Mesoblast Limited

Mesoblast Limited (MESO) Market Cap

Mesoblast Limited has a market capitalization of $1.91B, based on the latest available market data.

Financials updated on 2025-06-30

SectorHealthcare
IndustryBiotechnology
Employees73
ExchangeNASDAQ Global Select

Price: $14.81

-0.99 (-6.27%)

Market Cap: 1.91B

NASDAQ · time unavailable

CEO: Silviu Itescu

Sector: Healthcare

Industry: Biotechnology

IPO Date: 2010-01-20

Website: https://www.mesoblast.com

Mesoblast Limited (MESO) - Company Information

Market Cap: 1.91B · Sector: Healthcare

Mesoblast Limited, a biopharmaceutical company, develops and commercializes allogeneic cellular medicines in the United States, Australia, Singapore, the United Kingdom, and Switzerland. The company offers products in the areas of cardiovascular, spine orthopedic disorder, oncology, hematology, and immune-mediated and inflammatory diseases. Its proprietary regenerative medicine technology platform is based on specialized cells known as mesenchymal lineage cells. The company's products under the Phase III clinical trials include remestemcel-L for the treatment of steroid refractory acute graft versus host disease, as well as acute respiratory distress syndrome due to COVID-19 infection; Rexlemestrocel-L to treat advanced chronic heart failure; and MPC-06-ID for chronic low back pain due to degenerative disc disease. It is also developing MPC-300-IV for the treatment of biologic refractory rheumatoid arthritis diabetic nephropathy. The company has strategic partnerships with Tasly Pharmaceutical Group to offer MPC-150-IM for heart failure and MPC-25-IC for heart attacks in China; JCR Pharmaceuticals Co. Ltd. for the treatment of wound healing in patients with epidermolysis bullosa; and Grünenthal to develops and commercializes cell therapy for the treatment of chronic low back pain. Mesoblast Limited was incorporated in 2004 and is headquartered in Melbourne, Australia.

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📘 Mesoblast Limited (MESO) — Investment Overview

🧩 Business Model Overview

Mesoblast Limited is a biotechnology company focused on developing and commercialising allogeneic, off-the-shelf cell therapies designed to treat inflammatory and immune-mediated diseases. Its platform centers on mesenchymal lineage cells engineered and selected for consistent biological potency—an approach aimed at enabling scalable manufacturing and predictable clinical performance relative to autologous cell therapies.

The business model is typical for clinical-stage and early-commercial biopharma: (1) internal R&D and partnering to advance multiple programs through preclinical and clinical milestones, (2) licensing and co-development arrangements that can monetise pipeline assets, and (3) commercialisation activities supported by manufacturing scale-up, regulatory submissions, and payer/health-technology assessment engagement once products are approved.

A key feature of Mesoblast’s model is that it is pursuing therapies across distinct therapeutic areas that share a common immunological rationale: controlling excessive or dysregulated inflammation, immune activation, and tissue injury. This cross-program rationale can support platform learning, manufacturing know-how, and evidence generation that may strengthen overall credibility with regulators and partners.

💰 Revenue Streams & Monetisation Model

Mesoblast’s revenue profile is best understood as a blend of: (i) product revenue from any approved and reimbursed indications, (ii) milestone payments and collaboration income from partners, and (iii) royalties or tiered payments tied to development, regulatory progress, commercial uptake, or sales performance under licensing agreements.

In a typical licensing structure, Mesoblast retains core scientific and manufacturing responsibilities for its assets while partners may contribute to development costs, regulatory pathways, or commercial execution in defined geographies and indications. This can reduce near-term cash burn for the company while accelerating time-to-market for programs with large unmet needs and significant payer adoption potential.

Commercial monetisation depends on multiple layers beyond clinical efficacy: manufacturing throughput and cost, product differentiation versus standard-of-care (including biologics and small molecules), safety tolerability over repeated exposure (where applicable), and the ability to secure reimbursement pathways. In many immunology-adjacent markets, payer decisions are strongly influenced by evidence of meaningful outcomes, durability of benefit, and risk–benefit clarity.

Accordingly, Mesoblast’s revenue engine is influenced by both binary events (regulatory decisions, label expansions) and continuous variables (facility readiness, supply reliability, and physician uptake). Investors should evaluate how the company’s commercial strategy aligns with payer and provider workflows, because adoption curves can materially affect revenue trajectories even when clinical outcomes are solid.

🧠 Competitive Advantages & Market Positioning

Mesoblast’s primary competitive thesis is the off-the-shelf nature of its cell therapies coupled with an engineering/selection strategy intended to produce a more uniform product profile at scale. In competitive cell therapy and regenerative medicine landscapes, consistency and reproducibility are central determinants of clinical credibility. A product that can demonstrate stable potency and quality across batches can reduce uncertainty for regulators and improve confidence for providers.

From a market positioning standpoint, the company targets indications where inflammatory signaling is a dominant driver of morbidity and where the addressable population can be substantial. Even when individual patients are clinically complex, health systems often seek therapies that can reduce hospital length of stay, prevent escalation of care, or reduce recurrence. If Mesoblast’s therapies can show such operational and clinical advantages, positioning can strengthen through real-world value proposition framing.

Another advantage relates to platform learning. Because multiple programs draw from shared manufacturing and characterization capabilities, operational improvements (process consistency, analytics, and quality systems) can potentially translate across programs. This “platform compounding” effect can strengthen the overall cost structure and reduce incremental development friction.

