AAV gene therapy immunogenicity concerns and potential for adverse regulatory actions following industry-wide safety signals (hepatotoxicity, thrombotic microangiopathy observed in competing programs)
Medicare/Medicaid reimbursement uncertainty for ultra-high-cost gene therapies ($1M+ per treatment) as payers implement outcomes-based contracts and amortization requirements
Manufacturing scalability challenges for AAV vectors at commercial scale, with limited CDMO capacity industry-wide
Well-capitalized competitors (Neurocrine, Sangamo, Spark Therapeutics) advancing parallel AAV-CNS programs with potentially superior capsid designs or earlier clinical timelines
Alternative modalities including antisense oligonucleotides (ASOs), small molecules, and antibody therapies targeting same neurological indications with lower manufacturing complexity
Patent expiration risks on foundational AAV technology (2030s) and freedom-to-operate challenges in crowded gene therapy IP landscape
Accelerating cash burn with no near-term revenue catalysts creates equity dilution risk within 12-18 months at current $30M annual OpEx run rate
Dependence on volatile collaboration revenue (down 68% YoY) creates unpredictable cash flow timing and potential covenant violations if debt is raised
Negative tangible book value (-48.9% ROE) limits asset-backed financing options and increases cost of capital
StructuralCompetitiveBalance Sheet