taysha Gene Therapies, Inc. undertakes no obligation to revise or update any forward-looking statements to reflect events or circumstances after the date of this conference call, except as may be required by applicable securities laws. With that, I would now like to turn the call over to our CEO, Sean Nolan.

Sean Nolan: Thank you, Hayleigh. On to our full-year 2025 financial results and corporate update conference call. On today’s call, we will begin with a brief update on recent clinical, regulatory, and commercial readiness activities. Then Dr. Sukumar Nagendran, our President and Head of R&D, will provide a clinical update on the TSHA-102 program. Kamran Alam, our Chief Financial Officer, will follow up with a financial update, and I will provide closing remarks and then open the call up for questions. 2025 was a year of significant execution for Taysha Gene Therapies, Inc.

We announced compelling REVEAL Phase 1/2 data across pediatric, adolescent, and adult patients with Rett syndrome treated with TSHA-102, received FDA Breakthrough Therapy designation for TSHA-102, and secured written FDA alignment on our REVEAL pivotal and ASPIRE trial designs, paving the way for a potentially streamlined path toward BLA submission. This progress has set the stage for what we expect to be a transformative year ahead for Taysha Gene Therapies, Inc. as we focus on completing the pivotal development of TSHA-102 and bolstering our commercial readiness efforts as we advance towards potential registration.

We have maintained ongoing, constructive dialogue with the FDA over the past two years, which has enabled alignment on a pathway that we believe reflects the rigorous, systematic data collection and well-controlled study design and endpoints required by the FDA for a robust, data-driven application. In 2025, we finalized alignment with the FDA on our REVEAL pivotal trial protocol and statistical analysis plan in support of our planned BLA submission, and we were pleased to initiate the pivotal trial in 2025 with the dosing of our first patient. Multiple patients have now been dosed in the trial, with enrollment advancing across multiple sites. We remain on track to complete dosing in 2026.

Importantly, both high- and low-dose TSHA-102 continue to be generally well tolerated, with no treatment-related serious adverse events or dose-limiting toxicities observed in the patients treated in both the REVEAL Phase 1/2 and REVEAL pivotal trials as of the March 2026 data cutoff. In addition to initiating our REVEAL pivotal trial, we recently received FDA clearance to initiate the safety-focused ASPIRE trial, following written FDA alignment on the ASPIRE trial design and data for inclusion in our BLA submission to support a broad label for TSHA-102 for patients aged two years and older with Rett syndrome.

ASPIRE will enroll three females with Rett syndrome aged two to less than four years, evaluating the safety and preliminary efficacy of a single intrathecal administration of the high dose of TSHA-102, 1e15 total vector genomes scaled to account for the lower brain volume in the two to less than four-year-olds. The written alignment we reached with the FDA outlines that our planned BLA submission will include a minimum of three months of ASPIRE safety data, while the efficacy in the two to less than six-year-old population will be extrapolated from the data collected in the REVEAL pivotal trial to support the broad label. We are on track to complete dosing for ASPIRE in 2026.

We believe this recent FDA alignment on ASPIRE, together with the alignment on a six-month interim analysis for the REVEAL pivotal trial, potentially streamlines our path toward BLA submission for TSHA-102. In 2026, we attended a Type C meeting with the FDA and reached written alignment on the CMC requirements for our planned BLA submission. Specifically, we further aligned with FDA on our proposed comparability approach between TSHA-102 material derived from the clinical and final commercial manufacturing processes. The FDA agreed that the approach may support pooling data from the REVEAL Phase 1/2 trials with data from the ongoing REVEAL pivotal trial and the ASPIRE trial for the planned BLA submission.

Importantly, we believe this creates flexibility and will further strengthen the overall dataset for the BLA package by including longer-term data and enabling a comprehensive assessment of safety and efficacy data that has been generated across the entire development program. Additionally, the FDA endorsed our proposed process performance qualification, or PPQ, campaign strategy to support process validation for the BLA submission. This included the stability data package, the potency assay strategy, and the execution of BLA-enabling PPQ lots using the commercial manufacturing process, which we expect to initiate in 2026. This feedback aligns with the agency’s January 2026 guidance aimed at increasing flexibility on requirements for cell and gene therapies to advance innovation.

With this alignment, we are confident that our CMC activities are on track to support our planned BLA submission in step with the pivotal dataset readout. We truly appreciate the consistent, constructive, and collaborative interaction we have had with the FDA to date and believe our regulatory progress highlights the strength of our data-driven approach and further supports our goal to bring TSHA-102 to patients with Rett syndrome as safely and expeditiously as possible. We will continue to engage with the FDA as we prepare for our planned BLA submission. In addition to our clinical and regulatory progress, we have continued to bolster our commercial readiness activities.