However, the competitive landscape for immunology therapeutics is intense. Investors should consider how the company’s differentiated mechanism and clinical outcomes compare with established biologics, emerging small molecules, and other cell therapy platforms. Competitive success ultimately depends on evidence quality, label scope, safety signals, and the practicality of delivering the therapy within routine care settings.

🚀 Multi-Year Growth Drivers

Mesoblast’s multi-year outlook typically hinges on five categories of growth drivers:

  1. Regulatory approvals and label expansion: The ability to secure approvals in initial indications and expand into broader patient segments can extend market size and improve revenue resilience. Label specificity and inclusion/exclusion criteria also determine the commercial addressable population.
  2. Clinical differentiation and durability: Therapies in immune-mediated diseases must demonstrate clinically meaningful outcomes that hold relevance for both patients and payers. Durability of response and clarity on retreatment (where relevant) can shift adoption.
  3. Manufacturing scale and unit economics: Sustainable supply at controlled costs is essential for cell therapies. Improvements in yield, release testing efficiency, and facility utilisation can improve gross margin potential and reduce the likelihood of stockouts that can impair physician confidence.
  4. Partnership execution: Collaboration partners can amplify commercial reach and accelerate development. Effective governance, resourcing, and strategic alignment influence whether milestone schedules translate into actual cash inflows and compounding growth.
  5. Expansion of clinical footprint: Additional trials across disease subtypes can increase the therapy’s utility. In immunology, stratification by biomarkers or disease stage (when supported by evidence) can enhance outcomes and market uptake.

Beyond these drivers, Mesoblast’s investment case can benefit from positive external validation—such as strong peer-reviewed evidence, guideline inclusion, or favorable payer assessments—that can reduce friction for adoption. Over time, a broader evidence base can also strengthen negotiating power with partners and payers.

⚠ Risk Factors to Monitor

Investment risk in Mesoblast is primarily tied to clinical, regulatory, operational, and financing dimensions typical of development-stage and early-commercial biopharma. Key risk areas include:

  1. Clinical and regulatory uncertainty: Cell therapies can face variability in outcomes, and adverse events can alter regulatory trajectories or limit label scope. Additionally, evolving standards of care can reduce perceived incremental value.
  2. Efficacy durability and endpoint interpretability: Even when endpoints are met, investors should evaluate whether outcomes translate into sustained clinical benefit and whether claims are robust to post-hoc subgroup analyses.
  3. Manufacturing and quality systems: Demonstrating consistent potency and compliance at scale is a critical execution risk. Any disruption to manufacturing reliability can impair supply, increase costs, and delay revenue.
  4. Commercial adoption and reimbursement: For specialty biologics and cell therapies, adoption can be constrained by payer coverage decisions, evidence thresholds, budget impact, and institutional contracting practices. Physician learning curves can also matter.
  5. Partner dependency and governance: Licensing structures can be beneficial but create reliance on partner priorities and funding. Misalignment can affect development pace, commercial reach, or milestone realization.
  6. Financing and dilution: Biotechnology companies often require capital to fund trials, regulatory work, and manufacturing scale. Capital markets conditions and operational progress can influence equity dilution or debt terms.
  7. Competitive intensity: New entrants—both biologic and non-biologic—can erode market share if they demonstrate better safety, outcomes, convenience, or pricing.

Collectively, these risks suggest that valuation should be grounded in scenario-based probability-weighting around approvals, commercial ramp, and manufacturing performance, rather than a single-point forecast.

📊 Valuation & Market View

Valuation for Mesoblast is best approached as a pipeline and platform optionality story with a commercial component, rather than as a mature, stable cash-flow business. Investors commonly use a combination of probability-weighted net present value (rNPV) for pipeline assets and an assessment of the commercial pathway for any approved programs.

Key valuation levers include:

  • Probability of approval and label breadth: Broader labels and clearer differentiation generally increase expected value by enlarging the treatable population.
  • Time-to-commercial realisation: Even without relying on specific calendar assumptions, the market value is sensitive to the efficiency of evidence generation, regulatory timelines, and payer coverage paths.
  • Gross margin and manufacturing scale: Cell therapy economics are influenced by manufacturing yield, release testing, logistics, and facility utilisation.
  • Commercial uptake trajectory: Pricing, reimbursement coverage, and physician adoption can drive the sales curve materially above or below conservative baselines.
  • Partner economics: Net royalties, milestone structures, and cost-sharing provisions determine how much value flows back to the company.

In market view terms, Mesoblast is typically valued with heightened sensitivity to de-risking events: meaningful clinical readouts, regulatory achievements, and operational milestones that demonstrate reliable supply and consistent product quality. Conversely, any signals that weaken efficacy, raise safety concerns, or expose manufacturing bottlenecks can lead to sharp repricing.

A balanced investment stance often considers whether the current market expectation already reflects optimistic assumptions. Without anchoring to specific contemporaneous numbers, the practical approach is to compare the implied expectations embedded in the valuation to a conservative-to-base-to-upside set of scenarios for approvals, commercial ramp, and margin structure.

🔍 Investment Takeaway

Mesoblast Limited offers an investment thesis grounded in off-the-shelf immunomodulatory cell therapy capabilities, with value creation driven by regulatory de-risking, label breadth, manufacturing scalability, and successful reimbursement-driven adoption. The company’s platform positioning aims to overcome key limitations associated with autologous therapies—particularly variability and scalability—while targeting diseases where inflammatory biology creates a durable therapeutic rationale.

