Form 10-Q - Quarterly report [Sections 13 or 15(d)]

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

FORM 10-Q

(Mark One)

☒ QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the quarterly period ended September 30, 2023

☐ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the transition period from _____________ to _____________

Commission file number: 01-39834

CLENE INC.

(Exact name of registrant as specified in its charter)

Delaware		85-2828339
(State or other jurisdiction of incorporation or organization)		(I.R.S. Employer Identification No.)

6550 South Millrock Drive, Suite G50

Salt Lake City, Utah

84121

(Address of principal executive offices)

(Zip Code)

(801) 676 9695

(Registrant’s telephone number, including area code)

N/A

(Former name, former address, and former fiscal year, if changed since last report)

Securities registered pursuant to Section 12(b) of the Act:

Title of each class	Trading Symbol(s)	Name of each exchange on which registered
Common Stock, $0.0001 par value	CLNN	The Nasdaq Capital Market
Warrants, to acquire one-half of one share of Common Stock for $11.50 per share	CLNNW	The Nasdaq Capital Market

Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes ☒ No ☐

Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files). Yes ☒ No ☐

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the Exchange Act.

Large accelerated filer	☐	Accelerated filer	☐
Non-accelerated filer	☒	Smaller reporting company	☒
		Emerging growth company	☒

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☐

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes ☐ No ☒

The number of shares outstanding of the Registrant’s common stock as of November 3, 2023 was 128,415,605.

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CLENE INC.

Quarterly Report on Form 10-Q for the Quarter Ended September 30, 2023

PART I—FINANCIAL INFORMATION			1
	Item 1.	Financial Statements (Unaudited)	1
		Condensed Consolidated Balance Sheets	1
		Condensed Consolidated Statements of Operations and Comprehensive Loss	2
		Condensed Consolidated Statements of Stockholders’ Equity (Deficit)	3
		Condensed Consolidated Statements of Cash Flows	4
		Notes to Condensed Consolidated Financial Statements	5
	Item 2.	Management’s Discussion and Analysis of Financial Condition and Results of Operations	24
	Item 3.	Quantitative and Qualitative Disclosures About Market Risk	36
	Item 4.	Controls and Procedures	36

PART II—OTHER INFORMATION			38
	Item 1.	Legal Proceedings	38
	Item 1A.	Risk Factors	38
	Item 2.	Unregistered Sales of Equity Securities and Use of Proceeds	39
	Item 3.	Defaults Upon Senior Securities	39
	Item 4.	Mine Safety Disclosures	39
	Item 5.	Other Information	39
	Item 6.	Exhibits	39

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PART I—FINANCIAL INFORMATION

Item 1. Financial Statements

CLENE INC.

CONDENSED CONSOLIDATED BALANCE SHEETS

(In thousands, except share and per share amounts)

(Unaudited)

	*September 30,*			*December 31,*
	*2023*			*2022*
ASSETS
Current assets:
Cash and cash equivalents	$	42,113		$	18,332
Marketable securities		—			4,983
Accounts receivable		64			189
Inventory		104			43
Prepaid expenses and other current assets		4,165			5,648
Total current assets		46,446			29,195
Restricted cash		58			58
Operating lease right-of-use assets		4,287			4,602
Property and equipment, net		9,642			10,638
TOTAL ASSETS	$	60,433		$	44,493

LIABILITIES AND STOCKHOLDERS’ EQUITY
Current liabilities:
Accounts payable	$	1,889		$	3,014
Accrued liabilities		3,194			3,863
Operating lease obligations, current portion		553			488
Finance lease obligations, current portion		44			74
Notes payable, current portion		9,588			6,418
Total current liabilities		15,268			13,857
Operating lease obligations, net of current portion		5,080			5,557
Finance lease obligations, net of current portion		—			34
Notes payable, net of current portion		6,675			9,483
Convertible notes payable		9,975			9,770
Common stock warrant liabilities		1,860			—
Clene Nanomedicine contingent earn-out liability		150			2,264
Initial Stockholders contingent earn-out liability		19			291
TOTAL LIABILITIES		39,027			41,256
Commitments and contingencies (Note 9)
Stockholders’ equity:
Common stock, $0.0001 par value: 300,000,000 and 150,000,000 shares authorized at September 30, 2023 and December 31, 2022, respectively; 128,411,981 and 74,759,591 shares issued and outstanding at September 30, 2023 and December 31, 2022, respectively		13			7
Additional paid-in capital		253,854			196,246
Accumulated deficit		(232,550	)		(193,219	)
Accumulated other comprehensive income		89			203
TOTAL STOCKHOLDERS’ EQUITY		21,406			3,237
TOTAL LIABILITIES AND STOCKHOLDERS’ EQUITY	$	60,433		$	44,493

See accompanying notes to the condensed consolidated financial statements.

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CLENE INC.

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE LOSS

(In thousands, except share and per share amounts)

(Unaudited)

	*Three Months Ended September 30,*						*Nine Months Ended September 30,*
	*2023*			*2022*			*2023*			*2022*
Revenue:
Product revenue	$	65		$	130		$	355		$	139
Royalty revenue		43			44			129			100
Total revenue		108			174			484			239
Operating expenses:
Cost of revenue		12			19			83			19
Research and development		5,972			6,403			19,982			24,149
General and administrative		3,666			3,557			11,029			12,807
Total operating expenses		9,650			9,979			31,094			36,975
Loss from operations		(9,542	)		(9,805	)		(30,610	)		(36,736	)
Other income (expense), net:
Interest income		546			59			931			144
Interest expense		(1,188	)		(857	)		(3,358	)		(2,390	)
Gain on termination of lease		—			—			—			420
Commitment share expense		—			—			(402	)		—
Issuance costs for common stock warrant liability		—			—			(333	)		—
Loss on initial issuance of equity		—			—			(14,840	)		—
Change in fair value of common stock warrant liabilities		6,341			149			5,958			151
Change in fair value of Clene Nanomedicine contingent earn-out liability		1,004			(1,591	)		2,114			6,662
Change in fair value of Initial Stockholders contingent earn-out liability		129			(205	)		272			849
Research and development tax credits and unrestricted grants		247			1,346			902			2,001
Other income (expense), net		45			(72	)		35			35
Total other income (expense), net		7,124			(1,171	)		(8,721	)		7,872
Net loss before income taxes		(2,418	)		(10,976	)		(39,331	)		(28,864	)
Income tax benefit		—			—			—			—
Net loss		(2,418	)		(10,976	)		(39,331	)		(28,864	)

Other comprehensive loss:
Unrealized gain (loss) on available-for-sale securities		(4	)		33			16			(54	)
Foreign currency translation adjustments		(81	)		(39	)		(130	)		(99	)
Total other comprehensive loss		(85	)		(6	)		(114	)		(153	)
Comprehensive loss	$	(2,503	)	$	(10,982	)	$	(39,445	)	$	(29,017	)

Net loss per share – basic and diluted	$	(0.02	)	$	(0.17	)	$	(0.41	)	$	(0.46	)
Weighted average common shares used to compute basic and diluted net loss per share		128,405,483			63,508,928			97,026,964			63,234,757

See accompanying notes to the condensed consolidated financial statements.

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CLENE INC.

CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY (DEFICIT)

(In thousands, except share amounts)

(Unaudited)

	*Common Stock*				*Additional Paid-In*			*Accumulated*			*Accumulated Other Comprehensive*			*Total Stockholders’*
	*Shares*		*Amount*		*Capital*			*Deficit*			*Income (Loss)*			*Equity (Deficit)*
Balances at December 31, 2022		74,759,591	$	7	$	196,246		$	(193,219	)	$	203		$	3,237
Issuance of common stock		3,227,758		1		4,664			—			—			4,665
Stock-based compensation expense		—		—		2,223			—			—			2,223
Unrealized gain on available-for-sale securities		—		—		—			—			14			14
Foreign currency translation adjustment		—		—		—			—			4			4
Net loss		—		—		—			(11,770	)		—			(11,770	)
Balances at March 31, 2023		77,987,349	$	8	$	203,133		$	(204,989	)	$	221		$	(1,627	)
Issuance of common stock		50,402,893		5		40,924			—			—			40,929
Issuance of equity-classified warrants		—		—		4,970			—			—			4,970
Stock-based compensation expense		—		—		2,451			—			—			2,451
Issuance of common stock upon vesting of restricted stock awards		10,870		—		—			—			—			—
Unrealized gain on available-for-sale securities		—		—		—			—			6			6
Foreign currency translation adjustment		—		—		—			—			(53	)		(53	)
Net loss		—		—		—			(25,143	)		—			(25,143	)
Balances at June 30, 2023		128,401,112	$	13	$	251,478		$	(230,132	)	$	174		$	21,533
Common stock issuance costs		—		—		(20	)		—			—			(20	)
Stock-based compensation expense		—		—		2,396			—			—			2,396
Issuance of common stock upon vesting of restricted stock awards		10,869		—		—			—			—			—
Unrealized loss on available-for-sale securities		—		—		—			—			(4	)		(4	)
Foreign currency translation adjustment		—		—		—			—			(81	)		(81	)
Net loss		—		—		—			(2,418	)		—			(2,418	)
Balances at September 30, 2023		128,411,981	$	13	$	253,854		$	(232,550	)	$	89		$	21,406

Balances at December 31, 2021		62,312,097		6		175,659			(163,301	)		233			12,597
Reclassification of common stock warrant liability to equity		—		—		305			—			—			305
Exercise of stock options		934,448		—		267			—			—			267
Stock-based compensation expense		—		—		2,202			—			—			2,202
Unrealized loss on available-for-sale securities		—		—		—			—			(50	)		(50	)
Foreign currency translation adjustment		—		—		—			—			50			50
Net loss		—		—		—			(13,354	)		—			(13,354	)
Balances at March 31, 2022		63,246,545	$	6	$	178,433		$	(176,655	)	$	233		$	2,017
Exercise of stock options		110,000		—		17			—			—			17
Stock-based compensation expense		—		—		2,184			—			—			2,184
Issuance of common stock upon vesting of restricted stock awards		65,363		—		—			—			—			—
Unrealized loss on available-for-sale securities		—		—		—			—			(37	)		(37	)
Offering costs		—		—		(100	)		—			—			(100	)
Foreign currency translation adjustment		—		—		—			—			(110	)		(110	)
Net loss		—		—		—			(4,534	)		—			(4,534	)
Balances at June 30, 2022		63,421,908	$	6	$	180,534		$	(181,189	)	$	86		$	(563	)
Issuance of common stock, net of issuance costs		40,000		—		128			—			—			128
Stock-based compensation expense		—		—		2,098			—			—			2,098
Issuance of common stock upon vesting of restricted stock awards		80,076		—		—			—			—			—
Unrealized gain on available-for-sale securities		—		—		—			—			33			33
Foreign currency translation adjustment		—		—		—			—			(39	)		(39	)
Net loss		—		—		—			(10,976	)		—			(10,976	)
Balances at September 30, 2022		63,541,984	$	6	$	182,760		$	(192,165	)	$	80		$	(9,319	)

See accompanying notes to the condensed consolidated financial statements.

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CLENE INC.

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

(In thousands)

(Unaudited)

	*Nine Months Ended September 30,*
	*2023*			*2022*
Cash flows from operating activities:
Net loss	$	(39,331	)	$	(28,864	)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation		1,283			715
Non-cash lease expense		315			285
Commitment share expense		402			—
Issuance costs for common stock warrant liability		333			—
Loss on initial issuance of equity		14,840			—
Change in fair value of common stock warrant liabilities		(5,958	)		(151	)
Change in fair value of Clene Nanomedicine contingent earn-out liability		(2,114	)		(6,662	)
Change in fair value of Initial Stockholders contingent earn-out liability		(272	)		(849	)
Stock-based compensation expense		7,070			6,484
Gain on termination of lease		—			(420	)
Loss on sale of marketable securities		—			2
Accretion of debt discount		819			661
Non-cash interest expense		273			83
Changes in operating assets and liabilities:
Accounts receivable		125			(77	)
Inventory		(61	)		3
Prepaid expenses and other current assets		1,483			(884	)
Accounts payable		(1,125	)		213
Accrued liabilities		(669	)		(1,474	)
Operating lease obligations		(412	)		(360	)
Net cash used in operating activities		(22,999	)		(31,295	)
Cash flows from investing activities:
Purchases of marketable securities		—			(24,582	)
Proceeds from maturities of marketable securities		5,000			8,000
Proceeds from sales of marketable securities		—			7,614
Purchases of property and equipment		(287	)		(3,478	)
Net cash provided by (used in) investing activities		4,713			(12,446	)
Cash flows from financing activities:
Proceeds from exercise of stock options		—			284
Proceeds from at-the-market offering		—			132
Payments of at-the-market offering commissions		—			(4	)
Proceeds from issuance of common stock and warrants, net of offering costs		42,094			—
Payments of finance lease obligations		(63	)		(101	)
Proceeds from the issuance of notes payable		350			694
Payments of notes payable issuance costs		—			(30	)
Payments of notes payable modification fees		(200	)		—
Payment of deferred offering costs		—			(100	)
Net cash provided by financing activities		42,181			875
Effect of foreign exchange rate changes on cash and restricted cash		(114	)		(155	)
Net increase (decrease) in cash, cash equivalents and restricted cash		23,781			(43,021	)
Cash, cash equivalents and restricted cash – beginning of period		18,390			50,346
Cash, cash equivalents and restricted cash – end of period	$	42,171		$	7,325

Reconciliation of cash, cash equivalents and restricted cash to the consolidated balance sheets
Cash and cash equivalents		42,113			7,267
Restricted cash		58			58
Cash, cash equivalents and restricted cash	$	42,171		$	7,325

Supplemental disclosure of non-cash investing and financing activities:
Common stock warrant liability recorded upon debt modification	$	692		$	—
Common stock warrant liability recorded upon public stock offering	$	7,126		$	—
Lease liability arising from obtaining right-of-use assets, leasehold improvements, and lease incentives	$	—		$	2,343
Lease incentive realized	$	—		$	500
Lease liability settled through termination of lease	$	—		$	602
Reclassification of common stock warrant liability to permanent equity	$	—		$	305
Purchases of property and equipment in accounts payable	$	—		$	1,318
Supplemental cash flow information:
Cash paid for interest expense	$	2,266		$	1,646

See accompanying notes to the condensed consolidated financial statements.

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CLENE INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

(Unaudited)

Note 1. Nature of the Business

Clene Inc. (the “Company,” “we,” “us,” or similar such references) is a clinical-stage pharmaceutical company pioneering the discovery, development, and commercialization of novel clean-surfaced nanotechnology therapeutics. We have developed an electro-crystal-chemistry drug development platform which enables production of concentrated, stable, highly active, clean-surfaced nanocrystal suspensions. We have multiple drug assets currently in development for applications primarily in neurology. Our efforts are currently focused on addressing the high unmet medical needs in central nervous system disorders including Amyotrophic Lateral Sclerosis (“ALS”), Multiple Sclerosis (“MS”), and Parkinson’s Disease (“PD”). Our patented electro-crystal-chemistry manufacturing platform further enables us to develop very low concentration dietary supplements to advance the health and well-being of broad populations. These dietary supplements can vary greatly and include nanocrystals of varying composition, shapes and sizes as well as ionic solutions with diverse metallic constituents. Dietary supplements are marketed and distributed through our wholly owned subsidiary, dOrbital, Inc., or through an exclusive license with 4Life Research LLC (“4Life”), a related party (see Note 15).

Clene Nanomedicine, Inc. (“Clene Nanomedicine”) became a public company on December 30, 2020 (the “Closing Date”) when it completed a reverse recapitalization (the “Reverse Recapitalization”) with Tottenham Acquisition I Limited (“Tottenham”), Tottenham’s wholly-owned subsidiary and our predecessor, Chelsea Worldwide Inc., and Creative Worldwide Inc., a wholly-owned subsidiary of Chelsea Worldwide Inc. On the Closing Date, Chelsea Worldwide Inc. changed its name to Clene Inc. and listed its shares of common stock, par value $0.0001 per share (“Common Stock”) on the Nasdaq Capital Market (“Nasdaq”) under the symbol “CLNN.”

Going Concern

We incurred a loss from operations of $9.5 million and $9.8 million for the three months ended September 30, 2023 and 2022, respectively; and $30.6 million and $36.7 million for the nine months ended September 30, 2023 and 2022, respectively. Our accumulated deficit was $232.6 million and $193.2 million as of September 30, 2023 and December 31, 2022, respectively. Our cash, cash equivalents, and marketable securities totaled $42.1 million and $23.3 million as of September 30, 2023 and December 31, 2022, respectively, and net cash used in operating activities was $23.0 million and $31.3 million for the nine months ended September 30, 2023 and 2022, respectively.

We have incurred significant losses and negative cash flows from operations since our inception. We have not generated significant revenues since our inception, and we do not anticipate generating significant revenues unless we successfully complete development and obtain regulatory approval for commercialization of a drug candidate. We expect to incur additional losses in the future, particularly as we advance the development of our clinical-stage drug candidates, continue research and development of our preclinical drug candidates, and initiate additional clinical trials of, and seek regulatory approval for, these and other future drug candidates. We expect that within the next twelve months, we will not have sufficient cash and other resources on hand to sustain our current operations or meet our obligations as they become due unless we obtain additional financing. Additionally, pursuant to our term loan with Avenue Venture Opportunities Fund, L.P. (“Avenue”), we are required to maintain unrestricted cash and cash equivalents of at least $5.0 million to avoid acceleration of the full balance of the loan (see Note 8). These conditions raise substantial doubt about the Company’s ability to continue as a going concern.

To mitigate our funding needs, we plan to raise additional funding, including exploring equity financing and offerings, debt financing, licensing or collaboration arrangements with third parties, as well as utilizing our existing at-the-market facility and equity purchase agreement and potential proceeds from the exercise of outstanding warrants and stock options. These plans are subject to market conditions and reliance on third parties, and there is no assurance that effective implementation of our plans will result in the necessary funding to continue current operations. We have implemented cost-saving initiatives, including delaying and reducing certain research and development programs and commercialization efforts and elimination of certain staff positions. We have concluded that our plans do not alleviate the substantial doubt about our ability to continue as a going concern beyond one year from the date the condensed consolidated financial statements are issued.

The accompanying condensed consolidated financial statements have been prepared assuming we will continue as a going concern, which contemplates the realization of assets and satisfaction of liabilities in the normal course of business. As a result, the accompanying condensed consolidated financial statements do not include any adjustments relating to the recoverability and classification of assets and their carrying amounts, or the amounts and classification of liabilities that may result should we be unable to continue as a going concern.

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Note 2. Summary of Significant Accounting Policies

Basis of Presentation

The accompanying condensed consolidated financial statements include the accounts of Clene Inc. and our wholly-owned subsidiaries, Clene Nanomedicine, Inc., a subsidiary incorporated in Delaware, Clene Australia Pty Ltd (“Clene Australia”), a subsidiary incorporated in Australia, Clene Netherlands B.V. (“Clene Netherlands”), a subsidiary incorporated in the Netherlands, and dOrbital, Inc., a subsidiary incorporated in Delaware, after elimination of all intercompany accounts and transactions. We have prepared the accompanying condensed consolidated financial statements in accordance with United States (“U.S.”) Generally Accepted Accounting Principles (“GAAP”) for interim financial reporting and as required by Regulation S-X, Rule 10-01. The condensed consolidated financial statements have been prepared on the same basis as our audited annual consolidated financial statements and, in the opinion of management, reflect all adjustments, which are normal and recurring in nature, necessary for fair financial statement presentation. The financial data and other information disclosed in the condensed consolidated financial statements and related notes for the three and nine months ended September 30, 2023 and 2022 are unaudited.

Results of operations for the three and nine months ended September 30, 2023 and 2022 are not necessarily indicative of the results for the entire fiscal year or any other period. The condensed consolidated financial statements for the three and nine months ended September 30, 2023 and 2022 should be read in conjunction with the audited consolidated financial statements included in our Annual Report on Form 10-K.

Use of Estimates

The preparation of condensed consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets, liabilities, and disclosure of contingent assets and liabilities, and the reported amounts of expenses. We base our estimates on historical experience and various other assumptions that we believe to be reasonable. Actual results may differ from those estimates or assumptions. Estimates are periodically reviewed in light of changes in circumstances, facts, and experience, and any changes in estimates will be recorded in future periods as they develop.

Risks and Uncertainties

We are subject to certain risks and uncertainties and believe that changes in any of the following areas could have a material adverse effect on future financial condition, results of operations, or cash flows: ability to obtain additional financing; regulatory approval and market acceptance of, and reimbursement for, product candidates; performance of third-party contract research organizations (“CROs”) and manufacturers upon which we rely; protection of our intellectual property; litigation or claims against us based on intellectual property, patent, product, regulatory, or other factors; and our ability to attract and retain employees necessary to support our growth. The product candidates we develop require approvals from regulatory agencies prior to commercial sales. There can be no assurance that our current and future product candidates will receive the necessary approvals or be commercially successful. If we are denied approval or approval is delayed, it will have a material adverse impact on our business and our condensed consolidated financial statements.

The extent of the impact of the COVID-19 pandemic, including the resurgence of cases relating to the spread of new variants, on our business and operations is highly uncertain. While the COVID-19 pandemic has led to various research restrictions and led to pauses and early conclusion of one of our clinical trials, these impacts have been temporary and to date we have not experienced material business disruptions or incurred impairment losses in the carrying values of our assets as a result of the COVID-19 pandemic. We are not aware of any specific related event or circumstance that would require us to revise the estimates reflected in our condensed consolidated financial statements. The extent to which the COVID-19 pandemic will directly or indirectly impact our business, financial condition, results of operations, and cash flows, including planned future clinical trials and research and development costs, will depend on future developments that are highly uncertain, including as a result of new information that may emerge concerning COVID-19, the actions taken to contain or treat it, and the duration and intensity of the related effects.

Concentrations of Credit Risk

Financial instruments which potentially subject us to significant concentrations of credit risk consist primarily of cash. Our cash is held in financial institutions and amounts on deposit may at times exceed federally insured limits. We have not experienced any losses on our deposits of cash and do not believe that we are subject to unusual credit risk beyond the normal credit risk associated with commercial banking relationships.

Cash and Cash Equivalents

We consider all short-term investments with original maturities of 90 days or less when purchased to be cash equivalents.

Restricted Cash

We classify cash as restricted when it is unavailable for withdrawal or use in our general operating activities. Restricted cash is classified as current and noncurrent on the condensed consolidated balance sheets based on the nature of the restriction. Our restricted cash balance includes contractually restricted deposits related to our corporate credit card.

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Marketable Securities

Marketable securities are investments with original maturities of more than 90 days when purchased. We do not invest in securities with original maturities of more than one year. Marketable debt securities are considered available-for-sale, and are recorded at fair value, with unrealized gains and losses included as a component of accumulated other comprehensive income until realized. Realized gains and losses are included in other income (expense), net, on the basis of specific identification. The cost of marketable securities is adjusted for amortization of premiums or accretion of discounts to maturity, and such amortization or accretion is included in other income (expense), net.

Inventory

Inventory is stated at historic cost on a first-in first-out basis. Our inventory consisted of $72,000 in raw materials and $32,000 in finished goods as of September 30, 2023, and $29,000 in raw material and $14,000 in finished goods as of December 31, 2022. Inventory relates to our Supplements segment.

Property and Equipment

Property and equipment are stated at cost less accumulated depreciation. Property and equipment consist of laboratory and office equipment, computer software, and leasehold improvements. Depreciation is calculated using the straight-line method over the estimated economic useful lives of the assets, which are 3-5 years for laboratory equipment, 3-7 years for furniture and fixtures, and 2-5 years for computer software. Leasehold improvements are amortized over the lesser of the estimated lease term or the estimated useful life of the assets. Costs for capital assets not yet placed into service are capitalized as construction-in-progress and depreciated or amortized in accordance with the above useful lives once placed into service. Upon retirement or sale, the related cost and accumulated depreciation and amortization are removed from the accounts and any resulting gain or loss is included in the condensed consolidated statements of operations and comprehensive loss. Maintenance and repairs that do not improve or extend the lives of the respective assets are expensed to operations as incurred.

We capitalize costs to obtain or develop computer software for internal use, including development costs incurred during the software development stage and costs to obtain software for access and conversion of historical data. We also capitalize costs to modify, upgrade, or enhance existing internal-use software that result in additional functionality. We expense costs incurred during the preliminary project stage, training costs, data conversion costs, and maintenance costs.

Debt

When debt is issued and a derivative is required to be separated (e.g., bifurcated conversion option) or another separate freestanding financial instrument (e.g., warrant) is issued, costs and fees incurred are allocated to the instruments issued (or bifurcated) in proportion to the allocation of proceeds. When some portions of the costs and fees relate to a bifurcated derivative or freestanding financial instrument that is being subsequently measured at fair value, those allocated costs are expensed immediately. Debt discounts, debt premiums, and debt issuance costs related to debt are recorded as deductions that net against the principal value of the debt and are amortized to interest expense over the contractual term of the debt using the effective interest method.

Convertible Debt

In accordance with ASU 2020-06, Debt—Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging—Contracts in Entity’s Own Equity (Subtopic 815-40): Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity, when we issue notes with conversion features, we evaluate if the conversion feature is freestanding or embedded. If the conversion feature is embedded, we do not separate the conversion feature from the host contract for convertible notes that are not required to be accounted for as derivatives, or that do not result in substantial premiums accounted for as paid-in-capital. Consequently, we account for a convertible note as a single liability measured at its amortized cost, and we account for a convertible preferred stock as a single equity instrument measured at its historical cost, as long as no other features require separation and recognition as derivatives. If the conversion feature is freestanding, or is embedded and meets the requirements to be separated, we account for the conversion feature as a derivative under ASC 815, Derivatives and Hedging (“ASC 815”). We record the derivative instrument at fair value at inception, and subsequently re-measure to fair value at each reporting period and immediately prior to the extinguishment of the derivative instrument, with any changes recorded in the condensed consolidated statements of operations and comprehensive loss.

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Leases

At inception of a contract, we determine if a contract meets the definition of a lease. We determine if the contract conveys the right to control the use of an identified asset for a period of time. We assess throughout the period of use whether we have both of the following: (i) the right to obtain substantially all of the economic benefits from use of the identified asset, and (ii) the right to direct the use of the identified asset. This determination is reassessed if the terms of the contract are changed. Leases are classified as operating or finance leases based on the terms of the lease agreement and certain characteristics of the identified asset. Right-of-use assets and lease liabilities are recognized at the lease commencement date based on the present value of the future lease payments less any lease incentives received. At the lease commencement date, the discount rate implicit in the lease is used to discount the lease liability if readily determinable. If not readily determinable or leases do not contain an implicit rate, our incremental borrowing rate is used as the discount rate. Our policy is to not record leases with an original term of twelve months or less within the condensed consolidated balance sheets and we recognize lease expense for these short-term leases on a straight-line basis over the lease term.

Certain lease agreements may require us to pay additional amounts for taxes, insurance, maintenance, and other expenses, which are generally referred to as non-lease components. Such variable non-lease components are treated as variable lease payments and recognized in the period in which the obligation for these payments is incurred. Variable lease components and variable non-lease components are not measured as part of the right-of-use asset and liability. Only when lease components and their associated non-lease components are fixed are they accounted for as a single lease component and are recognized as part of a right-of-use asset and liability. Total contract consideration is allocated to the fixed lease and non-lease component. This policy election applies consistently to all asset classes under lease agreements.

Leases may contain clauses for renewal at our option. Payments to be made in option periods are recognized as part of the right-of-use lease assets and lease liabilities when it is reasonably certain that the option to extend the lease will be exercised, or is not at our option. We determine whether the reasonably certain threshold is met by considering contract-, asset-, market-, and entity-based factors. Operating lease expense, which is recognized on a straight-line basis over the lease term, and the amortization of finance lease right-of-use assets, which are included in property and equipment and depreciated, are included in research and development or general and administrative expenses consistent with the leased assets’ primary use. Accretion on the liabilities for finance leases is included in interest expense.

Contingent Earn-Out Liabilities

In connection with the Reverse Recapitalization, certain Clene Nanomedicine stockholders are entitled to receive additional shares of Common Stock (the “Clene Nanomedicine Contingent Earn-out”) as follows: (i) 3,338,483 shares if (a) the volume-weighted average price (“VWAP”) of our Common Stock equals or exceeds $15.00 (the “Milestone 1 Price”) in any twenty trading days within a thirty trading day period within three years of the Reverse Recapitalization or (b) the change of control price equals or exceeds the Milestone 1 Price if a change of control transaction occurs within three years of the closing of the Reverse Recapitalization (the requirements in (a) and (b) collectively, “Milestone 1”); (ii) 2,503,851 shares if (a) the VWAP of our Common Stock equals or exceeds $20.00 (the “Milestone 2 Price”) in any twenty trading days within a thirty trading day period within five years of the closing of the Reverse Recapitalization or (b) the change of control price equals or exceeds the Milestone 2 Price if a change of control transaction occurs within five years of the Reverse Recapitalization (the requirements in (a) and (b) collectively, “Milestone 2”). If Milestone 1 is not achieved but Milestone 2 is achieved, the Clene Nanomedicine stockholders will receive additional shares equal to Milestone 1. Tottenham’s former officers, directors, sponsor, and public stockholders (the “Initial Stockholders”) are entitled to receive earn-out shares (the “Initial Stockholders Contingent Earn-out,” and collectively with the Clene Nanomedicine Contingent Earn-out, the “Contingent Earn-outs”) as follows: (i) 375,000 shares upon the achievement of Milestone 1; and (ii) 375,000 shares upon achievement of Milestone 2. If Milestone 1 is not achieved but Milestone 2 is achieved, the Initial Stockholders will receive additional shares equal to Milestone 1.

In accordance with ASC 815, the Contingent Earn-outs are not indexed to our own stock and therefore were accounted for as a liability at the Reverse Recapitalization date and are subsequently remeasured to fair value at each reporting date with changes recorded as a component of other income (expense), net.

Common Stock Warrants

We account for common stock warrants as either equity-classified instruments or liability-classified instruments based on an assessment of the warrant terms and applicable authoritative guidance. The assessment considers whether the warrants are freestanding financial instruments pursuant to ASC 480, meet the definition of a liability pursuant to ASC 480, and whether the warrants meet all of the requirements for equity classification under ASC 815, including whether the warrants are indexed to our Common Stock, among other conditions for equity classification. This assessment, which requires the use of professional judgment, is conducted at the time of warrant issuance and, for liability-classified warrants, at each reporting period end date while the warrants are outstanding.

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Grant Funding

We may submit applications to receive grant funding from governmental and non-governmental entities. We account for grants by analogizing to the grant accounting model under IAS 20, Accounting for Government Grants and Disclosure of Government Assistance (“IAS 20”). We recognize grant funding without conditions or continuing performance obligations, including certain research and development tax credits, as other income in the condensed consolidated statements of operations and comprehensive loss. We accrue certain research and development tax credits receivable in other current assets (see Note 4) in an amount equal to the qualifying expenses incurred in each period multiplied by the applicable reimbursement percentage and we recognize other income in the condensed consolidated statements of operations and comprehensive loss. After submission of our tax returns, we receive a cash refund of certain research and development tax credits and relieve the receivable.

We recognize grant funding with conditions or continuing performance obligations as a reduction in research and development expenses in the period during which the related qualifying expenses are incurred and as the conditions or performance obligations are fulfilled. Any amount received in advance of fulfilling such conditions or performance obligations is recorded in accrued liabilities (see Note 6) if the conditions or performance obligations are expected to be met within the next twelve months. We recognized grant funding of $0.2 million and $0.3 million as a reduction of research and development expenses during the three and nine months ended September 30, 2023, respectively. We did not fulfill any grant conditions or performance obligations during the three and nine months ended September 30, 2022.

Foreign Currency Translation and Transactions

Our functional currency is the U.S. dollar. Clene Australia determined its functional currency to be the Australian dollar and Clene Netherlands determined its functional currency to be the Euro. We use the U.S. dollar as our reporting currency for the condensed consolidated financial statements. The results of our non-U.S. dollar based functional currency operations are translated to U.S. dollars at the average exchange rates during the period. Our assets and liabilities are translated using the current exchange rate as of the balance sheet date and stockholders’ equity is translated using historical rates. Adjustments resulting from the translation of the condensed consolidated financial statements of our foreign functional currency subsidiaries into U.S. dollars are excluded from the determination of net loss and are accumulated in a separate component of stockholders’ equity. We also incur foreign exchange transaction gains and losses for purchases denominated in foreign currencies. Foreign exchange transaction gains and losses are included in other income (expense), net, as incurred.

Comprehensive Loss

Comprehensive loss includes net loss as well as other changes in stockholders’ equity that result from transactions and economic events other than those with stockholders. The only elements of other comprehensive loss in any periods presented were translation of foreign currency denominated balances of Clene Australia and Clene Netherlands to U.S. dollars for consolidation and unrealized gain (loss) on available-for-sale securities.