As a reminder, Rett syndrome is a devastating, rare, and progressive neurodevelopmental disease with high unmet need and a profound lifelong burden for patients and caregivers. It is well-characterized clinically, defined by impairments across multiple clinical domains, including fine and gross motor function, communication, autonomic function, and seizures. While Rett syndrome is a heterogeneous condition that presents with different levels of clinical severity based on each patient’s distinct genetic background, natural history data show that patients follow a common trajectory regarding the achievement of functional developmental skills, with the likelihood of spontaneous gain or regain of developmental milestones falling to approximately zero after six years of age.

The multi-domain impairments result in loss of independence, with most individuals requiring 24/7 care and lifelong support for daily activities, such as eating or sitting up, severely impacting quality of life for patients and caregivers. This burden and the limitations of currently approved therapies, which focus on symptom management and do not address the underlying genetic root cause, have created strong urgency for new treatment options capable of delivering functional improvements. We believe this urgency, combined with the estimated 15,000 to 20,000 patients with Rett syndrome across the U.S., EU, and UK, underscores the substantial market opportunity for TSHA-102. Within the U.S. specifically, patient estimates range from 6,000 to 9,000 patients based on claims data and epidemiology data.

Because Rett syndrome is a neurodevelopmental condition, and based on the Phase 1/2 data we have reported to date across pediatric, adolescent, and adult patients, we believe that most patients with Rett syndrome can meaningfully benefit from treatment. TSHA-102 is uniquely designed to address the root cause of Rett syndrome and, as such, has the potential to meaningfully alter the natural history of the disease and offer patients the opportunity to achieve functional milestones that would otherwise not be possible according to natural history. Recently completed market research reinforces this opportunity, as it demonstrated high anticipated demand from both clinicians and caregivers in the U.S. and a clear preference for intrathecal administration.

The research findings are compelling for two main reasons. First, the research suggests that clinicians anticipate broad adoption of TSHA-102 across pediatric and adult patients with Rett syndrome. Caregivers similarly indicated that they would actively pursue an improved gene therapy with a target product profile consistent with TSHA-102. Caregivers emphasized that improvements in existing function or the achievement of new functional gains would be meaningful for individuals with Rett syndrome, as they translate into greater independence in daily living, such as speaking in phrases, walking with support, or finger feeding, which we have observed in patients treated with TSHA-102 in REVEAL Part A.

Second, clinical outcomes will be the ultimate driver; however, market research indicated that clinicians and caregivers strongly prefer intrathecal administration over direct-to-brain CNS delivery, citing its familiarity, accessibility, and scalability, enabling the potential to safely and efficiently treat patients across institutions, from large centers of excellence to regional and local institutions. This facilitates broad patient access. Specifically, intrathecal administration, as it is used to deliver TSHA-102, is a routine, minimally invasive delivery approach that does not require a surgical suite or delivery by a neurosurgery expert.

This enables the potential for TSHA-102 to be delivered as an outpatient procedure, which in turn may meaningfully expand the treatment footprint, given that administration in the commercial setting will not be limited only to centers of excellence. We believe this broader footprint would enable us to reach patients where they are already receiving care and support, and this is scalable as adoption and demand grow. Finally, as we advance towards registration, we are continuing to build out our internal commercial infrastructure. To that end, we recently appointed Brad Martin as Senior Vice President of Market Access and Value, further strengthening our commercial leadership team.

Brad brings over two decades of leadership experience in market and commercial strategy, pre-commercial and product launch planning, as well as payer and health system engagement within the gene therapy space. He previously held senior roles at Neurotech Pharmaceuticals, Sarepta Therapeutics, and AveXis. At AveXis, he played a crucial role in securing market access for the blockbuster gene therapy Zolgensma, for the treatment of spinal muscular atrophy. We plan to continue to build out commercial capabilities as we prepare for a potential commercialization, and we expect to share additional details on our TSHA-102 commercial strategy in the second half of the year.

I would now like to turn the call over to Sukumar to discuss progress on the clinical front in more detail. Suku? Thank you, Sean.

Sukumar Nagendran: As Sean mentioned, we believe we have made significant progress on advancing our Phase 1/2 program and the FDA alignment. As a reminder, we presented data from Part A of the REVEAL Phase 1/2 trial last year, demonstrating a 100% response rate from the 10 treated patients in both low- and high-dose cohorts. An 83% response rate was seen at six months post-treatment, with five out of six patients gaining or regaining one or more milestones defined across the six treated high-dose patients. In addition to the 32 developmental milestones, an average of approximately 19 gains per patient as captured by validated clinical assessments.

We have observed a consistent pattern of early gains that was sustained, with additional gains over time. We will provide the six-month interim analysis for the REVEAL pivotal trial and efficacy data across all 12 pediatric patients treated in REVEAL Part A in the second quarter of this year, and all patients will average 12-month follow-up time points across multiple clinical outcome measures, as well as continued well-tolerated safety profile. Today, on the trajectory of the gain, loss, and regain of development provided for TSHA-102, the combined likelihood of spontaneous milestone gain or regain drops to 6.3% after age six compared to rates as high as 85% between the ages of one and five years.