The principal risks are clinical/regulatory uncertainty, execution in manufacturing and quality systems, and the commercial realities of payer coverage and physician adoption. Given these factors, the risk–reward profile aligns with a scenario-based, catalyst-aware framework rather than a single deterministic forecast.

For investors, the most decision-useful diligence centers on: evidence strength and endpoint robustness, product quality and manufacturing reliability, the economic terms of partnerships, and the company’s capacity to convert clinical differentiation into reimbursed, repeatable commercial outcomes.


⚠ AI-generated — informational only. Validate using filings before investing.

Mesoblast’s Q2’26 readout is driven by concrete Ryoncil traction and a clear funding runway: $49M net product revenue in the first half and $110M–$120M full-year guidance, alongside $130M cash. Management’s tone is confident—Ryoncil is positioned as the only FDA-approved allogeneic MSC product, with 49 centers onboarded and payer policies covering 280M+ lives including no step therapy. However, the Q&A exposes the real pressure points. The key analyst focus wasn’t on the upbeat rollout; it was on (1) how much of pediatric penetration is assumptive (20% by end of FY’26 based on ~375 patients and a stated 40% peak share assumption) and (2) the FDA “remaining to be negotiated” items for Revascor labeling—especially ischemic vs non-ischemic and whether biomarker language will constrain the label. For back pain, they assert endpoint approvability for approval, but FDA subgroup discussions (opioid dependence) remain in motion. Overall, bullish execution meets ongoing regulatory/labeling execution risk.

AI IconGrowth Catalysts

  • Ryoncil launch momentum: net product revenues of $49.0M in first half of FY'26; quarter-on-quarter growth since April 2025 launch
  • Uptake/penetration drive: targeting ~20% market share by end of year 1 and continuing repeated utilization by existing treatment centers
  • Label expansion groundwork for Ryoncil in adults with acute GVHD: pivotal adult second-line study protocol design locked with FDA; Central IRB approval expected in March; enrollment/site initiation to begin after
  • Rexlemestrocel-L (back pain) catalyst: confirmatory Phase III enrollment of 300 patients expected complete March/April; BLA filing expected calendar 2027
  • Revascor (CHF/LVAD) catalyst: moving from accelerated to full approval BLA for next quarter (full approval does not require confirmatory study)

Business Development

  • NIH-funded Bone Marrow Transplant Clinical Trials Network partner for adult acute GVHD pivotal study
  • Optum Frontier specialty pharmacy partner: 13 hospitals using Optum Frontier (described as virtually eliminating their financial responsibilities with the product)
  • FDA discussion/engagement around filing packages and endpoints across Ryoncil adult GVHD, Revascor full approval, and rexlemestrocel-L endpoint approvability

AI IconFinancial Highlights

  • Total revenues: $51.3M for half year ended Dec 31, 2025
  • Net product revenues (Ryoncil): $49.0M
  • Gross margin: 93% (reported gross margin)
  • Loss: $40.2M for the period vs $48.0M prior year period (prior-year loss impacted by $23M reversal of inventory provision)
  • R&D expenses: $46.2M (prior year $5.1M; prior year skewed by $23M inventory provision reversal)
  • SG&A: $28.5M vs $18.0M prior year period (increase attributed to sales/marketing driving growth)
  • Cash: $130M at end of Dec 31, 2025
  • Full-year Ryoncil net revenue guidance (FY'26): $110M to $120M

AI IconCapital Funding

  • Entered Dec 30, 2025 into $125M non-dilutive credit line facility
  • Tranche 1: $75M drawn at closing to repay prior senior secured loan in full
  • Partially repaid subordinated royalty facility; described as fully repaid by middle of 2026
  • Tranche 2: $50M available to draw through June 2026
  • Management stated new facility has lower cost of capital, can be repaid any time without early prepayment/make-whole fees, no exit fees, and does not cover company major assets

AI IconStrategy & Ops

  • Commercial infrastructure build-out for Ryoncil: 49 treatment centers onboarded; Ryoncil listed on formulary of 30 of those centers
  • Payer coverage achieved: over 280M lives covered; Medicaid coverage in all states
  • Billing/reimbursement operational change: J-Code J3402 effective Oct 1 (for Ryoncil)
  • No step therapy: commercial payer policies (Aetna, Cigna, UnitedHealthcare, Anthem, Humana, Prime Therapeutics/Blue Cross plans) described as not requiring step therapy
  • Manufacturing logistics optimization for rexlemestrocel-L and inventory for projected Ryoncil growth
  • R&D/to-BLA preparation spend heavily front-loaded: adult GVHD BLA preparation and manufacturing work referenced in H1

AI IconMarket Outlook

  • Ryoncil guidance reaffirmed: full fiscal 2026 net revenues $110M-$120M (to June 2026 timeframe)
  • Ryoncil pediatric penetration: 20% market share target by end of year 1; Q4 FY'26 specifically referenced as the endpoint of ~20% penetration based on a pediatric patient set of ~375 patients
  • Revascor BLA: expect to file for full approval in the next quarter
  • Rexlemestrocel-L back pain confirmatory Phase III: enrollment expected complete March/April; data readout and BLA filing expected in calendar 2027
  • Adult acute GVHD (Ryoncil) adult pivotal study: Central IRB approval expected in March; site initiation/enrollment to commence after