Segment Information

We have determined that our chief executive officer is the chief operating decision maker (“CODM”). Operating segments are identified as components of an enterprise about which separate discrete financial information is available for evaluation by the CODM in making decisions regarding resource allocation and assessing performance. We view our operations and manage our business in two operating segments, which are our reportable segments: (1) the development and commercialization of novel clean-surfaced nanotechnology therapeutics (“Drugs”), and (2) the development and commercialization of dietary supplements (“Supplements”).

Income Taxes

We account for income taxes using the asset and liability method, which requires the recognition of deferred tax assets and liabilities for the expected future tax consequences of events that have been recognized in the condensed consolidated financial statements or in our tax returns. Deferred tax assets and liabilities are determined based on the differences between the financial statement basis and tax basis of assets and liabilities using enacted tax rates in effect for the year in which the differences are expected to reverse. Changes in deferred tax assets and liabilities are recorded in the provision for income taxes. We assess the likelihood that our deferred tax assets will be recovered from future taxable income and, to the extent we believe, based upon the weight of available evidence, that it is more likely than not that all or a portion of the deferred tax assets will not be realized, a valuation allowance is established through a charge to income tax expense. Potential for recovery of deferred tax assets is evaluated by estimating the future taxable profits expected and considering prudent and feasible tax planning strategies.

We account for uncertainty in income taxes recognized in the condensed consolidated financial statements by applying a two-step process to determine the amount of tax benefit to be recognized. First, the tax position must be evaluated to determine the likelihood that it will be sustained upon external examination by the taxing authorities. If the tax position is deemed more-likely-than-not to be sustained, the tax position is then assessed to determine the amount of benefit to recognize in the condensed consolidated financial statements. The amount of the benefit that may be recognized is the largest amount that has a greater than 50% likelihood of being realized upon ultimate settlement. The provision for income taxes includes the effects of any resulting tax reserves, or unrecognized tax benefits, which are considered appropriate as well as the related net interest and penalties.

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Stock-Based Compensation

We account for stock-based compensation arrangements using a fair value-based method for costs related to all share-based payments including stock options and stock awards. Stock-based compensation expense is recorded in research and development and general and administrative expenses based on the classification of the work performed by the grantees. The fair value is recognized over the period during which a grantee is required to provide services in exchange for the option award and service-based stock awards, known as the requisite service period (usually the vesting period), on a straight-line basis. For stock awards with market conditions, the fair value is recognized over the period based on the expected milestone achievement dates as the derived service period (usually the vesting period), on a straight-line basis. For stock awards with performance conditions, the grant-date fair value of these awards is the market price on the applicable grant date, and compensation expense will be recognized when the conditions become probable of being satisfied. We recognize a cumulative true-up adjustment once the conditions become probable of being satisfied as the related service period had been completed in a prior period. We elect to account for forfeitures as they occur, rather than estimating expected forfeitures. We determine the fair value of each share of Common Stock underlying stock-based awards using a Black-Scholes option pricing model based on the closing price of our Common Stock as reported by Nasdaq on the date of grant. The fair value of stock awards with market conditions are determined using a Monte Carlo valuation model.

Note 3. Cash, Cash Equivalents, and Marketable Securities

Available-for-Sale Securities

Available-for-sale securities as of September 30, 2023, which had contractual maturities within 90 days and were classified within cash equivalents in the condensed consolidated balance sheets, were as follows:

	*September 30, 2023*
(in thousands)	*Amortized Cost*		*Gross Unrealized Gains*		*Gross Unrealized Losses*		*Fair Value*
U.S. Treasury securities	$	24,163	$	1	$	—	$	24,164
Money market funds		14,058		—		—		14,058
Total	$	38,221	$	1	$	—	$	38,222

Available-for-sale securities as of December 31, 2022, which had contractual maturities within one year, were as follows:

	December 31, 2022
(in thousands)	Amortized Cost		Gross Unrealized Gains		Gross Unrealized Losses			Fair Value
Commercial paper	$	3,496	$	—	$	(14	)	$	3,482
Corporate debt securities		1,501		—		—			1,501
Total	$	4,997	$	—	$	(14	)	$	4,983

Proceeds from the sale and maturity of marketable securities held as available-for-sale were as follows:

	*Three Months Ended September 30,*				*Nine Months Ended September 30,*
(in thousands)	*2023*		*2022*		*2023*		*2022*
Proceeds from maturities of marketable securities	$	—	$	5,500	$	5,000	$	8,000
Proceeds from sales of marketable securities		—		4,597		—		7,614
Total	$	—	$	10,097	$	5,000	$	15,614

Realized gains and losses included in earnings from the sale of available-for-sale securities were insignificant. As of September 30, 2023 and December 31, 2022, we did not have any allowance for credit losses or impairments of available-for-sale securities.

Note 4. Prepaid Expenses and Other Current Assets

Prepaid expenses and other current assets as of September 30, 2023 and December 31, 2022 were as follows:

	*September 30,*		*December 31,*
(in thousands)	*2023*		*2022*
Research and development tax credits receivable	$	1,084	$	2,777
Metals to be used in research and development		2,052		2,290
Other		1,029		581
Total prepaid expenses and other current assets	$	4,165	$	5,648

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Note 5. Property and Equipment, Net

Property and equipment, net, as of September 30, 2023 and December 31, 2022 were as follows:

	*September 30,*			*December 31,*
(in thousands)	*2023*			*2022*
Lab equipment	$	4,135		$	3,934
Office equipment		178			177
Computer software		459			459
Leasehold improvements		9,983			5,677
Construction in progress		1,406			5,664
		16,161			15,911
Less accumulated depreciation		(6,519	)		(5,273	)
Total property and equipment, net	$	9,642		$	10,638

Depreciation expense recorded in research and development expense and general and administrative expense for the three and nine months ended September 30, 2023 and 2022 was as follows:

	*Three Months Ended September 30,*				*Nine Months Ended September 30,*
(in thousands)	*2023*		*2022*		*2023*		*2022*
General and administrative	$	66	$	67	$	200	$	163
Research and development		373		166		1,083		552
Total depreciation expense	$	439	$	233	$	1,283	$	715

Note 6. Accrued Liabilities

Accrued liabilities as of September 30, 2023 and December 31, 2022 were as follows:

	*September 30,*		*December 31,*
(in thousands)	*2023*		*2022*
Accrued compensation and benefits	$	1,507	$	2,007
Accrued CRO and clinical fees		1,154		1,297
Other		533		559
Total accrued liabilities	$	3,194	$	3,863

Note 7. Leases

We lease laboratory and office space and certain laboratory equipment under non-cancellable operating and finance leases. The carrying value of our right-of-use lease assets is substantially concentrated in our real estate leases, while the volume of lease agreements is primarily concentrated in equipment leases. We expect that, in the normal course of business, the existing leases will be renewed or replaced by similar leases.

Operating Leases

Operating leases primarily consist of real estate leases for office and laboratory space. We have three real estate leases: (i) a laboratory and manufacturing facility which commenced in September 2021 with a ten-year term and an option to extend for two five-year periods; (ii) a laboratory and manufacturing facility which commenced in February 2022 with a seven-year term and an option to extend for two five-year periods, which replaced a previous lease for the same facility and resulted a gain on termination of $0.4 million for the year ended December 31, 2022; and (iii) our corporate office which commenced a renewed term in September 2022 for seven years with an option to extend for five years. We did not recognize the payments to be made in the option periods as part of the right-of-use asset or lease liability because the exercise of the option is not reasonably certain.

As of September 30, 2023 and December 31, 2022, our operating lease obligations had a weighted-average discount rate of 9.6% and 9.6%, respectively; and a weighted-average remaining term of 6.6 years and 7.3 years, respectively.

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Finance Leases

Assets recorded under finance lease obligations and included in property and equipment as of September 30, 2023 and December 31, 2022 were as follows:

	*September 30,*			*December 31,*
(in thousands)	*2023*			*2022*
Lab equipment	$	408		$	408
Work in process		228			228
Total		636			636
Less accumulated depreciation		(383	)		(326	)
Net	$	253		$	310

As of September 30, 2023 and December 31, 2022, our finance lease obligations had a weighted-average interest rate of 10.9% and 10.2%, respectively; and a weighted-average remaining term of 0.6 years and 1.2 years, respectively.

Maturity Analysis of Lease Obligations

The maturity analysis of our finance and operating lease obligations as of September 30, 2023 was as follows:

(in thousands)	*Finance Leases*			*Operating Leases*
2023 (remainder)	$	19		$	194
2024		27			1,178
2025		—			1,208
2026		—			1,236
2027		—			1,132
2028		—			1,093
Thereafter		—			1,694
Total minimum lease payments		46			7,735
Less amount representing interest/discounting		(2	)		(2,102	)
Present value of minimum lease payments		44			5,633
Less lease obligations, current portion		(44	)		(553	)
Lease obligations, net of current portion	$	—		$	5,080

Components of Lease Cost

The components of finance and operating lease costs for the three and nine months ended September 30, 2023 and 2022 were as follows:

	*Three Months Ended September 30,*				*Nine Months Ended September 30,*
(in thousands)	*2023*		*2022*		*2023*		*2022*
Finance lease costs:
Amortization	$	16	$	20	$	57	$	61
Interest on lease liabilities		1		6		10		12
Operating lease costs		254		256		758		695
Short-term lease costs		1		—		3		—
Variable lease costs		70		65		192		238
Total lease costs	$	342	$	347	$	1,020	$	1,006

Supplemental Cash Flow Information

	*Nine Months Ended September 30,*
(in thousands)	*2023*			*2022*
Operating cash flows from operating leases	$	(953	)	$	(933	)
Operating cash flows from finance leases	$	(10	)	$	(12	)
Financing cash flows from finance leases	$	(63	)	$	(101	)

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Note 8. Notes Payable and Convertible Notes Payable

Our notes payable and convertible notes payable as of September 30, 2023 and December 31, 2022 was as follows:

	*Stated*			*September 30,*			*December 31,*
(in thousands, except interest rates)	*Interest Rate*			*2023*			*2022*
Notes payable
Advance Cecil, Inc. (commenced April 2019)		8.00	%	$	136		$	130
Maryland DHCD (commenced February 2019)		8.00	%		684			654
Maryland DHCD (commenced May 2022)		6.00	%		1,083			704
Avenue Venture Opportunities Fund, L.P. (commenced May 2021)		15.10	%		15,000			15,000
					16,903			16,488
Less unamortized discount and debt issuance costs					(640	)		(587	)
Less notes payable, current portion, net of unamortized discount and debt issuance costs					(9,588	)		(6,418	)
Total notes payable, net of current portion				$	6,675		$	9,483

Convertible notes payable
Avenue Venture Opportunities Fund, L.P. (commenced May 2021)		15.10	%	$	5,000		$	5,000
Maryland DHCD (commenced December 2022)		6.00	%		5,233			5,007
					10,233			10,007
Less unamortized discount and debt issuance costs					(258	)		(237	)
Total convertible notes payable				$	9,975		$	9,770

Maryland Loans

In February 2019, we entered into a term loan agreement (the “2019 MD Loan”) with the Department of Housing and Community Development (“DHCD”), a principal department of the State of Maryland, for $0.5 million bearing simple interest at an annual rate of 8.00%. We are subject to covenants until maturity, including limitations on our ability to retire, repurchase, or redeem our stock, options, and warrants other than per the terms of the securities; and limitations on our ability to pay dividends. We are not in violation of any covenants. The 2019 MD Loan established “Phantom Shares” based on 119,907 shares of Common Stock. The 2019 MD Loan matures in full on February 22, 2034, with the repayment amount equal to the greater of (i) principal plus accrued interest or (ii) the Phantom Shares multiplied by the closing price of our Common Stock on Nasdaq on the trading day prior to the maturity date. As of September 30, 2023 and December 31, 2022, the 2019 MD Loan was recorded at principal plus accrued interest as it was greater than the value of the Phantom Shares. We recognized interest expense of $10,000 and $10,000 for the three months ended September 30, 2023 and 2022, respectively; and interest expense of $30,000 and $30,000 for the nine months ended September 30, 2023 and 2022, respectively.

In April 2019, we entered into a term loan agreement (the “2019 Cecil Loan”) with Advance Cecil Inc., a non-stock corporation formed under the laws of the State of Maryland, for $0.1 million bearing simple interest at an annual rate of 8.00%. The 2019 Cecil Loan established “Phantom Shares” based on 23,981 shares of Common Stock. The 2019 Cecil Loan matures in full on April 30, 2034, with the repayment amount equal to the greater of (i) principal plus accrued interest or (ii) the Phantom Shares multiplied by the closing price of our Common Stock on Nasdaq on the trading day prior to the maturity date. As of September 30, 2023 and December 31, 2022, the 2019 Cecil Loan was recorded at principal plus accrued interest as it was greater than the value of the Phantom Shares. We recognized interest expense of $2,000 and $2,000 for the three months ended September 30, 2023 and 2022, respectively; and interest expense of $6,000 and $6,000 for the nine months ended September 30, 2023 and 2022, respectively.

In May 2022, we entered into a term loan agreement (the “2022 MD Loan”) with DHCD for up to $3.0 million bearing simple interest at an annual rate of 6.00% for the purchase of certain manufacturing equipment. As of September 30, 2023, we had drawn $1.0 million with the remainder available for future equipment purchases until May 17, 2024. The first 12 payments, commencing July 1, 2022, are deferred, followed by 18 monthly installments of interest-only based on the outstanding principal, each up to $15,000 maximum; followed by monthly installments of principal and interest in the amount of $33,306, payable for the lesser of 30 months or until the principal and accrued and unpaid interest is fully repaid, with a balloon payment of all remaining principal and unpaid interest due on the maturity date of July 1, 2027. As of September 30, 2023 and December 31, 2022, the balance of accrued and unpaid interest was $0.1 million and $22,000, respectively, and is recorded as part of the carrying amount of the loan. We recorded debt issuance costs of $31,000 as a debt discount. Under an agreement between DHCD and Avenue, an existing secured creditor of the Company, DHCD was granted a first priority lien on the Assets as collateral. We recognized interest expense of $15,000 and $10,000 for the three months ended September 30, 2023 and 2022, respectively; and interest expense of $43,000 and $12,000 for the nine months ended September 30, 2023 and 2022, respectively.

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In December 2022, we entered into a term loan agreement (the “2022 DHCD Loan”) with DHCD for $5.0 million bearing simple interest at an annual rate of 6.00%. The first 12 payments, commencing January 1, 2023, are deferred, followed by 48 monthly installments of interest-only, with a balloon payment of all principal and unpaid interest due on the maturity date of January 1, 2028. As of September 30, 2023 and December 31, 2022, the balance of accrued and unpaid interest was $0.2 million and $8,000, respectively, and is recorded as part of the carrying amount of the loan. We recorded debt issuance costs of $0.1 million as a debt discount. At any time after December 8, 2023, DHCD may, in its sole discretion, convert up to $5.0 million of principal into Common Stock in increments of $1.0 million, at a price equal to the greater of: (i) 97% of the 30-day trailing VWAP of our Common Stock; or (ii) $4.00 per share (the “DHCD Conversion Feature”). The DHCD Conversion Feature did not meet the requirements for derivative accounting. For the three and nine months ended September 30, 2023, we recognized (i) total interest expense of $0.1 million and $0.2 million, respectively; (ii) coupon interest expense of $0.1 million and $0.2 million, respectively; and (iii) amortization of debt issuance costs of $1,000 and ($1,000), respectively; and the effective interest rate was 5.91%.

Avenue Loan

In May 2021, we entered into a term loan agreement (the “2021 Avenue Loan”) with Avenue for up to $30.0 million, bearing interest at a variable rate equal to (i) the greater of (a) the prime rate or (b) 3.25%, plus (ii) 6.60%. As of September 30, 2023 and December 31, 2022, the interest rate was 15.10% and 14.10%, respectively. The first tranche consisted of $15.0 million funded in May 2021 plus $5.0 million funded in September 2021 (“Tranche 1”). The remaining unfunded $10.0 million (“Tranche 2”) was not drawn and expired. Payments were interest-only for the first 12 months and the interest-only period was extended 12 months due to our achievement of a statistically significant result in certain clinical trials, plus an additional 12 months (through June 30, 2024), pursuant to an amendment to the 2021 Avenue Loan in June 2023 (the “Second Amendment”), due to our receipt of at least $35.0 million from the sale and issuance of Common Stock in a public offering in June 2023 (“Equity Milestone 1”). The interest-only period may be extended through December 31, 2024, subject to (i) our receipt of net proceeds of at least $40.0 million, in addition to Equity Milestone 1, from the sale and issuance of our equity securities on or before June 30, 2024 (“Equity Milestone 2”) and (ii) acceptance of a New Drug Application (“NDA”) by the U.S. Food and Drug Administration (“FDA”) filed by us for the treatment of ALS (the “ALS NDA Milestone”). Following the interest-only period, we are required to make equal monthly installments of principal plus interest at the variable rate then in effect until December 1, 2024, which may be extended to December 1, 2025 so long as no event of default has occurred and is continuing and we have achieved (i) Equity Milestone 2 and (ii) the ALS NDA Milestone. Additionally, a payment of 4.25% of the funded principal, equal to $0.9 million (the “Final Payment”), is due at maturity, which we recorded as a debt premium. We incurred $0.8 million of debt issuance costs of which $47,000 was expensed immediately and the remainder was recorded as a debt discount.

At any time between May 21, 2022 and May 21, 2024, Avenue may, in its sole discretion, convert up to $5.0 million of outstanding principal into Common Stock at $10.36 per share (the “Avenue Conversion Feature”), subject to certain price and volume restrictions related to our Common Stock on Nasdaq. The Final Payment and Avenue Conversion Feature did not meet the requirements for derivative accounting. As of September 30, 2023 and December 31, 2022, unamortized debt discount and issuance costs related to the convertible note were $0.2 million and $0.2 million, respectively. For the convertible note for the three months ended September 30, 2023 and 2022, we recognized (i) total interest expense of $0.3 million and $0.2 million, respectively; (ii) coupon interest expense of $0.2 million and $0.2 million, respectively; and (iii) amortization of debt discount and issuance costs of $0.1 million and $0.1 million, respectively; and the effective interest rate was 22.79% and 18.41%, respectively. For the nine months ended September 30, 2023 and 2022, we recognized (i) total interest expense of $0.8 million and $0.6 million, respectively; (ii) coupon interest expense of $0.6 million and $0.4 million, respectively; and (iii) amortization of debt discount and issuance costs of $0.2 million and $0.2 million, respectively; and the effective interest rate was 22.79% and 18.41%, respectively.

We are subject to covenants until maturity, including limitations on our ability to retire, repurchase, or redeem our stock, options, and warrants other than per the terms of the securities; limitations on our ability to pay dividends; and we are required to maintain unrestricted cash and cash equivalents of at least $5.0 million. We are not in violation of any covenants. Avenue has the ability to immediately accelerate all obligations under the 2021 Avenue Loan upon the occurrence of certain events of default or material adverse effects. The 2021 Avenue Loan is collateralized by substantially all of our assets other than intellectual property, including our capital stock and the capital stock of our subsidiaries, in which Avenue is granted a continuing security interest. We recognized interest expense of $1.1 million and $0.8 million for the three months ended September 30, 2023 and 2022, respectively; and interest expense of $3.0 million and $2.3 million for the nine months ended September 30, 2023 and 2022, respectively.

At the inception of the 2021 Avenue Loan, we issued a warrant to Avenue to purchase 115,851 shares of Common Stock at an exercise price of $8.63 per share (the “Original Avenue Warrant”). A portion of the net proceeds at issuance of the 2021 Avenue Loan were allocated to the Avenue Warrant in an amount equal to its fair value of $0.7 million and were recorded as a debt discount. Pursuant to the Second Amendment, the Original Avenue Warrant was cancelled and a new warrant to purchase 3,000,000 shares of Common Stock at $0.80 per share was issued (the “New Avenue Warrant”). Avenue may exercise the New Avenue Warrant for cash or on a net or “cashless” basis. In the event of a change of control of the Company, the New Avenue Warrant shall be automatically exchanged for the number of shares of Common Stock which remain exercisable thereunder immediately prior to the change of control transaction, for no payment or consideration from Avenue for such shares, and the New Avenue Warrant shall be terminated. At issuance, the New Avenue Warrant was recorded as a liability and debt discount in amount equal to its fair value of $0.7 million. The Second Amendment, including the revised terms, cancellation of the Original Avenue Warrant, and issuance of the New Avenue Warrant was accounted for as a debt modification.

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Debt Maturities

Future debt payments, net of unamortized discounts and debt issuance costs, and without giving effect to any potential future exercise of conversion features, are as follows:

(in thousands)	*2019 MD Loan*		*2019 Cecil Loan*		*2021 Avenue Loan*			*2022 MD Loan*			*2022 DHCD Loan*
2023 (remainder)	$	—	$	—	$	—		$	—		$	—
2024		—		—		20,000			—			—
2025		—		—		—			347			—
2026		—		—		—			369			—
2027		—		—		—			317			—
2028		—		—		—			—			5,000
Thereafter		500		100		—			—			—
Total debt principal payments		500		100		20,000			1,033			5,000
Accrued and unpaid interest		184		36		—			50			233
Less unamortized discount and debt issuance costs		—		—		(824	)		(23	)		(51	)
Future debt payments, net	$	684	$	136	$	19,176		$	1,060		$	5,182

Note 9. Commitments and Contingencies

Commitments

We enter into agreements in the normal course of business with CROs for clinical trials and with vendors for preclinical studies and other services and products for operating purposes, which are cancelable at any time by us, subject to payment of our remaining obligations under binding purchase orders and, in certain cases, nominal early termination fees. These commitments are not deemed significant. As of September 30, 2023 and December 31, 2022, we had commitments under various agreements for capital expenditures totaling $0.4 million and $1.6 million, respectively, related to the construction of our manufacturing facilities.

Contingencies

From time to time, we may have certain contingent legal liabilities that arise in the ordinary course of business activities. We accrue a liability for such matters when it is probable that future expenditures will be made, and such expenditures can be reasonably estimated. We are not aware of any current material pending legal matters or claims.

We received the following grants from the National Multiple Sclerosis Society (“NMSS”): (i) $0.3 million in September 2019 (the “2019 Grant”) to fund biomarker research related our VISIONARY-MS Phase 2 clinical trial, and (ii) $0.7 million in May 2023 (the “2023 Grant”) to fund brain target engagement research related to our REPAIR-MS and REPAIR-PD Phase 2 clinical trials. Pursuant to the grant agreements, if we make future commercial sales of CNM-Au8 for the treatment of MS, we will repay: (i) 50% of the grants upon the first commercial product sale, (ii) an additional 50% of the grants upon cumulative sales of $10.0 million, (iii) an additional 150% of the grants upon cumulative sales of $50.0 million, and (iv) an additional 200% of the grants upon cumulative sales of $100.0 million, with the maximum repayment equal to 450% of the grants if all milestones are achieved. If NMSS has not yet received repayments equal in the aggregate to 300% of the 2019 Grant or 150% of the 2023 Grant, then upon the closing of any of the following events we will repay 300% of the 2019 Grant, equal to $1.0 million, or 150% of the 2023 Grant, equal to $1.0 million, less any amounts previously paid by us: (i) sale of all or substantially all of our assets and business, (ii) a public offering that occurs more than twelve months after completion of the applicable research, (iii) sale of any portion of our assets and business including CNM-Au8 for the treatment of MS, (iv) exclusive licensing of our intellectual property claiming CNM-Au8 for the treatment of MS, (v) a collaboration with a third-party to develop CNM-Au8 for the treatment of MS (for the 2019 Grant only), or (vi) licensing of our commercialization rights to CNM-Au8 for the treatment of MS (for the 2023 Grant only). As of September 30, 2023, we have not met any of the above milestones and the applicable research has not been completed. We accounted for these contingencies in accordance with ASC 450, Contingencies. Management has assessed the likelihood of each contingent event as less than probable and therefore no contingent liability is recognized. Management’s estimate of the possible range of loss is between the minimum and maximum repayment amounts, equal to 50% and 450% of each grant, or approximately $0.2 million and $1.5 million for the 2019 Grant, respectively; and approximately $0.3 million and $3.0 million for the 2023 Grant, respectively. However, it is at least reasonably possible that Management’s estimate of the likelihood of each contingent event and the possible range of loss will change in the near term.

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Note 10. Income Taxes

The components of loss before income taxes for the three and nine months ended September 30, 2023 and 2022 were as follows:

	*Three Months Ended September 30,*						*Nine Months Ended September 30,*
(in thousands)	*2023*			*2022*			*2023*			*2022*
United States	$	(2,206	)	$	(9,432	)	$	(38,608	)	$	(25,787	)
Foreign		(212	)		(1,544	)		(723	)		(3,077	)
Net loss before income taxes	$	(2,418	)	$	(10,976	)	$	(39,331	)	$	(28,864	)

We are subject to taxation in the U.S., Australia, Netherlands, and various state jurisdictions. Our tax returns from 2016 to present are subject to examination by the U.S. and state authorities due to the carry forward of unutilized net operating losses and research and development credits. There are currently no pending examinations. We compute our quarterly income tax provision by using a forecasted annual effective tax rate and adjust for any discrete items arising during the quarter. The primary difference between the effective tax rate and the federal statutory tax rate relates to the full valuation allowance on our net operating losses and other deferred tax assets.

Note 11. Benefit Plans

401(k) Plan

Our 401(k) plan is a deferred salary arrangement under Section 401(k) of the Internal Revenue Code. We match 100% of a participating employee’s deferral contributions up to 3% of annual compensation, limited to $4,500 of matching contributions. Our contributions to the 401(k) plan totaled $31,000 and $34,000 for the three months ended September 30, 2023 and 2022, respectively; and $0.2 million and $0.2 million for the nine months ended September 30, 2023 and 2022, respectively.

Stock Compensation Plans

The Clene Nanomedicine, Inc. 2014 Stock Plan (“the 2014 Plan”) was adopted in July 2014. Effective as of the closing of the Reverse Recapitalization, no additional awards may be granted under the 2014 Plan. As of September 30, 2023, 5,361,318 stock options remained outstanding under the 2014 Plan.

The Clene Inc. 2020 Amended Stock Plan (the “2020 Plan”) was adopted in December 2020 and amended in May 2023 and 18,400,000 shares of Common Stock are reserved for issuance thereunder. As of September 30, 2023, a total of 17,251,106 stock options and other stock awards had been granted under the 2020 Plan, and 1,148,894 shares remained available for future grant.

Stock-Based Compensation Expense

Stock-based compensation expense recorded in research and development expense and general and administrative expense for the three and nine months ended September 30, 2023 and 2022 was as follows:

	*Three Months Ended September 30,*				*Nine Months Ended September 30,*
(in thousands)	*2023*		*2022*		*2023*		*2022*
General and administrative	$	1,311	$	1,247	$	3,888	$	4,056
Research and development		1,085		851		3,182		2,428
Total stock-based compensation expense	$	2,396	$	2,098	$	7,070	$	6,484

Stock-based compensation expense by award type for the three and nine months ended September 30, 2023 and 2022 was as follows:

	*Three Months Ended September 30,*				*Nine Months Ended September 30,*
(in thousands)	*2023*		*2022*		*2023*		*2022*
Stock options	$	2,384	$	2,098	$	7,044	$	6,484
Stock awards		12		—		26		—
Total stock-based compensation expense	$	2,396	$	2,098	$	7,070	$	6,484

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Stock Options

Outstanding stock options and related activity for the nine months ended September 30, 2023 was as follows:

(in thousands, except share, per share, and term data)	*Number of Options*			*Weighted Average Exercise Price Per Share*		*Weighted Average Remaining Term (Years)*		*Intrinsic Value*
Outstanding – December 31, 2022		15,260,297		$	2.98		7.28	$	2,348
Granted		6,690,263			0.95		9.70		—
Forfeited		(433,262	)		4.51		—		—
Outstanding – September 30, 2023		21,517,298		$	2.30		7.49	$	712
Vested and exercisable – September 30, 2023		10,074,211		$	2.69		5.60	$	712
Vested, exercisable or expected to vest – September 30, 2023		21,517,298		$	2.30		7.49	$	712

As of September 30, 2023 and December 31, 2022, we had approximately $15.6 million and $18.2 million, respectively, of unrecognized stock-based compensation costs related to non-vested stock options which is expected to be recognized over a weighted-average period of 2.28 years and 2.58 years, respectively.

The weighted-average grant-date fair value of stock options granted during the nine months ended September 30, 2023 and 2022 was $0.75 and $2.24, respectively. The assumptions used to calculate the fair value of stock options granted during the nine months ended September 30, 2023 and 2022 were as follows:

	*Nine Months Ended September 30,*
	*2023*			*2022*
Expected stock price volatility		96.22% – 103.24%			89.57% – 98.13%
Risk-free interest rate		3.26% – 4.41%			1.65% – 3.00%
Expected dividend yield		0.00	%		0.00	%
Expected term of options (in years)		5.00 – 6.43			5.00 – 6.98

Stock Awards

Stock awards include rights to restricted stock awards with market-based vesting conditions and restricted stock units with service-based vesting conditions. Outstanding stock awards and related activity for the nine months ended September 30, 2023 was as follows:

	*Number of Stock Awards*			*Weighted Average Grant Date Fair Value*
Unvested balance – December 31, 2022		769,139		$	9.84
Granted		43,479			1.15
Converted to shares of Common Stock upon vesting		(21,739	)		1.15
Forfeited		(746	)		9.84
Unvested balance – September 30, 2023		790,133		$	9.60

As of September 30, 2023, we had approximately $24,000 of unrecognized stock-based compensation costs related to non-vested stock awards which is expected to be recognized over a weighted-average period of 0.48 years. As of December 31, 2022, we had no unrecognized stock-based compensation costs related to non-vested stock awards.

Note 12. Fair Value

Cash, cash equivalents, and marketable securities are carried at fair value. Financial instruments, including accounts receivable, accounts payable, and accrued expenses are carried at cost, which approximates fair value given their short-term nature. Our remaining fair value measures are discussed below.

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Financial Instruments with Fair Value Measurements on a Recurring Basis

The fair value hierarchy for financial instruments measured at fair value on a recurring basis as of September 30, 2023 is as follows:

	*September 30, 2023*
(in thousands)	*Level 1*		*Level 2*		*Level 3*		*Total*
Cash equivalents:
Money market funds	$	14,058	$	—	$	—	$	14,058
U.S. Treasury securities		—		24,164		—		24,164
Common stock warrant liabilities		—		—		1,860		1,860
Clene Nanomedicine contingent earn-out liability		—		—		150		150
Initial Stockholders contingent earn-out liability		—		—		19		19

The fair value hierarchy for financial instruments measured at fair value on a recurring basis as of December 31, 2022 is as follows:

	*December 31, 2022*
(in thousands)	*Level 1*		*Level 2*		*Level 3*		*Total*
Cash equivalents:
Money market funds	$	14,317	$	—	$	—	$	14,317
Marketable securities:
Commercial paper		—		3,482		—		3,482
Corporate debt securities		—		1,501		—		1,501
Clene Nanomedicine contingent earn-out liability		—		—		2,264		2,264
Initial Stockholders contingent earn-out liability		—		—		291		291

There were no transfers between Level 1, Level 2, or Level 3 during any of the periods above.

Changes in the fair value of our Level 3 financial instruments for the nine months ended September 30, 2023 were as follows:

(in thousands)	*Common Stock Warrant Liabilities*			*Clene Nanomedicine Contingent Earn-out*			*Initial Stockholders Contingent Earn-out*
Balance – December 31, 2022	$	—		$	2,264		$	291
Initial fair value of instruments		7,818			—			—
Change in fair value		(5,958	)		(2,114	)		(272	)
Balance – September 30, 2023	$	1,860		$	150		$	19

Changes in the fair value of our Level 3 financial instruments for the nine months ended September 30, 2022 were as follows:

(in thousands)	*Common Stock Warrant Liability*			*Clene Nanomedicine Contingent Earn-out*			*Initial Stockholders Contingent Earn-out*
Balance – December 31, 2021	$	474		$	18,100		$	2,317
Change in fair value		(151	)		(6,662	)		(849	)
Reclassification from liability to equity		(305	)		—			—
Balance – September 30, 2022	$	18		$	11,438		$	1,468

Valuation of Notes Payable and Convertible Notes Payable

The 2019 MD Loan and the 2019 Cecil Loan are carried at the greater of principal plus accrued interest or the value of Phantom Shares (see Note 8), which approximates fair value. The 2021 Avenue Loan, the 2022 MD Loan, and the 2022 DHCD Loan are carried at amortized cost, which approximates fair value due to our credit risk and market interest rates. Our notes payable and convertible notes payable are categorized within Level 3 of the fair value hierarchy.