These findings align with our own analysis, which allows us to generate data across the broader population while significantly mitigating statistical risk by enrolling 15 patients aged six to less than 52 years in the developmentally regressed population of Rett syndrome, the population with the most stable baseline and lowest spontaneous improvement rate. Importantly, this design enables us to test our response rate against the known hypothesis of 6.7% at age six and older. As Sean mentioned, we have dosed multiple patients in our REVEAL pivotal trial. Enrollment continues to advance across multiple clinical trial sites. We expect to complete dosing in the REVEAL and ASPIRE studies in 2026.

We believe our ongoing dialogue with the FDA over the last two years supports the potential path to registration. Looking ahead, we remain focused on our clinical trial execution and data generation as we work to complete patient enrollment and advance towards registration. We believe the thoughtful, data-driven approach we have taken in designing and executing our pivotal development strategy positions us to deliver. I would now like to turn the call over to Kamran to discuss financial results. Thank you, Suku.

Kamran Alam: Research and development expenses were $86,400,000 for the year ended 12/31/2025 compared to $66,000,000 for the year ended 12/31/2024. The $20,400,000 increase was primarily driven by higher compensation expenses due to increased research and development headcount. Clinical trial and GMP expenses also increased during the year ended 12/31/2025 due to clinical trial activities in the REVEAL studies and BLA-enabling PPQ manufacturing initiatives. General and administrative expenses were $33,900,000 for the year ended 12/31/2025 compared to $29,000,000 for the year ended 12/31/2024.

The increase of $4,900,000 was primarily due to higher compensation expenses and higher legal and professional fees, as well as debt issuance costs incurred in connection with the 2025 Trinity term loan that are recorded in general and administrative expense under the fair value option. Net loss for the year ended 12/31/2025 was $109,000,000, or $0.34 per share, compared to a net loss of $89,300,000, or $0.36 per share, for the year ended 12/31/2024. As of 12/31/2025, Taysha Gene Therapies, Inc. had $319,800,000 in cash and cash equivalents.

During the fourth quarter, we raised an additional $50,000,000 in gross proceeds by utilizing our at-the-market, or ATM, equity offering program, with proceeds intended to support a potential commercial inventory build in 2027. We expect that our current cash resources will be sufficient to fund planned operating expenses into 2028. I will now turn the call over to Sean for his closing remarks.

Hayleigh Collins: Sean?

Sean Nolan: Thank you, Kamran. The progress we made in 2025 has set the stage for what we expect to be a transformative year ahead as we advance towards registration, and our confidence in a differentiated TSHA-102 gene therapy candidate continues to strengthen based on the recent developments highlighted today. With a favorable tolerability profile demonstrated to date, continued patient enrollment, and a well-defined regulatory and commercial path, we believe TSHA-102 has the potential to meaningfully address the genetic root cause of this devastating disease and provide meaningful benefit to a broad population of patients with Rett syndrome using a minimally invasive delivery approach.

On behalf of the entire Taysha Gene Therapies, Inc. team, we remain committed to bringing a potentially transformative therapy to the Rett syndrome community. I will now ask the operator to begin our Q&A session.

Operator: Thank you. Star 11 on your telephone and wait for your name to be announced. To withdraw your question, please press 11 again. Our first question comes from the line of Kristen Kluska with Cantor Fitzgerald. Your line is now open.

Kristen Kluska: Hi, good morning everybody, and congratulations on all the progress. So you had a lot of comments about why the community might favor intrathecal administration. I wanted to first ask if you believe the community has a good understanding of why this route of administration gets to the brain. And then also, you listed several reasons why this might be more favorable. I am curious, both from the clinician standpoint as well as the parent or caregiver, if there is one item on that list that is standing out more than others. Thank you.

Sean Nolan: Yeah. Kristen, thanks for the question. You know, I would say that the support for IT, there were manifold reasons why people wanted to go down that route. The most obvious is everyone can relate to a lumbar puncture. Right? I mean, most of the moms out there have undergone that to some extent. People are familiar with it. They know it is not scary. And I think the most interesting thing is people are taking what I think is a very pragmatic approach. They are basically saying, hey, listen.

The clinical data are going to be the most important thing, and if the data are, let us say, equal, then I am going to go do the least invasive approach I can for the person that I love, for the very simple reason that it does not involve drilling burr holes and going into the ICU and having a neurosurgeon involved. As they learn more about that, I think they are just like, hey, you know what? If all things are equal here, at a minimum, then I am going to take what I feel is the safest approach and the easiest approach.

I think from the clinical perspective, it is the same kind of a logic set where they are saying, listen. Ultimately, it is going to be the clinical data that is going to carry the day. But based on what we know right now, it is easy for us to do this lumbar puncture. And when they start to talk about the practical logistics of the sites, the throughput necessary for intrathecal delivery done in an outpatient is much easier to manage. You do not have to schedule suite time, surgeon time, things like that.

