Q4 2023 Cytosorbents Corp Earnings Call
Participants
Eric Ribner; IR; LifeSci Advisors, LLC
Phillip Chan; Chief Executive Officer; Cytosorbents Corp
Kathleen Bloch; Chief Financial Officer; Cytosorbents Corp
Efthymios Deliargyris; Chief Medical Officer; Cytosorbents Corp
Yuan Zhi; Analyst; B. Riley
Thomas Kerr; Analyst; Zacks Investment Research
Presentation
Operator
Afternoon, and welcome to the CytoSorbents Fourth Quarter and Full Year 2023 financial and operating results conference call. (Operator Instructions) Please be advised that the call will be recorded at the company's request. At this time, I'd like to turn the call over to our moderator, Eric Ribner. Please go ahead, Mr. Ribner.
Eric Ribner
Thank you and good afternoon. Welcome to CytoSorbents Fourth Quarter and Full Year 2023 financial and operating results conference call. Joining me today from the Company are Dr. Phil Chan, Chief Executive Officer; Vincent Capponi, President and Chief Operating Officer; Kathleen Bloch, Chief Financial Officer; Dr. Makis Deliargyris, Chief Medical Officer; Dr. Christian Steiner, Executive Vice President of Sales and Marketing and Managing Director of CytoSorbents Europe; Christopher Cramer, Senior Vice President of Business Development; and Dr. Irina Kulinets, Senior Vice President of Regulatory Affairs.
Before I turn it over to Dr. Chan, I'd like to remind listeners that during the call, management's prepared remarks may contain forward-looking statements, which are subject to risks and uncertainties. Management and management may make additional forward-looking statements in response to your questions today.
Therefore, the Company claims protection under the Safe Harbor for forward-looking statements contained in the Private Securities Litigation Reform Act of 1995. Actual results may differ from results discussed today, and therefore, we refer you to a more detailed discussion of these risks and uncertainties in the Company's filings with the SEC.
Any projections as to the Company's future performance represented by management include estimates as of today as of March 14th, 2024 and we assume no obligation to update these projections in the future as market conditions change.
During today's call, we will have an overview presentation covering the operating and financial highlights for the fourth quarter and full year 2023 by Dr. Chan and Miss Blough. Following that presentation, we will open up the line to your questions during the live Q&A session with the rest of the management team.
And now it is my pleasure to turn the call over to Dr. Chan bill, but thank you very much, Eric.
Phillip Chan
Thank you very much. Eric. Today, I'd like to talk a little bit about our recent operational highlights. First of all, we're pleased to say that as of the end of 2023, we had more than 228,000 cumulative CytoSorb treatments delivered. It was up 17% from the end of 2022. Our European Union CE Mark for CytoSorb was extended under the medical device directive MDD., the earlier of either December 2028 or one. We achieve EU medical device regulation certification, also known as MDR, which effort is currently ongoing.
We also entered into a new strategic partnership and temporary distribution agreement in India for CytoSorb with the publicly traded Indian pharmaceutical company, Eris Lifesciences following its definitive agreement with Biocon Biologics to acquire Bio-Quant nephrology Branded Formulations unit. And with it by a kind of key leadership and field force of these businesses, including the personnel, we are commercializing CytoSorb in India.
Also of importance is our stand-alone chemo precision pump initiative. Our stand-alone pump initiative is expected to bring our next-generation blood purification capability to countries that do not have a strong dialysis infrastructure. We're expecting to launch our new purified pump later this year following the expiration of our distribution agreement with Nikkiso Europe GmbH for its pure just pump in September of last year, and this is a picture of the pump. This is how it will look. It's very easy to use.
We've had excellent feedback from users who have been beta testing this unit, and we're very excited to be able to get this out into the market, hopefully in the very near future.
Moving on to the STAR two trial, the pivotal start key randomized controlled trial. We're pleased to say was selected for a breakout presentation at the American Association of Thoracic Surgery annual meeting being held April 27th through the 30th in Toronto Canada. The ATS Annual Meeting is one of the most prestigious cardiothoracic surgery conferences in the world and attracts users not only cardiac surgeons but for Fusion U.S. and a whole host of other health care workers who are involved in cardiothoracic surgery to learn about new innovations and clinical data in the area, cardiothoracic surgery.
Following this presentation, we plan to have a subsequent Analyst and Investor Day and provide a review of the data with investors and analysts by an esteemed five router panel. This will not be the same day as the ATS meeting presentation, but it will likely be high either later that week or the following week, based upon our additional analysis that we've done following our top-line data announcement in December.