Valuation of the Common Stock Warrant Liabilities

The Original Avenue Warrant, comprised of the Tranche 1 warrant and the contingently issuable Tranche 2 warrant to purchase shares of Common Stock, was classified as a liability and recorded at fair value at inception of the 2021 Avenue Loan. As of March 31, 2022, we reclassified the Tranche 1 warrant to additional paid-in capital. Our ability to draw Tranche 2 expired on December 31, 2022 and the warrant liability was extinguished and we recognized income of $0.2 million as of December 31, 2022.

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The New Avenue Warrant is classified as a liability and carried at fair value. We estimate the fair value using a Black-Scholes option-pricing model with probability weights for the occurrence of the following events: (i) settlement of the instrument upon a change of control transaction, (ii) dissolution of the Company, or (iii) another outcome outside of (i)-(ii). These estimates require significant judgment. The carrying amount may fluctuate significantly and the actual settlement amount may be materially different from the estimated fair value. The unobservable inputs to the Black-Scholes option pricing model were as follows:

	*September 30,*
	*2023*
Expected stock price volatility		70.00% – 110.00%
Risk-free interest rate		4.63% – 5.52%
Expected dividend yield		0.00	%
Expected term (in years)		0.58 – 4.75
Probability of change of control		5.00	%
Probability of dissolution		60.00	%
Probability of other outcome		35.00	%

The Tranche A Warrant is classified as a liability and carried at fair value. We estimate the fair value using a Black-Scholes option-pricing model with probability weights for the occurrence of the following events: (i) FDA acceptance of an NDA for CNM-Au8, (ii) settlement upon a fundamental transaction, (iii) dissolution of the Company, and (iv) another outcome outside of (i)-(iii). These estimates require significant judgment. The carrying amount may fluctuate significantly and the actual settlement amount may be materially different from the estimated fair value. The unobservable inputs to the Black-Scholes option pricing model were as follows:

	*September 30,*
	*2023*
Expected stock price volatility		75.00% – 110.00%
Risk-free interest rate		4.87% – 5.50%
Expected dividend yield		0.00	%
Expected term (in years)		0.75 – 2.71
Probability of NDA acceptance		30.00	%
Probability of fundamental transaction		5.00	%
Probability of dissolution		60.00	%
Probability of other outcome		5.00	%

The Tranche B Warrant qualified for equity classification at issuance. We estimated the nonrecurring fair value measurement using a Black-Scholes option-pricing model with probability weights for the occurrence of the following events: (i) FDA approval of an NDA for CNM-Au8, (ii) settlement upon a fundamental transaction, (iii) dissolution of the Company, and (iv) another outcome outside of (i)-(iii). These estimates require significant judgment. The unobservable inputs to the Black-Scholes option pricing model were as follows:

	*June 16,*
	*2023*
Expected stock price volatility		100.00% – 110.00%
Risk-free interest rate		3.88% – 4.97%
Expected dividend yield		0.00	%
Expected term (in years)		1.46 – 7.00
Probability of NDA approval		22.50	%
Probability of fundamental transaction		5.00	%
Probability of dissolution		71.50	%
Probability of other outcome		1.00	%

Valuation of the Contingent Earn-Out Liabilities

The Contingent Earn-outs are carried at fair value, determined using a Monte Carlo valuation model in order to simulate the future path of our stock price over the earn-out periods. The carrying amount of the liabilities may fluctuate significantly and actual amounts paid may be materially different from the liabilities’ estimated value. The unobservable inputs to the Monte Carlo valuation model were as follows:

	*September 30,*			*December 31,*
	*2023*			*2022*
Expected stock price volatility		100.00	%		115.00	%
Risk-free interest rate		5.00	%		4.20	%
Expected dividend yield		0.00	%		0.00	%
Expected term (in years)		2.25			3.00

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Note 13. Capital Stock

As of September 30, 2023 and December 31, 2022, our amended and restated certificate of incorporation (the “Certificate”) authorized us to issue 300,000,000 and 150,000,000 shares of Common Stock, par value $0.0001 per share, respectively, and 1,000,000 shares of preferred stock, par value $0.0001 per share. As of September 30, 2023 and December 31, 2022, we had 128,411,981 and 74,759,591 shares of Common Stock issued and outstanding, respectively, and no shares of preferred stock issued or outstanding.

Our common stockholders are entitled to one vote per share and to notice of any stockholders’ meeting. Voting, dividend, and liquidation rights of the holders of Common Stock are subject to the prior rights of holders of all classes of stock and are qualified by the rights, powers, preferences, and privileges of the holders of preferred stock. No distributions shall be made with respect to Common Stock until all declared dividends to preferred stock have been paid or set aside for payment. Common Stock is not redeemable at the option of the holder.

Common Stock Warrants

As of September 30, 2023 and December 31, 2022, outstanding warrants to purchase shares of Common Stock were as follows:

						*Number of Shares Issuable*
						*September 30,*		*December 31,*
Date Exercisable	*Exercise Price*		*Expiration*		*Classification*	*2023*		*2022*
December 2020	$	11.50	December 2025	⁽¹⁾	Equity		2,407,500		2,407,500
December 2020	$	11.50	December 2025	⁽²⁾	Equity		24,583		24,583
December 2020	$	1.97	April 2023	⁽³⁾	Equity		—		1,929,111
May 2021	$	8.63	May 2026	⁽⁴⁾	Equity		—		115,851
June 2023	$	0.80	June 2028	⁽⁵⁾	Liability		3,000,000		—
June 2023	$	1.10	June 2026	⁽⁶⁾	Liability		50,000,000		—
June 2023	$	1.50	June 2030	⁽⁷⁾	Equity		50,000,000		—
Total							105,432,083		4,477,045

(1)

Represents 2,407,500 shares of Common Stock underlying warrants to purchase one-half (1/2) of one share of Common Stock, issued during Tottenham’s initial public offering. We may redeem the outstanding warrants at $0.01 per warrant if the last sales price of our Common Stock equals or exceeds $16.50 per share for any 20 trading days within a 30-trading day period. As of September 30, 2023 and December 31, 2022, no warrants had been exercised.

(2)

Represents 24,583 shares of Common Stock underlying warrants to purchase one-half (1/2) of one share of Common Stock, issued to the financial advisor and lead underwriter of Tottenham’s initial public offering upon their exercise of a unit purchase option in July 2021. As of September 30, 2023 and December 31, 2022, no warrants had been exercised.

(3)	Represents 1,929,111 shares of Common Stock underlying warrants to purchase one share of Common Stock, issued by Clene Nanomedicine as Series A preferred stock warrants and senior equity warrants in August 2013. As of April 2023, the warrants expired.

(4)	Represents 115,851 shares of Common Stock underlying the Original Avenue Warrant. As of June 2023, the warrant had not been exercised and was cancelled pursuant to an amendment to the 2021 Avenue Loan (see Note 8).

(5)	Represents 3,000,000 shares of Common Stock underlying the New Avenue Warrant, issued pursuant to an amendment to the 2021 Avenue Loan (see Note 8). As of September 30, 2023, the warrant had not been exercised.

(6)	Represents 50,000,000 shares of Common Stock underlying Tranche A Warrants to purchase one share of Common Stock, issued in our June 2023 public equity offering. As of September 30, 2023, no warrants had been exercised.

(7)	Represents 50,000,000 shares of Common Stock underlying Tranche B Warrants to purchase one share of Common Stock, issued in our June 2023 public equity offering. As of September 30, 2023, no warrants had been exercised.

Public Offerings

In October 2022, we sold 10,723,926 shares of Common Stock at a sale price of $1.01 per share to certain existing stockholders, including affiliates of our directors. The aggregate gross proceeds were $10.8 million and we paid expenses of $25,000. The offering was made pursuant to our registration statement on Form S-3 (file number 333-264299), which was declared effective by the SEC on April 26, 2022, and our prospectus supplement relating to the offering.

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In June 2023, we sold 50,000,000 units at a sale price of $0.80 per unit pursuant to an underwriting agreement with Canaccord Genuity LLC(“Canaccord”) as underwriter. Each unit consisted of (i) one share of Common Stock, (ii) one warrant to purchase one share of Common Stock at an exercise price of $1.10 per share (the “Tranche A Warrants”), and (iii) one warrant to purchase one share of Common Stock at an exercise price of $1.50 per share (the “Tranche B Warrants”). The aggregate gross proceeds were $40.0 million, excluding the proceeds, if any, from the exercise of the Tranche A Warrants and Tranche B Warrants. We cannot predict when or if the Tranche A Warrants or Tranche B Warrants will be exercised, and it is possible they may expire and/or never be exercised. We paid underwriting discounts and commissions of $2.4 million and offering expenses of $0.2 million. The Tranche A Warrants were exercisable immediately and will expire on the earlier of (i) sixty (60) days following the date of our public announcement that the filing of an NDA for CNM-Au8 has been accepted by the FDA, or (ii) June 16, 2026. The Tranche B Warrants were exercisable immediately and will expire on the earlier of (i) sixty (60) days following the date of our public announcement that an NDA for CNM-Au8 has been approved by the FDA, or (ii) June 16, 2030. If we enter into or become party to a fundamental transaction (which generally includes a merger of the Company with or into another entity; the sale, lease, license, or transfer of all or substantially all of our assets; tender or exchange offers; or reclassification, reorganization, or recapitalization of the our Common Stock), then (i) we or our successor entity shall purchase all outstanding Tranche A Warrants by paying the holders cash in an amount equal to the Black-Scholes value of the remaining unexercised portion of each Tranche A Warrant, and (ii) upon any subsequent exercise of a Tranche B Warrant, the holder shall be entitled to receive, at the option of the holder, the number of shares of Common Stock of the successor or acquiring corporation or of the Company, if it is the surviving corporation, and any additional consideration receivable upon or as a result of such fundamental transaction by a holder of the number of shares of Common Stock for which the warrant is exercisable immediately prior to such fundamental transaction. The offering was made pursuant to our registration statement on Form S-3 (file number 333-264299), which was declared effective by the SEC on April 26, 2022, a related registration statement pursuant to Rule 462(b) (file number 333-272692), filed with the SEC and effective on June 16, 2023, and our prospectus supplement relating to the offering. The total fair value of the Tranche A Warrants, Tranche B Warrants, and shares of Common Stock sold in the offering exceeded the offering proceeds by $14.8 million, therefore pursuant to ASC 815, this amount was recognized as a loss on the initial issuance of equity in the condensed consolidated statements of operations and comprehensive loss. The underwriting discounts and commissions and underwriting expenses were allocated to the shares of Common Stock, Tranche A Warrants, and Tranche B Warrants sold in the offering based on their relative fair values, with the amount allocated to the liability-classified Tranche A Warrants recorded as an expense in the condensed consolidated statements of operations and comprehensive loss, and the amounts allocated to the shares of Common Stock and Tranche B Warrants as a reduction to their initial carrying values.

Common Stock Sales Agreement

In April 2022, we entered into an Equity Distribution Agreement (the “ATM Agreement”) with Canaccord and Oppenheimer & Co. Inc., as placement agents (the “Placement Agents”). In December 2022, we amended the ATM Agreement and removed Oppenheimer & Co. Inc. as a Placement Agent. In accordance with the terms of the ATM Agreement, we may offer and sell shares of Common Stock having an aggregate offering price of up to $50.0 million from time to time through the Placement Agent. The issuance and sale of Common Stock by us under the ATM Agreement was made pursuant to our registration statement on Form S-3 (file number 333-264299), which was declared effective by the Securities and Exchange Commission on April 26, 2022, and our prospectus supplement relating to the offering. On June 16, 2023, we delivered written notice to Canaccord that we were suspending and terminating the prospectus supplement (the “ATM Prospectus Supplement”) related to our Common Stock issuable pursuant to the ATM Agreement. We will not make any further sales of our securities pursuant to the ATM Agreement, unless and until a new prospectus supplement is filed. Other than the termination and suspension of the ATM Prospectus Supplement, the ATM Agreement remains in full force and effect.

Subject to terms of the ATM Agreement, the Placement Agent is not required to sell any specific number or dollar amount of Common Stock but will act as our placement agent, using commercially reasonable efforts to sell, on our behalf, all of the Common Stock requested by us to be sold, consistent with the Placement Agent’s normal trading and sales practices, on terms mutually agreed between the Placement Agent and us. The Placement Agent will be entitled to compensation under the terms of the ATM Agreement at a fixed commission rate of 3.0% of the gross proceeds from each issuance and sale of Common Stock, if any. During the nine months ended September 30, 2023, we sold 2,895,090 shares of Common Stock under the ATM Agreement, generated gross proceeds of $4.5 million, and paid commissions of $0.1 million. We did not make any sales during the three months ended September 30, 2023. During the three and nine months ended September 30, 2022 we sold 40,000 shares of Common Stock and generated gross proceeds of $0.1 million. Commissions paid to the Placement Agents were insignificant.

Common Stock Purchase Agreement

On March 3, 2023, we entered into a purchase agreement (the “Purchase Agreement”) with Lincoln Park Capital Fund, LLC (“Lincoln Park”), pursuant to which Lincoln Park committed to purchase up to $25.0 million of shares of Common Stock at our sole discretion, from time to time over a 36-month period commencing on March 7, 2023. The issuance and sale of Common Stock under the Purchase Agreement was made pursuant to our registration statement on Form S-3 (file number 333-264299), which was declared effective by the SEC on April 26, 2022, and our prospectus supplement relating to the transaction. On June 16, 2023, we delivered written notice to Lincoln Park that we were terminating the prospectus supplement (the “Purchase Agreement Prospectus Supplement”) and the offering with respect to our unsold shares of Common Stock issuable pursuant to the Purchase Agreement. We will not make any further sales of our securities pursuant to the Purchase Agreement, unless and until a new prospectus supplement is filed. Other than the termination of the Purchase Agreement Prospectus Supplement and offering with respect to future sales by us, the Purchase Agreement remains in full force and effect.

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Pursuant to the Purchase Agreement, we may direct Lincoln Park to purchase up to 75,000 shares of Common Stock (a “Regular Purchase”), which may be increased up to (i) 100,000 shares if the closing price of our Common Stock is not below $1.00, (ii) 150,000 shares if the closing price of our Common Stock is not below $2.00, and (iii) 200,000 shares if the closing price of our Common Stock is not below $4.00. The purchase price for a Regular Purchase is based on the market price of our Common Stock at the time of sale. We may sell shares in excess of a Regular Purchase (an “Accelerated Purchase”) on any day on which we have directed Lincoln Park to purchase the maximum amount allowed for such Regular Purchase, up to the lesser of (i) 300% of the number of shares purchased pursuant to such prior business day Regular Purchase or (ii) 30% of the aggregate shares of our Common Stock traded on Nasdaq on the trading day immediately following the purchase date for such Regular Purchase (subject to certain volume and market price limitations). Additionally, we may sell shares in excess of an Accelerated Purchase (an “Additional Accelerated Purchase”) on any day on which we have directed Lincoln Park to purchase the maximum amount allowed for such Accelerated Purchase, up to the lesser of (i) 300% of the number of shares purchased pursuant to such prior business day Regular Purchase or (ii) 30% of the aggregate shares of our Common Stock traded on Nasdaq during a certain period on the date of the Additional Accelerated Purchase (subject to certain volume and market price limitations). The purchase price for Accelerated Purchases and Additional Accelerated Purchases is equal to 97% of the lesser of (i) the VWAP of our Common Stock on Nasdaq during certain periods on the date of the Accelerated Purchase or Additional Accelerated Purchase or (ii) the closing price of our Common Stock on the date of the Accelerate Purchase or Additional Accelerated Purchase.

On the date of the Purchase Agreement, we issued 332,668 shares of Common Stock (the “Initial Commitment Shares”) to Lincoln Park as an initial fee for its commitment under the Purchase Agreement. We recorded the fair value of the Initial Commitment Shares on the date of issuance in other income (expense), net. We may further issue up to 166,334 additional shares of Common Stock (the “Additional Commitment Shares,” and, together with the Initial Commitment Shares, the “Commitment Shares”) on a pro rata basis upon each purchase by Lincoln Park under the Purchase Agreement. Under applicable Nasdaq listing rules, the total number of shares of Common Stock that we may sell to Lincoln Park is limited to 15,310,115 shares (including the Commitment Shares), representing 19.99% of the outstanding shares of our Common Stock immediately prior to the execution of the Purchase Agreement, unless we (i) first obtain stockholder approval in accordance with applicable Nasdaq listing rules or (ii) the average price paid by Lincoln Park for all shares of Common Stock issued by us under the Purchase Agreement is equal to or greater than $1.2404. The Purchase Agreement prohibits us from directing Lincoln Park to purchase any shares of Common Stock that would result in Lincoln Park having beneficial ownership of greater than 4.99% of our outstanding Common Stock, which Lincoln Park may, in its sole discretion, increase up to 9.99% of our outstanding Common Stock by delivering written notice thereof to us, which shall not be effective until the 61st day after such written notice is delivered to us. We may terminate the Purchase Agreement at any time, for any reason and without any payment or liability to us, by giving Lincoln Park a termination notice with effect one business date after the notice has been received by Lincoln Park.

We evaluated the Purchase Agreement under ASC 815-40 “Derivatives and Hedging—Contracts on an Entity's Own Equity” as it represents the right to require Lincoln Park to purchase shares of Common Stock in the future, similar to a put option. We concluded it represents a freestanding derivative instrument that does not qualify for equity classification and therefore requires fair value accounting. We analyzed the terms of the contract and concluded the derivative instrument has no value as of September 30, 2023. During the nine months ended September 30, 2023, we sold 400,000 shares of Common Stock under the Purchase Agreement, issued 2,893 Additional Commitment Shares, and generated proceeds of $0.4 million. We did not sell any Common Stock under the Purchase Agreement during the three months ended September 30, 2023.

Note 14. Net Loss Per Share

The computation of basic and diluted net loss per share attributable to common stockholders for the three and nine months ended September 30, 2023 and 2022 was as follows:

	*Three Months Ended September 30,*						*Nine Months Ended September 30,*
(in thousands, except share and per share data)	*2023*			*2022*			*2023*			*2022*
Numerator:
Net loss attributable to common stockholders	$	(2,418	)	$	(10,976	)	$	(39,331	)	$	(28,864	)
Denominator:
Weighted average common shares outstanding		128,405,483			63,508,928			97,026,964			63,234,757
Net loss per share attributable to common stockholders – basic and diluted	$	(0.02	)	$	(0.17	)	$	(0.41	)	$	(0.46	)

The following shares of potentially dilutive securities were excluded from the computation of diluted net loss per share attributable to common stockholders for the three and nine months ended September 30, 2023 and 2022 because they were antidilutive, out-of-the-money, or the issuance of such shares is contingent upon certain conditions which were not satisfied by the end of the period:

	*Three Months Ended September 30,*				*Nine Months Ended September 30,*
	*2023*		*2022*		*2023*		*2022*
Convertible notes payable (see Note 8)		1,732,703		482,703		1,732,703		482,703
Common stock warrants (see Note 13)		105,432,083		4,477,045		105,432,083		4,477,045
Options to purchase common stock (see Note 11)		21,517,298		12,173,570		21,517,298		12,173,570
Unvested restricted stock awards (see Note 11)		790,133		769,139		790,133		769,139
Contingent earn-out shares (see Note 2)		6,592,334		6,592,334		6,592,334		6,592,334
Total		136,064,551		24,494,791		136,064,551		24,494,791

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Note 15. Related Party Transactions

License and Supply Agreements

In August 2018, we entered into a license agreement and exclusive supply agreement (collectively, the “4Life Agreement”) in conjunction with 4Life’s investment in our Series C preferred stock and warrants. Pursuant to the 4Life Agreement, we granted 4Life an exclusive license to sell certain dietary supplements. The term of the exclusive license is five years from the commencement of product sales under the 4Life Agreement, which was in April 2021, with options to renew for additional five-year terms. We provide non-pharmaceutical product to 4Life for development, and 4Life pays royalties of 3% of incremental sales. 4Life is subject to an annual minimum sales requirement. If the minimum sales are unmet, 4Life may pay us an additional fee to maintain exclusivity or have the license converted to non-exclusive.

Total revenue under the 4Life Agreement for the three and nine months ended September 30, 2023 and 2022 was as follows:

	*Three Months Ended September 30,*				*Nine Months Ended September 30,*
(in thousands)	*2023*		*2022*		*2023*		*2022*
Product revenue from related parties	$	64	$	127	$	320	$	127
Royalty revenue from related parties		43		44		129		100
Total revenue from related parties	$	107	$	171	$	449	$	227

Note 16. Segment Information

Our operating segment profit measure is segment loss from operations, which is calculated as revenue less cost of revenue, research and development, and general and administrative expenses. Profit and loss information by reportable segment for the three and nine months ended September 30, 2023 and 2022 was as follows:

	*Three Months Ended September 30,*						*Nine Months Ended September 30,*
(in thousands)	*2023*			*2022*			*2023*			*2022*
Drugs:
Revenue from external customers	$	—		$	—		$	—		$	—
Loss from operations		(9,622	)		(10,073	)		(30,945	)		(37,012	)
Supplements:
Revenue from external customers	$	108		$	174		$	484		$	239
Income from operations		80			268			335			276
Consolidated:
Revenue from external customers	$	108		$	174		$	484		$	239
Loss from operations		(9,542	)		(9,805	)		(30,610	)		(36,736	)

A reconciliation of the total of the reportable segments’ loss from operations to consolidated net loss before income taxes for the three and nine months ended September 30, 2023 and 2022 was as follows:

	*Three Months Ended September 30,*						*Nine Months Ended September 30,*
(in thousands)	*2023*			*2022*			*2023*			*2022*
Segment loss from operations	$	(9,542	)	$	(9,805	)	$	(30,610	)	$	(36,736	)
Total other income (expense), net		7,124			(1,171	)		(8,721	)		7,872
Net loss before income taxes	$	(2,418	)	$	(10,976	)	$	(39,331	)	$	(28,864	)

Segment assets exclude corporate assets, such as cash, restricted cash, and corporate facilities. Total assets by reportable segment as of September 30, 2023 and December 31, 2022, were as follows:

	*September 30,*		*December 31,*
(in thousands)	*2023*		*2022*
Total assets:
Drugs	$	17,787	$	20,476
Supplements		268		386
Corporate		42,378		23,631
Consolidated	$	60,433	$	44,493

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Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations

The following discussion and analysis of our financial condition and results of operations should be read in conjunction with our condensed consolidated financial statements and related notes included elsewhere in this Quarterly Report on Form 10-Q. This discussion contains forward-looking statements reflecting our or management team’s expectations, hopes, beliefs, intentions, strategies, estimates, and assumptions concerning events and financial trends that may affect our future financial condition or results of operations. In addition, any statements that refer to projections, forecasts or other characterizations of future events or circumstances, including any underlying assumptions, are forward-looking statements. The words “anticipate,” “believe,” “contemplate,” “continue,” “could,” “estimate,” “expect,” “intends,” “may,” “might,” “plan,” “possible,” “potential,” “predict,” “project,” “should,” “will,” “would,” and similar expressions may identify forward-looking statements, but the absence of these words does not mean that a statement is not forward-looking. Actual results and the timing of events may differ materially from those contained in these forward-looking statements due to a number of factors, including those discussed in the section titled “Risk Factors” in our Annual Report on Form 10-K. We undertake no obligation to update forward-looking statements to reflect events or circumstances after the date they were made, whether as a result of new information, future events, or otherwise, except as may be required under applicable securities laws. Unless the context otherwise requires, for purposes of this section, the terms the “Company,” “we,” “us,” or “our” are intended to mean the business and operations of Clene Inc. and its consolidated subsidiaries.

Business Overview

We are a clinical-stage pharmaceutical company pioneering the discovery, development, and commercialization of novel clean-surfaced nanotechnology (“CSN^®”) therapeutics. CSN^® therapeutics are comprised of atoms of transition elements that, when assembled in nanocrystal form, possess unusually high, unique catalytic activities not present in those same elements in bulk form. These catalytic activities drive, support, and maintain beneficial metabolic and energetic cellular reactions within diseased, stressed, and damaged cells.

Our patent-protected, proprietary position affords us the potential to develop a broad and deep pipeline of novel CSN therapeutics to address a range of diseases with high impact on human health. We began in 2013 by innovating an electro-crystal-chemistry drug development platform that draws from advances in nanotechnology, plasma and quantum physics, material science, and biochemistry. Our platform process results in nanocrystals with faceted structures and surfaces that are free of the chemical surface modifications that accompany other production methods. Many traditional methods of nanoparticle synthesis involve the unavoidable deposition of potentially toxic organic residues and stabilizing surfactants on the particle surfaces. Synthesizing stable nanocrystals that are both nontoxic and highly catalytic has overcome this significant hurdle in harnessing transition metal catalytic activity for human therapeutic use. Our clean-surfaced nanocrystals exhibit catalytic activities many-fold higher than multiple other commercially available nanoparticles, produced using various techniques, that we have comparatively evaluated.

We have multiple drug assets currently in development and/or clinical trials for applications primarily in neurology. Our development and clinical efforts are currently focused on addressing the high unmet medical needs in central nervous system disorders including Amyotrophic Lateral Sclerosis (“ALS”), Multiple Sclerosis (“MS”), and Parkinson’s Disease (“PD”). We currently have no drugs approved for commercial sale and have not generated any revenue from drug sales. We have never been profitable and have incurred operating losses in each year since inception. We generate revenue from sales of dietary supplements through our wholly owned subsidiary, dOrbital, Inc., or through an exclusive license with 4Life Research LLC (“4Life”), a stockholder and related party. We anticipate these revenues to be small compared to our operating expenses and to the revenue we expect to generate from potential future sales of our drug candidates, for which we are currently conducting clinical trials.

Reverse Recapitalization

Clene Nanomedicine, Inc. (“Clene Nanomedicine”) became a public company on December 30, 2020 (the “Closing Date”) when it completed a reverse recapitalization (the “Reverse Recapitalization”) with Tottenham Acquisition I Limited (“Tottenham”), and with Tottenham’s wholly-owned subsidiary and our predecessor, Chelsea Worldwide Inc., and Creative Worldwide Inc., a wholly-owned subsidiary of Chelsea Worldwide Inc. On the Closing Date, Chelsea Worldwide Inc. changed its name to Clene Inc. and listed its shares of common stock, par value $0.0001 per share (“Common Stock”) on the Nasdaq Capital Market (“Nasdaq”) under the symbol “CLNN.”

In connection with the Reverse Recapitalization, certain of Clene Nanomedicine’s common stockholders are entitled to receive earn-out payments (the “Clene Nanomedicine Contingent Earn-out”), and Tottenham’s former officers and directors and Norwich Investment Limited (collectively, the “Initial Stockholders”) are entitled to receive earn-out payments (the “Initial Stockholders Contingent Earn-out,” and both collectively the “Contingent Earn-outs”) based on achieving certain milestones.

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Recent Developments of Our Clinical Programs

Amyotrophic Lateral Sclerosis

On September 25, 2023, we reported long-term follow-up data for patients treated with CNM-Au8 for up to 133 weeks in the open label extension (“OLE”) of the Phase 2/3 HEALEY ALS Platform Trial, which evaluated the safety and efficacy of CNM-Au8 in patients with ALS. These post hoc results show significantly improved survival compared to the Pooled Resource Open-Access ALS Clinical Trials (“PRO-ACT”) database, the largest U.S. clinical database of previous ALS trials. ALS clinical trials with shorter double-blind treatment duration such as 24 weeks have used historical placebo controls from prior trials to determine the relative survival benefit of investigational treatment over longer-term follow-up (open label data). The PRO-ACT dataset is derived from pooled ALS clinical trial data from 29 completed Phase 2 and Phase 3 ALS clinical trials. Millions of de-identified longitudinally collected records from more than 11,600 individuals with ALS were standardized across trials and merged to create the PRO-ACT database. This database provides a useful and validated surrogate for survival status of past participants in ALS clinical trials with long-term follow-up. In this analysis, 59 participants who were originally randomized to CNM-Au8 30mg were compared to matched placebo participants derived from the PRO-ACT dataset:

●

Originally randomized CNM-Au8 30mg treated participants (n=59) demonstrated a statistically significant 49% decreased risk of death compared to PRO-ACT matched placebo patients through long-term follow-up (covariate adjusted HR=0.510; 95% CI 0.263-0.987, p=0.046).

●

In a pooled analysis of the HEALEY ALS Platform Trial and the RESCUE-ALS clinical trial, participants originally randomized to CNM-Au8 30mg (n=82) demonstrated a statistically significant 59% decreased risk of death compared to PRO-ACT matched placebo patients through long-term follow-up (covariate adjusted HR=0.406, 95% CI: 0.220-0.749, p=0.004).

We previously reported a statistically significant reduction of plasma neurofilament light chain (“NfL”) levels for CNM-Au8 treated participants compared to placebo after 24 weeks of treatment in the double-blind, placebo-controlled period of the HEALEY ALS Platform Trial. NfL is a key biomarker of neurodegeneration and is released from neurons following axonal injury, especially in people living with ALS, where higher levels of NfL have been found to predict more rapid decline in clinical function and increased mortality risk. Surrogate biomarkers such as NfL have recently been used to support an approval by the U.S. Food and Drug Administration (“FDA”) for the treatment of ALS.

Additional biomarker and long-term survival data from the HEALEY ALS Platform Trial double-blind and OLE periods have been collected and are undergoing testing preparatory for analysis, and we expect to report the data as follows: (i) plasma NfL data from the OLE by the first quarter of 2024, (ii) additional long-term survival data from the OLE by the first quarter of 2024, and (iii) exploratory results for time to clinical worsening events and ALSFRS-R for the OLE in the first quarter of 2024.

On August 29, 2023, we reported updated data from the long-term OLE of the Phase 2 RESCUE-ALS clinical trial, which evaluated the efficacy, safety, and pharmacokinetics of CNM-Au8 in patients with early symptomatic ALS. The 24-month data cut, as of July 2023, showed a significant median survival benefit of 19.3 months using the rank-preserving structural failure time model (“RPSFTM”). The RPSFTM analysis method estimates the survival gained by receiving active treatment using the data from all study participants and then subtracts the benefit from ex-placebo participants switched to CNM-Au8 during the OLE to provide a comparison of CNM-Au8 versus placebo across the entire study period. This well-recognized method has been used to estimate cross-over treatment effects in a recent ALS trial, and oncology and other rare disease trials. The 24-month data cut also showed a significant 52% decreased risk of ALS clinical worsening (defined as the first occurrence of death, tracheostomy, assisted ventilation, or feeding tube placement) with CNM-Au8 treatment. The full data cut is as follows:

●

Cross-over adjusted median survival (RPSFTM, all study participants, post hoc):

○

19.3 month median survival benefit (CNM-Au8 median survival of 34.2 months, placebo-adjusted median survival of 14.9 months).

○

75% decreased risk of long-term all-cause mortality in participants originally randomized to treatment with CNM-Au8 compared to those originally randomized to placebo after adjusting for benefit received by placebo after switching to CNM-Au8 (HR: 0.252, 95% CI: 0.106 to 0.597; bootstrap log-rank p<0.001).

●

Unadjusted median survival (without adjusting for the benefit received in ex-placebo participants; analyses include all study participants):

○

10.1 month median survival benefit when not accounting for the improvement by ex-placebo treated participants who switched to CNM-Au8 at the start of the OLE (CNM-Au8 median survival of 34.2 months; placebo median survival of 24.1 months).

○

46% decreased risk of all-cause mortality in participants originally randomized to treatment with CNM-Au8 compared to those originally randomized to placebo (HR: 0.54, 95% CI: 0.25-1.1, log-rank p=0.09).

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●

Observed survival versus ALS historical placebo controls:

○

70% decreased risk of long-term mortality in participants originally randomized to treatment with CNM-Au8 compared to matched placebo participants derived from the PRO-ACT database (Cox adjusted HR: 0.300, 95% CI: 0.09 to 0.79; p=0.03).

●

52% decreased risk of ALS clinical worsening events (HR: 0.48, 95% CI: 0.23-1.0, log-rank p=0.049) in the participants originally randomized to CNM-Au8 treatment versus original placebo.

CNM-Au8 was well-tolerated without long term safety concerns in both RESCUE-ALS and the HEALEY ALS Platform Trial, with over 500 collective years of exposure across ALS, MS, and PD participants in CNM-Au8 clinical trials and Expanded Access Protocol (compassionate use) programs without any identified safety signals. No serious adverse events have been assessed as related to CNM-Au8 treatment; adverse events observed with CNM-Au8 have been characterized as transient and predominantly mild-to-moderate in severity.

We are presently discussing the design of an international Phase 3 study, RESTORE-ALS, with expert ALS clinical advisors and expect to initiate the trial in the first half of 2024. We plan to work closely with regulatory health authorities from the FDA and European Medicines Agency (“EMA”), ALS experts, and patient representatives to determine the proper path to support potential approval. We do not know when or if we will be able to file a New Drug Application (“NDA”) with the FDA based on our accumulation of clinical evidence until we meet with the FDA to discuss the totality of our long-term survival data and NfL data. A meeting with the FDA has been scheduled in the fourth quarter of 2023. Contingent upon the outcome of the FDA meeting, we believe we could file an NDA with the FDA in the first half of 2024 with a potential accelerated approval Prescription Drug User Fee Act (“PDUFA”) action date by the end of 2024.