So they are saying, in terms of being able to broaden the reach, go to regional and local hospitals, and make sure that, broadly, the Rett community has access to this therapy, it is a much easier route of administration to administer and provide great care to their patients. Hopefully, that helps.

Kristen Kluska: Okay. Thanks. And just on that point, they do understand that this route of administration is reaching the brain, right?

Sean Nolan: Yes. We did not get into—we did not explain to them the biodistribution. They are basically making the leap that if I administer it that way and the clinical data are good, it is going to where it needs to go. They do not care about biodistribution. They care about the fact that, is my loved one going to get better or not? And they are judging that based on the clinical data, which, you know, the product profile is just the data that we have shown to date. So we feel very—like, we were not surprised by these results at all, frankly.

And I think it makes a lot of sense when you take a step back and just digest it all.

Kristen Kluska: Thank you, Sean.

Sean Nolan: Thanks, Kristen. Thank you.

Operator: Our next question comes from the line of Salveen Richter with Goldman Sachs. Your line is now open.

Salveen Richter: Good morning. Thanks for taking my questions. With the appointment of Brad Martin as Head of Market Access and Value, what will the first priorities be in this role? What are the key aspects of market access that Taysha Gene Therapies, Inc. should be focused on initially? And secondly, can you frame expectations for the update on longer-term safety and efficacy data from Part A? How many patients will we see, what kind of duration of follow-up, and what you are looking for in terms of the efficacy profile? Thank you.

Sean Nolan: Yeah. Thanks, Salveen. To start with the second part of the question first, what you can expect to see is—to take a step back—last time we reported data, it was 10 patients, and at the high dose, we had six months of data on five of the six patients. So what we are planning to do in the Q2 update, you will see data on all 12 Part A patients, and we will have a minimum of 12 months of data on all patients. The report out will be inclusive of the primary endpoint, which would be milestones. We are also going to give an update on the skills, the improvements.

That is the data that we presented at CNS last year. You will see the CGIs. You will see the R-MBA. So you will get a very comprehensive picture of the dataset. And what we hope to show is what we have been able to demonstrate to date, which is that the early improvements are sustained and we continue to see deepening of response over the course of time. If you remember, the first patient we dosed, by the time we report this data, will be about three years post-dose. So we are starting to generate some nice durability data, which is fantastic.

As it relates to what the market access team is doing, there are a lot of steps to take, of course. We generally begin by making sure we are mapping out where the patients are. And then, what is the mix of the payers, so how much commercial pay is there? How much Medicaid pay is there? And then what we will do is make sure from a site activation perspective that we are thinking about the right way to roll this out.

So as an example, because of our market research and what we have seen on the route of administration, what is going to be really nice is that we are going to be able to essentially get to the regional and local hospitals. We want to make sure, though, that we roll this out in a very thoughtful manner and anyone using TSHA-102 is very educated on how to do this, knows how to manage gene therapy patients, and that we are comfortable with them and their institution doing that. So part of it is mapping all that out so that we have a good sequence to the flow.

And then, you know, beginning to work with the payers and talking to them about the market size, talking to them about the clinical data. And the approach that we have taken historically, Salveen, has been get in early with the payers, be very transparent about what type of—what is the volume of patients that they could potentially see, educate them on the disease state, and educate them on your dataset, and really just take them along on the journey. So we look to build relationships with the payers, and that is what the nice thing about Brad is—he has those relationships. He has done this multiple times. And it is never too early to start on this.

You really want to get in as early as you can to really pave the road so that there are no surprises on the back end.

Operator: Thank you. Our next question comes from the line of Biren Amin with Piper Sandler. Your line is now open.

Biren Amin: Yeah. Hi, guys. Thanks for taking my questions. Congrats on all the progress. Sean, I noticed that the company had a successful Type C meeting with FDA this quarter on CMC for TSHA-102. So maybe on the BLA PPQ lots that you are initiating in the second quarter, when would these complete? And if the REVEAL interim data are positive, how soon do you think you can file the BLA after the interim data? Thanks.

Sean Nolan: Hey, Biren. Can you repeat the first question? Yeah. So on the BLA-enabling PPQ lots that are initiating in the second quarter of this year, when would these complete? Kamran, do you want to take that?

Kamran Alam: Yeah. Sure, Sean. So, Biren, nice to talk to you. Yeah. So the PPQ lots will be completed by end of this year. And in terms of the alignment with FDA, I will turn it over to Sean.

Sean Nolan: Yeah. I think, Biren, the plan we have would be we can do the analysis, the interim analysis, once all patients dosed in the pivotal are at six months. That is when the blind would get broken. Obviously, that is going to be dependent on the last patient dosed. Right? So that is going to happen sometime in the second quarter, based on everything that we are tracking to, which looks good. And then we have to adjudicate all that data. We have to make sure it is correct. The next step, we would sit down with the FDA, go through that data with them, and work to align them on what the next steps could potentially be. Right?