AI IconRisks & Headwinds

  • Ryoncil pediatric adoption hurdle: reliance on continued physician education to change practice habits; management emphasizes that physicians may not use early steroid-failure window
  • Revascor labeling negotiation risk: despite claimed efficacy in overall population without subgrouping, management said label for entire population remains 'to be negotiated' with FDA around ischemic vs non-ischemic phenotypes and possible biomarker language
  • Back pain filing package risk/uncertainty: ongoing discussion with FDA regarding opioid-dependent subgroup; intention is that primary file uses all-comers across two trials, but subgroup labeling discussions are 'ongoing'
  • Manufacturing confirmation dependency for back pain/Class IV programs: need 'more confirmation from the agency' even though manufacturing process is largely similar (made at Lonza in same facility as Ryoncil)

Sentiment: POSITIVE

Note: This summary was synthesized by AI from the MESO Q2 2026 earnings transcript. Financial data is complex; please verify all metrics against official SEC filings before making investment decisions.

🧾 Full Earnings Call Transcript

Ticker: MESO

Quarter: Q2 2026

Date: 2026-02-27 17:00:00

Operator: Hello, and welcome to the Mesoblast financial results for the half year ended December 31, 2025. An announcement and presentation have been lodged with the ASX and are also available on the Home and Investor pages at www.mesoblast.com. [Operator Instructions] As a reminder, this conference call is being recorded. Before we begin, let me remind you that during today's conference call, the company will be making forward-looking statements that represent the company's intentions, expectations or beliefs concerning future events. These forward-looking statements are qualified by important factors set forth in today's announcement and the company's filings with the SEC, which could cause actual results to differ materially from those in such forward-looking statements. In addition, any forward-looking statements represent the company's views only at the date of this webcast and should not be relied upon as representing the company's views of any subsequent date. The company specifically disclaims any obligations to update such statements. With that, I would like to turn the call over to Paul Hughes.

Paul Hughes: Thank you. Welcome, everyone, to the Mesoblast financial results call for the period ending 31 December 2025. My name is Paul Hughes. I'm Head of Corporate Finance and Investor Relations. In the room with me today is our CEO, Silviu Itescu; our CFO, Jim O'Brien; and our CCO, Marcelo Santoro. We have a presentation to run through highlighting the financial results and the operations for the period, and then we'll have some time for questions at the end. So now I'll hand over to Silviu to begin.

Silviu Itescu: Thank you, Paul. We could go to Slide 4, please. This slide highlights the corporate priorities for 2026. We intend to continue to show strong growth in Ryoncil sales driven by market adoption. We will build a strong cash flow with judicious use of funds for operations and an optimal capital structure. Cultural transition is critical so that we can move to an efficient commercial organization. We will expand Ryoncil label indications and obtain approval -- seek to obtain approval for remestemcel-L products, our second-generation platform. Our manufacturing focus will seek to increase diversification, capacity and cost efficiency for our platforms, and we will continue to focus on appropriate commercial partnering backed by demonstrable value drivers, including FDA approvals, strong revenues and advanced clinical programs. Next slide, please. This year was marked by a very successful product launch. We initially received FDA approval for Ryoncil in December 2024. Ryoncil is the first and only FDA-approved allogeneic mesenchymal stromal cell product. The product was launched in April of 2025 with revenues growing quarter-on-quarter. There is significant unmet need for continued uptake and increasing market adoption. And our net revenue from Ryoncil was USD 49 million in the first half of FY '26. Next slide, please.

Paul Hughes: Thanks, Silviu. Jim will take us through the financial slides. Thanks, Jim.

James O’Brien: Thank you, Paul. Hi, everybody. I'd like to now review our first half fiscal 2026 operating results. And I should mention that all figures are in U.S. dollars. Total revenues for the period were $51.3 million, driven by the successful launch of Ryoncil. Our net product revenues, as Silviu mentioned, were $49 million, and we had a gross margin of a strong 93%. Our R&D expenses for the period were $46.1 million (sic) [ $46.2 million ] compared to what we reported last year of $5.1 million. Now last year's numbers were a bit skewed because we had a $23 million reversal of the inventory provision once we got approval of Ryoncil. Without that adjustment, the prior year number would have been about $18.1 million. So -- I'm sorry, we would have grown about $18.1 million over the prior year. And again, the spending in the period really related to our adult GVHD trials, back pain and also our LVAD program as well as getting ready for the BLA and some manufacturing work. Our sales and general and administrative expenses were $28.5 million compared to $18 million in the prior year. And that increase really related to the sales and marketing effort that Marcelo and the sales team did in terms of driving sales growth. The loss during the period this year was $40.2 million compared to $48 million in the prior year period. Again, as I mentioned a few moments ago, that prior year loss was impacted by the $23 million worth of reversal on inventory. And -- but for not those items, we were down -- we were up about -- we were down on a net loss of about $30 million year-over-year. Just in terms of our operating spend and our cash flows for the first fiscal quarter -- first fiscal half of the year, excuse me, we were at $30.3 million. As we look to the second half of the year, we expect our operating cash flow usage to decline when compared to the first half of fiscal '26 based upon our projected cash receipts from revenues as well as maintaining disciplined cost control measures and efficiencies in the operation. And on the next slide, just to point out our profitability and growth pipeline from Ryoncil. As I mentioned, we had strong revenues for the period. Gross margin, excluding amortization expense would have been about $44.2 million. Our direct selling costs were $7.7 million. And again, we have strong operating performance that allows us to invest in our R&D programs and our life cycle extensions. And we do have a very robust pipeline, and we continue to invest in our manufacturing footprint as well as building inventory where needed and getting our second-generation products to market. On Page 9, next slide, please. We had $130 million worth of cash at the end of December of this year, which you can also note that the reduction in our net spend over the year, as I said, will decline over the second half of this year. On December 30, 2025, we entered into a $125 million nondilutive credit line facility. The first tranche of which is $75 million was drawn at closing and enabled Mesoblast to replay in full its prior senior secured loan. We also partially repaid the subordinated royalty facility, which will continue to be reduced from ongoing revenue and will be fully repaid by the middle of 2026. The second tranche of $50 million is available to be drawn on our option through June of 2026. The new facility has a lower cost of capital for the company, freed up its major assets to provide flexibility for strategic partnerships and commercialization. In addition, the new facility can be repaid at any time without incurring early prepayment or make-whole fees. It does not include any exit fees and does not cover any of Mesoblast assets, which is a very strong point for the reason why we did this. This is terrific for the company. And we have no restrictions on doing additional unsecured debt or any licensing activities. We're very pleased with this line of credit and believe it will strengthen our balance sheet to support an exciting growth period for Mesoblast. On the next slide, looking ahead to the second half of 2026, we anticipate full year Ryoncil net revenues to range between $110 million and $120 million on a full year basis. With that, I'll turn the call back to Silviu for additional comments.