We plan to submit now for regulatory approval of drugs, RETR. two US FDA and Health Canada in the second half of 2024, with a with the idea of reducing the severity of bleeding in patients undergoing isolated cabbage surgery on the blood center platform. Here you see is a tentative estimated start T time line where the final data analysis is pending imminently.
We expect to have the data presented at the late-breaking session at APS. in late April, data from the STAR registry, which is a real-world collection of data coming from Europe for using CytoSorb in the application to remove blood centers up well, an analysis of that registry, the third analysis will be presented at the Euro PCR conference in Europe in May 2024. If everything goes well, we will be in a position to submit to FDA in the second half of this year based upon FDA time lines, 45 days after submission.
The FDA will give formal notice if appropriate, of acceptance. And from there, it's about an eight to 10 month process based upon FDA published timelines to potential approval. In the meantime, we will also be preparing the Health Canada submission, and we'll hopefully be able to get that out before the end of this year, setting up a time line for the second half of 2025 to obtain potentially approval for FDA from FDA for drugs of ATR and also approval from Health Canada as well.
If things go well, we expect to begin commercialization shortly after receiving approval in the second half of 2025. We believe that focusing on our approval requests on isolated cabbage population will not significantly change our US and Canadian total addressable market opportunity.
Given that patients on ticagrelor needing isolated, cabbage represent the overwhelming majority facing this clinical need and on the next slide, you can see that the numbers haven't changed much from what has been in our investor presentation. It's about 65,000 patients on par with the meeting emergent or urgent cabbage surgery annually.
And about 5,000 of device represents about a 325 million initial U.S. and Canada total addressable market. We expect that the growth and market share will grow, given that drug survey tier would make front with the only reversible P2Y12 platelet inhibitor on the market and also because prolific goes off patent in 2024 this year, likely leading to a drop in prices, which has been the major advantage of Plavix, which is generic in the United States market. Once that price differential goes away, we expect the superior drug for Lenta to gain market share, helping to potentially expand the total addressable market in the United States and Canada by twofold.
Now turning to our sales update from the press release, I think goes over the sales highlights for 2023. However, I wanted to point out a few things. One is that core CytoSorb sales grew 10% year over year. And although that number is relatively modest, I think it masks some excellent performance that we have been seeing in our certain of our sales divisions.
As you recall, we have a hybrid sales model where we sell direct in Germany. We sell direct internationally and 14 other countries with our own direct sales force. And we sell in 60 other countries through our distributor and partner division.
What we saw in 2023 was strong performance from our international direct division, again, accounting for 14 countries where they saw 27% sales growth, $6 million or roughly 19% of product sales for the year. This is important as we look to continue to diversify our revenue base to really account for the 75 countries around the world where we sell CytoSorb today, distributor partner sales in the first three quarters of 2024 actually grew 18% versus the same period in 2022, not including US distributor sales.
However, because of the change that we made and the decision to let the Nikkiso pure just chemo profusion distribution agreement or precision pump Fisher Fusion agreement expire in favor of bringing our own pump to market.
This impacted ordering from distributors and wound up with a delay in distributor orders slipping into 2024 because of this, overall sales growth for the year was 9%, including US distributor sales for 39% of product sales for the year and finally, direct sales in Germany grew 3%, although the market significantly improved in 2023, hospitals are still feeling the weight of the aftermath of COVID-19 in terms of staffing shortages, fewer ICU beds, fewer ICU patients, fewer high revenue generating procedures moving through the intensive care unit, but also a range of additional costs driven by inflation, including energy and staffing for us as well.
However, we are seeing a significantly improved outlook for 2024, and we hope that this will begin a recovery in Germany. Germany represented 42% of our product sales last year. That said, we are currently tracking a proposal for health care reform maternity hospital system.
In July 2023, Germany's Federal and state governments issued a consensus white paper that could result in new laws that change how hospitals are funded government payments to hospitals would deemphasize the GRG also known as a diagnosis related group lump sum payment system that incentivizes revenue generation through more patients treated and procedures performed.
And it's that emphasize based payments focused on quality measures and appropriate patient care. This is expected to favor a shift of routine operations and procedures to outpatient centers, consolidation of smaller hospitals into larger ones, and importantly, an increased focus of remaining hospitals on sicker patients more complex operations such as cardiothoracic surgery and organ transplant and on therapies that help reduce the severity of illness and help patients recover faster, given that the goal of our therapies is to improve clinical outcomes while reducing the cost of critical care and cardiac surgery by controlling deadly inflammation and other life-threatening conditions.