And so, post that and post getting minutes, we would come back to the market and give you the update. The reason we do not want to say what the data are before we meet with the FDA is that is only half the story. Right? So we think it is important to meet with the FDA. And I think there are a couple of potential avenues that could happen. Right? I mean, the best-case scenario would be the agency is very pleased with the data and they tell us to proceed to file on the six-month dataset, in which case we would work to do that immediately.

So to be clear, what we are doing in the background—we are writing the CMC modules, the preclinical modules. Those will be in the can and done. So if we get the clearance on the clinical, that would be the only piece that we would have to write, and then we could file the BLA and things would move forward relatively quickly. Another scenario could be the agency says, look, we think the data are good. Historically, we have always liked to see 12 months of data. We would like to see 12 months of data. In that instance, we would make the case, well, okay.

But then let us start the rolling submission because we have got all this other stuff done. You already know the primary endpoint has been met. You are looking for some additional time. Okay. Now we would have made the case that the durability from Part A we can now pool based on our recent update on CMC would help us with that case upfront, the six-month course of action. But if they want that, I think even in that scenario, again, the only thing that they would have to review would be the clinical module at the end. So that still pulls things up a couple of quarters.

And then the last scenario would be they want to do things the traditional way and wait for 12 months. I think even in that scenario, the nice thing about the interim data—and again, we would share this with the market—is that I believe what we would be able to show is that the product works. You have met the endpoint. You have met the statistics of things. Now it is just time and execution, which I think the market would respond very favorably to as well. So the way I look at it is the FDA gave us the option to do the interim analysis.

I believe it is based on the data that we showed in the early responses that we showed and the rigor in which the data were collected. So, look, we have got a few good cards to play here, and we are looking forward to it as we step it through 2026.

Biren Amin: Perfect. Thanks for taking my questions.

Sean Nolan: Thanks, Biren.

Operator: Thank you. Our next question comes from the line of Tazeen Ahmad with Bank of America. Your line is now open.

Tazeen Ahmad: Hey. Good morning. Thanks for taking my questions. Can you talk about what you think the potential read-through from the recent negative opinion for Daybue from CHMP has for your program and also whether this changes what you think the commercial opportunity in Europe is? And related to that, what is your alignment currently with EU regulators on that?

Sean Nolan: Sure, Tazeen. I do not think there is a read-through based on what happened to Acadia. For those of you that have been around since Suku and I joined the management team here, back in the days when everyone talked about CGI and RSBQ, we were on the opposite side of that, if you remember. For gene therapy, you had to be able to demonstrate that the eye could see that truly had impact on the patient and the caregivers and it was unequivocal. And so, we feel the data that we are generating is very unique.

And really no one has been able to demonstrate restoration of function in a neurodevelopmental disease before, and we are able to do that in multiple patients and across multiple clinical domains. And we have got natural history that is absolutely stellar. It is unequivocal. I think Jeff Neul’s paper reinforces everything that we have done from a strategic perspective and supports our thesis on things.

And then if we are able to demonstrate what is happening with the primary endpoint and people gaining these milestones, but then beyond that, what we are trying to emphasize on the script is when you look at milestone gains outside the primary endpoint, and you look at improvements that people are having, it is almost 20 per patient so far. That is based on what we reported last year. So it is a significant impact that you cannot ignore. And the other thing too I would point to in the natural history data—there is R-MBA data.

So we can demonstrate in multiple ways against natural history how we are changing the course of disease and how this is a transformational treatment, which then gives us the power to capture value through price in a very meaningful way and get reimbursed for it. If you take a look at what happened with Sarepta, up until they had some of the unfortunate safety things, their launch was going great. And I would argue that the data that we are generating is quite demonstrable. We are not having to talk about a scale. We are not having to talk about a one- or two-point change in the North Star or a one-point change in the CGI.

The payers do not care. The payers want to see functional gains. They want to see concrete improvements. That is what is going to lead to getting you approved. Hope that helps.

Tazeen Ahmad: Yeah, Sean. And maybe just a quick follow-up. On Europe again, usually there is a pretty deep discount on price. But, again, just given that there would be a lack of therapies available, do you think that strengthens your position on pricing when it comes time to that?

Sean Nolan: Yeah. I mean, I think we are going to be in a very strong position on price because of the data that we have and because of the high unmet need in the disease state. So we feel that—we are—obviously it is early days to get into what the actual price will be. But I think with where we sit and the data that we are capturing, and the fact that it is happening across multiple domains, and no matter what COA we are looking at, all the needles are moving in the right direction in a meaningful way, I think we will be able to capture the appropriate value.

Sukumar Nagendran: Thank you.

Operator: Our next question comes from the line of Maury Raycroft with Jefferies LLC. Your line is now open.

Maury Raycroft: Hi, good morning. Congrats on the progress and thanks for taking my question. For the REVEAL Part A update first half of this year, do you plan to provide a sub-analysis showing the proportion of patients that achieve more than one developmental milestone by 12 months? And are you planning to show any patient-level data with vignettes? And if so, how are you setting expectations for number of patients and milestone gains that you can show in that update?