Silviu Itescu: Thanks, Jim. If we can go to Slide 12, I'd like to bring Marcelo Santoro, our Chief Commercial Officer, please.

Marcelo Santoro: Thank you very much. Next slide, please. So good afternoon, good morning, everyone. We are extremely pleased with the performance of the launch to date, and I couldn't be proud of the work, the commitment and the passion that our colleagues at Mesoblast demonstrate every single day towards these children. We have treated numerous patients since we launched and Ryoncil is having a transformational impact in the treatment of these children according to the feedback we received from treatment centers and treatment teams. In fact, we are on track to achieve 20% market share by the end of year 1 in the market. The commercial performance to date has been exceptional. This holds true not only against our initial expectations, but also when benchmarked against other successful rare disease launches. We have been laser-focused on building the infrastructure needed to ensure Ryoncil reaches its full potential. I am very happy to report that we have onboarded 49 treatment centers to date. In addition, Ryoncil is now listed on the formulary of 30 of those centers, a number that continues to grow steadily as more P&T committees review and approve its use. Formulary inclusion is critical, as you know, as it streamlines the adoption and use of Ryoncil when it's selected for a patient. Having these many formulary approvals in less than 1 year demonstrates the outstanding value of the product and the tireless commitment of the team to build the appropriate infrastructure to expand utilization. In addition, 13 hospitals have opted to use Optum Frontier, our specialty pharmacy partner, virtually eliminating their financial responsibilities with the product. On the payer side, we have also made exceptional progress. Ryoncil is now covered by insurance plans, representing over 280 million lives across both commercial and government payers. Medicaid coverage is in place in all states and a specific J-Code for Ryoncil, J3402 went into effect on October 1, allowing for more efficient billing and reimbursement for both sites of care and payers, along with CMS published rates. Commercial payer support has also been very strong. All major payers, including Aetna, Cigna, UnitedHealthcare, Anthem, Humana and Prime Therapeutics covering all Blue Cross plans have issued favorable coverage policies for Ryoncil. Notably, these policies do not require step therapy, which simplifies patient access significantly. All of this has occurred within the first 6 months post launch. Next slide, please. From a strategic priority standpoint, the Ryoncil team is 100% focused on 3 key strategic pillars. The first is to proactively identify and prioritize appropriate patients who may benefit from Ryoncil therapy. The second to reinforce our superior patient outcomes in first-line treatment right after steroids. And the third is to empower caregivers to demand Ryoncil for their children. We have been working with several advocacy groups and will soon launch a comprehensive campaign dedicated to supporting both caregivers and patients. With that, let me turn back to Paul.

Paul Hughes: Thanks, Marcelo. I'll hand over to Silviu, who's going to take us through the rest of the deck before we open it up to Q&A. Thanks.