While reducing the need for expensive life-support measures that keep patients in the hospital we believe such reform may favor our business in the longer term hospital administrators. Expect such change will take careful planning and time potentially even years to implement, and we look to track these developments with interest.
Now many of you have seen this slide before we talk about the extensive support of our technology by the U.S. government to the tune of about $50 million in grants and contracts and other nondilutive funding. And on the left-hand side, you see here three products that are actually being commercialized today. We typically focus on CytoSorb, and we don't really talk too much about equals 300 CY. or event rescue.
But today I wanted to trying to do that. In addition on the right-hand side, our products under current development and one of the products HemoDefend BGA for the development of universal plasma is a program which we've received $17 million for DoD grant funding to bring this to market. And I thought I'd spend a slide on each of these products, just to give you a flavor of what we're doing today to introduce 300 TY., okay.
Is approved in the European Union for ex vivo organ perfusion and for solid organ transplant. Solid organ transplant is the main treatment option in advanced organ failure, but is limited by the availability of suitable and healthy organs, achievable organ perfusion or otherwise known as EVOP. with temperature controlled oxygenated nutrient rich fluid or blood is being increasingly used as an alternative to transporting to Oregon on ice to improved functioning of transplanted organs that the salvage substandard ones that would otherwise be discarded.
However, it does not directly control inflammation with all within the organ. That is often the core to the organ dysfunction that is seen Paris operatively because 300 C., why specifically you approved to reduce inflammatory mediators during EVLP. And on the lower left hand side here, you can see an ex vivo organ perfusion machine by, call it the per life system by one of our partners after Radica. We've been one of the pioneers in this space and we work with them and provide a private label cartridge called Perstorp that plugs right into their system.
And the goals and cited benefits of ECO. 300 CY. and early data are that it reduces inflammatory mediators. It helps to recondition poorly functioning organs that would normally be discarded, increasing the donor pool of organs and in early data in both pigs as well as in early human studies, has been shown to reduce rates of primary graft dysfunction, particularly in lung transplants, helping to improve clinical outcomes.
On the next slide is that rescue, which is essentially CytoSorb for companion animals and the COVID pandemic has driven companion animal ownership now with 45% of U.S. households owning a dog in 26%, owning a cat according to the American Veterinary Medical Society companion animals approach to a wide variety of medical emergencies ranging from drug intoxication, heat stroke infection such as leftist versus sepsis and septic shock, trauma and others.
That rescue brings the power of CytoSorb to veterinary medicine with three sizes of cartridges intended to treat the full size range of companion animals that you can see here. And in 2023, we had eliminated but successful launch of that rescue to a number of regional veterinary centers and a 2024 and will be due our integrated all-in-one solution that includes the chemo profusion pump for them.
And last but not least, human FNPGA., which holds the promise of universal plasma HemoDefend PJ. was developed to create universal plasma, which is Plaza that does not need blood typing. It can be given off the shelf to anyone in need regardless of blood type by removing SIANAFIB. antibodies that meet plasma blood type specific.
And what you can see here on the right hand side is the current status of plasma logistics today where blood banks have to maintain pools of stores of Type A. Type B type AB. and Type CO. plasma, but universal plasma, which simplify those logistics because then a simple unit called universal plasma that could be given off the shelf to a patient regardless of their blood type.
Many applications of life-saving plasma include trauma, resuscitation, treatment of critically ill patients and component purification, such as the isolation of clotting factors for hemophilia, for example, albumin for critical illness and IVIT. for autoimmune disease treatment and infectious disease in the United States alone, more than 10,000 units of fresh frozen plasma are administered daily for $3.6 million units per year.
And again, with more than $17 million in funding from the US Department of Defense, CytoSorb has successfully developed a demonstrated a prototype HemoDefend VGA absorber that removes anti A. and anti B. antibody from human plasma with the goal of having our off-the-shelf one-size fits all blood type independent universal plasma provided that we can collaborate with a freeze-dried plasma provider to have that universal freeze-dried plasma in every ambulance and emergency room around the world. This is a big opportunity and we have now met recently with FDA and preliminary discussions with the goal of advancing HemoDefend BGA to human clinical trials and commercialization.
So with that, let me turn it over to Kathy to go back and cover financial highlights for 2023. Kathy?
Kathleen Bloch
Thank you, Phil, and hello to everyone on the call today, I will discuss our full year and fourth quarter 2023 financial results, including revenue gross margins. I will also be providing an update on our working capital and cash runway.