Sean Nolan: Thanks, Maury. Yeah. To take the second part of your question first, we will likely highlight a couple of patient vignettes. And just to give you some perspective on why we show the data like we do, number one, we are going to have 12 patients’ worth of data. This drug is going to get approved or not approved in the aggregate. Right? The aggregate data is what you get approved on. So I think making sure it is clear—and we will share every endpoint that we are effectively capturing—and then the investor will get to judge the data and the probability of success in getting approved. So we think that is the most important thing.

We think that is where the emphasis should be. I think highlighting a couple of patient vignettes would be helpful to basically show the early improvement and then the sustainability and the deepening of response over time, getting into more specifics about what is actually happening on a patient basis. So if we say that people are effectively gaining about 19 to 20 skills or milestones and improvements, let us tell you the story of what that looks like. Now if I did that for 12 patients, we would be on the call for five hours. So that is why we do not want to go through all 12 patients. We just want to highlight a couple things.

And then, again, based on the aggregate, you can say, hey, I like this data or I do not like this data. But we think that is the right way to portray it. Can you remind me the first part of your question?

Maury Raycroft: Yeah. Just some sort of a formal sub-analysis showing the proportion of patients that achieve more than one developmental milestone by 12 months.

Sean Nolan: We will take that into consideration. We are still working on the ultimate way to portray things. We have got a few ideas on how to get at—you know, we have gotten some feedback from investors on what they would like to see. So we will take all that into consideration, and we look forward to that update.

Maury Raycroft: Got it. Likewise. Okay. Thanks for taking my questions.

Sean Nolan: Thanks, Maury.

Operator: Thank you. Our next question comes from the line of Gil Blum with Needham & Company. Your line is now open.

Gil Blum: Good morning, and allow me also to add my congratulations on the progress. Just a couple ones from us. So as it relates to your recent update on the ASPIRE study, was this in line with prior expectations? Was this faster, or this is just, you know, run of course here? And our second question, it is good to see submissions using your RMAT designation of the CMC materials. This is a known issue in this space. Are you guys going to receive any feedback on what you have already submitted ahead of completing your filing, or is this just going to happen later? Thank you.

Sean Nolan: Okay. Let us take the ASPIRE. I would say—and Suku, jump in—I would say we got a pleasant surprise in that initially what we proposed to the FDA was a study of two to less than six-year-olds, and the FDA came back and said, listen, the brain volumes of a five-year-old and a four-year-old are effectively the same as a six-plus, so we feel that data are already being captured and collected, and therefore they just wanted us to focus on the safety of the two- and three-year-old because they do have less brain volume. And so that was the experiment that they wanted us to run. We did recommend the three-month, and they agreed with that.

I do not know, Suku, if there is anything else you found interesting about that whole thing?

Sukumar Nagendran: No. I would add to that, Sean, that it is clear that the FDA is pretty comfortable with our safety and efficacy data up to a six-plus age group, and they are willing to let that dataset be used for the less than six. I mean, that two- to three-year-old, as you pointed out, because of the brain volume adjustment that is needed, they felt that was the appropriate age group for us to give them a small sample set on safety. And that could potentially be more than adequate for a complete BLA filing.

Sean Nolan: Yep. Yep. And, Gil, your question about the CMC—can you just restate that?

Gil Blum: Yeah. Just wondering because you have an RMAT designation, is there any feedback the FDA could provide you on what you have submitted ahead of completing your filing, or is that not part of—thanks.

Sean Nolan: So, I mean, we have got—because of Breakthrough, it is an additional way to get access to the FDA. So we do have our first Breakthrough meeting with the agency coming up, and there will be more of those along the way. But we will use that to have a discussion around potential BLA submission scenarios and working to get at your question, which is, you have seen CMC, you have seen our preclinical—just working to gain alignment on the completeness of the packages that we are putting together and what we share with the FDA. So I think we are going to have really good line of sight to where we stand. CMC is a good example.

We could not be in a better position right now. So back when we did our first commercial lot, the agency said they deemed that the clinical lot and the commercial lot were analytically comparable. Now that we have done more lots, they are continuing to say that. And now they are saying, if you continue to demonstrate this through PPQ, you can pool your data from Part A and from the pivotal and from ASPIRE because the product is the same. So that is the best you can possibly have right now, and I think that is an example of working closely with the agency.

I know that they feel like there is nothing more on the preclinical side that needs to get done. It really is just generating the pivotal data and the ASPIRE data are going to be the last aspects of the submission package.

Gil Blum: Excellent. Very helpful. Thank you.

Sean Nolan: Thanks, Gil.

Operator: Our next question comes from the line of Chris Raymond with Raymond James. Your line is now open.

Chris Raymond: Hey, thanks guys and congrats from us on the progress. Just have maybe a competitive two-part question, I guess, and maybe also wanted to drill down a bit on the BLA filing timing question. So Neurogene has made some comments in the past couple weeks to the effect that the six-month time endpoint—from—they have gotten word from FDA that is not clinically meaningful. And, Sean, I think I have heard you say, you know, the difference here is you guys will have 12-month data from Part A to supplement, and that is kind of the difference maker.