On October 5, 2023, in collaboration with Columbia University and Synapticure, a neurology specialty telehealth clinic, we announced the award of a four-year grant totaling $45.1 million from the National Institute of Neurological Disorders and Stroke, a division of the National Institute of Health, to support an Expanded Access Protocol (“EAP”) for CNM-Au8 (the “NIH EAP Grant”). In addition to this new EAP, we will continue to conduct our currently ongoing EAPs that have enrolled more than 200 participants since 2019. The NIH EAP Grant is part of the Accelerating Access to Critical Therapies for ALS Act, which was signed into law on December 23, 2021, with a call for increased public support of public-private partnerships that will innovate the development of, and increase access to, potential new treatments for ALS.

Multiple Sclerosis

In February and March 2023, we reported updated exploratory data from our Phase 2 VISIONARY-MS clinical trial, which evaluated the efficacy and safety of CNM-Au8 in stable relapsing remitting MS patients. We expect additional results up to 144 weeks from the OLE by the first quarter of 2024. We also completed the first dosing cohort of REPAIR-MS, an open-label, investigator blinded Phase 2 clinical trial, and have initiated a second dosing cohort in non-active progressive MS patients which is expected to be complete in the first half of 2024. We plan to work closely with regulatory health authorities from the FDA and EMA, MS experts, and patient representatives to determine the proper path to advance our assets into Phase 3 and potential future approval. We expect to meet with the FDA in an end of Phase 2 meeting in mid-2024. We are presently discussing the design of an international Phase 3 MS study with expert MS clinical advisors and expect to initiate the trial in the second half of 2024, contingent on funding.

The chart below reflects the growing body of evidence for CSN therapeutics from our completed and ongoing clinical programs.

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Recent Competition Update

Despite the great need for an effective disease-modifying treatment for ALS and significant research efforts by the pharmaceutical industry to meet this need, there have been limited clinical successes and no curative therapies approved to date. In May 2022, the FDA approved an orally administered version of edaravone, which has been available since 2017 as an intravenous infusion for the treatment of ALS. In September 2022, the FDA approved AMX0035, branded as Relyvrio, a drug from Amylyx Pharmaceuticals, Inc. for the treatment of ALS. AMX0035 previously received a conditional approval by Health Canada in June 2022. In October 2023, the EMA Committee for Medicinal Products for Human Use (“CHMP”) confirmed a June 2023 recommendation to refuse a marketing authorization for AMX0035 in the European Union, with the final decision expected from the European Commission by the end of 2023. In April 2023, the FDA granted accelerated approval to tofersen, branded as QALSODY, a drug from Biogen Inc. for the treatment of SOD1-ALS. A Marketing Authorization Application for tofersen is currently under review by the EMA.

On September 27, 2023, the FDA held a meeting of the FDA Cellular, Tissue and Gene Therapies Advisory Committee (the “Committee”) to review the Biologics License Application for NurOwn, an investigation therapeutic from BrainStorm Cell Therapeutics Inc. for the treatment of ALS. The Committee voted yes (1), no (17), and abstain (1) as to whether the NurOwn data presented demonstrate substantial evidence of effectiveness for treatment of mild to moderate ALS. The PDUFA action date is by December 8, 2023.

Impact of the COVID-19 Pandemic

The extent of the impact of the COVID-19 pandemic, including the resurgence of cases relating to the spread of new variants, on our business and operations is highly uncertain. While the COVID-19 pandemic has led to various research restrictions and led to pauses and early conclusion of one of our clinical trials, these impacts have been temporary and to date we have not experienced material business disruptions or incurred impairment losses in the carrying values of our assets as a result of the COVID-19 pandemic. We are not aware of any specific related event or circumstance that would require us to revise the estimates reflected in our condensed consolidated financial statements. The extent to which the COVID-19 pandemic will directly or indirectly impact our business, financial condition, results of operations, and cash flows, including planned future clinical trials and research and development costs, will depend on future developments that are highly uncertain, including as a result of new information that may emerge concerning COVID-19, the actions taken to contain or treat it, and the duration and intensity of the related effects.

Financial Overview

Our financial condition, results of operations, and the period-to-period comparability of our financial results are principally affected by the following factors:

Research and Development Expense

The discovery and development of novel drug candidates require a significant investment of resources over a prolonged period of time, and a core part of our strategy is to continue making sustained investments in this area. As a result of this commitment, our pipeline of drug candidates has been advancing and expanding.

Historically, substantially all of our research and development expenses relate to CNM-Au8, our lead asset, with the remainder spend on our CNM-ZnAg asset. Our research and development expenses are affected by the timing and advancement of our existing product pipeline as well as the timing and quantity of commencing new drug programs. Drug candidates in later stages of clinical development generally have higher development costs than those in earlier stages, primarily due to costs and fees for per patient clinical trial sites for larger clinical trials, opening and monitoring clinical sites, contract research organization (“CRO”) activity, and manufacturing. We anticipate that our research and development expenses will decrease in 2023 due to the completion of many of our ongoing clinical trials but will increase in future years as we advance our assets into Phase 3 and explore potential accelerated approval with the FDA.

Research and development costs consist primarily of payroll and personnel expenses for salaries, benefits, and stock-based compensation; supplies and materials expenses to support our clinical trials; payments to CROs, principal investigators, and clinical trial sites; costs of preclinical activities; consulting costs; and allocated overhead costs, including rent, equipment, utilities, depreciation, insurance, and facilities maintenance. Research and development costs are charged to operations as incurred, and nonrefundable advance payments related to future research and development activities are initially recorded as assets and are expensed when we receive the related goods or services.

Our clinical trial accrual process seeks to account for expenses resulting from obligations under contracts with CROs, consultants, and clinical sites in connection with conducting clinical trials. The financial terms of these contracts vary and may result in payment flows that do not match the periods over which materials or services are provided to us under such contracts. We reflect the appropriate clinical trial expenses in the condensed consolidated financial statements by matching the appropriate expenses with the period in which services are performed. In the event advance payments are made to CROs, the payments are recorded as prepaid assets and expensed over the period in which services are performed.

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General and Administrative Expense

General and administrative expenses consist primarily of payroll and personnel expenses for salaries, benefits, and stock-based compensation; fees for legal, accounting, tax, and information technology services; fees for directors’ and officers’ insurance; expenses for business development activities and investor and public relations; rent, utilities, and facility costs; travel costs; and consulting fees.

We anticipate that our general and administrative expenses in future periods will be contingent on the outcome of our meeting with the FDA, which has been scheduled in the fourth quarter of 2023. If we are able to file an NDA with the FDA based on our accumulation of clinical evidence, we anticipate our general and administrative expenses would increase in future periods to support increases in our drug development activities and as we build out our commercial capabilities in advance of receiving regulatory approval. This potential increase will likely include increased headcount, increased stock compensation expenses, expanded infrastructure including certain sales and marketing activities performed ahead of regulatory approval, and increased insurance expenses. If we are unable to file an NDA based on our accumulation of clinical evidence, we would need to continue investing in clinical research activities and we anticipate our general and administrative expenses would decrease in future periods as we decrease commercial expansion projects, including at our Elkton, Maryland facility, and as we implement cost-saving initiatives, including a reduction in executive compensation, a hiring freeze, and elimination of certain staff positions.

Total Other Income (Expense), Net

Total other income (expense), net, consists primarily of (i) interest income and interest expense, (ii) interest income and expense resulting from changes in fair value of our notes payable, (iii) changes in the fair value of our (a) common stock warrant liabilities and (b) Contingent Earn-outs, (iv) gains and losses on termination of leases, (v) commitment share expense from shares of Common Stock issued as a commitment fee, (vi) issuance costs allocated to liability-classified warrants, (vii) research and development tax credits, unconditional grants, and conditional grants for which applicable conditions have been met, and (viii) realized gains and losses on foreign currency transactions and other miscellaneous income and expense items.

Results of Operations

Our results of operations for the three and nine months ended September 30, 2023 and 2022 were as follows:

	Three Months Ended September 30,									Nine Months Ended September 30,
(in thousands)	2023			2022			Change			2023			2022			Change
Revenue:
Product revenue	$	65		$	130			(50	)%	$	355		$	139			155	%
Royalty revenue		43			44			(2	)%		129			100			29	%
Total revenue		108			174			(38	)%		484			239			103	%
Operating expenses:
Cost of revenue		12			19			(37	)%		83			19			337	%
Research and development		5,972			6,403			(7	)%		19,982			24,149			(17	)%
General and administrative		3,666			3,557			3	%		11,029			12,807			(14	)%
Total operating expenses		9,650			9,979			(3	)%		31,094			36,975			(16	)%
Loss from operations		(9,542	)		(9,805	)		(3	)%		(30,610	)		(36,736	)		(17	)%
Total other income (expense), net		7,124			(1,171	)		*			(8,721	)		7,872			*
Net loss	$	(2,418	)	$	(10,976	)		(78	)%	$	(39,331	)	$	(28,864	)		36	%

Revenue

Product revenue relates to our Supplements segment and consists of (i) sales of an aqueous zinc-silver ion dietary (mineral) supplement sold by our wholly-owned subsidiary, dOrbital, Inc., under the trade name “rMetx™ ZnAg Immune Boost,” or under a supply agreement with 4Life under the trade name “Zinc Factor,” and (ii) sales of KHC46, an aqueous gold dietary (mineral) supplement of very low-concentration, sold under a supply agreement with 4Life under the trade name “Gold Factor.” Royalty revenue relates to our Supplements segment and consists of proceeds under an exclusive and royalty-bearing license agreement with 4Life relating to the sale of Gold Factor. During the three and nine months ended September 30, 2023 and 2022, changes in product and royalty revenues were due to the timing of purchases of Zinc Factor and Gold Factor by 4Life under the supply and license agreements.

Cost of Revenue

Cost of revenue related to production and distribution costs for the sales of Gold Factor, Zinc Factor, and rMetx™ dietary supplements.

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Research and Development Expense

Research and development expense for the three and nine months ended September 30, 2023 and 2022 was as follows:

	Three Months Ended September 30,								Nine Months Ended September 30,
(in thousands)	2023			2022		Change			2023		2022		Change
CNM-Au8	$	1,207		$	2,083		(42	)%	$	5,172	$	7,916		(35	)%
CNM-ZnAg		(284	)		638		*			645		2,531		(75	)%
Unallocated		1,702			711		139	%		4,082		3,894		5	%
Personnel		2,262			2,120		7	%		6,901		7,380		(6	)%
Stock-based compensation		1,085			851		27	%		3,182		2,428		31	%
Total research and development	$	5,972		$	6,403		(7	)%	$	19,982	$	24,149		(17	)%

The change in research and development expenses was primarily due to the following:

(i)

a decrease in expenses related to our lead drug candidate, CNM-Au8, primarily due to a decrease in expenses in the HEALEY ALS Platform Trial and our RESCUE-ALS, REPAIR-MS, REPAIR-PD, and VISIONARY-MS clinical trials due to completion of the blinded period of each trial, and decreased CRO and clinical operations expenses, partially offset by an increase in expenses related to our two EAPs with the Sean M. Healey & AMG Center for ALS due to increased enrollment and expansion of one EAP, increased expenses related to the long-term extension of our VISIONARY-MS clinical trial, and increased expenses related to non-clinical, pre-clinical, and regulatory activities;

(ii)

a decrease in expenses related to CNM-ZnAg, primarily due to completion of the clinical trial for treatment of COVID-19 in 2022, and the renegotiation of our CRO fees during the three and nine months ended September 30, 2023,which resulted in a reversal of previously recognized expenses;

(iii)

an increase in unallocated expenses, primarily due to increased rent, utility, and depreciation expenses due to our newly-leased facility in Elkton, Maryland and our expanded facility in North East, Maryland, partially offset by decreased research, manufacturing, and materials expenses;

(iv)

a decrease in personnel expenses during the nine months ended September 30, 2023, primarily due to a reduction in headcount during the fourth quarter of 2022, partially offset by increased employee compensation and an increase clinical and regulatory activities during the three months ended September 30, 2023; and

(v)

an increase in stock-based compensation expense, primarily due to the timing of award grants, vesting, and forfeitures for research and development personnel, partially offset by our decreased headcount in 2023.

General and Administrative Expense

General and administrative expense for the three and nine months ended September 30, 2023 and 2022 was as follows:

	Three Months Ended September 30,							Nine Months Ended September 30,
(in thousands)	2023		2022		Change			2023		2022		Change
Directors’ and officersʼ insurance	$	398	$	849		(53	)%	$	1,195	$	2,547		(53	)%
Legal		35		87		(60	)%		296		414		(29	)%
Finance and accounting		489		217		125	%		1,207		901		34	%
Public and investor relations		94		124		(24	)%		362		593		(39	)%
Personnel		1,011		706		43	%		3,184		3,147		1	%
Stock-based compensation		1,311		1,247		5	%		3,888		4,056		(4	)%
Other		328		327		0	%		897		1,149		(22	)%
Total general and administrative	$	3,666	$	3,557		3	%	$	11,029	$	12,807		(14	)%

The change in general and administrative expense was primarily due to the following:

(i)

a decrease in directors’ and officers’ insurance fees;

(ii)

a decrease in legal fees, primarily due to a decrease in general corporate legal fees, intellectual property fees, and legal fees related to financing and fundraising;

(iii)

an increase in finance and accounting fees, primarily due to increased fees from auditors, consultants, advisors, and other financial vendors, partially offset by decreased tax fees;

(iv)

a decrease in fees related to our public and investor relations efforts;

(v)

an increase in personnel expenses primarily due to increased employee compensation during the three months ended September 30, 2023, partially offset by a reduction in headcount during the fourth quarter of 2022;

(vi)

an increase in stock-based compensation expense during the three months ended September 30, 2023 and a decrease in stock-based compensation expense during the nine months ended September 30, 2023, primarily due to the timing of award grants, vesting, and forfeitures for general and administrative personnel, and our decreased headcount in 2023; and

(vii)

a decrease in other expenses during the nine months ended September 30, 2023, primarily due to a decrease in expenses related to supplies and equipment, facilities, corporate and liability insurance, information technology, travel, business development, and office and professional expenses, partially offset by increased depreciation expense.

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Total Other Income (Expense), Net

Total other income (expense), net, for the three and nine months ended September 30, 2023 and 2022 was as follows:

	Three Months Ended September 30,									Nine Months Ended September 30,
(in thousands)	2023			2022			Change			2023			2022			Change
Interest income	$	546		$	59			825	%	$	931		$	144			547	%
Interest expense		(1,188	)		(857	)		39	%		(3,358	)		(2,390	)		41	%
Gain on termination of lease		—			—			*			—			420			*
Commitment share expense		—			—			*			(402	)		—			*
Issuance costs for common stock warrant liability		—			—			*			(333	)		—			*
Loss on initial issuance of equity		—			—			*			(14,840	)		—			*
Change in fair value of common stock warrant liabilities		6,341			149			4,156	%		5,958			151			3,846	%
Change in fair value of Clene Nanomedicine contingent earn-out liability		1,004			(1,591	)		*			2,114			6,662			(68	)%
Change in fair value of Initial Stockholders contingent earn-out liability		129			(205	)		*			272			849			(68	)%
Research and development tax credits and unrestricted grants		247			1,346			(82	)%		902			2,001			(55	)%
Other income (expense), net		45			(72	)		*			35			35			0	%
Total other income (expense), net	$	7,124		$	(1,171	)		*		$	(8,721	)	$	7,872			*

*	Not meaningful.

The change in total other income (expense), net, was primarily due to the following:

(i)

an increase in interest income primarily due to increased balances of cash and cash equivalents and increasing interest rates on cash and cash equivalents; and an increase in interest expense primarily due to increasing interest rates and increased amortization of debt discount and debt issuance costs on notes payable;

(ii)

a gain on termination of lease due to the termination of an operating lease for office space during the nine months ended September 30, 2022;

(iii)

commitment share expense, due to the shares of Common Stock issued to Lincoln Park Capital Fund, LLC (“Lincoln Park”), as an initial fee for Lincoln Park’s commitment to purchase shares of Common Stock under a purchase agreement with the Company during the nine months ended September 30, 2023;

(iv)

issuance costs from a public equity offering allocated to liability-classified warrants during the nine months ended September 30, 2023;

(v)

a loss on initial issuance of equity from the fair value in excess of proceeds from a public equity offering during the nine months ended September 30, 2023;

(vi)

a gain from a change in fair value of the common stock warrant liability due to the Original Avenue Warrant for the three and nine months ended September 30, 2022 and the New Avenue Warrant and Tranche A Warrant for the three and nine months ended September 30, 2023. The changes in fair value were due to the change in price of our Common Stock on Nasdaq and updates in the valuation model assumptions (see “Critical Accounting Estimates”). As of March 31, 2022, we reclassified Tranche 1 of the Original Avenue Warrant to additional paid-in capital. As of December 31, 2022, Tranche 2 of the Original Avenue Warrant expired, we recognized income of $0.2 million in the condensed consolidated statements of operations and comprehensive loss, and the warrant liability was extinguished;

(vii)

a gain from a change in fair value of the Clene Nanomedicine Contingent Earn-out liability and Initial Stockholders Contingent Earn-out liability during the three months ended September 30, 2023, compared to a loss during the three months ended September 30, 2022; and a gain during the nine months ended September 30, 2023 and 2022. The changes were due to the price of our Common Stock on Nasdaq and updates in the valuation model assumptions at the end of each respective period (see “Critical Accounting Estimates”);

(viii)

a decrease in research and development tax credits and unrestricted grants due to changes in the amount of qualifying research and development expenses incurred and changes in the reimbursement percentage; and

(ix)

other income during the three months ended September 30, 2023 and the nine months ended September 30, 2023 and 2022,compared to other expense during the three months ended September 30, 2022, primarily due to realized gains and losses on foreign currency transactions and other miscellaneous income and expense items.

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Taxation

United States

We are incorporated in the state of Delaware and subject to statutory U.S. federal corporate income tax at a rate of 21.00% for the nine months ended September 30, 2023 and 2022. We are also subject to state income tax in Utah at a rate of 4.65% and 4.85%, respectively, for the nine months ended September 30, 2023 and 2022, and in Maryland at a rate of 8.25% for the nine months ended September 30, 2023 and 2022. As of September 30, 2023 and December 31, 2022, we recorded a full valuation allowance against our net deferred tax assets due to the uncertainty as to whether such assets will be realized resulting from our three-year cumulative loss position and the uncertainty surrounding our ability to generate pre-tax income in the foreseeable future.

Australia

Our wholly-owned subsidiary, Clene Australia Pty Ltd (“Clene Australia”), was established in Australia in March 2018 and is subject to corporate income tax at a rate of 30.00% and 25.00% for the nine months ended September 30, 2023 and 2022, respectively. Clene Australia had no taxable income or provision for income taxes for the nine months ended September 30, 2023 and 2022. We recorded other income of $0.9 million and $2.0 million for the nine months ended September 30, 2023 and 2022, respectively, for research and development tax credits pertaining to Clene Australia for the 2023 and 2022 tax years, respectively.

Netherlands

Our wholly-owned subsidiary, Clene Netherlands B.V. (“Clene Netherlands”), was established in the Netherlands in April 2021 and is subject to corporate income tax at a rate of 19.00% up to €200,000 of taxable income and 25.80% for taxable income in excess of €200,000 for the nine months ended September 30, 2023, and 15.00% up to €395,000 of taxable income and 25.80% for taxable income in excess of €395,000 for the nine months ended September 30, 2022. Clene Netherlands had no taxable income or provision for income taxes for the nine months ended September 30, 2023 and 2022.

Liquidity and Capital Resources

Sources of Capital

We have incurred significant losses and negative cash flows from operations since our inception. We expect to incur additional losses in the future to fund our operations and conduct research and development of our drug candidates. We recognize the need to raise additional capital to fully implement our business plan. The long-term continuation of our business plan is dependent upon the generation of sufficient revenues from our products to offset expenses and capital expenditures. In the event that we do not generate sufficient revenues and are unable to obtain funding, we will be forced to delay, reduce, or eliminate some or all of our research and development programs, product portfolio expansion, commercialization efforts, or capital expenditures, which could adversely affect our business prospects, ability to meet long-term liquidity needs, or we may be unable to continue operations.

Since our inception, we have dedicated substantially all of our resources to the development of our drug candidates. We have financed our operations principally through the following sources:

●

gross proceeds of $175.1 million from equity financing, including sales of common stock, preferred stock, warrants to purchase common stock, our ATM offering program, and our equity purchase agreement program;

●

gross proceeds of $32.3 million from borrowings under convertible promissory notes;

●

gross proceeds of $27.3 million from borrowings under notes payable and convertible notes payable;

●

gross proceeds of $9.4 million from the Reverse Recapitalization;

●

gross proceeds of $8.9 million from refundable research and development tax credits;

●

gross proceeds of $2.9 million from grants from various organizations; and

●

gross proceeds of $1.0 million from stock option and warrant exercises.

We also received indirect financial support for the HEALEY ALS Platform Trial, administered by Massachusetts General Hospital, which conducted a platform trial for the treatment of ALS with certain drug candidates, including CNM-Au8, at significantly lower costs than we would have otherwise incurred if we had conducted a comparably designed clinical trial at reasonable market rates.

Going Concern

We incurred a loss from operations of $30.6 million and $36.7 million for the nine months ended September 30, 2023 and 2022, respectively. Our accumulated deficit was $232.6 million and $193.2 million as of September 30, 2023 and December 31, 2022, respectively. Our cash, cash equivalents, and marketable securities totaled $42.1 million and $23.3 million as of September 30, 2023 and December 31, 2022, respectively, and net cash used in operating activities was $23.0 million and $31.3 million for the nine months ended September 30, 2023 and 2022, respectively.

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We have incurred significant losses and negative cash flows from operations since our inception. We have not generated significant revenues since our inception, and we do not anticipate generating significant revenues unless we successfully complete development and obtain regulatory approval for commercialization of a drug candidate. We expect to incur additional losses in the future, particularly as we advance the development of our clinical-stage drug candidates, continue research and development of our preclinical drug candidates, and initiate additional clinical trials of, and seek regulatory approval for, these and other future drug candidates. We expect that within the next twelve months, we will not have sufficient cash and other resources on hand to sustain our current operations or meet our obligations as they become due unless we obtain additional financing. Additionally, pursuant to our term loan with Avenue Venture Opportunities Fund, L.P. (“Avenue”), we are required to maintain unrestricted cash and cash equivalents of at least $5.0 million to avoid acceleration of the full balance of the loan (see Note 8 to the condensed consolidated financial statements). These conditions raise substantial doubt about the Company’s ability to continue as a going concern.

To mitigate our funding needs, we plan to raise additional funding, including exploring equity financing and offerings, debt financing, licensing or collaboration arrangements with third parties, as well as utilizing our existing at-the-market facility and equity purchase agreement and potential proceeds from the exercise of outstanding warrants and stock options. These plans are subject to market conditions and reliance on third parties, and there is no assurance that effective implementation of our plans will result in the necessary funding to continue current operations. We have implemented cost-saving initiatives, including delaying and reducing certain research and development programs and commercialization efforts and elimination of certain staff positions. We have concluded that our plans do not alleviate the substantial doubt about our ability to continue as a going concern beyond one year from the date the condensed consolidated financial statements are issued.

The accompanying condensed consolidated financial statements have been prepared assuming we will continue as a going concern, which contemplates the realization of assets and satisfaction of liabilities in the normal course of business. As a result, the accompanying condensed consolidated financial statements do not include any adjustments relating to the recoverability and classification of assets and their carrying amounts, or the amounts and classification of liabilities that may result should we be unable to continue as a going concern.

Short-Term Material Cash Requirements

For at least the next twelve months, our primary capital requirements are to fund our operations, including research and development, personnel, regulatory, and other clinical trial costs related to development of our lead drug candidate, CNM-Au8; and general and administrative costs to support our drug development and pre-commercial activities in advance of receiving regulatory approval for our drug candidates. Firm commitments for funds include approximately $39,000 and $1.1 million of payments under finance and operating lease obligations, respectively; payment of principal and interest on notes payable totaling $13.1 million; and commitments under various agreements for capital expenditures totaling $0.4 million related to the construction of our manufacturing facilities. We expect to meet our short-term liquidity requirements primarily through cash on hand. Additional sources of funds include equity financing, debt financing, or other capital sources.

Long-Term Material Cash Requirements

Beyond the next twelve months, our primary capital requirements are to fund our operations, including research and development, personnel, regulatory, and other clinical trial costs related to development of our lead drug candidate, CNM-Au8; and general and administrative costs to support our drug development activities in advance of receiving regulatory approval for our drug candidates. Additional funds may be spent to initiate new clinical trials, at our discretion. Known obligations beyond the next twelve months include $7,000 and $6.7 million of payments under finance and operating lease obligations, respectively; and interest and principal repayment of notes payable of $19.1 million. We expect to meet our long-term liquidity requirements primarily through equity financing, debt financing, or other capital sources.

Use of Funds

Our cash flows for the nine months ended September 30, 2023 and 2022 were as follows:

	Nine Months Ended September 30,
(in thousands)	2023			2022
Net cash used in operating activities	$	(22,999	)	$	(31,295	)
Net cash provided by (used in) investing activities		4,713			(12,446	)
Net cash provided by financing activities		42,181			875
Effect of foreign exchange rate changes on cash		(114	)		(155	)
Net increase (decrease) in cash, cash equivalents and restricted cash	$	23,781		$	(43,021	)

Our primary use of cash in all periods presented was to fund our research and development, regulatory and other clinical trial costs, and general corporate expenditures.

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Operating Activities

Net cash used in operating activities was $23.0 million for the nine months ended September 30, 2023, which resulted from a net loss of $39.3 million, adjusted for non-cash items totaling $17.0 million and a net change in operating assets and liabilities of $0.7 million. Significant non-cash items included (i) depreciation expense of $1.3 million related to laboratory and office equipment and leasehold improvements; (ii) non-cash lease expense of $0.3 million; (iii) commitment share expense of $0.4 million related to the shares of Common Stock issued to Lincoln Park as an initial fee for Lincoln Park’s commitment to purchase shares of Common Stock under a purchase agreement with the Company; (iv) issuance costs of $0.3 million from a public equity offering allocated to liability-classified warrants; (v) a loss on initial issuance of equity of $14.8 million from the fair value in excess of proceeds from a public equity offering; (vi) stock-based compensation expense of $7.1 million; (vii) accretion of debt discount of $0.8 million; (viii) non-cash interest expense of $0.3 million; (ix) the changes in fair value of the Clene Nanomedicine and Initial Stockholders Contingent Earn-outs of $2.1 million and $0.3 million, respectively, primarily driven by the decrease of the closing price of our Common Stock on Nasdaq and changes in valuation model inputs; and (x) the change in fair value of the common stock warrant liabilities of $6.0 million, primarily driven by the increase of the closing price of our Common Stock on Nasdaq and changes in valuation model inputs. The net change in operating assets and liabilities was primarily attributable to the following: (a) a decrease in accounts receivable of $0.1 million and a decrease in accounts payable of $1.1 million due to the timing of vendor invoicing and payments; (b) an increase in inventory of $0.1 million; (c) a decrease in prepaid expenses and other current assets of $1.5 million due to the timing of vendor invoicing and payments, the timing of receipt of metals to be used in research and development, and a decrease in research and development tax credits receivable; (d) a decrease in accrued liabilities of $0.7 million primarily due to decreased accrued compensation and benefits and CRO and clinical fees; and (e) a decrease in operating lease obligations of $0.4 million.

Net cash used in operating activities was $31.3 million for the nine months ended September 30, 2022, which resulted from a net loss of $28.9 million, adjusted for non-cash items totaling $0.2 million and a net change in operating assets and liabilities of $2.6 million. Significant non-cash items included (i) depreciation expense of $0.7 million related to laboratory and office equipment and leasehold improvements; (ii) non-cash lease expense of $0.3 million; (iii) stock-based compensation expense of $6.5 million; (iv) gain on termination of lease of $0.4 million; (v) accretion of debt discount of $0.7 million; (vi) non-cash interest expense of $0.1 million; and (vii) the changes in the fair value of the Clene Nanomedicine and Initial Stockholders Contingent Earn-outs of $6.7 million and $0.9 million, respectively. The changes in fair value of these instruments were primarily driven by the decrease of the closing price of our Common Stock on Nasdaq. The net change in operating assets and liabilities was primarily attributable to the following: (a) an increase in accounts receivable of $0.1 million and an increase in accounts payable of $0.2 million due to the timing of vendor invoicing and payments; (b) an increase in prepaid expenses and other current assets of $0.9 million due to the timing of vendor invoicing and payments, the timing of receipt of metals to be used in research and development, and an increase in Australia research and development credit receivable; (c) a decrease in accrued liabilities of $1.5 million primarily due to decreased accrued compensation and benefits; and (d) a decrease in operating lease obligations of $0.4 million.

Investing Activities

Net cash provided by investing activities was $4.7 million for the nine months ended September 30, 2023, which consisted of proceeds from maturities of marketable securities of $5.0 million, partially offset by purchases of property and equipment of $0.3 million. Net cash used in investing activities was $12.5 million for the nine months ended September 30, 2022, which consisted of (i) purchases of marketable securities of $24.6 million and (ii) purchases of property and equipment of $3.5 million, offset primarily by (iii) proceeds from maturity of marketable securities of $8.0 million and (iv) proceeds from sale of marketable securities of $7.6 million.

Financing Activities

Net cash provided by financing activities was $42.2 million for the nine months ended September 30, 2023, which consisted of (i) proceeds from issuance of common stock and warrants, net of offering costs, of $42.1 million, and (ii) proceeds from the issuance of notes payable of $0.4 million; partially offset by (iii) payments of notes payable modification fees of $0.2 million and (iv) payments of finance lease obligations of $0.1 million. Net cash provided by financing activities was $0.9 million for the nine months ended September 30, 2022, which consisted of (i) proceeds from exercise of stock options of $0.3 million, (ii) at-the-market offering proceeds of $0.1 million net of $4,000 placement agent commissions, and (iii) proceeds from the issuance of notes payable of $0.7 million; offset primarily by (iv) payments of finance lease obligations of $0.1 million, (v) payment of debt issuance costs of $30,000, and (vi) payment of deferred offering costs of $0.1 million.

Public Offering

In June 2023, we sold 50,000,000 units at a sale price of $0.80 per unit pursuant to an underwriting agreement with Canaccord Genuity LLC(“Canaccord”) as underwriter. Each unit consisted of (i) one share of Common Stock, (ii) one warrant to purchase one share of Common Stock at an exercise price of $1.10 per share (the “Tranche A Warrants”), and (iii) one warrant to purchase one share of Common Stock at an exercise price of $1.50 per share (the “Tranche B Warrants”). The aggregate gross proceeds were $40.0 million, excluding the proceeds, if any, from the exercise of the Tranche A Warrants and Tranche B Warrants. We cannot predict when or if the Tranche A Warrants or Tranche B Warrants will be exercised, and it is possible they may expire and/or never be exercised. We paid underwriting discounts and commissions of $2.4 million and offering expenses of $0.2 million. The offering was made pursuant to our registration statement on Form S-3 (file number 333-264299), which was declared effective by the SEC on April 26, 2022, a related registration statement pursuant to Rule 462(b) (file number 333-272692), filed with the SEC and effective on June 16, 2023, and our prospectus supplement relating to the offering.

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Common Stock Sales Agreement

During the nine months ended September 30, 2023, we sold 2,895,090 shares of Common Stock under our Equity Distribution Agreement (the “ATM Agreement”) with Canaccord, generated gross proceeds of $4.5 million, and paid commissions of $0.1 million. We did not make any sales during the three months ended September 30, 2023. During the three and nine months ended September 30, 2022 we sold 40,000 shares of Common Stock and generated gross proceeds of $0.1 million. Commissions paid to the Placement Agents were insignificant. The issuance and sale of Common Stock by us under the ATM Agreement was made pursuant to our registration statement on Form S-3 (file number 333-264299), which was declared effective by the Securities and Exchange Commission on April 26, 2022, and our prospectus supplement relating to the offering. On June 16, 2023, we delivered written notice to Canaccord that we were suspending and terminating the prospectus supplement (the “ATM Prospectus Supplement”) related to our Common Stock issuable pursuant to the ATM Agreement. We will not make any further sales of our securities pursuant to the ATM Agreement, unless and until a new prospectus supplement is filed. Other than the termination and suspension of the ATM Prospectus Supplement, the ATM Agreement remains in full force and effect.