Silviu Itescu: Thank you. If we could move to Slide 14. This slide summarizes our plans for label expansion of Ryoncil into adults. A pivotal study of Ryoncil as part of second-line treatment regimen in adults with severe steroid-refractory graft versus host disease is underway with our partners at the NIH-funded Bone Marrow Transplant Clinical Trials Network. The basis for this trial is that 50% of adults who have severe GVHD fail existing second-line treatment, including predominantly ruxolitinib. These patients who fail have a 25% abysmal survival at 100 days. We have previously used Ryoncil under expanded access in patients aged 12 and older, in many adults as well, 18 and older who have failed ruxolitinib or other second-line agents and use of our product in this patient population was associated with 76% survival at day 100, a remarkable result. As a result of these results, the final protocol design for the registrational study in adults has been locked down and has been worked through with the FDA recently in a meeting with the FDA agency. We expect that following Central Institutional Review Board approval coming up in March, site initiation and patient enrollment will commence. Next slide, please. Further extension strategy for Ryoncil is focused on various opportunities in pediatric and adult inflammatory diseases. The team is currently evaluating multiple indications to unlock value, including in the inflammatory bowel, neurodegenerative and respiratory conditions. Our portfolio will be prioritized to maximize shareholder return by utilizing either internal investment strategies versus external partnership initiatives. Next slide, Slide 16. Now I'll be updating you on our second-generation platform, rexlemestrocel-L currently being developed for discogenic chronic low back pain and chronic ischemic heart failure. Slide 17, our Phase III chronic low back pain program, a first 404-patient randomized controlled Phase III trial has already completed, and that included about 40% of patients who are opioid dependent. We met with the FDA recently and received positive feedback on potential filing of a BLA based on achieving a clinically meaningful reduction in pain intensity at 12 months between the treatment arm and placebo arm. The robust result in opioid reduction from at least one adequate and well-controlled trial could be included according to our meeting with the agency as part of product labeling, which is a very, very, very important outcome. We, in fact, do already have an RMAT, Regenerative Medicine Advanced Therapy designation for rexlemestrocel-L as a potential opioid-sparing therapy in chronic lower back pain. Next slide. The confirmatory Phase III trial is recruiting currently 300 patients across 40 sites in the U.S. with a primary endpoint, 12-month reduction in pain. As I've mentioned on multiple occasions, FDA has confirmed that, that is an approvable endpoint. The enrollment of these 300 patients is expected to be completed in March or April. Data readout and BLA filing are expected in calendar year 2027. We have, at the same time, undergoing commercial manufacturing in order to leverage our existing capacity and cost efficiencies. I will reinforce that there are many patients who are suffering from this terrible disease. Over 7 million patients across each of the U.S. and EU5 are due to generative this disease, patients who are otherwise have run out of options other than surgery. This is a large unmet need for a potential blockbuster opportunity. Next slide, Slide 19. Now I'd like to update you on Revascor, our product based on our rexlemestrocel-L platform that is being developed for chronic heart failure with reduced ejection fraction and persistent inflammation in either patients with Class II/III heart failure or very end-stage heart failure patients who are being kept alive with a ventricular assist device in the left ventricle. We can go to Slide 20. LVAD implantation improves overall survival in these end-stage patients, and that's well established. However, the underlying causes of heart failure in these patients, notably inflammation, persists. And whilst the left ventricle improving the left side -- the LVAD is improving on the left side of the heart, the right ventricular pump function remains vulnerable and continues to deteriorate. Therefore, progressive right heart failure continues to occur in up to 30% of patients and is the primary cause of multi-organ failure and death in this group of patients, mortality occurring within the first 12 months. In addition, life-threatening major mucosal bleeding due to progressive right heart failure and portal hypertension occur in about 30% of patients and is the major morbidity in this group, the main cause of recurrent hospitalization. Next slide. Now we performed 2 randomized controlled studies in this patient population. The more recent study was called LVAD Study II, and that randomized 159 patients in a 2:1 randomization to provide primary evidence of Revascor's efficacy in reducing major bleeding events. A second study, LVAD Study I, an earlier study, is a supportive study for LVAD II, randomized 30 patients in a 2:1 fashion and provided supportive evidence also of Revascor's efficacy in reducing major bleeding events. Intramyocardial injections in both of these studies of either Revascor or control were performed at the time of LVAD implantation. Importantly, both trials, both randomized controlled trials showed the Revascor reduced cumulative incidence of major bleeding events, life-threatening GI bleeding, the trial's primary efficacy and safety endpoint and related hospitalizations through 6 months, both were significant. We go to the next slide, Slide 22. This provides you with some new data that we have not previously presented. This slide demonstrates the total number of major bleeding events resulting in hospitalizations over 6 months on the left-hand side and over 12 months compared to controls in the entire study LVAD II. As you can see both on the left-hand side and the panel B on the right-hand side, Revascor reduced major bleeding events and hospitalizations by about fivefold, a very significant reduction throughout a 12-month period compared to MPC treatment compared to control treatment. Next slide, please. Now moreover, particularly in the ischemic group of patients, what you can see is that on the left-hand side, in controls, in red, the ischemic controls had approximately a three to fourfold increase in hospitalizations due to right heart failure. The non-ischemics had a very low incidence and risk of heart failure hospitalization. In contrast, on the right-hand side, by 12 months, you can see that the MPC treatment reduced the right heart failure hospitalization events in ischemic patients back to background levels, the same levels as I see in non-ischemic controls. And again, those reductions of hospitalization from right heart failure were significant. Next slide, please. This slide focuses on the risk of death from right heart failure in controls on the left, and in Revascor-treated patients on the right. As you can see in Panel A on the left, amongst patient controls who have at least one hospitalization from right heart failure, the presence of -- sorry, amongst controls, the presence of right heart failure hospitalization, at least 1 right heart failure hospitalization in red was associated with a mortality risk and a hazard ratio of 7 or more than 7 compared to patients who did not have right heart failure. So in controls, particularly early within the first 4 months after LVAD implantation, the presence of a right heart failure hospitalization was a very strong predictor of death. In contrast, what you can see on the right-hand side, amongst Revascor-treated patients, the risk of death, particularly in that early period 4-month period is almost completely abolish. And you can see that the overall survival over a 12-month period in Revascor-treated patient was the same, irrespective of whether they had a right heart failure hospitalization or not. So what this means is that Revascor not only reduces the incidence of hospitalization rates, but protects these patients against death from right heart failure. If you go to the next slide, please. So the summary of these new data, data that I haven't shown you here, but we have also observed is that Revascor reduces the inflammatory cytokines and through inflammation reduction protects the at-risk right ventricle in these patients, the same right ventricle that continues to fail despite the fact that there's an LVAD in the left ventricle. The strengthened right ventricle reduces hospitalization rates in the intensive care unit due to right heart failure and improves survival. The strengthened right ventricle decreases the risk of portal hypertension and therefore, decreases GI bleeding events. This leads us to think very carefully about how Revascor beyond its potential use in patients with left heart failure problems, also has the potential to be used to improve right heart failure function in patients not only with ischemic heart disease, but other causes of right heart failure, including primary pulmonary hypertension and chronic lung diseases. Next slide, please, Slide 26. So let me give you an update on our CHF program, particularly our plans to file for approval. With these new data and our existing orphan drug designation for treating this group of high-risk patients with high mortality as well as FDA's stated preference for randomized controlled trials, Mesoblast is moving from filing for an accelerated approval to filing for a full approval. Unlike an accelerated approval, full approval does not require a confirmatory study. Aligned with FDA on items required for filing the BLA regarding CMC potency assays for product release and commercial manufacturing, we now have these activities well and truly underway, and we expect to file our BLA for full approval for this indication in the next quarter. Let me summarize our highlights and our upcoming milestones. Ryoncil is the first and only FDA-approved MSC product. It delivered net revenues of USD 49 million in the first half of FY '26. As you heard, 49 centers have been onboarded, 64 centers account for 94% of the entire pediatric bone marrow transplant population, so well underway to achieve that in record time. We're initiating label expansion to adult acute GVHD, a market that is 3x larger than the pediatric market. We are currently prioritizing our portfolio, which includes the potential to go into the inflammatory bowel disease, neurodegenerative diseases and respiratory conditions, and we will update the market as we focus on certain areas in priority over others. Our second-generation rexlemestrocel-L is enrolling the second trial in back pain with full enrollment expected to complete by the end of March or end of April. BLA filing next quarter is in line for full approval for patients with right heart failure and end-stage heart failure with LVAD. And we're actively optimizing manufacturing logistics to support commercialization, both of the rexlemestrocel-L pipeline and obviously, to have further inventory for the projected growth in Ryoncil sales. With $130 million in cash on hand as of December 31 and the new credit line that you heard about, which still has the potential for $50 million available to draw down, we're in a very strong financial position. And as you heard earlier, we are projecting full year fiscal 2026 Ryoncil net revenue to range between USD 110 million and USD 120 million. And I think I'll stop there. And hopefully, there are some questions that we can all address. Thank you.