But I guess, is that the only difference maker or, you know, is there potentially something else, like maybe the risk-reward of the therapy or other factors? And then the second point is—you got my attention with some of your market research commentary. And I think it is an aspect that could be pretty important. You know, you are talking about intrathecal administration being able to reach patients outside of large centers of excellence, and being able to dose patients at the community center.

Do you have any detail around the breakdown of patients between these centers of excellence and out in the community, and from just sort of the setup there commercially, just assuming both therapies are on the market at some point?

Sean Nolan: Yeah. I can say that the research we have done to date shows that about 50% of the Rett patients are associated with a center of excellence. That means that over the course of one year, there is one visit to the center of excellence. So that does not necessarily mean that it is the most convenient place for them to get the therapy. And put it another way, there are 50% more patients outside of the COEs. So we think it is very important to make sure that there is a network of care that gets to where the patients are.

And so with the data we have, we are able to map where the patients are, and then we are going to take a very thoughtful approach about working through access to care and making sure that the people that are using this are well trained, the facility has the right mechanisms in place to support gene therapy and things of that nature. But what is nice about the intrathecal route is it allows us to broaden that footprint in a relatively straightforward manner. And getting access to patients is the most important thing. Suku, let us tag team the question on the meaningfulness of six months. I mean, I can just say the FDA never said that to us.

So every case is unique. I guess the simplistic way I would answer that question is it depends what data you are generating in the first six months. And I think if those data are compelling from a clinical perspective, then the agency is going to take note.

Sukumar Nagendran: Yeah. What I would add to that, Sean, is that I have not seen any data from Neurogene’s initial studies that show that they have actual clinical efficacy in the first six months post-dosing. And most of their clinical impact appears to come much later, maybe 10 months post-dosing. Usually, FDA looks at proof of concept before they agree to an earlier analysis. And we have six-month interim analysis from our Part A data that is more than convincing, that allowed them to say, yes, we can evaluate and bring the dataset in for actual review and approval if necessary. And then the second component is they always wind back to the construct because Neurogene’s construct is single-stranded.

And single-stranded constructs usually take much longer to come together in the nucleus of the cell of interest and actually become efficacious from a protein production standpoint. So I think that may have played a role in also the six-month interim analysis being given to us while in that case there may have been some pushback.

Sean Nolan: Yeah. The other thing too, just to highlight, Chris, Daybue got approved on 12-week data. So I think it is really just what is being demonstrated at a point in time. Right? We—Yep. Hope that helps.

Chris Raymond: Yeah. Sure.

Operator: Thank you. In the interest of time, we ask that you please limit yourself to one question. Our next question comes from the line of Jack Allen with Baird. Your line is now open.

Jack Allen: Congrats on the progress made over the course of 2025. I wanted to ask briefly about how enrollment is going in the pivotal studies and what aspects you are looking to screen these patients on the basis of. Can you talk a little bit about the pre-dosing period in the trial and how you are identifying patients that are really apt for the clinical studies that you are enrolling right now?

Sean Nolan: Well, Suku, we can tag team this. I would say, number one, Jack, there is consistency between Part A and Part B in that the severity of the patients is still a CGI-S between four and six. We did—one of the things we did—we have not provided the number—but one of the things we did put in the pivotal protocol is that, of the 28 milestones, there needs to be a certain number of open milestones to get into the study from a screening perspective. So that is probably the most interesting aspect of things that you are looking at. Suku, you want to talk about the enrollment and the progress that we are making?

Sukumar Nagendran: Yeah. So, Jack, I mean, we have dosed multiple patients already. Multiple sites are active, and we are—frankly, I would say—we potentially have more patients than we need to actually screen and go forward. And we are well on our timeline when it comes to dosing all 15 patients and actually having results, hopefully, for the six-month interim analysis by the end of this year. I think that is where things are progressing at the present time.

Sean Nolan: Yeah. Jack, I think one thing that is really important is that the training at the sites is super important, meaning we have created a standalone DMA. Right? That is the Developmental Milestone Assessment—our name for that—call it a new COA that we developed to standardize the data collection of the milestones. And the FDA—that was really where they spent most of their time with us—was how are you going to systematize and make sure that the data collection are rigorous to make sure that we understand at baseline what a patient could and could not do and then you replicate that in a consistent manner every single time you conduct the DMA.

So that is really—Suku’s team has done a stellar job in activating the sites and training the sites and getting them up and running. But that really is, in our discussions with the agency, a fundamental aspect that we wanted to make sure we had our hands tightly around.

Jack Allen: Great. Congrats on all the progress.

Sean Nolan: Thanks, Jack.

Operator: Our next question comes from the line of Yanan Zhu with Wells Fargo. Your line is now open.