Common Stock Purchase Agreement

During the nine months ended September 30, 2023, we sold 400,000 shares of Common Stock under the purchase agreement (the “Purchase Agreement”) with Lincoln Park, issued 2,893 Additional Commitment Shares, and generated proceeds of $0.4 million. We did not sell any Common Stock under the Purchase Agreement during the three months ended September 30, 2023. The issuance and sale of Common Stock under the Purchase Agreement was made pursuant to our registration statement on Form S-3 (file number 333-264299), which was declared effective by the SEC on April 26, 2022, and our prospectus supplement relating to the transaction. On June 16, 2023, we delivered written notice to Lincoln Park that we were terminating the prospectus supplement (the “Purchase Agreement Prospectus Supplement”) and the offering with respect to our unsold shares of Common Stock issuable pursuant to the Purchase Agreement. We will not make any further sales of our securities pursuant to the Purchase Agreement, unless and until a new prospectus supplement is filed. Other than the termination of the Purchase Agreement Prospectus Supplement and offering with respect to future sales by us, the Purchase Agreement remains in full force and effect.

Critical Accounting Estimates

Our discussion and analysis of our financial condition and results of operations is based on our condensed consolidated financial statements, which have been prepared in accordance with U.S. Generally Accepted Accounting Principles. The preparation of these condensed consolidated financial statements requires us to make estimates, assumptions, and judgments that affect the reported amounts of assets, liabilities, revenues, costs, and expenses. We evaluate our estimates and judgments on an ongoing basis, and our actual results may differ from these estimates. We base our estimates on historical experience, known trends and events, contractual milestones, and other various factors that are believed to be reasonable under the circumstances, the results of which form the basis for making judgments about the carrying values of assets and liabilities that are not readily apparent from other sources.

We consider the following estimates to be critical as they involve a significant level of estimation uncertainty and have had or are reasonably likely to have a material impact on our financial condition and results of operations.

Contingent Earn-Out Liabilities

In connection with the Reverse Recapitalization, certain stockholders are entitled to the Contingent Earn-outs payments based on achievement of certain milestones. In accordance with ASC 815, we classified the Contingent Earn-outs as liabilities and measured them at fair value on the date of the Reverse Recapitalization. We remeasure the liabilities at each reporting date and record the change in fair value as a component of other income (expense), net, in the condensed consolidated statements of operations and comprehensive loss. We estimate the fair value using a Monte Carlo valuation model, which requires significant judgment. The unobservable inputs include the expected stock price volatility, the risk-free interest rate, and the expected term. As of September 30, 2023 and December 31, 2022, the unobservable inputs were as follows:

	September 30,			December 31,
	2023			2022
Expected stock price volatility		100.00	%		115.00	%
Risk-free interest rate		5.00	%		4.20	%
Expected dividend yield		0.00	%		0.00	%
Expected term (in years)		2.25			3.00

The change in fair value of the Clene Nanomedicine Contingent Earn-out resulted in a gain of $2.1 million and $6.7 million for the nine months ended September 30, 2023 and 2022, respectively. The change in fair value of the Initial Stockholders Contingent Earn-out resulted in a gain of $0.3 million and $0.9 million for the nine months ended September 30, 2023 and 2022, respectively.

Convertible Notes

Pursuant to the 2021 Avenue Loan, $5.0 million of the outstanding principal is subject to the Avenue Conversion Feature. In accordance with ASU 2020-06, Debt—Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging—Contracts in Entity’s Own Equity (Subtopic 815-40): Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity, we classified this portion as convertible notes payable in the condensed consolidated balance sheets and did not separate the Avenue Conversion Feature from the host contract as it did not meet the requirements for accounting as a derivative instrument. We account for the convertible note as a single liability measured at its amortized cost. As of September 30, 2023 and December 31, 2022, the convertible note was carried at $4.8 million and $4.8 million, respectively.

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We classified the 2022 DHCD Loan as convertible notes payable in the condensed consolidated balance sheets and did not separate the conversion option from the host contract as it did not meet the requirements for accounting as a derivative instrument. We account for the convertible note as a single liability measured at its amortized cost. As of September 30, 2023 and December 31, 2022, the convertible note was carried at $5.2 million and $5.0 million, respectively.

Common Stock Warrant Liabilities

Pursuant to an amendment to the 2021 Avenue Loan in June 2023, we issued a warrant to purchase 3,000,000 shares of Common Stock at $0.80 per share (the “New Avenue Warrant”). In accordance with ASC 815, we recognized the New Avenue Warrant as a derivative liability measured at fair value and will remeasure the New Avenue Warrant at each reporting date and record the change in fair value as a component of other income (expense), net, in the condensed consolidated statements of operations and comprehensive loss. We estimate the fair value using a Black-Scholes option-pricing model with probability weights for the occurrence of the following events: (i) settlement of the instrument upon a change of control transaction, (ii) dissolution of the Company, or (iii) another outcome outside of (i)-(ii). These estimates require significant judgment. As of September 30, 2023, the unobservable inputs were as follows:

	September 30,
	2023
Expected stock price volatility		70.00% – 110.00%
Risk-free interest rate		4.63% – 5.52%
Expected dividend yield		0.00	%
Expected term (in years)		0.58 – 4.75
Probability of change of control		5.00	%
Probability of dissolution		60.00	%
Probability of other outcome		35.00	%

Pursuant to an underwritten public offering in June 2023, we issued the Tranche A Warrants to purchase 50,000,000 shares of Common Stock at $1.10 per share and the Tranche B Warrants to purchase 50,000,000 shares of Common Stock at $1.50 per share. In accordance with ASC 815, we recognized the Tranche A Warrant as a derivative liability measured at fair value and will remeasure the Tranche A Warrant at each reporting date and record the change in fair value as a component of other income (expense), net, in the condensed consolidated statements of operations and comprehensive loss. We estimate the fair value using a Black-Scholes option-pricing model with probability weights for the occurrence of the following events: (i) FDA acceptance of an NDA for CNM-Au8, (ii) settlement upon a fundamental transaction, (iii) dissolution of the Company, and (iv) another outcome outside of (i)-(iii). These estimates require significant judgment. As of September 30, 2023, the unobservable inputs were as follows:

	September 30,
	2023
Expected stock price volatility		75.00% – 110.00%
Risk-free interest rate		4.87% – 5.50%
Expected dividend yield		0.00	%
Expected term (in years)		0.75 – 2.71
Probability of NDA acceptance		30.00	%
Probability of fundamental transaction		5.00	%
Probability of dissolution		60.00	%
Probability of other outcome		5.00	%

The Tranche B Warrant qualified for equity classification at issuance. We estimated the nonrecurring fair value measurement using a Black-Scholes option-pricing model with probability weights for the occurrence of the following events: (i) FDA approval of an NDA for CNM-Au8, (ii) settlement upon a fundamental transaction, (iii) dissolution of the Company, and (iv) another outcome outside of (i)-(iii). These estimates require significant judgment. The unobservable inputs to the Black-Scholes option pricing model were as follows:

	June 16,
	2023
Expected stock price volatility		100.00% – 110.00%
Risk-free interest rate		3.88% – 4.97%
Expected dividend yield		0.00	%
Expected term (in years)		1.46 – 7.00
Probability of NDA approval		22.50	%
Probability of fundamental transaction		5.00	%
Probability of dissolution		71.50	%
Probability of other outcome		1.00	%

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Income Taxes

We account for uncertainty in income taxes by applying a two-step process to determine the amount of tax benefit to be recognized in the condensed consolidated financial statements. First, the tax position is evaluated to determine the likelihood that it will be sustained upon external examination by the taxing authorities. If the tax position is deemed more-likely-than-not to be sustained, the tax position is then assessed to determine the amount of benefit to recognize. The amount of the benefit that may be recognized is the largest amount that has a greater than 50% likelihood of being realized upon ultimate settlement. Additionally, we assess the likelihood that our deferred tax assets will be recovered from future taxable income and, to the extent we believe, based upon the weight of available evidence, that it is more likely than not that all or a portion of the deferred tax assets will not be realized, a valuation allowance is established through a charge to income tax expense. Potential for recovery of deferred tax assets is evaluated by estimating the future taxable profits expected and considering prudent and feasible tax planning strategies. The estimation of these factors requires significant judgment. Based on our evaluation of these factors, we have not recorded income tax benefits for the net operating losses or for research and development tax credits or other deferred tax assets due to uncertainty of realizing benefits from these items.

Stock-Based Compensation

We account for stock-based compensation arrangements using a fair value-based method for costs related to all share-based payments including stock options and stock awards. The fair value is recognized over the period during which a grantee was required to provide services in exchange for the option award and service-based stock awards, known as the requisite service period (usually the vesting period), on a straight-line basis. For stock awards with market conditions, the fair value is recognized over the period based on the expected milestone achievement dates as the derived service period (usually the vesting period), on a straight-line basis. For stock awards with performance conditions, the grant-date fair value of these awards is the market price on the applicable grant date, and compensation expense will be recognized when the conditions become probable of being satisfied. We will recognize a cumulative true-up adjustment once the conditions become probable of being satisfied as the related service period had been completed in a prior period. We elect to account for forfeitures as they occur, rather than estimating expected forfeitures.

We estimate the fair value of stock options using a Black-Scholes option-pricing model, which requires significant judgment. The unobservable inputs include the expected price volatility, risk-free interest rate, expected dividend yield, and expected term. For the nine months ended September 30, 2023 and 2022, the unobservable inputs were as follows:

	Nine Months Ended September 30,
	2023			2022
Expected stock price volatility		96.22% – 103.24%			89.57% – 98.13%
Risk-free interest rate		3.26% – 4.41%			1.65% – 3.00%
Expected dividend yield		0.00	%		0.00	%
Expected term of options (in years)		5.00 – 6.43			5.00 – 6.98

We estimate the fair value of restricted stock awards using a Monte Carlo valuation model to simulate the achievement of certain stock price milestones. The unobservable inputs include the expected stock price volatility, risk-free interest rate, and expected term. No restricted stock awards were granted during the nine months ended September 30, 2023 and 2022.

Item 3. Quantitative and Qualitative Disclosures About Market Risk

As a smaller reporting company, we are not required to provide information required by this Item.

Item 4. Controls and Procedures

Evaluation of Disclosure Controls and Procedures

Under the supervision and with the participation of management, including our principal executive officer and principal financial officer, we conducted an evaluation of the effectiveness of our disclosure controls and procedures as of September 30, 2023, as such term is defined in Rules 13a-15(e) and 15d-15(e) of the Securities Exchange Act of 1934 (the “Exchange Act”). As a result of this evaluation, our principal executive officer and principal financial officer have concluded that, as of September 30, 2023, our disclosure controls and procedures were not effective due to the material weaknesses in internal control over financial reporting described below. Notwithstanding the identified material weaknesses, management, including our principal executive officer and principal financial officer, believes the condensed consolidated financial statements included in this Quarterly Report on Form 10-Q fairly represent, in all material respects, our financial condition, results of operations and cash flows as of and for the periods presented in accordance with United States Generally Accepted Accounting Principles.

Disclosure controls and procedures are designed to ensure that information required to be disclosed by us in the reports that we file or submit under the Exchange Act is recorded, processed, summarized, and reported within the time periods specified in the Securities and Exchange Commission (the “SEC”) rules and forms, and that such information is accumulated and communicated to our management, including our principal executive officer and principal financial officer, as appropriate to allow timely decisions regarding required disclosure.

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Material Weaknesses in Internal Control over Financial Reporting

In connection with the audit of our financial statements as of and for the years ended December 31, 2022 and 2021, our management identified material weaknesses in our internal control over financial reporting. A material weakness is a deficiency, or combination of deficiencies, in internal control over financial reporting, such that there is a reasonable possibility that a material misstatement of our annual or interim financial statements will not be prevented or detected on a timely basis. The material weaknesses identified relate to the fact that we did not design or maintain an effective control environment commensurate with our financial reporting requirements. This deficiency in our control environment contributed to the following additional material weaknesses related to control activities and information and communication within our internal control over financial reporting:

●

we did not design and maintain controls over the preparation and review of reconciliations and the review and segregation of duties over manual journal entries, including controls over the completeness and accuracy of information; and

●

we did not design and maintain information technology (“IT”) general controls for IT systems that are relevant to the preparation of the financial statements. Specifically, we did not design and maintain: (a) user access controls to ensure appropriate segregation of duties and that adequately restrict user and privileged access to financial applications, programs, and data to our appropriate personnel; (b) program change management controls to ensure that IT program and data changes affecting financial IT applications and underlying accounting records are identified, tested, authorized, and implemented appropriately; (c) computer operations controls to ensure that data backups are authorized and monitored; and (d) testing and approval controls for program development to ensure that new software development is aligned with business and IT requirements.

Each of the control deficiencies described above could result in a misstatement of one or more account balances or disclosures that would result in a material misstatement to the annual or interim consolidated financial statements that would not be prevented or detected. Accordingly, our management has determined that each of the control deficiencies described above constitute material weaknesses.

Material Weakness Remediation

Management continues to be actively engaged and committed to taking the steps necessary to remediate the control deficiencies that constituted the above material weaknesses. During 2022, we made the following enhancements to our control environment:

●

we have strengthened the experience of our internal accounting team, to provide oversight, structure and reporting lines, and to provide additional review over our disclosures, including hiring a new Chief Financial Officer;

●

we engaged external consultants to provide support and to assist us in our evaluation of more complex applications of GAAP, and to assist us with documenting and assessing our accounting policies and procedures; and

●

we implemented a new Enterprise Resource Planning system to enhance the accuracy of our financial records, enable the enforcement of systematic segregation of duties, and improve our information technology general controls environment.

Our remediation activities are continuing during 2023. In addition to the above actions, we expect to engage in additional activities, or have completed additional activities, including, but not limited to:

●

adding more technical accounting resources to enhance our control environment; and

●

until we have sufficient technical accounting resources, engaging external consultants to provide support and to assist us in our evaluation of more complex applications of GAAP.

We continue to enhance corporate oversight over process-level controls and structures to ensure that there is appropriate assignment of authority, responsibility, and accountability to enable remediation of our material weaknesses. We believe that our remediation plan will be sufficient to remediate the identified material weaknesses and strengthen our internal control over financial reporting. As we continue to evaluate, and work to improve, our internal control over financial reporting, management may determine that additional measures to address control deficiencies or modifications to the remediation plan are necessary.

Changes in Internal Control over Financial Reporting

Other than changes described under “—Material Weakness Remediation,” there were no changes in our internal control over financial reporting during the quarter ended September 30, 2023, that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.

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PART II—OTHER INFORMATION

Item 1. Legal Proceedings

We are not currently a party to any material pending legal proceedings. From time to time, we may, however, be involved in legal proceedings in the ordinary course of business. We cannot predict the outcome of any such legal proceedings, and despite the potential outcomes, the existence thereof may have an adverse impact on us because of defense and settlement costs, diversion of management resources and other factors.

Item 1A. Risk Factors

Our business, financial condition, and results of operations can be affected by a number of factors, whether currently known or unknown, including but not limited to those described in Part I, Item 1A, Risk Factors of our 2022 Annual Report on Form 10-K which was filed with the SEC on March 13, 2023. Except for the risk factor disclosed below, and the risk factor disclosed in Part II, Item 1A, Risk Factors, of our Quarterly Report on Form 10-Q for the period ended March 31, 2023, which was filed with the SEC on May 12, 2023, there have been no material changes to the risk factors since previously disclosed in the 2022 Annual Report on Form 10-K. Any one or more of these factors could, directly or indirectly, cause our actual financial condition and results of operations to vary materially from past, or from anticipated future, financial condition and results of operations. Any of these factors, in whole or in part, could materially and adversely affect our business, financial condition, results of operations, and stock price.

We do not satisfy all continued listing requirements of Nasdaq. There can be no assurance that we will be able to comply with the continued listing requirements of Nasdaq.

As previously disclosed, on August 1, 2023, we received a written notice (the “Notice”) from The Nasdaq Stock Market LLC that for the last 30 consecutive business days, the bid price for our Common Stock had closed below the minimum $1.00 per share requirement for continued listing on Nasdaq pursuant to Nasdaq Listing Rule 5550(a)(2) (the “Minimum Bid Price Requirement”). The Notice had no immediate effect on the listing of our Common Stock and our Common Stock will continue to be listed on Nasdaq under the symbol “CLNN.”

In accordance with Nasdaq Listing Rule 5810(c)(3)(A), we have a period of 180 calendar days, or until January 29, 2024, to regain compliance with the Minimum Bid Price Requirement. If at any time before January 29, 2024, the bid price of our Common Stock closes at $1.00 per share or more for a minimum of 10 consecutive business days, Nasdaq will provide us with a written confirmation of compliance with the Minimum Bid Price Requirement.

If we do not regain compliance with the Minimum Bid Price Requirement by January 29, 2024, we may be eligible for an additional 180-day compliance period, provided that on the 180th day of the first compliance period we meet the continued listing requirement for market value of publicly held shares and all other applicable requirements for initial listing on Nasdaq, with the exception of the Minimum Bid Price Requirement, and notifies Nasdaq of our intent to cure the deficiency with the Minimum Bid Price Requirement during the second compliance period by effecting a reverse stock split, if necessary. If we do not regain compliance with the Minimum Bid Price Requirement when required, Nasdaq will provide written notification to us that our Common Stock is subject to delisting. At that time, we may appeal the delisting determination to a Nasdaq hearings panel.

We intend to actively monitor the bid price for our Common Stock between now and January 29, 2024, and will consider our available options to regain compliance with the Minimum Bid Price Requirement. There can be no assurance that we will regain compliance with the Minimum Bid Price Requirement or maintain compliance with any of the other Nasdaq continued listing requirements.

If Nasdaq delists our shares of Common Stock or warrants from trading on its exchange for failure to meet Nasdaq’s listing requirements, we and our stockholders could face significant material adverse consequences including:

●

a limited availability of market quotations for our securities;

●

reduced liquidity for our securities;

●

a determination that our Common Stock is a “penny stock” which will require brokers trading in our Common Stock to adhere to more stringent rules and possibly result in a reduced level of trading activity in the secondary trading market for our securities;

●

a limited amount of news and analyst coverage; and

●

a decreased ability to issue additional securities or obtain additional financing in the future.

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Item 2. Unregistered Sales of Equity Securities and Use of Proceeds

(a)

Recent Sales of Unregistered Securities

None.

(b)

Use of Proceeds

None.

(c)

Purchases of Equity Securities by the Issuer and Affiliated Purchasers

None.

Item 3. Defaults Upon Senior Securities

None.

Item 4. Mine Safety Disclosures

Not Applicable.

Item 5. Other Information

None.

Item 6. Exhibits

Exhibit Number		Exhibit Description
3.1		Fourth Amended and Restated Certificate of Incorporation of Clene Inc. (incorporated by reference to Exhibit 3.1 to the Current Report on Form 8-K filed by the Registrant on May 11, 2023).
3.2		Bylaws of Clene Inc. (incorporated by reference to Exhibit 3.2 to the Current Report on Form 8-K filed by the Registrant on January 5, 2021).
31.1*		Certification of Chief Executive Officer pursuant to Rule 13a-14(a) and Rule 15d-14(a), promulgated under the Securities and Exchange Act of 1934, as amended.
31.2*		Certification of Chief Financial Officer pursuant to Rule 13a-14(a) and Rule 15d-14(a), promulgated under the Securities and Exchange Act of 1934, as amended.
32.1**		Certification of Chief Executive Officer pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.
32.2**		Certification of Chief Financial Officer pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.
101.INS		Inline XBRL Instance Document.
101.SCH		Inline XBRL Taxonomy Extension Schema Document.
101.CAL		Inline XBRL Taxonomy Extension Calculation Linkbase Document.
101.DEF		Inline XBRL Taxonomy Extension Definition Linkbase Document.
101.LAB		Inline XBRL Taxonomy Extension Label Linkbase Document.
101.PRE		Inline XBRL Taxonomy Extension Presentation Linkbase Document.
104		Cover Page Interactive Data File (formatted as Inline XBRL and contained in Exhibit 101).

*	Filed herewith.
**	Furnished herewith.

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SIGNATURES

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned, thereunto duly authorized.

	CLENE INC.

Dated: November 7, 2023	By:	/s/ Robert Etherington
	Name:	Robert Etherington
	Title:	President, Chief Executive Officer and Director

Dated: November 7, 2023	By:	/s/ Morgan R. Brown
	Name:	Morgan R. Brown
	Title:	Chief Financial Officer

Exhibit 31.1

CERTIFICATION

I, Robert Etherington, certify that:

1.	I have reviewed this Quarterly Report on Form 10-Q of Clene Inc.;

2.	Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3.	Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

The registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:

(a)

Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

(b)

Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;

(c)

Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

(d)

Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and

5.	The registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

(a)

All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

(b)

Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Date: November 7, 2023

	/s/ Robert Etherington
	Robert Etherington
	President and Chief Executive Officer

Exhibit 31.2

CERTIFICATION

I, Morgan R. Brown, certify that:

1.	I have reviewed this Quarterly Report on Form 10-Q of Clene Inc.;

2.	Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3.	Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

(a)

(b)

(c)

(d)

5.	The registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

(a)

(b)

Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Date: November 7, 2023


	/s/ Morgan R. Brown
	Morgan R. Brown
	Chief Financial Officer

Exhibit 32.1

CERTIFICATION

Pursuant to the requirement set forth in Rule 13a-14(b) of the Securities Exchange Act of 1934, as amended, (the “Exchange Act”) and Section 1350 of Chapter 63 of Title 18 of the United States Code (18 U.S.C. §1350), Robert Etherington, President and Chief Executive Officer of Clene Inc. (the “Company”), hereby certifies that, to the best of his knowledge:

1.	The Company’s Quarterly Report on Form 10-Q for the period ended September 30, 2023, to which this Certification is attached as Exhibit 32.1 (the “Quarterly Report”), fully complies with the requirements of Section 13(a) or Section 15(d) of the Exchange Act; and

2.	The information contained in the Quarterly Report fairly presents, in all material respects, the financial condition and results of operations of the Company.

Dated: November 7, 2023


	/s/ Robert Etherington
	Robert Etherington
	President and Chief Executive Officer

A signed original of this written statement required by Section 906 of 18 U.S.C. § 1350 has been provided to the Company, and will be retained by the Company and furnished to the Securities and Exchange Commission or its staff upon request.

This certification accompanies the Form 10-Q to which it relates, is not deemed filed with the Securities and Exchange Commission and is not to be incorporated by reference into any filing of the Company under the Securities Act of 1933, as amended, or the Exchange Act (whether made before or after the date of the Form 10-Q), irrespective of any general incorporation language contained in such filing.

Exhibit 32.2

CERTIFICATION

Pursuant to the requirement set forth in Rule 13a-14(b) of the Securities Exchange Act of 1934, as amended, (the “Exchange Act”) and Section 1350 of Chapter 63 of Title 18 of the United States Code (18 U.S.C. §1350), Morgan R. Brown, Chief Financial Officer of Clene Inc. (the “Company”), hereby certifies that, to the best of his knowledge:

1.	The Company’s Quarterly Report on Form 10-Q for the period ended September 30, 2023, to which this Certification is attached as Exhibit 32.2 (the “Quarterly Report”), fully complies with the requirements of Section 13(a) or Section 15(d) of the Exchange Act; and

2.	The information contained in the Quarterly Report fairly presents, in all material respects, the financial condition and results of operations of the Company.

Dated: November 7, 2023


	/s/ Morgan R. Brown
	Morgan R. Brown
	Chief Financial Officer

Document And Entity Information - shares	9 Months Ended
Document And Entity Information - shares	Sep. 30, 2023	Nov. 03, 2023
Document Information [Line Items]
Entity Central Index Key	0001822791
Entity Registrant Name	Clene Inc.
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Document Fiscal Period Focus	Q3
Document Fiscal Year Focus	2023
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2023
Document Transition Report	false
Entity File Number	01-39834
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	85-2828339
Entity Address, Address Line One	6550 South Millrock Drive, Suite G50
Entity Address, City or Town	Salt Lake City
Entity Address, State or Province	UT
Entity Address, Postal Zip Code	84121
City Area Code	801
Local Phone Number	676 9695
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	true
Entity Ex Transition Period	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		128,415,605
Warrant [Member]
Document Information [Line Items]
Title of 12(b) Security	Warrants, to acquire one-half of one share of Common Stock for $11.50 per share
Trading Symbol	CLNNW
Security Exchange Name	NASDAQ
Common Stock [Member]
Document Information [Line Items]
Title of 12(b) Security	Common Stock, $0.0001 par value
Trading Symbol	CLNN
Security Exchange Name	NASDAQ

Condensed Consolidated Balance Sheets (Current Period Unaudited) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Current assets:
Cash and cash equivalents	$ 42,113	$ 18,332
Marketable securities	0	4,983
Accounts receivable	64	189
Inventory	104	43
Prepaid expenses and other current assets	4,165	5,648
Total current assets	46,446	29,195
Restricted cash	58	58
Operating lease right-of-use assets	4,287	4,602
Property and equipment, net	9,642	10,638
TOTAL ASSETS	60,433	44,493
Current liabilities:
Accounts payable	1,889	3,014
Accrued liabilities	3,194	3,863
Operating lease obligations, current portion	553	488
Finance lease obligations, current portion	44	74
Notes payable, current portion	9,588	6,418
Total current liabilities	15,268	13,857
Operating lease obligations, net of current portion	5,080	5,557
Finance lease obligations, net of current portion	0	34
Notes payable, net of current portion	6,675	9,483
Convertible notes payable	9,975	9,770
Common stock warrant liabilities	1,860	0
Clene Nanomedicine contingent earn-out liability	150	2,264
Initial Stockholders contingent earn-out liability	19	291
TOTAL LIABILITIES	39,027	41,256
Commitments and contingencies (Note 9)
Stockholders’ equity:
Common stock, $0.0001 par value: 300,000,000 and 150,000,000 shares authorized at September 30, 2023 and December 31, 2022, respectively; 128,411,981 and 74,759,591 shares issued and outstanding at September 30, 2023 and December 31, 2022, respectively	13	7
Additional paid-in capital	253,854	196,246
Accumulated deficit	(232,550)	(193,219)
Accumulated other comprehensive income	89	203
TOTAL STOCKHOLDERS’ EQUITY	21,406	3,237
TOTAL LIABILITIES AND STOCKHOLDERS’ EQUITY	$ 60,433	$ 44,493

Condensed Consolidated Balance Sheets (Current Period Unaudited) (Parentheticals) - $ / shares	Sep. 30, 2023	Dec. 31, 2022	Dec. 30, 2020
Common stock, par value (in dollars per share)	$ 0.0001	$ 0.0001	$ 0.0001
Common stock, shares authorized (in shares)	300,000,000	150,000,000
Common stock, shares issued (in shares)	128,411,981	74,759,591
Common stock, shares outstanding (in shares)	128,411,981	74,759,591

Condensed Consolidated Statements of Operations and Comprehensive Loss (Unaudited) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Revenue:
Total revenue	$ 108	$ 174	$ 484	$ 239
Operating expenses:
Cost of revenue	12	19	83	19
Research and development	5,972	6,403	19,982	24,149
General and administrative	3,666	3,557	11,029	12,807
Total operating expenses	9,650	9,979	31,094	36,975
Loss from operations	(9,542)	(9,805)	(30,610)	(36,736)
Other income (expense), net:
Interest income	546	59	931	144
Interest expense	(1,188)	(857)	(3,358)	(2,390)
Gain on termination of lease	0	0	0	420
Commitment share expense	0	0	(402)	0
Issuance costs for common stock warrant liability	0	0	(333)	0
Loss on initial issuance of equity	0	0	(14,840)	0
Change in fair value of common stock warrant liabilities	6,341	149	5,958	151
Change in fair value of Clene Nanomedicine contingent earn-out liability	1,004	(1,591)	2,114	6,662
Change in fair value of Initial Stockholders contingent earn-out liability	129	(205)	272	849
Research and development tax credits and unrestricted grants	247	1,346	902	2,001
Other income (expense), net	45	(72)	35	35
Total other income (expense), net	7,124	(1,171)	(8,721)	7,872
Net loss before income taxes	(2,418)	(10,976)	(39,331)	(28,864)
Income tax benefit	0	0	0	0
Net loss	(2,418)	(10,976)	(39,331)	(28,864)
Other comprehensive loss:
Unrealized gain (loss) on available-for-sale securities	(4)	33	16	(54)
Foreign currency translation adjustments	(81)	(39)	(130)	(99)
Total other comprehensive loss	(85)	(6)	(114)	(153)
Comprehensive loss	$ (2,503)	$ (10,982)	$ (39,445)	$ (29,017)
Net loss per share – basic and diluted (in dollars per share)	$ (0.02)	$ (0.17)	$ (0.41)	$ (0.46)
Weighted average common shares used to compute basic and diluted net loss per share (in shares)	128,405,483	63,508,928	97,026,964	63,234,757
Product [Member]
Revenue:
Total revenue	$ 65	$ 130	$ 355	$ 139
Royalty [Member]
Revenue:
Total revenue	$ 43	$ 44	$ 129	$ 100

Condensed Consolidated Statements of Stockholders' Equity (Deficit) (Unaudited) - USD ($) $ in Thousands	Common Stock [Member]	Additional Paid-in Capital [Member]	Retained Earnings [Member]	AOCI Attributable to Parent [Member]	Total
Balances (in shares) at Dec. 31, 2021	62,312,097
Balances at Dec. 31, 2021	$ 6	$ 175,659	$ (163,301)	$ 233	$ 12,597
Stock-based compensation expense	0	2,202	0	0	2,202
Unrealized gain on available-for-sale securities	0	0	0	(50)	(50)
Foreign currency translation adjustments	0	0	0	50	50
Net loss	0	0	(13,354)	0	(13,354)
Reclassification of common stock warrant liability to permanent equity	$ 0	305	0	0	305
Exercise of stock options (in shares)	934,448
Exercise of stock options	$ 0	267	0	0	267
Balances (in shares) at Mar. 31, 2022	63,246,545
Balances at Mar. 31, 2022	$ 6	178,433	(176,655)	233	2,017
Balances (in shares) at Dec. 31, 2021	62,312,097
Balances at Dec. 31, 2021	$ 6	175,659	(163,301)	233	12,597
Foreign currency translation adjustments					(99)
Net loss					(28,864)
Reclassification of common stock warrant liability to permanent equity					305
Balances (in shares) at Sep. 30, 2022	63,541,984
Balances at Sep. 30, 2022	$ 6	182,760	(192,165)	80	(9,319)
Balances (in shares) at Mar. 31, 2022	63,246,545
Balances at Mar. 31, 2022	$ 6	178,433	(176,655)	233	2,017
Stock-based compensation expense	0	2,184	0	0	2,184
Unrealized gain on available-for-sale securities	0	0	0	(37)	(37)
Foreign currency translation adjustments	0	0	0	(110)	(110)
Net loss	$ 0	0	(4,534)	0	(4,534)
Issuance of common stock upon vesting of restricted stock awards (in shares)	65,363
Issuance of common stock upon vesting of restricted stock awards	$ 0	0	0	0	0
Common stock issuance costs	$ 0	(100)	0	0	(100)
Exercise of stock options (in shares)	110,000
Exercise of stock options	$ 0	17	0	0	17
Balances (in shares) at Jun. 30, 2022	63,421,908
Balances at Jun. 30, 2022	$ 6	180,534	(181,189)	86	(563)
Issuance of common stock (in shares)	40,000
Issuance of common stock	$ 0	128	0	0	128
Stock-based compensation expense	0	2,098	0	0	2,098
Unrealized gain on available-for-sale securities	0	0	0	33	33
Foreign currency translation adjustments	0	0	0	(39)	(39)
Net loss	$ 0	0	(10,976)	0	(10,976)
Issuance of common stock upon vesting of restricted stock awards (in shares)	80,076
Issuance of common stock upon vesting of restricted stock awards	$ 0	0	0	0	0
Balances (in shares) at Sep. 30, 2022	63,541,984
Balances at Sep. 30, 2022	$ 6	182,760	(192,165)	80	(9,319)
Balances (in shares) at Dec. 31, 2022	74,759,591
Balances at Dec. 31, 2022	$ 7	196,246	(193,219)	203	3,237
Issuance of common stock (in shares)	3,227,758
Issuance of common stock	$ 1	4,664	0	0	4,665
Stock-based compensation expense	0	2,223	0	0	2,223
Unrealized gain on available-for-sale securities	0	0	0	14	14
Foreign currency translation adjustments	0	0	0	4	4
Net loss	$ 0	0	(11,770)	0	(11,770)
Balances (in shares) at Mar. 31, 2023	77,987,349
Balances at Mar. 31, 2023	$ 8	203,133	(204,989)	221	(1,627)
Balances (in shares) at Dec. 31, 2022	74,759,591
Balances at Dec. 31, 2022	$ 7	196,246	(193,219)	203	3,237
Foreign currency translation adjustments					(130)
Net loss					(39,331)
Reclassification of common stock warrant liability to permanent equity					0
Balances (in shares) at Sep. 30, 2023	128,411,981
Balances at Sep. 30, 2023	$ 13	253,854	(232,550)	89	21,406
Balances (in shares) at Mar. 31, 2023	77,987,349
Balances at Mar. 31, 2023	$ 8	203,133	(204,989)	221	(1,627)
Issuance of common stock (in shares)	50,402,893
Issuance of common stock	$ 5	40,924	0	0	40,929
Stock-based compensation expense	0	2,451	0	0	2,451
Unrealized gain on available-for-sale securities	0	0	0	6	6
Foreign currency translation adjustments	0	0	0	(53)	(53)
Net loss	0	0	(25,143)	0	(25,143)
Issuance of equity-classified warrants	$ 0	4,970	0	0	4,970
Issuance of common stock upon vesting of restricted stock awards (in shares)	10,870
Issuance of common stock upon vesting of restricted stock awards	$ 0	0	0	0	0
Balances (in shares) at Jun. 30, 2023	128,401,112
Balances at Jun. 30, 2023	$ 13	251,478	(230,132)	174	21,533
Stock-based compensation expense	0	2,396	0	0	2,396
Unrealized gain on available-for-sale securities	0	0	0	(4)	(4)
Foreign currency translation adjustments	0	0	0	(81)	(81)
Net loss	$ 0	0	(2,418)	0	(2,418)
Issuance of common stock upon vesting of restricted stock awards (in shares)	10,869
Issuance of common stock upon vesting of restricted stock awards	$ 0	0	0	0	0
Common stock issuance costs	$ 0	(20)	0	0	(20)
Balances (in shares) at Sep. 30, 2023	128,411,981
Balances at Sep. 30, 2023	$ 13	$ 253,854	$ (232,550)	$ 89	$ 21,406