Next slide, please. Total 2023 revenue which includes both product sales and grant revenue was approximately $36.3 million as compared to $34.7 million in 2022, which is an increase of approximately $1.6 million or 5%. Cytosorb product sales were 31 million in 2023 compared to $28.6 million in 2022, which is an increase of approximately $2.4 million or 9%.
There was an increase in the average exchange rate of the euro to the US dollar and this favorably impacted 2023 CytoSorb product sales by approximately $780,000. Other non CytoSorb product revenue was $70,000 for 2023 compared to $787,000 for 2022 due to the discontinuation of orders from a customer who no longer required a specialized polymer.
Our product gross margin was 72% in 2023, up from 70% in 2022. And the company expects that gross margins will continue to improve into 2024 as we realize economies of scale at our new manufacturing facility. And finally, 2023 grant revenue was 5.3 million, which is approximately the same as 2022 grant revenue.
Next slide, please this next slide, bar graphs on which the blue bars represent our annual product sales for each year of 2017 to 2023. And we know that 2020 and 2021, product sales were very favorably impacted because CytoSorb was used to treat COVID-19 patients.
And of course, this usage ceased following the containment of the pandemic in subsequent years. Taking a look though, at the orange trend line Arrow, which tracks along the non-COVID revenue years, we see that 2022 and 2023 continues to show positive year over year growth in product sales.
The post COVID market has been challenging, particularly in Germany, for reasons already articulated by Phil in his comments. However, while gradual, we are seeing improvements in the marketplace, which we expect will bring more growth to our product sales for 2024 and into the future.
I also wanted to just comment on the green line which tracks our year-over-year gross margins, where we experienced a slight decline in 2022 when we began manufacturing at our new facility. And this was a result of manufacturing inefficiencies for example, we had to do test runs on as we brought the new facility into full operation.
And again, we do expect to see improvements in product gross margins in 2020 for Next slide, please. Now I'd just like to briefly review our fourth quarter 2023 results. Total revenue for the fourth quarter of 2023, which includes both product sales and grant revenue decreased 8% to approximately $8.7 million compared to approximately $9.4 million in the fourth quarter of 2023 sales.
Cytosorb product sales were $7.3 million in the fourth quarter of 2023 compared to $7.4 million in the fourth quarter of 2020. Sales, a decrease of 1% the increase in the average exchange rate of the euro to the US dollar favorably impacted Q4 2023 CytoSorb product sales by approximately $369,000 other product revenue was $14,000 in 2023 compared to $246,000 in 2020 sales.
As we mentioned due this is due to the discontinuation of orders from especially from customers who require a specialized polymer and grant revenue in the fourth quarter of 2023 was $1.3 million compared to $1.7 million in the fourth quarter of 2022.
Next slide, please. As of December 31st, 2023, we have $15.6 million in cash, which includes $1.5 million of restricted cash. This amount includes net proceeds of $9.8 million from our equity raise in December 2023 and approximately $4.5 million raised in 2023 utilizing our ATM facility. Conservation of cash is a corporate priority. We have adjusted our budget and we've taken measures to reduce our quarterly cash burn in 2024.
We have also instituted and continue to maintain tight controls over spending, and these actions are expected to preserve our cash runway. We know that we will need to raise capital to support our ongoing operations in the future. And the Company is actively pursuing other sources of capital, including less are non-dilutive debt financing, royalty financing strategic or direct investments, equity financing and or combinations thereof.
That concludes my remarks for today. At this time, I'm going to turn the call back over to Phil. Phil?
Phillip Chan
Thank you, Kathy. So in summary, today, CytoSorb drives our growth bets or forms. The company's foundation is EU approved and sold around the world has generated more than $200 million in sales since launch is a high-margin razor blade business model with historical 80% blended product gross margins that has strong validation by customers, partners and government agencies. We believe we can return to and potentially even exceed our historic compound annual growth rate of approximately 25%.
We have previously discussed a number of macro trends in healthcare that favor our therapies such as the aging population that is prone to critical illness use of blood thinners by millions of people worldwide to reduce the risk of heart attack and stroke and the epidemic of chronic liver disease that afflicts one in every five people globally.
Meanwhile, we have also discussed our numerous growth initiatives like our stand-alone pump initiative with the pending launch of our own purified machine, the impact that supportive data from Starkey may have on the blood center opportunity worldwide.