Paul Hughes: Operator, if you could please open the lines for questions. Thank you.

Operator: [Operator Instructions] Your first question comes from Edward Tenthoff with Piper Sandler.

Edward Tenthoff: Congrats on all the great progress across the board. Could you just repeat the guidance you broke up a little bit for this coming year?

James O’Brien: Yes. Yes. What we're projecting for the full fiscal year are net revenues ranging from $110 million to $120 million again, on a full year fiscal basis 2026 hitting June 2026.

Operator: Your next question comes from Olivia Brayer with Cantor Fitzgerald.

Olivia Brayer: I have a few, if you don't mind. Maybe just first on Ryoncil in peds. You all mentioned potentially hitting 20% penetration of that pediatric population by the -- I think it was by the end of your fiscal year, if I heard that correctly. So can you maybe just run through what those assumptions include to get to that 20%? And how high of penetration do you think you can realistically reach in this specifically peds population over time? And then I've got a couple more on your pipeline programs.

Marcelo Santoro: Yes. So thank you. So let me start with the second one and then go to the first, right? So the second one, we assume a 40% peak share. And you have to understand, we believe it should be 100%. This is a product that should be used by everyone. But let's be responsible and realistic, a 40% share is reasonable, right? So if you assume a range of patients, and obviously, that's dynamic of 375 patients, that's what the 20% is based on. It's 20% until the end of our fiscal year. That's what we aim on achieving at that point.

Olivia Brayer: And is that specifically for the fourth quarter of your fiscal year? Like if I'm kind of doing the math.

Silviu Itescu: Yes.

Olivia Brayer: Okay. That's helpful. And then for your Revascor BLA next quarter, how is the FDA viewing the ischemic versus non-ischemic phenotypes? And have they given any input on to or around potential labeling language around the ischemic etiology or inflammation biomarkers?

Silviu Itescu: Well, so I think it's important to note that in the 159-patient trial, we achieved the principal endpoint of -- in overall in the full patient population without having to go to any subgroups in terms of the cumulative incidence of major bleeding events over 6 months. Also, we achieved a significant reduction in hospitalizations for major bleeding events across the entire patient population without having to go to subgroup. So our position is that we will be seeking a label for the entire patient population, especially given that the confirmatory study, LVAD I, also achieved the same endpoint across all patients. There's no question that the patients at greatest risk are those with ischemic etiology. And those patients have a higher level of inflammation, they have a higher risk for bleeding, right heart failure and death. And interestingly, we saw the very same sort of thing in the larger trial in Class II/III heart failure, where, again, we saw patients with ischemic heart disease as an etiology had high levels of inflammation, greater risk of 3-point MACE and greater treatment benefit. So we will be providing the FDA with the totality of the data that confirm the supportive trials, demonstration that ischemic patients are at greater risk and treatment with our cells is even more effective in that subgroup, but we've achieved the endpoint around the prespecified bleeding endpoint and hospitalization endpoint across the entire population. So that remains to be negotiated.