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	3 Months Ended				9 Months Ended		12 Months Ended
	Sep. 30, 2023	Mar. 31, 2023	Sep. 30, 2022	Mar. 31, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Cash flows from operating activities:
Net loss	$ (2,418)	$ (11,770)	$ (10,976)	$ (13,354)	$ (39,331)	$ (28,864)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation	439		233		1,283	715
Non-cash lease expense					315	285
Commitment share expense	(0)		(0)		402	(0)
Issuance costs for common stock warrant liability	(0)		(0)		333	(0)
Loss on initial issuance of equity	0		0		14,840	0
Change in fair value of common stock warrant liabilities	(6,341)		(149)		(5,958)	(151)
Change in fair value of Clene Nanomedicine contingent earn-out liability	(1,004)		1,591		(2,114)	(6,662)
Change in fair value of Initial Stockholders contingent earn-out liability	(129)		205		(272)	(849)
Stock-based compensation expense					7,070	6,484
Gain on termination of lease					0	(420)
Loss on sale of marketable securities					0	2
Accretion of debt discount					819	661
Non-cash interest expense					273	83
Changes in operating assets and liabilities:
Accounts receivable					125	(77)
Inventory					(61)	3
Prepaid expenses and other current assets					1,483	(884)
Accounts payable					(1,125)	213
Accrued liabilities					(669)	(1,474)
Operating lease obligations					(412)	(360)
Net cash used in operating activities					(22,999)	(31,295)
Cash flows from investing activities:
Purchases of marketable securities					0	(24,582)
Proceeds from maturities of marketable securities	0		5,500		5,000	8,000
Proceeds from sales of marketable securities	0		4,597		0	7,614
Purchases of property and equipment					(287)	(3,478)
Net cash provided by (used in) investing activities					4,713	(12,446)
Cash flows from financing activities:
Proceeds from exercise of stock options					0	284
Proceeds from at-the-market offering					0	132
Payments of at-the-market offering commissions					0	(4)
Proceeds from issuance of common stock and warrants, net of offering costs					42,094	0
Payments of finance lease obligations					(63)	(101)
Proceeds from the issuance of notes payable					350	694
Payments of notes payable issuance costs					0	(30)
Payments of notes payable modification fees					(200)	0
Payment of deferred offering costs					0	(100)
Net cash provided by financing activities					42,181	875
Effect of foreign exchange rate changes on cash and restricted cash					(114)	(155)
Net increase (decrease) in cash, cash equivalents and restricted cash					23,781	(43,021)
Cash, cash equivalents and restricted cash – beginning of period		$ 18,390		50,346	18,390	50,346	$ 50,346
Cash, cash equivalents and restricted cash – end of period	42,171		7,325		42,171	7,325	$ 18,390
Reconciliation of cash, cash equivalents and restricted cash to the consolidated balance sheets
Cash and cash equivalents	42,113		7,267		42,113	7,267
Restricted cash	58		58		58	58
Cash, cash equivalents and restricted cash	$ 42,171		$ 7,325		42,171	7,325
Supplemental disclosure of non-cash investing and financing activities:
Common stock warrant liability recorded upon debt modification					692	0
Common stock warrant liability recorded upon public stock offering					7,126	0
Lease liability arising from obtaining right-of-use assets, leasehold improvements, and lease incentives					0	2,343
Lease incentive realized					0	500
Lease liability settled through termination of lease					0	602
Reclassification of common stock warrant liability to permanent equity				$ 305	0	305
Purchases of property and equipment in accounts payable					0	1,318
Supplemental cash flow information:
Cash paid for interest expense					$ 2,266	$ 1,646

Note 1 - Nature of the Business

9 Months Ended

Sep. 30, 2023

Notes to Financial Statements

Business Description and Basis of Presentation [Text Block]

Note 1. Nature of the Business

Going Concern

Note 2 - Summary of Significant Accounting Policies

9 Months Ended

Sep. 30, 2023

Notes to Financial Statements

Significant Accounting Policies [Text Block]

Note 2. Summary of Significant Accounting Policies

Basis of Presentation

Use of Estimates

Risks and Uncertainties

Concentrations of Credit Risk

Cash and Cash Equivalents

We consider all short-term investments with original maturities of 90 days or less when purchased to be cash equivalents.

Restricted Cash

Marketable Securities

Inventory

Property and Equipment

Debt

Convertible Debt

Leases

Contingent Earn-Out Liabilities

Common Stock Warrants

Grant Funding

Foreign Currency Translation and Transactions

Comprehensive Loss

Segment Information

Income Taxes

Stock-Based Compensation

Note 3 - Cash, Cash Equivalents, and Marketable Securities

9 Months Ended

Sep. 30, 2023

Notes to Financial Statements

Cash, Cash Equivalents, and Marketable Securities [Text Block]

Note 3. Cash, Cash Equivalents, and Marketable Securities

Available-for-Sale Securities

	*September 30, 2023*
(in thousands)	*Amortized Cost*		*Gross Unrealized Gains*		*Gross Unrealized Losses*		*Fair Value*
U.S. Treasury securities	$	24,163	$	1	$	—	$	24,164
Money market funds		14,058		—		—		14,058
Total	$	38,221	$	1	$	—	$	38,222

Available-for-sale securities as of December 31, 2022, which had contractual maturities within one year, were as follows:

	December 31, 2022
(in thousands)	Amortized Cost		Gross Unrealized Gains		Gross Unrealized Losses			Fair Value
Commercial paper	$	3,496	$	—	$	(14	)	$	3,482
Corporate debt securities		1,501		—		—			1,501
Total	$	4,997	$	—	$	(14	)	$	4,983

Proceeds from the sale and maturity of marketable securities held as available-for-sale were as follows:

	*Three Months Ended September 30,*				*Nine Months Ended September 30,*
(in thousands)	*2023*		*2022*		*2023*		*2022*
Proceeds from maturities of marketable securities	$	—	$	5,500	$	5,000	$	8,000
Proceeds from sales of marketable securities		—		4,597		—		7,614
Total	$	—	$	10,097	$	5,000	$	15,614

Note 4 - Prepaid Expenses and Other Current Assets

9 Months Ended

Sep. 30, 2023

Notes to Financial Statements

Prepaid Expenses and Other Current Assets [Text Block]

Note 4. Prepaid Expenses and Other Current Assets

Prepaid expenses and other current assets as of September 30, 2023 and December 31, 2022 were as follows:

	*September 30,*		*December 31,*
(in thousands)	*2023*		*2022*
Research and development tax credits receivable	$	1,084	$	2,777
Metals to be used in research and development		2,052		2,290
Other		1,029		581
Total prepaid expenses and other current assets	$	4,165	$	5,648

Note 5 - Property and Equipment, Net

9 Months Ended

Sep. 30, 2023

Notes to Financial Statements

Property, Plant and Equipment Disclosure [Text Block]

Note 5. Property and Equipment, Net

Property and equipment, net, as of September 30, 2023 and December 31, 2022 were as follows:

	*September 30,*			*December 31,*
(in thousands)	*2023*			*2022*
Lab equipment	$	4,135		$	3,934
Office equipment		178			177
Computer software		459			459
Leasehold improvements		9,983			5,677
Construction in progress		1,406			5,664
		16,161			15,911
Less accumulated depreciation		(6,519	)		(5,273	)
Total property and equipment, net	$	9,642		$	10,638

Depreciation expense recorded in research and development expense and general and administrative expense for the three and nine months ended September 30, 2023 and 2022 was as follows:

	*Three Months Ended September 30,*				*Nine Months Ended September 30,*
(in thousands)	*2023*		*2022*		*2023*		*2022*
General and administrative	$	66	$	67	$	200	$	163
Research and development		373		166		1,083		552
Total depreciation expense	$	439	$	233	$	1,283	$	715

Note 6 - Accrued Liabilities

9 Months Ended

Sep. 30, 2023

Notes to Financial Statements

Accounts Payable, Accrued Liabilities, and Other Liabilities Disclosure, Current [Text Block]

Note 6. Accrued Liabilities

Accrued liabilities as of September 30, 2023 and December 31, 2022 were as follows:

	*September 30,*		*December 31,*
(in thousands)	*2023*		*2022*
Accrued compensation and benefits	$	1,507	$	2,007
Accrued CRO and clinical fees		1,154		1,297
Other		533		559
Total accrued liabilities	$	3,194	$	3,863

Note 7 - Leases

9 Months Ended

Sep. 30, 2023

Notes to Financial Statements

Lessee, Operating and Finance Leases [Text Block]

Note 7. Leases

Operating Leases

Finance Leases

Assets recorded under finance lease obligations and included in property and equipment as of September 30, 2023 and December 31, 2022 were as follows:

	*September 30,*			*December 31,*
(in thousands)	*2023*			*2022*
Lab equipment	$	408		$	408
Work in process		228			228
Total		636			636
Less accumulated depreciation		(383	)		(326	)
Net	$	253		$	310

Maturity Analysis of Lease Obligations

The maturity analysis of our finance and operating lease obligations as of September 30, 2023 was as follows:

(in thousands)	*Finance Leases*			*Operating Leases*
2023 (remainder)	$	19		$	194
2024		27			1,178
2025		—			1,208
2026		—			1,236
2027		—			1,132
2028		—			1,093
Thereafter		—			1,694
Total minimum lease payments		46			7,735
Less amount representing interest/discounting		(2	)		(2,102	)
Present value of minimum lease payments		44			5,633
Less lease obligations, current portion		(44	)		(553	)
Lease obligations, net of current portion	$	—		$	5,080

Components of Lease Cost

The components of finance and operating lease costs for the three and nine months ended September 30, 2023 and 2022 were as follows:

	*Three Months Ended September 30,*				*Nine Months Ended September 30,*
(in thousands)	*2023*		*2022*		*2023*		*2022*
Finance lease costs:
Amortization	$	16	$	20	$	57	$	61
Interest on lease liabilities		1		6		10		12
Operating lease costs		254		256		758		695
Short-term lease costs		1		—		3		—
Variable lease costs		70		65		192		238
Total lease costs	$	342	$	347	$	1,020	$	1,006

Supplemental Cash Flow Information

	*Nine Months Ended September 30,*
(in thousands)	*2023*			*2022*
Operating cash flows from operating leases	$	(953	)	$	(933	)
Operating cash flows from finance leases	$	(10	)	$	(12	)
Financing cash flows from finance leases	$	(63	)	$	(101	)

Note 8 - Notes Payable and Convertible Notes Payable

9 Months Ended

Sep. 30, 2023

Notes to Financial Statements

Debt Disclosure [Text Block]

Note 8. Notes Payable and Convertible Notes Payable

Our notes payable and convertible notes payable as of September 30, 2023 and December 31, 2022 was as follows:

	*Stated*			*September 30,*			*December 31,*
(in thousands, except interest rates)	*Interest Rate*			*2023*			*2022*
Notes payable
Advance Cecil, Inc. (commenced April 2019)		8.00	%	$	136		$	130
Maryland DHCD (commenced February 2019)		8.00	%		684			654
Maryland DHCD (commenced May 2022)		6.00	%		1,083			704
Avenue Venture Opportunities Fund, L.P. (commenced May 2021)		15.10	%		15,000			15,000
					16,903			16,488
Less unamortized discount and debt issuance costs					(640	)		(587	)
Less notes payable, current portion, net of unamortized discount and debt issuance costs					(9,588	)		(6,418	)
Total notes payable, net of current portion				$	6,675		$	9,483

Convertible notes payable
Avenue Venture Opportunities Fund, L.P. (commenced May 2021)		15.10	%	$	5,000		$	5,000
Maryland DHCD (commenced December 2022)		6.00	%		5,233			5,007
					10,233			10,007
Less unamortized discount and debt issuance costs					(258	)		(237	)
Total convertible notes payable				$	9,975		$	9,770

Maryland Loans

Avenue Loan

Debt Maturities

Future debt payments, net of unamortized discounts and debt issuance costs, and without giving effect to any potential future exercise of conversion features, are as follows:

(in thousands)	*2019 MD Loan*		*2019 Cecil Loan*		*2021 Avenue Loan*			*2022 MD Loan*			*2022 DHCD Loan*
2023 (remainder)	$	—	$	—	$	—		$	—		$	—
2024		—		—		20,000			—			—
2025		—		—		—			347			—
2026		—		—		—			369			—
2027		—		—		—			317			—
2028		—		—		—			—			5,000
Thereafter		500		100		—			—			—
Total debt principal payments		500		100		20,000			1,033			5,000
Accrued and unpaid interest		184		36		—			50			233
Less unamortized discount and debt issuance costs		—		—		(824	)		(23	)		(51	)
Future debt payments, net	$	684	$	136	$	19,176		$	1,060		$	5,182

Note 9 - Commitments and Contingencies

9 Months Ended

Sep. 30, 2023

Notes to Financial Statements

Commitments and Contingencies Disclosure [Text Block]

Note 9. Commitments and Contingencies

Commitments

Contingencies

Note 10 - Income Taxes

9 Months Ended

Sep. 30, 2023

Notes to Financial Statements

Income Tax Disclosure [Text Block]

Note 10. Income Taxes

The components of loss before income taxes for the three and nine months ended September 30, 2023 and 2022 were as follows:

	*Three Months Ended September 30,*						*Nine Months Ended September 30,*
(in thousands)	*2023*			*2022*			*2023*			*2022*
United States	$	(2,206	)	$	(9,432	)	$	(38,608	)	$	(25,787	)
Foreign		(212	)		(1,544	)		(723	)		(3,077	)
Net loss before income taxes	$	(2,418	)	$	(10,976	)	$	(39,331	)	$	(28,864	)

Note 11 - Benefit Plans

9 Months Ended

Sep. 30, 2023

Notes to Financial Statements

Share-Based Payment Arrangement [Text Block]

Note 11. Benefit Plans

401(k) Plan

Stock Compensation Plans

Stock-Based Compensation Expense

	*Three Months Ended September 30,*				*Nine Months Ended September 30,*
(in thousands)	*2023*		*2022*		*2023*		*2022*
General and administrative	$	1,311	$	1,247	$	3,888	$	4,056
Research and development		1,085		851		3,182		2,428
Total stock-based compensation expense	$	2,396	$	2,098	$	7,070	$	6,484

Stock-based compensation expense by award type for the three and nine months ended September 30, 2023 and 2022 was as follows:

	*Three Months Ended September 30,*				*Nine Months Ended September 30,*
(in thousands)	*2023*		*2022*		*2023*		*2022*
Stock options	$	2,384	$	2,098	$	7,044	$	6,484
Stock awards		12		—		26		—
Total stock-based compensation expense	$	2,396	$	2,098	$	7,070	$	6,484

Stock Options

Outstanding stock options and related activity for the nine months ended September 30, 2023 was as follows:

(in thousands, except share, per share, and term data)	*Number of Options*			*Weighted Average Exercise Price Per Share*		*Weighted Average Remaining Term (Years)*		*Intrinsic Value*
Outstanding – December 31, 2022		15,260,297		$	2.98		7.28	$	2,348
Granted		6,690,263			0.95		9.70		—
Forfeited		(433,262	)		4.51		—		—
Outstanding – September 30, 2023		21,517,298		$	2.30		7.49	$	712
Vested and exercisable – September 30, 2023		10,074,211		$	2.69		5.60	$	712
Vested, exercisable or expected to vest – September 30, 2023		21,517,298		$	2.30		7.49	$	712

	*Nine Months Ended September 30,*
	*2023*			*2022*
Expected stock price volatility		96.22% – 103.24%			89.57% – 98.13%
Risk-free interest rate		3.26% – 4.41%			1.65% – 3.00%
Expected dividend yield		0.00	%		0.00	%
Expected term of options (in years)		5.00 – 6.43			5.00 – 6.98

Stock Awards

	*Number of Stock Awards*			*Weighted Average Grant Date Fair Value*
Unvested balance – December 31, 2022		769,139		$	9.84
Granted		43,479			1.15
Converted to shares of Common Stock upon vesting		(21,739	)		1.15
Forfeited		(746	)		9.84
Unvested balance – September 30, 2023		790,133		$	9.60

Note 12 - Fair Value

9 Months Ended

Sep. 30, 2023

Notes to Financial Statements

Fair Value Disclosures [Text Block]

Note 12. Fair Value

Financial Instruments with Fair Value Measurements on a Recurring Basis

The fair value hierarchy for financial instruments measured at fair value on a recurring basis as of September 30, 2023 is as follows:

	*September 30, 2023*
(in thousands)	*Level 1*		*Level 2*		*Level 3*		*Total*
Cash equivalents:
Money market funds	$	14,058	$	—	$	—	$	14,058
U.S. Treasury securities		—		24,164		—		24,164
Common stock warrant liabilities		—		—		1,860		1,860
Clene Nanomedicine contingent earn-out liability		—		—		150		150
Initial Stockholders contingent earn-out liability		—		—		19		19

The fair value hierarchy for financial instruments measured at fair value on a recurring basis as of December 31, 2022 is as follows:

	*December 31, 2022*
(in thousands)	*Level 1*		*Level 2*		*Level 3*		*Total*
Cash equivalents:
Money market funds	$	14,317	$	—	$	—	$	14,317
Marketable securities:
Commercial paper		—		3,482		—		3,482
Corporate debt securities		—		1,501		—		1,501
Clene Nanomedicine contingent earn-out liability		—		—		2,264		2,264
Initial Stockholders contingent earn-out liability		—		—		291		291

There were no transfers between Level 1, Level 2, or Level 3 during any of the periods above.

Changes in the fair value of our Level 3 financial instruments for the nine months ended September 30, 2023 were as follows:

(in thousands)	*Common Stock Warrant Liabilities*			*Clene Nanomedicine Contingent Earn-out*			*Initial Stockholders Contingent Earn-out*
Balance – December 31, 2022	$	—		$	2,264		$	291
Initial fair value of instruments		7,818			—			—
Change in fair value		(5,958	)		(2,114	)		(272	)
Balance – September 30, 2023	$	1,860		$	150		$	19

Changes in the fair value of our Level 3 financial instruments for the nine months ended September 30, 2022 were as follows:

(in thousands)	*Common Stock Warrant Liability*			*Clene Nanomedicine Contingent Earn-out*			*Initial Stockholders Contingent Earn-out*
Balance – December 31, 2021	$	474		$	18,100		$	2,317
Change in fair value		(151	)		(6,662	)		(849	)
Reclassification from liability to equity		(305	)		—			—
Balance – September 30, 2022	$	18		$	11,438		$	1,468

Valuation of Notes Payable and Convertible Notes Payable

Valuation of the Common Stock Warrant Liabilities

	*September 30,*
	*2023*
Expected stock price volatility		70.00% – 110.00%
Risk-free interest rate		4.63% – 5.52%
Expected dividend yield		0.00	%
Expected term (in years)		0.58 – 4.75
Probability of change of control		5.00	%
Probability of dissolution		60.00	%
Probability of other outcome		35.00	%

	*September 30,*
	*2023*
Expected stock price volatility		75.00% – 110.00%
Risk-free interest rate		4.87% – 5.50%
Expected dividend yield		0.00	%
Expected term (in years)		0.75 – 2.71
Probability of NDA acceptance		30.00	%
Probability of fundamental transaction		5.00	%
Probability of dissolution		60.00	%
Probability of other outcome		5.00	%

	*June 16,*
	*2023*
Expected stock price volatility		100.00% – 110.00%
Risk-free interest rate		3.88% – 4.97%
Expected dividend yield		0.00	%
Expected term (in years)		1.46 – 7.00
Probability of NDA approval		22.50	%
Probability of fundamental transaction		5.00	%
Probability of dissolution		71.50	%
Probability of other outcome		1.00	%

Valuation of the Contingent Earn-Out Liabilities

	*September 30,*			*December 31,*
	*2023*			*2022*
Expected stock price volatility		100.00	%		115.00	%
Risk-free interest rate		5.00	%		4.20	%
Expected dividend yield		0.00	%		0.00	%
Expected term (in years)		2.25			3.00

Note 13 - Capital Stock

9 Months Ended

Sep. 30, 2023

Notes to Financial Statements

Equity [Text Block]

Note 13. Capital Stock

Common Stock Warrants

As of September 30, 2023 and December 31, 2022, outstanding warrants to purchase shares of Common Stock were as follows:

						*Number of Shares Issuable*
						*September 30,*		*December 31,*
Date Exercisable	*Exercise Price*		*Expiration*		*Classification*	*2023*		*2022*
December 2020	$	11.50	December 2025	⁽¹⁾	Equity		2,407,500		2,407,500
December 2020	$	11.50	December 2025	⁽²⁾	Equity		24,583		24,583
December 2020	$	1.97	April 2023	⁽³⁾	Equity		—		1,929,111
May 2021	$	8.63	May 2026	⁽⁴⁾	Equity		—		115,851
June 2023	$	0.80	June 2028	⁽⁵⁾	Liability		3,000,000		—
June 2023	$	1.10	June 2026	⁽⁶⁾	Liability		50,000,000		—
June 2023	$	1.50	June 2030	⁽⁷⁾	Equity		50,000,000		—
Total							105,432,083		4,477,045

(1)

(2)

(3)	Represents 1,929,111 shares of Common Stock underlying warrants to purchase one share of Common Stock, issued by Clene Nanomedicine as Series A preferred stock warrants and senior equity warrants in August 2013. As of April 2023, the warrants expired.

(4)	Represents 115,851 shares of Common Stock underlying the Original Avenue Warrant. As of June 2023, the warrant had not been exercised and was cancelled pursuant to an amendment to the 2021 Avenue Loan (see Note 8).

(5)	Represents 3,000,000 shares of Common Stock underlying the New Avenue Warrant, issued pursuant to an amendment to the 2021 Avenue Loan (see Note 8). As of September 30, 2023, the warrant had not been exercised.

(6)	Represents 50,000,000 shares of Common Stock underlying Tranche A Warrants to purchase one share of Common Stock, issued in our June 2023 public equity offering. As of September 30, 2023, no warrants had been exercised.

(7)	Represents 50,000,000 shares of Common Stock underlying Tranche B Warrants to purchase one share of Common Stock, issued in our June 2023 public equity offering. As of September 30, 2023, no warrants had been exercised.

Public Offerings

Common Stock Sales Agreement

Common Stock Purchase Agreement

Note 14 - Net Loss Per Share

9 Months Ended

Sep. 30, 2023

Notes to Financial Statements

Earnings Per Share [Text Block]

Note 14. Net Loss Per Share

The computation of basic and diluted net loss per share attributable to common stockholders for the three and nine months ended September 30, 2023 and 2022 was as follows:

	*Three Months Ended September 30,*						*Nine Months Ended September 30,*
(in thousands, except share and per share data)	*2023*			*2022*			*2023*			*2022*
Numerator:
Net loss attributable to common stockholders	$	(2,418	)	$	(10,976	)	$	(39,331	)	$	(28,864	)
Denominator:
Weighted average common shares outstanding		128,405,483			63,508,928			97,026,964			63,234,757
Net loss per share attributable to common stockholders – basic and diluted	$	(0.02	)	$	(0.17	)	$	(0.41	)	$	(0.46	)

	*Three Months Ended September 30,*				*Nine Months Ended September 30,*
	*2023*		*2022*		*2023*		*2022*
Convertible notes payable (see Note 8)		1,732,703		482,703		1,732,703		482,703
Common stock warrants (see Note 13)		105,432,083		4,477,045		105,432,083		4,477,045
Options to purchase common stock (see Note 11)		21,517,298		12,173,570		21,517,298		12,173,570
Unvested restricted stock awards (see Note 11)		790,133		769,139		790,133		769,139
Contingent earn-out shares (see Note 2)		6,592,334		6,592,334		6,592,334		6,592,334
Total		136,064,551		24,494,791		136,064,551		24,494,791

Note 15 - Related Party Transactions

9 Months Ended

Sep. 30, 2023

Notes to Financial Statements

Note 15. Related Party Transactions

License and Supply Agreements

Total revenue under the 4Life Agreement for the three and nine months ended September 30, 2023 and 2022 was as follows:

	*Three Months Ended September 30,*				*Nine Months Ended September 30,*
(in thousands)	*2023*		*2022*		*2023*		*2022*
Product revenue from related parties	$	64	$	127	$	320	$	127
Royalty revenue from related parties		43		44		129		100
Total revenue from related parties	$	107	$	171	$	449	$	227

Note 16 - Segment Information

9 Months Ended

Sep. 30, 2023

Notes to Financial Statements

Segment Reporting Disclosure [Text Block]

Note 16. Segment Information

	*Three Months Ended September 30,*						*Nine Months Ended September 30,*
(in thousands)	*2023*			*2022*			*2023*			*2022*
Drugs:
Revenue from external customers	$	—		$	—		$	—		$	—
Loss from operations		(9,622	)		(10,073	)		(30,945	)		(37,012	)
Supplements:
Revenue from external customers	$	108		$	174		$	484		$	239
Income from operations		80			268			335			276
Consolidated:
Revenue from external customers	$	108		$	174		$	484		$	239
Loss from operations		(9,542	)		(9,805	)		(30,610	)		(36,736	)

	*Three Months Ended September 30,*						*Nine Months Ended September 30,*
(in thousands)	*2023*			*2022*			*2023*			*2022*
Segment loss from operations	$	(9,542	)	$	(9,805	)	$	(30,610	)	$	(36,736	)
Total other income (expense), net		7,124			(1,171	)		(8,721	)		7,872
Net loss before income taxes	$	(2,418	)	$	(10,976	)	$	(39,331	)	$	(28,864	)

	*September 30,*		*December 31,*
(in thousands)	*2023*		*2022*
Total assets:
Drugs	$	17,787	$	20,476
Supplements		268		386
Corporate		42,378		23,631
Consolidated	$	60,433	$	44,493