Our global marketing agreement with for Attenace medical care for CytoSorb is the featured solution for cytokine bilirubin and myoglobin removal on its critical care platforms worldwide. Our new EU trademark of expanding the dimension of blood purification that highlights the up to 40 50% of patients in the ICU where our therapies could be beneficial and the relatively new applications with exciting recently published clinical data.
Because of that, we believe that CytoSorb, which is designed to address the $20 billion to $30 billion worldwide total addressable market of major unmet medical needs in critical care, cardiac surgery, as well as liver and kidney disease gives us a massive potential growth engine going forward, we believe the skill set to service the potential upside of a biotechnology company with a lower risk profile of a high margin medical device company.
But sales, but soon to start to be successful in drugs or ATR achieved US FDA and Health Canada regulatory approval, we intend to commercialize drugs our HR in both United States and Canada, a potential second engine of growth for working in tandem with CytoSorb to drive sales and ultimately profitability. At this stage, we believe our Company represents an exceptional value proposition and with that.
Operator, that ends our formal comments. Please open up the lines for questions.
Question and Answer Session
Operator
Thank you. (Operator Instructions)
Yuan Zhi, B. Riley.
Yuan Zhi
Thank you for taking our questions and congrats on the TS group confrontational fintech customers who understand the timing of data release. So the conference will be in late April to you anticipate some abstract release before that? Thank you.
Phillip Chan
Sure. Thanks, Yuan. Mike, do you want to take that?
Efthymios Deliargyris
Sure. Thank you for the question. And the data is part of a breakout session of clinical trials at the conference and the acceptance goes together with the agreement of an embargo of release of that information ahead of the conference. So the data will be released live during the ATS. conference in Toronto. Not not to have that.
Yuan Zhi
Got it. And then, Phil, on the FDA myostatin mutation. Now with this Starkey trial result, do you intend to submit Taiwan K application or the premarket authorization platform to track if there's a change in standard?
Phillip Chan
Currently we have not disclosed what the regulatory strategy will be, but suffice it to say that we are currently working on that, but at the appropriate time closer to a submission, we'll make that publicly known.
Yuan Zhi
Got it. And maybe one last question from me. Just want to hear about this impact of this sales channel change. I'm curious how long will this impact and the should we see for recovery from this channel change in first half or second half this year?
Phillip Chan
When you're talking about the channel change, are you talking about the relative distribution of sales from our three divisions?
Yuan Zhi
Yes.
Phillip Chan
Surprisingly, as it turns out that the the percentage contribution to product sales has remained relatively constant. But what we have seen is that distributor sales have been growing in importance as that channel has gotten stronger and as those markets are being developed worldwide.
So historically, Germany sales had been 50% of our sales base currently as of last year, 42%. And our distributor sales, which had been historically 30% are now 40%. And so we believe that if everything goes to plan that those percentages should remain roughly the same.
But it is predicated on Germany, obviously recovering faster than we've seen it historically. But the good part is that we we do see a change in the German market compared to a year ago. And maybe, Christian, you'd like to comment and maybe on Germany and what you're seeing there?
Efthymios Deliargyris
Yes. Thank you, Phil. Thank you Yuan for the question that. So just to add some context to what Phil said, some. Yes, we see obviously a stabilization of the of the business in the more mature markets. So the more mature markets, I specifically say the Central European markets like Germany, Austria and Switzerland. But on the other hand, we see a much more pronounced path towards growth in the other direct markets and our distributor markets.
And this is some this is very much dependent on the state of development, and I very much expect that these direct markets outside Germany, Austria, Switzerland and the distributor markets coming to a similar growth phase as we have seen in Germany and two, three years ago.
So that was one point and the other point is coming back to Germany that, as I said, we have seen the stabilization of the markets, but still there's a lot of them post pandemic, but also structural problems in the health care system. We are at the momentum on the path to overcome this.
And on top, we are having initiated or scheduled a number of initiatives over the year of which two campaigns have started already. And we see already our progress in this and these two campaigns. And so I think that on top of the stabilization, I talked about, we will see additional development and this is satisfying for you as an answer your next question.
Yuan Zhi
Got it. Thanks for the additional color, and that will be all from my side. Thank you.
Operator
Thomas Kerr, Zacks Investment Research.
Thomas Kerr
Hello, everyone. Some of my questions were just answered but can you give us more color on the India arrangement in terms of time line and that fits your thing?
And secondly, related to that, the slide said you're approved in the EU, obviously, and it's sold around the world, but is CytoSorb approved and other regions, Asia, South America, et cetera?