Yanan Zhu: Hi. Thanks for taking our questions. Wanted to follow up on the pooling of data between the Phase 1/2 and the pivotal study, given that sounds like something—you know, why you did—that is why you did the manufacturing comparability study. So in what form will the data be pooled? Are we talking about a supportive dataset separate from the top primary endpoint analysis, or could the two studies combine into one and give one number in a label? And then I have one additional question. Thanks.

Sean Nolan: I would, at a high level, say what the pooling allows you to do is multiple types of analyses looking at the totality of your data. So you can pool for safety. You can pool for efficacy. You can pool for age distribution. You can pool for a lot of different things. And the agency is going to do all those things anyway. The fact that you have got the ability to do that, though, does create the ability for you to support further your package because you have got different and, I would say, additive analytics that you can utilize to support the package that you are making.

I do not know what else you would add to that, Suku.

Sukumar Nagendran: Well, Sean, I would not add much else other than to say it gives us a comprehensive, large dataset in this rare disease of Rett syndrome that allows us to look at, as you said, multiple analyses, but also duration of efficacy, and impact on multiple milestone achievements over time. So I think it is a pretty comprehensive strategy that we have come up with. And frankly, the FDA agrees with us, given that they agree that, from a technical aspect, the clinical lots and the commercial lots that they are studying are both equitable. So I think it is a huge win for us to move this forward in a rapid manner.

Yanan Zhu: Right. Thanks. Congrats for the ability to do that. And my follow-up question is on expectations for the upcoming data update. Now with 12 months of data on the milestones, what is the expectation for patients continuing to gain milestones between six and 12 months? And is there any chance to observe a loss of milestones, or is that captured in the data so that we have a sense of true durability? Thank you.

Sean Nolan: Yeah. Yanan, we would expect that there are continuous gains that happen, continuous improvements that occur over the course of time. So that is what we would anticipate seeing in this dataset. I would say, in terms of loss of gains and things like that, it is not what you would anticipate. I can say that, you know, sometimes on the day of assessment, you can see something may not be demonstrated. Like, if one of the girls has the flu or a UTI, it is very possible that they are not feeling well, and they are not going to demonstrate something. It does not mean they lost it.

And I can just say in what we have reported on to date, we have never seen a loss of any gain. So we will work to highlight that when we give the update in the first half.

Kamran Alam: Thank you.

Operator: Our next question comes from the line of Whitney Ijem with Canaccord Genuity. Your line is now open.

Whitney Ijem: Hey, guys. I am going to ask one ASPIRE question in two parts. First is just to double check on the language around the extrapolation, is there any nuance there or like math involved, or is it just that the REVEAL efficacy will be assumed for the ASPIRE population? And then the second question is just on dosing in ASPIRE. I think there was mention of a scaling based on brain volume. So any color you can give on that?

Sean Nolan: Yeah, Whitney. There is really no math on the extrapolation. It was really just whatever you see in the six-plus, that is going to get extrapolated into the younger age group. So that is where the alignment is with the agency. It is at a macro level. And then on the second part of the question on the scaling, yeah, it is a very consistent mathematical equation that you use from the preclinical to get to your human equivalent dose. And we will be using that same calculation in the two- to three-year-old. So, Suku, I do not know if there is anything more you would add to that.

Sukumar Nagendran: All I would add, Sean, is that the calculation for the two- to four-year-olds is essentially equivalent to the 1e15 dose from an efficacy standpoint when we look at our preclinical models.

Sean Nolan: Right. So in terms of what they are getting—

Sukumar Nagendran: Exactly.

Sean Nolan: Yes. Exactly.

Sukumar Nagendran: So that makes sense, Whitney. So a two-year-old, even though they are getting less of a dose, it is equal to the 1e15 in a larger person. So they are getting the same therapeutic effect.

Sean Nolan: Effect. Right.

Whitney Ijem: Yep. Understood. That makes sense. Thanks so much.

Sean Nolan: Thank you. Thank you. This concludes the question-and-answer session. I would now like to hand the call back over to Sean Nolan for closing remarks.

Sean Nolan: We appreciate everyone taking the time to listen to our 2025 update and corporate update as well, and look forward to making progress throughout the year and providing an update in Q2. Take care, everyone.

Operator: This concludes today’s conference. Thank you for your participation. You may now disconnect.

This article is a transcript of this conference call produced for The Motley Fool. While we strive for our Foolish Best, there may be errors, omissions, or inaccuracies in this transcript. Parts of this article were created using Large Language Models (LLMs) based on The Motley Fool's insights and investing approach. It has been reviewed by our AI quality control systems. Since LLMs cannot (currently) own stocks, it has no positions in any of the stocks mentioned. As with all our articles, The Motley Fool does not assume any responsibility for your use of this content, and we strongly encourage you to do your own research, including listening to the call yourself and reading the company's SEC filings. Please see our Terms and Conditions for additional details, including our Obligatory Capitalized Disclaimers of Liability.

The Motley Fool has no position in any of the stocks mentioned. The Motley Fool has a disclosure policy.