Significant Accounting Policies (Policies)	9 Months Ended
Significant Accounting Policies (Policies)	Sep. 30, 2023
Accounting Policies [Abstract]
Basis of Accounting, Policy [Policy Text Block]	*Basis of Presentation* The accompanying condensed consolidated financial statements include the accounts of Clene Inc. and our wholly-owned subsidiaries, Clene Nanomedicine, Inc., a subsidiary incorporated in Delaware, Clene Australia Pty Ltd (“Clene Australia”), a subsidiary incorporated in Australia, Clene Netherlands B.V. (“Clene Netherlands”), a subsidiary incorporated in the Netherlands, and dOrbital, Inc., a subsidiary incorporated in Delaware, after elimination of all intercompany accounts and transactions. We have prepared the accompanying condensed consolidated financial statements in accordance with United States (“U.S.”) Generally Accepted Accounting Principles (“GAAP”) for interim financial reporting and as required by Regulation S-X, Rule 10-01. The condensed consolidated financial statements have been prepared on the same basis as our audited annual consolidated financial statements and, in the opinion of management, reflect all adjustments, which are normal and recurring in nature, necessary for fair financial statement presentation. The financial data and other information disclosed in the condensed consolidated financial statements and related notes for the three and nine months ended September 30, 2023 and 2022 are unaudited. Results of operations for the three and nine months ended September 30, 2023 and 2022 are not necessarily indicative of the results for the entire fiscal year or any other period. The condensed consolidated financial statements for the three and nine months ended September 30, 2023 and 2022 should be read in conjunction with the audited consolidated financial statements included in our Annual Report on Form 10-K.
Use of Estimates, Policy [Policy Text Block]	*Use of Estimates* The preparation of condensed consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets, liabilities, and disclosure of contingent assets and liabilities, and the reported amounts of expenses. We base our estimates on historical experience and various other assumptions that we believe to be reasonable. Actual results may differ from those estimates or assumptions. Estimates are periodically reviewed in light of changes in circumstances, facts, and experience, and any changes in estimates will be recorded in future periods as they develop.
Risk and Uncertainties [Policy Text Block]	*Risks and Uncertainties* We are subject to certain risks and uncertainties and believe that changes in any of the following areas could have a material adverse effect on future financial condition, results of operations, or cash flows: ability to obtain additional financing; regulatory approval and market acceptance of, and reimbursement for, product candidates; performance of third-party contract research organizations (“CROs”) and manufacturers upon which we rely; protection of our intellectual property; litigation or claims against us based on intellectual property, patent, product, regulatory, or other factors; and our ability to attract and retain employees necessary to support our growth. The product candidates we develop require approvals from regulatory agencies prior to commercial sales. There can be no assurance that our current and future product candidates will receive the necessary approvals or be commercially successful. If we are denied approval or approval is delayed, it will have a material adverse impact on our business and our condensed consolidated financial statements. The extent of the impact of the COVID-19 pandemic, including the resurgence of cases relating to the spread of new variants, on our business and operations is highly uncertain. While the COVID-19 pandemic has led to various research restrictions and led to pauses and early conclusion of one of our clinical trials, these impacts have been temporary and to date we have not experienced material business disruptions or incurred impairment losses in the carrying values of our assets as a result of the COVID-19 pandemic. We are not aware of any specific related event or circumstance that would require us to revise the estimates reflected in our condensed consolidated financial statements. The extent to which the COVID-19 pandemic will directly or indirectly impact our business, financial condition, results of operations, and cash flows, including planned future clinical trials and research and development costs, will depend on future developments that are highly uncertain, including as a result of new information that may emerge concerning COVID-19, the actions taken to contain or treat it, and the duration and intensity of the related effects.
Concentration Risk, Credit Risk, Policy [Policy Text Block]	*Concentrations of Credit Risk* Financial instruments which potentially subject us to significant concentrations of credit risk consist primarily of cash. Our cash is held in financial institutions and amounts on deposit may at times exceed federally insured limits. We have not experienced any losses on our deposits of cash and do not believe that we are subject to unusual credit risk beyond the normal credit risk associated with commercial banking relationships.
Cash and Cash Equivalents, Unrestricted Cash and Cash Equivalents, Policy [Policy Text Block]	*Cash and Cash Equivalents* We consider all short-term investments with original maturities of 90 days or less when purchased to be cash equivalents.
Cash and Cash Equivalents, Restricted Cash and Cash Equivalents, Policy [Policy Text Block]	*Restricted Cash* We classify cash as restricted when it is unavailable for withdrawal or use in our general operating activities. Restricted cash is classified as current and noncurrent on the condensed consolidated balance sheets based on the nature of the restriction. Our restricted cash balance includes contractually restricted deposits related to our corporate credit card.
Marketable Securities, Policy [Policy Text Block]	*Marketable Securities* Marketable securities are investments with original maturities of more than 90 days when purchased. We do not invest in securities with original maturities of more than one year. Marketable debt securities are considered available-for-sale, and are recorded at fair value, with unrealized gains and losses included as a component of accumulated other comprehensive income until realized. Realized gains and losses are included in other income (expense), net, on the basis of specific identification. The cost of marketable securities is adjusted for amortization of premiums or accretion of discounts to maturity, and such amortization or accretion is included in other income (expense), net.
Inventory, Policy [Policy Text Block]	*Inventory* Inventory is stated at historic cost on a first-in first-out basis. Our inventory consisted of $72,000 in raw materials and $32,000 in finished goods as of September 30, 2023, and $29,000 in raw material and $14,000 in finished goods as of December 31, 2022. Inventory relates to our Supplements segment.
Property, Plant and Equipment, Policy [Policy Text Block]	*Property and Equipment* Property and equipment are stated at cost less accumulated depreciation. Property and equipment consist of laboratory and office equipment, computer software, and leasehold improvements. Depreciation is calculated using the straight-line method over the estimated economic useful lives of the assets, which are 3-5 years for laboratory equipment, 3-7 years for furniture and fixtures, and 2-5 years for computer software. Leasehold improvements are amortized over the lesser of the estimated lease term or the estimated useful life of the assets. Costs for capital assets not yet placed into service are capitalized as construction-in-progress and depreciated or amortized in accordance with the above useful lives once placed into service. Upon retirement or sale, the related cost and accumulated depreciation and amortization are removed from the accounts and any resulting gain or loss is included in the condensed consolidated statements of operations and comprehensive loss. Maintenance and repairs that do not improve or extend the lives of the respective assets are expensed to operations as incurred. We capitalize costs to obtain or develop computer software for internal use, including development costs incurred during the software development stage and costs to obtain software for access and conversion of historical data. We also capitalize costs to modify, upgrade, or enhance existing internal-use software that result in additional functionality. We expense costs incurred during the preliminary project stage, training costs, data conversion costs, and maintenance costs.
Debt, Policy [Policy Text Block]	Debt When debt is issued and a derivative is required to be separated (e.g., bifurcated conversion option) or another separate freestanding financial instrument (e.g., warrant) is issued, costs and fees incurred are allocated to the instruments issued (or bifurcated) in proportion to the allocation of proceeds. When some portions of the costs and fees relate to a bifurcated derivative or freestanding financial instrument that is being subsequently measured at fair value, those allocated costs are expensed immediately. Debt discounts, debt premiums, and debt issuance costs related to debt are recorded as deductions that net against the principal value of the debt and are amortized to interest expense over the contractual term of the debt using the effective interest method.
Convertible Notes [Policy Text Block]	Convertible Debt In accordance with ASU 2020-06, Debt—Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging—Contracts in Entity’s Own Equity (Subtopic 815-40): Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity, when we issue notes with conversion features, we evaluate if the conversion feature is freestanding or embedded. If the conversion feature is embedded, we do not separate the conversion feature from the host contract for convertible notes that are not required to be accounted for as derivatives, or that do not result in substantial premiums accounted for as paid-in-capital. Consequently, we account for a convertible note as a single liability measured at its amortized cost, and we account for a convertible preferred stock as a single equity instrument measured at its historical cost, as long as no other features require separation and recognition as derivatives. If the conversion feature is freestanding, or is embedded and meets the requirements to be separated, we account for the conversion feature as a derivative under ASC 815, Derivatives and Hedging (“ASC 815”). We record the derivative instrument at fair value at inception, and subsequently re-measure to fair value at each reporting period and immediately prior to the extinguishment of the derivative instrument, with any changes recorded in the condensed consolidated statements of operations and comprehensive loss.
Lessee, Leases [Policy Text Block]	Leases At inception of a contract, we determine if a contract meets the definition of a lease. We determine if the contract conveys the right to control the use of an identified asset for a period of time. We assess throughout the period of use whether we have both of the following: (i) the right to obtain substantially all of the economic benefits from use of the identified asset, and (ii) the right to direct the use of the identified asset. This determination is reassessed if the terms of the contract are changed. Leases are classified as operating or finance leases based on the terms of the lease agreement and certain characteristics of the identified asset. Right-of-use assets and lease liabilities are recognized at the lease commencement date based on the present value of the future lease payments less any lease incentives received. At the lease commencement date, the discount rate implicit in the lease is used to discount the lease liability if readily determinable. If not readily determinable or leases do not contain an implicit rate, our incremental borrowing rate is used as the discount rate. Our policy is to not record leases with an original term of twelve months or less within the condensed consolidated balance sheets and we recognize lease expense for these short-term leases on a straight-line basis over the lease term. Certain lease agreements may require us to pay additional amounts for taxes, insurance, maintenance, and other expenses, which are generally referred to as non-lease components. Such variable non-lease components are treated as variable lease payments and recognized in the period in which the obligation for these payments is incurred. Variable lease components and variable non-lease components are not measured as part of the right-of-use asset and liability. Only when lease components and their associated non-lease components are fixed are they accounted for as a single lease component and are recognized as part of a right-of-use asset and liability. Total contract consideration is allocated to the fixed lease and non-lease component. This policy election applies consistently to all asset classes under lease agreements. Leases may contain clauses for renewal at our option. Payments to be made in option periods are recognized as part of the right-of-use lease assets and lease liabilities when it is reasonably certain that the option to extend the lease will be exercised, or is not at our option. We determine whether the reasonably certain threshold is met by considering contract-, asset-, market-, and entity-based factors. Operating lease expense, which is recognized on a straight-line basis over the lease term, and the amortization of finance lease right-of-use assets, which are included in property and equipment and depreciated, are included in research and development or general and administrative expenses consistent with the leased assets’ primary use. Accretion on the liabilities for finance leases is included in interest expense.
Contingent Earnout [Policy Text Block]	*Contingent Earn-Out Liabilities* In connection with the Reverse Recapitalization, certain Clene Nanomedicine stockholders are entitled to receive additional shares of Common Stock (the “Clene Nanomedicine Contingent Earn-out”) as follows: (i) 3,338,483 shares if (a) the volume-weighted average price (“VWAP”) of our Common Stock equals or exceeds $15.00 (the “Milestone 1 Price”) in any twenty trading days within a thirty trading day period within three years of the Reverse Recapitalization or (b) the change of control price equals or exceeds the Milestone 1 Price if a change of control transaction occurs within three years of the closing of the Reverse Recapitalization (the requirements in (a) and (b) collectively, “Milestone 1”); (ii) 2,503,851 shares if (a) the VWAP of our Common Stock equals or exceeds $20.00 (the “Milestone 2 Price”) in any twenty trading days within a thirty trading day period within five years of the closing of the Reverse Recapitalization or (b) the change of control price equals or exceeds the Milestone 2 Price if a change of control transaction occurs within five years of the Reverse Recapitalization (the requirements in (a) and (b) collectively, “Milestone 2”). If Milestone 1 is not achieved but Milestone 2 is achieved, the Clene Nanomedicine stockholders will receive additional shares equal to Milestone 1. Tottenham’s former officers, directors, sponsor, and public stockholders (the “Initial Stockholders”) are entitled to receive earn-out shares (the “Initial Stockholders Contingent Earn-out,” and collectively with the Clene Nanomedicine Contingent Earn-out, the “Contingent Earn-outs”) as follows: (i) 375,000 shares upon the achievement of Milestone 1; and (ii) 375,000 shares upon achievement of Milestone 2. If Milestone 1 is not achieved but Milestone 2 is achieved, the Initial Stockholders will receive additional shares equal to Milestone 1. In accordance with ASC 815, the Contingent Earn-outs are not indexed to our own stock and therefore were accounted for as a liability at the Reverse Recapitalization date and are subsequently remeasured to fair value at each reporting date with changes recorded as a component of other income (expense), net.
Common Stock Warrants [Policy Text Block]	*Common Stock Warrants* We account for common stock warrants as either equity-classified instruments or liability-classified instruments based on an assessment of the warrant terms and applicable authoritative guidance. The assessment considers whether the warrants are freestanding financial instruments pursuant to ASC 480, meet the definition of a liability pursuant to ASC 480, and whether the warrants meet all of the requirements for equity classification under ASC 815, including whether the warrants are indexed to our Common Stock, among other conditions for equity classification. This assessment, which requires the use of professional judgment, is conducted at the time of warrant issuance and, for liability-classified warrants, at each reporting period end date while the warrants are outstanding.
Government Assistance [Policy Text Block]	*Grant Funding* We may submit applications to receive grant funding from governmental and non-governmental entities. We account for grants by analogizing to the grant accounting model under IAS 20, Accounting for Government Grants and Disclosure of Government Assistance (“IAS 20”). We recognize grant funding without conditions or continuing performance obligations, including certain research and development tax credits, as other income in the condensed consolidated statements of operations and comprehensive loss. We accrue certain research and development tax credits receivable in other current assets (see Note 4) in an amount equal to the qualifying expenses incurred in each period multiplied by the applicable reimbursement percentage and we recognize other income in the condensed consolidated statements of operations and comprehensive loss. After submission of our tax returns, we receive a cash refund of certain research and development tax credits and relieve the receivable. We recognize grant funding with conditions or continuing performance obligations as a reduction in research and development expenses in the period during which the related qualifying expenses are incurred and as the conditions or performance obligations are fulfilled. Any amount received in advance of fulfilling such conditions or performance obligations is recorded in accrued liabilities (see Note 6) if the conditions or performance obligations are expected to be met within the next twelve months. We recognized grant funding of $0.2 million and $0.3 million as a reduction of research and development expenses during the three and nine months ended September 30, 2023, respectively. We did not fulfill any grant conditions or performance obligations during the three and nine months ended September 30, 2022.
Foreign Currency Transactions and Translations Policy [Policy Text Block]	*Foreign Currency Translation and Transactions* Our functional currency is the U.S. dollar. Clene Australia determined its functional currency to be the Australian dollar and Clene Netherlands determined its functional currency to be the Euro. We use the U.S. dollar as our reporting currency for the condensed consolidated financial statements. The results of our non-U.S. dollar based functional currency operations are translated to U.S. dollars at the average exchange rates during the period. Our assets and liabilities are translated using the current exchange rate as of the balance sheet date and stockholders’ equity is translated using historical rates. Adjustments resulting from the translation of the condensed consolidated financial statements of our foreign functional currency subsidiaries into U.S. dollars are excluded from the determination of net loss and are accumulated in a separate component of stockholders’ equity. We also incur foreign exchange transaction gains and losses for purchases denominated in foreign currencies. Foreign exchange transaction gains and losses are included in other income (expense), net, as incurred.
Comprehensive Income, Policy [Policy Text Block]	*Comprehensive Loss* Comprehensive loss includes net loss as well as other changes in stockholders’ equity that result from transactions and economic events other than those with stockholders. The only elements of other comprehensive loss in any periods presented were translation of foreign currency denominated balances of Clene Australia and Clene Netherlands to U.S. dollars for consolidation and unrealized gain (loss) on available-for-sale securities.
Segment Reporting, Policy [Policy Text Block]	*Segment Information* We have determined that our chief executive officer is the chief operating decision maker (“CODM”). Operating segments are identified as components of an enterprise about which separate discrete financial information is available for evaluation by the CODM in making decisions regarding resource allocation and assessing performance. We view our operations and manage our business in two operating segments, which are our reportable segments: (1) the development and commercialization of novel clean-surfaced nanotechnology therapeutics (“Drugs”), and (2) the development and commercialization of dietary supplements (“Supplements”).
Income Tax, Policy [Policy Text Block]	*Income Taxes* We account for income taxes using the asset and liability method, which requires the recognition of deferred tax assets and liabilities for the expected future tax consequences of events that have been recognized in the condensed consolidated financial statements or in our tax returns. Deferred tax assets and liabilities are determined based on the differences between the financial statement basis and tax basis of assets and liabilities using enacted tax rates in effect for the year in which the differences are expected to reverse. Changes in deferred tax assets and liabilities are recorded in the provision for income taxes. We assess the likelihood that our deferred tax assets will be recovered from future taxable income and, to the extent we believe, based upon the weight of available evidence, that it is more likely than not that all or a portion of the deferred tax assets will not be realized, a valuation allowance is established through a charge to income tax expense. Potential for recovery of deferred tax assets is evaluated by estimating the future taxable profits expected and considering prudent and feasible tax planning strategies. We account for uncertainty in income taxes recognized in the condensed consolidated financial statements by applying a two-step process to determine the amount of tax benefit to be recognized. First, the tax position must be evaluated to determine the likelihood that it will be sustained upon external examination by the taxing authorities. If the tax position is deemed more-likely-than-not to be sustained, the tax position is then assessed to determine the amount of benefit to recognize in the condensed consolidated financial statements. The amount of the benefit that may be recognized is the largest amount that has a greater than 50% likelihood of being realized upon ultimate settlement. The provision for income taxes includes the effects of any resulting tax reserves, or unrecognized tax benefits, which are considered appropriate as well as the related net interest and penalties.
Share-Based Payment Arrangement [Policy Text Block]	*Stock-Based Compensation* We account for stock-based compensation arrangements using a fair value-based method for costs related to all share-based payments including stock options and stock awards. Stock-based compensation expense is recorded in research and development and general and administrative expenses based on the classification of the work performed by the grantees. The fair value is recognized over the period during which a grantee is required to provide services in exchange for the option award and service-based stock awards, known as the requisite service period (usually the vesting period), on a straight-line basis. For stock awards with market conditions, the fair value is recognized over the period based on the expected milestone achievement dates as the derived service period (usually the vesting period), on a straight-line basis. For stock awards with performance conditions, the grant-date fair value of these awards is the market price on the applicable grant date, and compensation expense will be recognized when the conditions become probable of being satisfied. We recognize a cumulative true-up adjustment once the conditions become probable of being satisfied as the related service period had been completed in a prior period. We elect to account for forfeitures as they occur, rather than estimating expected forfeitures. We determine the fair value of each share of Common Stock underlying stock-based awards using a Black-Scholes option pricing model based on the closing price of our Common Stock as reported by Nasdaq on the date of grant. The fair value of stock awards with market conditions are determined using a Monte Carlo valuation model.

Note 3 - Cash, Cash Equivalents, and Marketable Securities (Tables)

9 Months Ended

Sep. 30, 2023

Notes Tables

Schedule of Cash and Cash Equivalents [Table Text Block]

	*September 30, 2023*
(in thousands)	*Amortized Cost*		*Gross Unrealized Gains*		*Gross Unrealized Losses*		*Fair Value*
U.S. Treasury securities	$	24,163	$	1	$	—	$	24,164
Money market funds		14,058		—		—		14,058
Total	$	38,221	$	1	$	—	$	38,222

Marketable Securities [Table Text Block]

	December 31, 2022
(in thousands)	Amortized Cost		Gross Unrealized Gains		Gross Unrealized Losses			Fair Value
Commercial paper	$	3,496	$	—	$	(14	)	$	3,482
Corporate debt securities		1,501		—		—			1,501
Total	$	4,997	$	—	$	(14	)	$	4,983

Summary of Proceeds from Sale and Maturity of Available for Sale Securities [Table Text Block]

	*Three Months Ended September 30,*				*Nine Months Ended September 30,*
(in thousands)	*2023*		*2022*		*2023*		*2022*
Proceeds from maturities of marketable securities	$	—	$	5,500	$	5,000	$	8,000
Proceeds from sales of marketable securities		—		4,597		—		7,614
Total	$	—	$	10,097	$	5,000	$	15,614

Note 4 - Prepaid Expenses and Other Current Assets (Tables)

9 Months Ended

Sep. 30, 2023

Notes Tables

Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Table Text Block]

	*September 30,*		*December 31,*
(in thousands)	*2023*		*2022*
Research and development tax credits receivable	$	1,084	$	2,777
Metals to be used in research and development		2,052		2,290
Other		1,029		581
Total prepaid expenses and other current assets	$	4,165	$	5,648

Note 5 - Property and Equipment, Net (Tables)

9 Months Ended

Sep. 30, 2023

Notes Tables

Property, Plant and Equipment [Table Text Block]

	*September 30,*			*December 31,*
(in thousands)	*2023*			*2022*
Lab equipment	$	4,135		$	3,934
Office equipment		178			177
Computer software		459			459
Leasehold improvements		9,983			5,677
Construction in progress		1,406			5,664
		16,161			15,911
Less accumulated depreciation		(6,519	)		(5,273	)
Total property and equipment, net	$	9,642		$	10,638

Depreciation Of Property Plant And Equipment [Table Text Block]

	*Three Months Ended September 30,*				*Nine Months Ended September 30,*
(in thousands)	*2023*		*2022*		*2023*		*2022*
General and administrative	$	66	$	67	$	200	$	163
Research and development		373		166		1,083		552
Total depreciation expense	$	439	$	233	$	1,283	$	715

Note 6 - Accrued Liabilities (Tables)

9 Months Ended

Sep. 30, 2023

Notes Tables

Schedule of Accrued Liabilities [Table Text Block]

	*September 30,*		*December 31,*
(in thousands)	*2023*		*2022*
Accrued compensation and benefits	$	1,507	$	2,007
Accrued CRO and clinical fees		1,154		1,297
Other		533		559
Total accrued liabilities	$	3,194	$	3,863

Note 7 - Leases (Tables)

9 Months Ended

Sep. 30, 2023

Notes Tables

Schedule of Assets Under Finance Lease [Table Text Block]

	*September 30,*			*December 31,*
(in thousands)	*2023*			*2022*
Lab equipment	$	408		$	408
Work in process		228			228
Total		636			636
Less accumulated depreciation		(383	)		(326	)
Net	$	253		$	310

Finance and Operating Lease Liability, Maturity [Table Text Block]

(in thousands)	*Finance Leases*			*Operating Leases*
2023 (remainder)	$	19		$	194
2024		27			1,178
2025		—			1,208
2026		—			1,236
2027		—			1,132
2028		—			1,093
Thereafter		—			1,694
Total minimum lease payments		46			7,735
Less amount representing interest/discounting		(2	)		(2,102	)
Present value of minimum lease payments		44			5,633
Less lease obligations, current portion		(44	)		(553	)
Lease obligations, net of current portion	$	—		$	5,080

Lease, Cost [Table Text Block]

	*Three Months Ended September 30,*				*Nine Months Ended September 30,*
(in thousands)	*2023*		*2022*		*2023*		*2022*
Finance lease costs:
Amortization	$	16	$	20	$	57	$	61
Interest on lease liabilities		1		6		10		12
Operating lease costs		254		256		758		695
Short-term lease costs		1		—		3		—
Variable lease costs		70		65		192		238
Total lease costs	$	342	$	347	$	1,020	$	1,006

Schedule of Cash Flow, Supplemental Disclosures, Leases [Table Text Block]

	*Nine Months Ended September 30,*
(in thousands)	*2023*			*2022*
Operating cash flows from operating leases	$	(953	)	$	(933	)
Operating cash flows from finance leases	$	(10	)	$	(12	)
Financing cash flows from finance leases	$	(63	)	$	(101	)

Note 8 - Notes Payable and Convertible Notes Payable (Tables)

9 Months Ended

Sep. 30, 2023

Notes Tables

Schedule of Long-Term Debt Instruments [Table Text Block]

	*Stated*			*September 30,*			*December 31,*
(in thousands, except interest rates)	*Interest Rate*			*2023*			*2022*
Notes payable
Advance Cecil, Inc. (commenced April 2019)		8.00	%	$	136		$	130
Maryland DHCD (commenced February 2019)		8.00	%		684			654
Maryland DHCD (commenced May 2022)		6.00	%		1,083			704
Avenue Venture Opportunities Fund, L.P. (commenced May 2021)		15.10	%		15,000			15,000
					16,903			16,488
Less unamortized discount and debt issuance costs					(640	)		(587	)
Less notes payable, current portion, net of unamortized discount and debt issuance costs					(9,588	)		(6,418	)
Total notes payable, net of current portion				$	6,675		$	9,483

Convertible notes payable
Avenue Venture Opportunities Fund, L.P. (commenced May 2021)		15.10	%	$	5,000		$	5,000
Maryland DHCD (commenced December 2022)		6.00	%		5,233			5,007
					10,233			10,007
Less unamortized discount and debt issuance costs					(258	)		(237	)
Total convertible notes payable				$	9,975		$	9,770

Schedule of Maturities of Long-Term Debt [Table Text Block]

(in thousands)	*2019 MD Loan*		*2019 Cecil Loan*		*2021 Avenue Loan*			*2022 MD Loan*			*2022 DHCD Loan*
2023 (remainder)	$	—	$	—	$	—		$	—		$	—
2024		—		—		20,000			—			—
2025		—		—		—			347			—
2026		—		—		—			369			—
2027		—		—		—			317			—
2028		—		—		—			—			5,000
Thereafter		500		100		—			—			—
Total debt principal payments		500		100		20,000			1,033			5,000
Accrued and unpaid interest		184		36		—			50			233
Less unamortized discount and debt issuance costs		—		—		(824	)		(23	)		(51	)
Future debt payments, net	$	684	$	136	$	19,176		$	1,060		$	5,182

Note 10 - Income Taxes (Tables)

9 Months Ended

Sep. 30, 2023

Notes Tables

Schedule of Income before Income Tax, Domestic and Foreign [Table Text Block]

	*Three Months Ended September 30,*						*Nine Months Ended September 30,*
(in thousands)	*2023*			*2022*			*2023*			*2022*
United States	$	(2,206	)	$	(9,432	)	$	(38,608	)	$	(25,787	)
Foreign		(212	)		(1,544	)		(723	)		(3,077	)
Net loss before income taxes	$	(2,418	)	$	(10,976	)	$	(39,331	)	$	(28,864	)

Note 11 - Benefit Plans (Tables)

9 Months Ended

Sep. 30, 2023

Notes Tables

Share-Based Payment Arrangement, Cost by Plan [Table Text Block]

	*Three Months Ended September 30,*				*Nine Months Ended September 30,*
(in thousands)	*2023*		*2022*		*2023*		*2022*
General and administrative	$	1,311	$	1,247	$	3,888	$	4,056
Research and development		1,085		851		3,182		2,428
Total stock-based compensation expense	$	2,396	$	2,098	$	7,070	$	6,484

	*Three Months Ended September 30,*				*Nine Months Ended September 30,*
(in thousands)	*2023*		*2022*		*2023*		*2022*
Stock options	$	2,384	$	2,098	$	7,044	$	6,484
Stock awards		12		—		26		—
Total stock-based compensation expense	$	2,396	$	2,098	$	7,070	$	6,484

Share-Based Payment Arrangement, Option, Activity [Table Text Block]

(in thousands, except share, per share, and term data)	*Number of Options*			*Weighted Average Exercise Price Per Share*		*Weighted Average Remaining Term (Years)*		*Intrinsic Value*
Outstanding – December 31, 2022		15,260,297		$	2.98		7.28	$	2,348
Granted		6,690,263			0.95		9.70		—
Forfeited		(433,262	)		4.51		—		—
Outstanding – September 30, 2023		21,517,298		$	2.30		7.49	$	712
Vested and exercisable – September 30, 2023		10,074,211		$	2.69		5.60	$	712
Vested, exercisable or expected to vest – September 30, 2023		21,517,298		$	2.30		7.49	$	712

Schedule of Share-Based Payment Award, Stock Options, Valuation Assumptions [Table Text Block]

	*Nine Months Ended September 30,*
	*2023*			*2022*
Expected stock price volatility		96.22% – 103.24%			89.57% – 98.13%
Risk-free interest rate		3.26% – 4.41%			1.65% – 3.00%
Expected dividend yield		0.00	%		0.00	%
Expected term of options (in years)		5.00 – 6.43			5.00 – 6.98

Share-Based Payment Arrangement, Restricted Stock and Restricted Stock Unit, Activity [Table Text Block]

	*Number of Stock Awards*			*Weighted Average Grant Date Fair Value*
Unvested balance – December 31, 2022		769,139		$	9.84
Granted		43,479			1.15
Converted to shares of Common Stock upon vesting		(21,739	)		1.15
Forfeited		(746	)		9.84
Unvested balance – September 30, 2023		790,133		$	9.60

Note 12 - Fair Value (Tables)

9 Months Ended

Sep. 30, 2023

Notes Tables

Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis [Table Text Block]

	*September 30, 2023*
(in thousands)	*Level 1*		*Level 2*		*Level 3*		*Total*
Cash equivalents:
Money market funds	$	14,058	$	—	$	—	$	14,058
U.S. Treasury securities		—		24,164		—		24,164
Common stock warrant liabilities		—		—		1,860		1,860
Clene Nanomedicine contingent earn-out liability		—		—		150		150
Initial Stockholders contingent earn-out liability		—		—		19		19

	*December 31, 2022*
(in thousands)	*Level 1*		*Level 2*		*Level 3*		*Total*
Cash equivalents:
Money market funds	$	14,317	$	—	$	—	$	14,317
Marketable securities:
Commercial paper		—		3,482		—		3,482
Corporate debt securities		—		1,501		—		1,501
Clene Nanomedicine contingent earn-out liability		—		—		2,264		2,264
Initial Stockholders contingent earn-out liability		—		—		291		291

(in thousands)	*Common Stock Warrant Liabilities*			*Clene Nanomedicine Contingent Earn-out*			*Initial Stockholders Contingent Earn-out*
Balance – December 31, 2022	$	—		$	2,264		$	291
Initial fair value of instruments		7,818			—			—
Change in fair value		(5,958	)		(2,114	)		(272	)
Balance – September 30, 2023	$	1,860		$	150		$	19

(in thousands)	*Common Stock Warrant Liability*			*Clene Nanomedicine Contingent Earn-out*			*Initial Stockholders Contingent Earn-out*
Balance – December 31, 2021	$	474		$	18,100		$	2,317
Change in fair value		(151	)		(6,662	)		(849	)
Reclassification from liability to equity		(305	)		—			—
Balance – September 30, 2022	$	18		$	11,438		$	1,468

Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Table Text Block]

	*September 30,*
	*2023*
Expected stock price volatility		70.00% – 110.00%
Risk-free interest rate		4.63% – 5.52%
Expected dividend yield		0.00	%
Expected term (in years)		0.58 – 4.75
Probability of change of control		5.00	%
Probability of dissolution		60.00	%
Probability of other outcome		35.00	%

	*September 30,*
	*2023*
Expected stock price volatility		75.00% – 110.00%
Risk-free interest rate		4.87% – 5.50%
Expected dividend yield		0.00	%
Expected term (in years)		0.75 – 2.71
Probability of NDA acceptance		30.00	%
Probability of fundamental transaction		5.00	%
Probability of dissolution		60.00	%
Probability of other outcome		5.00	%

	*June 16,*
	*2023*
Expected stock price volatility		100.00% – 110.00%
Risk-free interest rate		3.88% – 4.97%
Expected dividend yield		0.00	%
Expected term (in years)		1.46 – 7.00
Probability of NDA approval		22.50	%
Probability of fundamental transaction		5.00	%
Probability of dissolution		71.50	%
Probability of other outcome		1.00	%

	*September 30,*			*December 31,*
	*2023*			*2022*
Expected stock price volatility		100.00	%		115.00	%
Risk-free interest rate		5.00	%		4.20	%
Expected dividend yield		0.00	%		0.00	%
Expected term (in years)		2.25			3.00

Note 13 - Capital Stock (Tables)

9 Months Ended

Sep. 30, 2023

Notes Tables

Schedule of Stockholders' Equity Note, Warrants or Rights [Table Text Block]

						*Number of Shares Issuable*
						*September 30,*		*December 31,*
Date Exercisable	*Exercise Price*		*Expiration*		*Classification*	*2023*		*2022*
December 2020	$	11.50	December 2025	⁽¹⁾	Equity		2,407,500		2,407,500
December 2020	$	11.50	December 2025	⁽²⁾	Equity		24,583		24,583
December 2020	$	1.97	April 2023	⁽³⁾	Equity		—		1,929,111
May 2021	$	8.63	May 2026	⁽⁴⁾	Equity		—		115,851
June 2023	$	0.80	June 2028	⁽⁵⁾	Liability		3,000,000		—
June 2023	$	1.10	June 2026	⁽⁶⁾	Liability		50,000,000		—
June 2023	$	1.50	June 2030	⁽⁷⁾	Equity		50,000,000		—
Total							105,432,083		4,477,045

Note 14 - Net Loss Per Share (Tables)

9 Months Ended

Sep. 30, 2023

Notes Tables

Schedule of Earnings Per Share, Basic and Diluted [Table Text Block]

	*Three Months Ended September 30,*						*Nine Months Ended September 30,*
(in thousands, except share and per share data)	*2023*			*2022*			*2023*			*2022*
Numerator:
Net loss attributable to common stockholders	$	(2,418	)	$	(10,976	)	$	(39,331	)	$	(28,864	)
Denominator:
Weighted average common shares outstanding		128,405,483			63,508,928			97,026,964			63,234,757
Net loss per share attributable to common stockholders – basic and diluted	$	(0.02	)	$	(0.17	)	$	(0.41	)	$	(0.46	)

Schedule of Antidilutive Securities Excluded from Computation of Earnings Per Share [Table Text Block]

	*Three Months Ended September 30,*				*Nine Months Ended September 30,*
	*2023*		*2022*		*2023*		*2022*
Convertible notes payable (see Note 8)		1,732,703		482,703		1,732,703		482,703
Common stock warrants (see Note 13)		105,432,083		4,477,045		105,432,083		4,477,045
Options to purchase common stock (see Note 11)		21,517,298		12,173,570		21,517,298		12,173,570
Unvested restricted stock awards (see Note 11)		790,133		769,139		790,133		769,139
Contingent earn-out shares (see Note 2)		6,592,334		6,592,334		6,592,334		6,592,334
Total		136,064,551		24,494,791		136,064,551		24,494,791

Note 15 - Related Party Transactions (Tables)

9 Months Ended

Sep. 30, 2023

Notes Tables

	*Three Months Ended September 30,*				*Nine Months Ended September 30,*
(in thousands)	*2023*		*2022*		*2023*		*2022*
Product revenue from related parties	$	64	$	127	$	320	$	127
Royalty revenue from related parties		43		44		129		100
Total revenue from related parties	$	107	$	171	$	449	$	227

Note 16 - Segment Information (Tables)

9 Months Ended

Sep. 30, 2023

Notes Tables

Reconciliation of Revenue from Segments to Consolidated [Table Text Block]

	*Three Months Ended September 30,*						*Nine Months Ended September 30,*
(in thousands)	*2023*			*2022*			*2023*			*2022*
Drugs:
Revenue from external customers	$	—		$	—		$	—		$	—
Loss from operations		(9,622	)		(10,073	)		(30,945	)		(37,012	)
Supplements:
Revenue from external customers	$	108		$	174		$	484		$	239
Income from operations		80			268			335			276
Consolidated:
Revenue from external customers	$	108		$	174		$	484		$	239
Loss from operations		(9,542	)		(9,805	)		(30,610	)		(36,736	)

Reconciliation of Operating Profit (Loss) from Segments to Consolidated [Table Text Block]

	*Three Months Ended September 30,*						*Nine Months Ended September 30,*
(in thousands)	*2023*			*2022*			*2023*			*2022*
Segment loss from operations	$	(9,542	)	$	(9,805	)	$	(30,610	)	$	(36,736	)
Total other income (expense), net		7,124			(1,171	)		(8,721	)		7,872
Net loss before income taxes	$	(2,418	)	$	(10,976	)	$	(39,331	)	$	(28,864	)

Reconciliation of Assets from Segment to Consolidated [Table Text Block]

	*September 30,*		*December 31,*
(in thousands)	*2023*		*2022*
Total assets:
Drugs	$	17,787	$	20,476
Supplements		268		386
Corporate		42,378		23,631
Consolidated	$	60,433	$	44,493

Note 1 - Nature of the Business (Details Textual) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022	Dec. 30, 2020
Common Stock, Par or Stated Value Per Share (in dollars per share)	$ 0.0001		$ 0.0001		$ 0.0001	$ 0.0001
Operating Income (Loss)	$ (9,542)	$ (9,805)	$ (30,610)	$ (36,736)
Retained Earnings (Accumulated Deficit)	(232,550)		(232,550)		$ (193,219)
Cash, Cash Equivalents, and Short-Term Investments	$ 42,100		42,100		$ 23,300
Net Cash Provided by (Used in) Operating Activities			(22,999)	$ (31,295)
Minimum Cash Balance For Loan Covenant			$ 5,000

Note 2 - Summary of Significant Accounting Policies (Details Textual) - USD ($)		3 Months Ended		9 Months Ended
	Dec. 30, 2020	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Inventory, Raw Materials, Gross		$ 72,000		$ 72,000		$ 29,000
Inventory, Finished Goods, Gross		32,000		32,000		$ 14,000
Research and Development Expense		5,972,000	$ 6,403,000	19,982,000	$ 24,149,000
Grant Funding on Conditional Grants [Member]
Research and Development Expense		$ 200,000	$ 0	$ 300,000	$ 0
Reverse Recapitalization [Member] \| Clene Nanomedicine Contingent Earn-out [Member]
Business Combination, Contingent Earnout Shares, Milestone One (in shares)	3,338,483
Business Combination, Contingent Earnout, Milestone One, Minimum Price (in dollars per share)	$ 15
Business Combination, Contingent Earnout, Milestone One, Consecutive Trading Days (Day)	20 days
Business Combination, Contingent Earnout, Milestone One, Trading Day Period (Day)	30 days
Business Combination, Contingent Earnout, Milestone One, Period (Year)	3 years
Business Combination, Contingent Earnout Shares, Milestone Two (in shares)	2,503,851
Business Combination, Contingent Earnout, Milestone Two, Minimum Price (in dollars per share)	$ 20
Business Combination, Contingent Earnout, Milestone Two, Consecutive Trading Days (Day)	20 days
Business Combination, Contingent Earnout, Milestone Two, Trading Day Period (Day)	30 days
Business Combination, Contingent Earnout, Milestone Two, Period (Year)	5 years
Business Combination, Contingent Earnout, Milestone Two, Change of Control Period (Year)	5 years
Reverse Recapitalization [Member] \| Initial Stockholders Contingent Earn-out [Member]
Business Combination, Contingent Earnout Shares, Milestone One (in shares)	375,000
Business Combination, Contingent Earnout Shares, Milestone Two (in shares)	375,000
Equipment [Member] \| Minimum [Member]
Property, Plant and Equipment, Useful Life (Year)		3 years		3 years
Equipment [Member] \| Maximum [Member]
Property, Plant and Equipment, Useful Life (Year)		5 years		5 years
Furniture and Fixtures [Member] \| Minimum [Member]
Property, Plant and Equipment, Useful Life (Year)		3 years		3 years
Furniture and Fixtures [Member] \| Maximum [Member]
Property, Plant and Equipment, Useful Life (Year)		7 years		7 years
Computer Equipment [Member] \| Minimum [Member]
Property, Plant and Equipment, Useful Life (Year)		2 years		2 years
Computer Equipment [Member] \| Maximum [Member]
Property, Plant and Equipment, Useful Life (Year)		5 years		5 years