Phillip Chan
Yes. Thank you, Kathy or Chris, would you like to comment on the Eris agreement? Or I can?
Kathleen Bloch
I can only say that based on my conversations with the operations people on in India, that the transition has gone very smoothly from Biocon to Eris. They've done a lot of freight train retraining of that. The actual employees of Bio-Quant who are knowledgeable of site at corp CytoSorb have transferred over to Aris. They've been retrained on and they are out and are off to a successful beginning of the year distribution partnerships?
Phillip Chan
Yes, I think on Biocon was an outstanding partner and Dan, but Arista is a $1 billion US market cap publicly traded company, not as large as Biocon, but a a kind of a specialty pharma company that is very has been very aggressive in the market and has been able to really take assets and grow them very impressively. And we have a temporary agreement that has the same terms as the distribution agreement that we have with Biocon with the exception of the expiration of the date of the agreement, which has been updated from September 2026 to now December 2020 -- to September 2026 from what was formerly December 2025 to basically give Aris some additional time in the market.
I've got to get their feet wet with CytoSorb and to and to see what it can do. We expect to enter into good faith agreements and we can negotiate you are agreement with Eris and that wall it's happening hopefully sometime in the near future.
Thomas Kerr
And the second part of the question was we're also famous for absorb right now as confused by why the slides in the presentation.
Phillip Chan
Yes. So we certainly saw that in fact, all over the world with the notable exception of the United States, Japan and China. But for example, we are in most of the I think if not all of the European Union countries for in many countries in Southeast Asia, for example, Singapore, Thailand, Vietnam, Hong Kong, South Korea, et cetera. We are in Russia. We are in many countries in the Middle East. We are in Australia and New Zealand.
We are in India, and we are in many countries in Latin America. So in fact, I see and we also have a footprint in South Africa as well. So not that much in Africa, notable exceptions of the US, Canada, Japan and China. But otherwise, we have a fairly broad footprint around the world where we leverage our EU approval and to be able to sell in these countries.
Thomas Kerr
Got it. Okay. I wasn't sure about that. But a normal quarterly burn rate for 2024, it used to be sort of in the $4 million to $4.5 million range with all the cost savings initiatives. Will it fall below that? Do you think in 2024 on a quarterly basis?
Phillip Chan
Kathy, do you want to take up?
Kathleen Bloch
Yes. So yes, you won't see the full impact of the cost-cutting measures in the first quarter of the year because there are some times some severance or other costs associated with the implementation. But you can expect our cash burn to be reduced to something around the order of $3 million a quarter in the last two quarters of the year.
Thomas Kerr
Okay. And that has little surprising stuff to support the drug ATR. development and that sort of stuff. So so the recovery I was assuming?
Phillip Chan
We actually still have from clinical trial costs in terms of winding down, Starkey, winding down star key. And we also have clinical programs ongoing such as the Cosmos registry, our STAR registry and our process randomized controlled trial that is running in Germany. So there is still significant clinical spend and that we are undertaking in 2024. But that being said, the burn will be dramatically lower than it was last year.
And our goal is to, obviously, as Cathy mentioned, in her presentation, cash cash conservation is key, right? And I think we detailed many cost-cutting efforts, not just a 15% workforce reduction, but you know, cutting nonessential programs, particularly on the R & D side as well as things even like a 3rd year of salary freezes for executives, for example.
And so there's there's a lot of things across the board that we've been doing in some challenging financing environment. But we hope that with additional operational progress this year that the value in our Company begins to be unlocked and it allows us to capitalize upon that strategy.
Thomas Kerr
Got it. Makes sense. And last question from, you know, the current share count close to the 10 K filing new Domino's who see workflow to your website?
Phillip Chan
Kathy, you have that number?
Kathleen Bloch
Yes, yes. So our common shares outstanding right now are $54.2 million. And then in addition, we have options warrants and RSUs, which bring our fully diluted common shares outstanding to $67.9 million. And I can send you that breakdown if that would help you, Tom.
Operator
Yes, there are no further questions at this time, I would like to turn the call back to management for any additional our closing remark.
Phillip Chan
Well, thank you, everyone, for joining the call today. If you do have any other questions, please feel free to reach out to Kathy Bloch at kbloch@cytosorbents.com, and we will reply to your questions. Where possible, we'll look forward to the next quarterly call. Thank you, everyone very much. Have a good day.
Operator
Thank you. That concludes our conference for today. I'd like to thank everyone for their participation. You may now disconnect.