Olivia Brayer: That's helpful. Understood. And then last question is just on the chronic back pain. Can you just clarify what data you're submitting to the FDA? Is it just a new analysis of the pre-existing data? And is your ongoing Phase III not actually going to be part of that submission package? Maybe just some clarity around that update because I do think that is a new disclosure.

Silviu Itescu: No, no, no. I didn't mean to say that we wouldn't be submitting the data from the new trial. The new trial, the second trial, which completes enrollment by over the next month to 6 weeks is the plan to complete enrollment. That trial becomes the primary data set and the previous trial becomes a supportive data set. That's certainly our intention. We have spoken with the FDA about looking at the subgroup of patients who are opioid dependent and that's a discussion that is ongoing with the agency. But with respect to the primary endpoint in all comers of pain reduction, we will be using the 2 trials to present full data sets.

Olivia Brayer: Okay. But that additional Phase III readout is coming in 2027, correct?

Silviu Itescu: That's correct.

Olivia Brayer: So will you -- you're kicking off filing before actually having that data?

Silviu Itescu: No. The objective is to complete that trial, get the readout and move to a filing with those data in the primary file.

Operator: Your next question comes from Madeleine Williams with Canaccord.

Madeleine Williams: Just in regards -- just going back to the pediatric Ryoncil and just the FY '26 guidance. Can you speak a little bit to sort of how you're seeing repeat utilization among centers or just how that kind of shakes out over the remaining of the year and sort of just trying to dig into more.

Marcelo Santoro: Yes. No, we'd be happy to do that. Yes. So we see the continuous growth in the centers, continuous adoption, not only by more centers, but also repeated use by the current centers we already have, which shows that they are finding utility in the products and repeating the treatment in other children, right? So that's one component. The second component, we're also seeing very big, very large centers coming on board, which will substantially increase our confidence in this guidance. And it's a reality that is happening every day.

Silviu Itescu: And I would add to that, I think a major additional components moving forward is continued physician education. We've shown both in our previous Phase III trials and in the real-world data that the earlier this product is used, the greater the survival. it's unquestionable. And so a lot of the effort by the team will be to educate physicians. Physicians have their own practice habits. And they all believe that their particular way of doing things is standard. Nothing is standard in this disease, especially given that only Ryoncil is approved by FDA for treatment of children. So I think a major focus and an area of growth is to educate the majority to use the product as early as possible after steroid failure. Do you agree, Marcelo?

Marcelo Santoro: For sure. And I would add 1 more, right? So as a father, unfortunately, my child had something like this horrible disease, I would like to know that this option is available. So it's our obligation to empower them to empower the caregivers, make sure that they understand that this product is available and it's the only FDA-approved product so that they can talk to their treatment teams and ask for this as a potential therapeutic option for their child.

Madeleine Williams: That's helpful. And just maybe 1 more for me. Just in regards to Revascor and the full approval -- filing for full approval rather than accelerated. I'm just interested, you've obviously discussed the additional data, but I'm assuming there's sort of been some sort of constructive discussions with the FDA. And just sort of if you can provide more color about what your confidence is in receiving that full approval?

Silviu Itescu: Well, we've had multiple discussions with the agency. We understand what they wanted to see and the data that I've highlighted to you today, particularly as it relates to mortality is the #1 area of focus. And the recent guidance by the agency to focus on randomized controlled trials rather than single-arm trials where major endpoints are being targeted like mortality give us the sort of confidence that particularly in an orphan disease indication where a single trial should be viewed as sufficient for approval, full approval.

Operator: [Operator Instructions] Your next question comes from Michael Okunewitch with Maxim Group.

Michael Okunewitch: Congrats on all the progress. I guess just to kick things off, there's obviously been a lot of changes at the FDA since you first launched the Phase III in chronic lower back pain. So I wanted to see if you've received confirmation from the current FDA administration that the 12-month pain-only endpoint is sufficient for approval?

Silviu Itescu: Yes, we have. Absolutely. That's exactly why we had the meeting recently to gain confirmation from the current administration that, that endpoint is an approvable endpoint, and that's exactly what we received. Moreover, the recent guidance from the FDA that a single well-conducted randomized controlled trial is sufficient for approvals in various indications also gives us great confidence that if we achieve that endpoint, this is an approvable trial and approval endpoint.

Michael Okunewitch: And then just 1 more for me, and I'll hop back in the queue. I wanted to ask when it comes to the upcoming filing in the Class IV heart failure programs, are there any outstanding items that FDA has requested that you need to finalize before you can submit that next quarter?

Silviu Itescu: Well, commercial manufacturing is always a very important component of this. And that is something that we are heavily engaged in. The product rexlemestrocel-L and its Phase III trials was all made at Lonza in the same facility where Ryoncil was made and which was approved for Ryoncil. And we believe that the vast majority of the manufacturing process is quite similar to the Ryoncil process. So I think that will be an advantage in our filing, but that remains -- we need to get some more confirmation from the agency. Nonetheless, we expect that the long history of manufactured product for back pain trials, cardiac trials will hold us in good stead.

Operator: That brings us to the end of today's call. I'll hand back to Paul, please.

Paul Hughes: Thank you. As you heard today, we're in a strong position with a number of significant milestones in this current second half through the period. We look forward to keeping you updated on the progress and the achievements. I'd like to thank everyone for their interest in Mesoblast and participation in the call today. Thank you, and have a great day.

Operator: That does conclude our conference for today. Thank you for participating. You may now disconnect.

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