Note 3 - Cash, Cash Equivalents, and Marketable Securities (Details Textual) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Debt Securities, Available-for-Sale, Allowance for Credit Loss	$ 0	$ 0

Note 3 - Cash, Cash Equivalents, and Marketable Securities - Available-for-sale Securities Classified as Cash Equivalents (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Amortized cost		$ 4,997
Gross unrealized gains		0
Gross unrealized losses		14
Fair value		$ 4,983
US Treasury Securities [Member]
Amortized cost	$ 24,163
Gross unrealized gains	1
Gross unrealized losses	0
Fair value	24,164
Money Market Funds [Member]
Amortized cost	14,058
Gross unrealized gains	0
Gross unrealized losses	0
Fair value	14,058
Cash Equivalents [Member]
Amortized cost	38,221
Gross unrealized gains	1
Gross unrealized losses	0
Fair value	$ 38,222

Note 3 - Cash, Cash Equivalents, and Marketable Securities - Available for Sale Securities (Details) $ in Thousands	Dec. 31, 2022 USD ($)
Amortized cost	$ 4,997
Gross unrealized gains	0
Gross unrealized losses	(14)
Fair value	4,983
Commercial Paper [Member]
Amortized cost	3,496
Gross unrealized gains	0
Gross unrealized losses	(14)
Fair value	3,482
Corporate Debt Securities [Member]
Amortized cost	1,501
Gross unrealized gains	0
Gross unrealized losses	0
Fair value	$ 1,501

Note 3 - Cash, Cash Equivalents, and Marketable Securities - Proceeds From Sale and Maturity of Available-for Sale Securities (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Proceeds from maturities of marketable securities	$ 0	$ 5,500	$ 5,000	$ 8,000
Proceeds from sales of marketable securities	0	4,597	0	7,614
Total	$ 0	$ 10,097	$ 5,000	$ 15,614

Note 4 - Prepaid Expenses and Other Current Assets - Schedule of Prepaid Expenses and Other Current Assets (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Research and development tax credits receivable	$ 1,084	$ 2,777
Metals to be used in research and development	2,052	2,290
Other	1,029	581
Total prepaid expenses and other current assets	$ 4,165	$ 5,648

Note 5 - Property and Equipment, Net - Schedule of Property and Equipment, Net (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Property and equipment, gross	$ 16,161	$ 15,911
Less accumulated depreciation	(6,519)	(5,273)
Total property and equipment, net	9,642	10,638
Equipment [Member]
Property and equipment, gross	4,135	3,934
Office Equipment [Member]
Property and equipment, gross	178	177
Computer Equipment [Member]
Property and equipment, gross	459	459
Leasehold Improvements [Member]
Property and equipment, gross	9,983	5,677
Construction in Progress [Member]
Property and equipment, gross	$ 1,406	$ 5,664

Note 5 - Property and Equipment, Net - Schedule of Depreciation Expense (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Depreciation	$ 439	$ 233	$ 1,283	$ 715
General and Administrative Expense [Member]
Depreciation	66	67	200	163
Research and Development Expense [Member]
Depreciation	$ 373	$ 166	$ 1,083	$ 552

Note 6 - Accrued Liabilities - Schedule of Accrued Liabilities (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Accrued compensation and benefits	$ 1,507	$ 2,007
Accrued CRO and clinical fees	1,154	1,297
Other	533	559
Total accrued liabilities	$ 3,194	$ 3,863

Note 7 - Leases (Details Textual) $ in Thousands	1 Months Ended			9 Months Ended		12 Months Ended
Note 7 - Leases (Details Textual) $ in Thousands	Sep. 30, 2022	Feb. 28, 2022	Sep. 30, 2021	Sep. 30, 2023 USD ($)	Sep. 30, 2022 USD ($)	Dec. 31, 2022 USD ($)
Number of Real Estate Leases				3
Gain (Loss) on Termination of Lease				$ (0)	$ 420
Operating Lease, Weighted Average Discount Rate, Percent				9.60%		9.60%
Operating Lease, Weighted Average Remaining Lease Term (Year)				6 years 7 months 6 days		7 years 3 months 18 days
Finance Lease, Weighted Average Discount Rate, Percent				10.90%		10.20%
Finance Lease, Weighted Average Remaining Lease Term (Year)				7 months 6 days		1 year 2 months 12 days
Lease for Laboratory Space [Member]
Lessee, Operating Lease, Term of Contract (Year)		7 years	10 years
Lessee, Operating Lease, Option To Extend Period (Year)	5 years	10 years	10 years
Gain (Loss) on Termination of Lease						$ 400
Lessee, Operating Lease, Renewal Term (Year)	7 years				7 years

Note 7 - Leases - Assets Recorded Under Finance Leases (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Finance lease asset, gross	$ 636	$ 636
Less accumulated depreciation	(383)	(326)
Net	253	310
Equipment [Member]
Finance lease asset, gross	408	408
Construction in Progress [Member]
Finance lease asset, gross	$ 228	$ 228

Note 7 - Leases - Maturity Analysis of Leases (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
2022 (remainder), finance leases	$ 19
2023 (remainder), operating leases	194
2024, finance leases	27
2024, operating leases	1,178
2025, finance leases	0
2025, operating leases	1,208
2026, finance leases	0
2026, operating leases	1,236
2027, finance leases	0
2027, operating leases	1,132
2028, finance leases	0
2028, operating leases	1,093
Thereafter, finance leases	0
Thereafter, operating leases	1,694
Total minimum lease payments, finance leases	46
Total minimum lease payments, operating leases	7,735
Less amount representing interest/discounting, finance leases	(2)
Less amount representing interest/discounting, operating leases	(2,102)
Present value of minimum lease payments, finance leases	44
Present value of minimum lease payments, operating leases	5,633
Less lease obligations, current portion, finance leases	44	$ 74
Less lease obligations, current portion, operating leases	553	488
Lease obligations, net of current portion, finance leases	0	34
Lease obligations, net of current portion, operating leases	$ 5,080	$ 5,557

Note 7 - Leases - Components of Lease Cost (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Amortization	$ 16	$ 20	$ 57	$ 61
Interest on lease liabilities	1	6	10	12
Operating lease costs	254	256	758	695
Short-term lease costs	1	0	3	0
Variable lease costs	70	65	192	238
Total lease costs	$ 342	$ 347	$ 1,020	$ 1,006

Note 7 - Leases - Supplemental Cash Flow Information (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Operating cash flows from operating leases	$ (953)	$ (933)
Operating cash flows from finance leases	(10)	(12)
Payments of finance lease obligations	$ (63)	$ (101)

Note 8 - Notes Payable and Convertible Notes Payable (Details Textual)			1 Months Ended					3 Months Ended		9 Months Ended		12 Months Ended	21 Months Ended
	Apr. 30, 2019 USD ($)	Feb. 28, 2019 USD ($)	Jun. 30, 2023 USD ($) shares	Dec. 31, 2022 USD ($) $ / shares shares	May 31, 2022 USD ($)	Sep. 30, 2021 USD ($)	May 31, 2021 USD ($) $ / shares shares	Sep. 30, 2023 USD ($) $ / shares shares	Sep. 30, 2022 USD ($)	Sep. 30, 2023 USD ($) $ / shares shares	Sep. 30, 2022 USD ($)	Dec. 31, 2022 USD ($) $ / shares shares	Sep. 30, 2023 USD ($) $ / shares shares
Proceeds from Notes Payable, Total										$ 350,000	$ 694,000
Class of Warrant or Right, Number of Securities Called by Warrants or Rights (in shares) \| shares				4,477,045				105,432,083		105,432,083		4,477,045	105,432,083
New Avenue Warrant [Member]
Class of Warrant or Right, Number of Securities Called by Warrants or Rights (in shares) \| shares			3,000,000
Avenue [Member] \| Warrants Issued with 2021 Avenue Loan [Member]
Class of Warrant or Right, Number of Securities Called by Warrants or Rights (in shares) \| shares							115,851
Class of Warrant or Right, Exercise Price of Warrants or Rights (in dollars per share) \| $ / shares							$ 8.63
Avenue [Member] \| New Avenue Warrant [Member]
Class of Warrant or Right, Number of Securities Called by Warrants or Rights (in shares) \| shares								3,000,000		3,000,000			3,000,000
Class of Warrant or Right, Exercise Price of Warrants or Rights (in dollars per share) \| $ / shares								$ 0.8		$ 0.8			$ 0.8
Warrants and Rights Outstanding								$ 700,000		$ 700,000			$ 700,000
Avenue [Member] \| Minimum [Member] \| Public Equity Offering [Member]
Equity Milestone 1 Condition for Extended Interest Only Period			$ 35,000,000
Equity Milestone 2 Condition for Extended Interest Only Period			$ 40,000,000
The 2019 MD Loan [Member] \| Department of Housing and Community Development [Member]
Debt Instrument, Face Amount		$ 500,000
Debt Instrument, Interest Rate, Stated Percentage		8.00%
Debt Instrument, Convertible, Number of Equity Instruments		119,907
Interest Expense, Debt								10,000	$ 10,000	30,000	30,000
The 2019 Cecil Loan [Member] \| Advance Cecil Inc. [Member]
Debt Instrument, Face Amount	$ 100,000
Debt Instrument, Interest Rate, Stated Percentage	8.00%
Debt Instrument, Convertible, Number of Equity Instruments	23,981
Interest Expense, Debt								2,000	2,000	6,000	6,000
The 2022 MD Loan [Member] \| Department of Housing and Community Development [Member]
Debt Instrument, Face Amount					$ 3,000,000
Debt Instrument, Interest Rate, Stated Percentage					6.00%
Interest Expense, Debt								15,000	10,000	43,000	12,000
Proceeds from Loans										1,000,000
Debt Instrument, Monthly Interest-only Payments, Maximum Amount, First Eighteen Installments					$ 15,000
Debt Instrument, Monthly Principal and Interest Payment, for the Next Thirty Installments					33,306
Interest Payable				$ 22,000				$ 100,000		$ 100,000		$ 22,000	$ 100,000
Debt Issuance Costs, Gross					$ 31,000
The 2022 DHCD Loan [Member] \| Convertible Notes Payable [Member]
Debt Instrument, Interest Rate, Stated Percentage								6.00%		6.00%			6.00%
The 2022 DHCD Loan [Member] \| Department of Housing and Community Development [Member]
Debt Instrument, Face Amount				$ 5,000,000								$ 5,000,000
Debt Instrument, Interest Rate, Stated Percentage				6.00%								6.00%
Interest Expense, Debt								$ 100,000		$ 200,000
Interest Payable				$ 8,000				200,000		200,000		$ 8,000	$ 200,000
Debt Issuance Costs, Gross				100,000								100,000
Debt Instrument, Convertible, Minimum Increment of Principal for Exercise				$ 1,000,000								$ 1,000,000
Debt Conversion, Conversion Price, Percent of 30-day Trailing Volume-weighted Average Sale Price of Common Stock				97.00%
Debt Instrument, Convertible, Conversion Price (in dollars per share) \| $ / shares				$ 4								$ 4
Coupon Interest Expense								100,000		200,000
Amortization of Debt Issuance Costs and Discounts								$ 1,000		$ 1,000
Debt Instrument, Interest Rate, Effective Percentage								5.91%		5.91%			5.91%
The 2021 Avenue Loan [Member] \| Avenue [Member]
Debt Instrument, Face Amount							$ 30,000,000
Debt Instrument, Interest Rate, Stated Percentage							3.25%
Interest Expense, Debt								$ 1,100,000	800,000	$ 3,000,000	2,300,000
Debt Instrument, Convertible, Conversion Price (in dollars per share) \| $ / shares								$ 10.36		$ 10.36			$ 10.36
Debt Instrument, Interest Rate During Period										15.10%		14.10%
Debt Instrument, Interest Only Payments, Period (Month)							12 months
Debt Instrument, First Interest-only Period Extension (Month)							12 months
Additional Payment at Debt Maturity, Percentage of Principal							4.25%
Additional Payment at Debt Maturity							$ 900,000
Debt Issuance Costs, Net								$ 800,000		$ 800,000			$ 800,000
Debt Issuance Costs Expensed										47,000
Debt Instrument, Convertible, Maximum Conversion Amount								5,000,000		5,000,000			5,000,000
Debt Instrument, Unamortized Discount (Premium) and Debt Issuance Costs, Net				$ 200,000				200,000		200,000		$ 200,000	200,000
Debt Instrument, Covenant, Cash and Certain Cash Equivalents, Minimum							5,000,000
Warrants and Rights Outstanding							700,000
The 2021 Avenue Loan [Member] \| Avenue [Member] \| Convertible Notes Payable [Member]
Interest Expense, Debt								300,000	200,000	800,000	600,000
Coupon Interest Expense								200,000	200,000	600,000	$ 400,000
Amortization of Debt Issuance Costs and Discounts								$ 100,000	$ 100,000	$ 200,000			$ 200,000
Debt Instrument, Interest Rate During Period								22.79%	18.41%	22.79%			18.41%
The 2021 Avenue Loan [Member] \| Avenue [Member] \| Notes Payable, Tranche 1 [Member]
Proceeds from Notes Payable, Total						$ 5,000,000	15,000,000
The 2021 Avenue Loan [Member] \| Avenue [Member] \| Notes Payable, Tranche 2 [Member]
Debt Instrument, Unfunded Balance							$ 10,000,000
The 2021 Avenue Loan [Member] \| Avenue [Member] \| Prime Rate [Member]
Debt Instrument, Basis Spread on Variable Rate							6.60%

Note 8 - Note Payable and Convertible Notes Payable - Long-term Debt (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Less notes payable, current portion, net of unamortized discount and debt issuance costs	$ (9,588)	$ (6,418)
Notes payable, net of current portion	6,675	9,483
Convertible notes payable	9,975	9,770
Notes Payable [Member]
Future debt payments, net	16,903	16,488
Notes payable	16,903	16,488
Less unamortized discount and debt issuance costs	(640)	(587)
Less notes payable, current portion, net of unamortized discount and debt issuance costs	(9,588)	(6,418)
Notes payable, net of current portion	6,675	9,483
Convertible Notes Payable [Member]
Future debt payments, net	10,233	10,007
Notes payable	10,233	10,007
Less unamortized discount and debt issuance costs	(258)	(237)
Convertible notes payable	$ 9,975	9,770
The 2019 Cecil Loan [Member] \| Notes Payable [Member]
Interest Rate	8.00%
Future debt payments, net	$ 136	130
Notes payable	$ 136	130
The 2019 Maryland DHCD [Member] \| Notes Payable [Member]
Interest Rate	8.00%
Future debt payments, net	$ 684	654
Notes payable	$ 684	654
The 2022 Maryland DHCD [Member] \| Notes Payable [Member]
Interest Rate	6.00%
Future debt payments, net	$ 1,083	704
Notes payable	$ 1,083	704
Avenue [Member] \| Notes Payable [Member]
Interest Rate	15.10%
Future debt payments, net	$ 15,000	15,000
Notes payable	$ 15,000	15,000
Avenue [Member] \| Convertible Notes Payable [Member]
Interest Rate	15.10%
Future debt payments, net	$ 5,000	5,000
Notes payable	5,000	5,000
The 2022 DHCD Loan [Member] \| Notes Payable [Member]
Future debt payments, net	5,182
Notes payable	$ 5,182
The 2022 DHCD Loan [Member] \| Convertible Notes Payable [Member]
Interest Rate	6.00%
Future debt payments, net	$ 5,233	5,007
Notes payable	$ 5,233	$ 5,007

Note 8 - Notes Payable and Convertible Notes Payable - Schedule of Future Payments (Details) - Notes Payable [Member] - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Future debt payments, net	$ 16,903	$ 16,488
The 2019 MD Loan [Member]
2023 (remainder)	0
2024	0
2025	0
2026	0
2027	0
2028	0
Thereafter	500
Total debt principal payments	500
Accrued and unpaid interest	184
Less unamortized discount and debt issuance costs	0
Future debt payments, net	684
The 2019 Cecil Loan [Member]
2023 (remainder)	0
2024	0
2025	0
2026	0
2027	0
2028	0
Thereafter	100
Total debt principal payments	100
Accrued and unpaid interest	36
Less unamortized discount and debt issuance costs	0
Future debt payments, net	136	$ 130
The 2021 Avenue Loan [Member]
2023 (remainder)	0
2024	20,000
2025	0
2026	0
2027	0
2028	0
Thereafter	0
Total debt principal payments	20,000
Accrued and unpaid interest	0
Less unamortized discount and debt issuance costs	(824)
Future debt payments, net	19,176
The 2022 MD Loan [Member]
2023 (remainder)	0
2024	0
2025	347
2026	369
2027	317
2028	0
Thereafter	0
Total debt principal payments	1,033
Accrued and unpaid interest	50
Less unamortized discount and debt issuance costs	(23)
Future debt payments, net	1,060
The 2022 DHCD Loan [Member]
2023 (remainder)	0
2024	0
2025	0
2026	0
2027	0
2028	5,000
Thereafter	0
Total debt principal payments	5,000
Accrued and unpaid interest	233
Less unamortized discount and debt issuance costs	(51)
Future debt payments, net	$ 5,182

Note 9 - Commitments and Contingencies (Details Textual) - USD ($) $ in Thousands	1 Months Ended		3 Months Ended		9 Months Ended		12 Months Ended
	May 31, 2023	Sep. 30, 2019	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Government Assistance, Amount			$ 247	$ 1,346	$ 902	$ 2,001
Grant Funding Related to VISIONARY-MS Phase 2 Clinical Trial [Member] \| National Multiple Sclerosis Society [Member]
Government Assistance, Amount	$ 700	$ 300
Government Assistance, Repayment, Percentage of Grant Funding Upon First Commercial Product Sale		50.00%
Government Assistance, Repayment, Additional Percentage of Grant Funding, Tranche One		50.00%
Government Assistance, Repayment, Cumulative Sales, Tranche One		$ 10,000
Government Assistance, Repayment, Additional Percentage of Grant Funding, Tranche Two		150.00%
Government Assistance, Repayment, Cumulative Sales, Tranche Two		$ 50,000
Government Assistance, Repayment, Additional Percentage of Grant Funding, Tranche Three		200.00%
Government Assistance, Repayment, Cumulative Sales, Tranche Three		$ 100,000
Government Assistance, Repayment, Maximum Percentage of Grant Funding When All Milestones Achieved		450.00%
Government Assistance, Aggregate Repayment, Percentage of Grant Funding	150.00%	300.00%
Government Assistance, Repayment, Percentage of Grant Funding Upon Closing	150.00%	300.00%
Government Assistance, Repayment Amount Upon Closing	$ 1,000	$ 1,000
Grant Funding Related to VISIONARY-MS Phase 2 Clinical Trial [Member] \| National Multiple Sclerosis Society [Member] \| Minimum [Member]
Government Assistance, Possible Loss, Percentage of Grant Funding		50.00%
Government Assistance, Possible Loss Between Minimum and Maximum Repayment Amounts		$ 200
Grant Funding Related to VISIONARY-MS Phase 2 Clinical Trial [Member] \| National Multiple Sclerosis Society [Member] \| Maximum [Member]
Government Assistance, Possible Loss, Percentage of Grant Funding		450.00%
Government Assistance, Possible Loss Between Minimum and Maximum Repayment Amounts		$ 1,500
Grant Funding Related to REPAIR-MS and REPAIR-PD Phase 2 Clinical Trial [Member] \| National Multiple Sclerosis Society [Member] \| Minimum [Member]
Government Assistance, Possible Loss Between Minimum and Maximum Repayment Amounts	300
Grant Funding Related to REPAIR-MS and REPAIR-PD Phase 2 Clinical Trial [Member] \| National Multiple Sclerosis Society [Member] \| Maximum [Member]
Government Assistance, Possible Loss Between Minimum and Maximum Repayment Amounts	$ 3,000
Capital Addition Purchase Commitments [Member]
Long-Term Purchase Commitment, Amount					$ 400		$ 1,600

Note 10 - Income Taxes - Components of Income (Loss) Before Income Taxes (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
United States	$ (2,206)	$ (9,432)	$ (38,608)	$ (25,787)
Foreign	(212)	(1,544)	(723)	(3,077)
Net loss before income taxes	$ (2,418)	$ (10,976)	$ (39,331)	$ (28,864)

Note 11 - Benefit Plans (Details Textual) - USD ($)	3 Months Ended		9 Months Ended		12 Months Ended
Note 11 - Benefit Plans (Details Textual) - USD ($)	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Share-Based Compensation Arrangement by Share-Based Payment Award, Options, Outstanding, Number (in shares)	21,517,298		21,517,298		15,260,297
Share-Based Compensation Arrangement by Share-Based Payment Award, Options, Grants in Period, Gross (in shares)			6,690,263
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Amount	$ 24,000		$ 24,000		$ 0
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Period for Recognition (Year)			5 months 23 days
Share-Based Compensation Arrangement by Share-Based Payment Award, Options, Grants in Period, Weighted Average Grant Date Fair Value (in dollars per share)			$ 0.75	$ 2.24
Share-Based Payment Arrangement, Option [Member]
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Amount	$ 15,600,000		$ 15,600,000		$ 18,200,000
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Period for Recognition (Year)			2 years 3 months 10 days		2 years 6 months 29 days
The 2014 Stock Plan [Member]
Share-Based Compensation Arrangement by Share-Based Payment Award, Options, Outstanding, Number (in shares)	5,361,318		5,361,318
The 2020 Stock Plan [Member]
Common Stock, Capital Shares Reserved for Future Issuance (in shares)	18,400,000		18,400,000
Share-Based Compensation Arrangement by Share-Based Payment Award, Options, Grants in Period, Gross (in shares)			17,251,106
Share-Based Compensation Arrangement by Share-Based Payment Award, Number of Shares Available for Grant (in shares)	1,148,894		1,148,894
The 401(k) Plan [Member]
Defined Contribution Plan, Employer Matching Contribution, Percent of Match			100.00%
Defined Contribution Plan, Maximum Annual Contributions Per Employee, Percent			3.00%
Defined Contribution Plan, Maximum Annual Contributions Per Employee, Amount			$ 4,500
Defined Contribution Plan, Cost	$ 31,000	$ 34,000	$ 200,000	$ 200,000

Note 11 - Benefit Plans - Stock-based Compensation Expense (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Total stock-based compensation expense	$ 2,396	$ 2,098	$ 7,070	$ 6,484
Share-Based Payment Arrangement, Option [Member]
Total stock-based compensation expense	2,384	2,098	7,044	6,484
Restricted Stock Awards [Member]
Total stock-based compensation expense	12	0	26	0
General and Administrative Expense [Member]
Total stock-based compensation expense	1,311	1,247	3,888	4,056
Research and Development Expense [Member]
Total stock-based compensation expense	$ 1,085	$ 851	$ 3,182	$ 2,428

Note 11 - Benefit Plans - Activity Related to Outstanding Stock Options (Details) - USD ($) $ / shares in Units, $ in Thousands	9 Months Ended	12 Months Ended
	Sep. 30, 2023	Dec. 31, 2022
Beginning balance outstanding, number of options (in shares)	15,260,297
Beginning balance outstanding, weighted average exercise price per share (in dollars per share)	$ 2.98
Outstanding, weighted average remaining term (Year)	7 years 5 months 26 days	7 years 3 months 10 days
Outstanding, intrinsic value	$ 712	$ 2,348
Granted, number of options (in shares)	6,690,263
Granted, weighted average exercise price per share (in dollars per share)	$ 0.95
Granted, weighted average remaining term (Year)	9 years 8 months 12 days
Forfeited, number of options (in shares)	(433,262)
Forfeited, weighted average exercise price per share (in dollars per share)	$ 4.51
Ending balance outstanding, number of options (in shares)	21,517,298	15,260,297
Ending balance outstanding, weighted average exercise price per share (in dollars per share)	$ 2.3	$ 2.98
Vested and exercisable, number of options (in shares)	10,074,211
Vested and exercisable, weighted average exercise price per share (in dollars per share)	$ 2.69
Vested and exercisable, weighted average remaining term (Year)	5 years 7 months 6 days
Vested and exercisable, intrinsic value	$ 712
Vested, exercisable and expected to vest, number of options (in shares)	21,517,298
Vested, exercisable and expected to vest, weighted average exercise price per share (in dollars per share)	$ 2.3
Vested, exercisable or expected to vest – September 30, 2023 (Year)	7 years 5 months 26 days
Vested, exercisable or expected to vest – September 30, 2023	$ 712

Note 11 - Benefit Plans - Assumptions of Stock Options (Details)	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Expected dividend yield	0.00%	0.00%
Minimum [Member]
Expected stock price volatility	96.22%	89.57%
Risk-free interest rate	3.26%	1.65%
Expected term of options (in years) (Year)	5 years	5 years
Maximum [Member]
Expected stock price volatility	103.24%	98.13%
Risk-free interest rate	4.41%	3.00%
Expected term of options (in years) (Year)	6 years 5 months 4 days	6 years 11 months 23 days

Note 11 - Benefit Plans - Activity Related to Restricted Stock Awards (Details)	9 Months Ended
	Sep. 30, 2023 $ / shares shares
Granted, number of restricted stock awards (in shares) \| shares	43,479
Granted, weighted average grant date fair value (in dollars per share) \| $ / shares	$ 1.15
Converted to shares of Common Stock upon vesting, number of restricted stock awards (in shares) \| shares	(21,739)
Converted to shares of Common Stock upon vesting, weighted average grant date fair value (in dollars per share) \| $ / shares	$ 1.15
Restricted Stock [Member]
Unvested balance, number of restricted stock awards (in shares) \| shares	769,139
Unvested balance, weighted average grant date fair value (in dollars per share) \| $ / shares	$ 9.84
Forfeited, number of restricted stock awards (in shares) \| shares	(746)
Forfeited, weighted average grant date fair value (in dollars per share) \| $ / shares	$ 9.84
Unvested balance, number of restricted stock awards (in shares) \| shares	790,133
Unvested balance, weighted average grant date fair value (in dollars per share) \| $ / shares	$ 9.6

Note 12 - Fair Value (Details Textual) $ in Millions	12 Months Ended
Note 12 - Fair Value (Details Textual) $ in Millions	Dec. 31, 2022 USD ($)
Common Stock Warrant Liability [Member]
Unrealized Gain (Loss) on Derivatives	$ 0.2

Note 12 - Fair Value - Assets and Liabilities Measured on a Recurring Basis (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Clene Nanomedicine contingent earn-out liability	$ 150		$ 2,264
Initial Stockholders contingent earn-out liability	19		291
Fair value			4,983
Commercial Paper [Member]
Fair value			3,482
Corporate Debt Securities [Member]
Fair value			1,501
Fair Value, Inputs, Level 1 [Member]
Clene Nanomedicine contingent earn-out liability	0		0
Initial Stockholders contingent earn-out liability	0		0
Fair Value, Inputs, Level 1 [Member] \| Commercial Paper [Member]
Fair value			0
Fair Value, Inputs, Level 1 [Member] \| Corporate Debt Securities [Member]
Fair value			0
Fair Value, Inputs, Level 2 [Member]
Clene Nanomedicine contingent earn-out liability	0		0
Initial Stockholders contingent earn-out liability	0		0
Fair Value, Inputs, Level 2 [Member] \| Commercial Paper [Member]
Fair value			3,482
Fair Value, Inputs, Level 2 [Member] \| Corporate Debt Securities [Member]
Fair value			1,501
Fair Value, Inputs, Level 3 [Member]
Clene Nanomedicine contingent earn-out liability	150		2,264
Initial Stockholders contingent earn-out liability	19		291
Fair Value, Inputs, Level 3 [Member] \| Commercial Paper [Member]
Fair value			0
Fair Value, Inputs, Level 3 [Member] \| Corporate Debt Securities [Member]
Fair value			0
Money Market Funds [Member]
Cash Equivalents	14,058		14,317
Money Market Funds [Member] \| Fair Value, Inputs, Level 1 [Member]
Cash Equivalents	14,058		14,317
Money Market Funds [Member] \| Fair Value, Inputs, Level 2 [Member]
Cash Equivalents	0		0
Money Market Funds [Member] \| Fair Value, Inputs, Level 3 [Member]
Cash Equivalents	0		$ 0
US Treasury Securities [Member]
Cash Equivalents	24,164
US Treasury Securities [Member] \| Fair Value, Inputs, Level 1 [Member]
Cash Equivalents	0
US Treasury Securities [Member] \| Fair Value, Inputs, Level 2 [Member]
Cash Equivalents	24,164
US Treasury Securities [Member] \| Fair Value, Inputs, Level 3 [Member]
Cash Equivalents	0
Common Stock Warrant Liability [Member]
Common stock warrant liabilities	1,860
Balance	0	$ 474
Initial fair value of instruments	7,818
Change in fair value	(5,958)	(151)
Balance	1,860	18
Reclassification from liability to equity		(305)
Common Stock Warrant Liability [Member] \| Fair Value, Inputs, Level 1 [Member]
Common stock warrant liabilities	0
Common Stock Warrant Liability [Member] \| Fair Value, Inputs, Level 2 [Member]
Common stock warrant liabilities	0
Common Stock Warrant Liability [Member] \| Fair Value, Inputs, Level 3 [Member]
Common stock warrant liabilities	1,860
Clene Nanomedicine Contingent Earn-out [Member]
Balance	2,264	18,100
Initial fair value of instruments	0
Change in fair value	(2,114)	(6,662)
Balance	150	11,438
Reclassification from liability to equity		0
Initial Stockholders Contingent Earn-out [Member]
Balance	291	2,317
Initial fair value of instruments	0
Change in fair value	(272)	(849)
Balance	$ 19	1,468
Reclassification from liability to equity		$ 0

Note 12 - Fair Value - Unobservable Inputs (Details)	Sep. 30, 2023	Dec. 31, 2022
Measurement Input, Price Volatility [Member] \| Contingent Earnout Shares [Member]
Derivative, unobservable input	1	1.15
Measurement Input, Price Volatility [Member] \| Minimum [Member] \| New Avenue Warrant [Member]
Derivative, unobservable input	0.70
Measurement Input, Price Volatility [Member] \| Minimum [Member] \| Tranche A Warrant [Member]
Derivative, unobservable input	0.75
Measurement Input, Price Volatility [Member] \| Minimum [Member] \| Tranche B Warrant [Member]
Derivative, unobservable input	1
Measurement Input, Price Volatility [Member] \| Maximum [Member] \| New Avenue Warrant [Member]
Derivative, unobservable input	1.10
Measurement Input, Price Volatility [Member] \| Maximum [Member] \| Tranche A Warrant [Member]
Derivative, unobservable input	1.10
Measurement Input, Price Volatility [Member] \| Maximum [Member] \| Tranche B Warrant [Member]
Derivative, unobservable input	1.10
Measurement Input, Risk Free Interest Rate [Member] \| Contingent Earnout Shares [Member]
Derivative, unobservable input	0.05	0.042
Measurement Input, Risk Free Interest Rate [Member] \| Minimum [Member] \| New Avenue Warrant [Member]
Derivative, unobservable input	0.0463
Measurement Input, Risk Free Interest Rate [Member] \| Minimum [Member] \| Tranche A Warrant [Member]
Derivative, unobservable input	0.0487
Measurement Input, Risk Free Interest Rate [Member] \| Minimum [Member] \| Tranche B Warrant [Member]
Derivative, unobservable input	0.0388
Measurement Input, Risk Free Interest Rate [Member] \| Maximum [Member] \| New Avenue Warrant [Member]
Derivative, unobservable input	0.0552
Measurement Input, Risk Free Interest Rate [Member] \| Maximum [Member] \| Tranche A Warrant [Member]
Derivative, unobservable input	0.055
Measurement Input, Risk Free Interest Rate [Member] \| Maximum [Member] \| Tranche B Warrant [Member]
Derivative, unobservable input	0.0497
Measurement Input, Expected Dividend Rate [Member] \| New Avenue Warrant [Member]
Derivative, unobservable input	0
Measurement Input, Expected Dividend Rate [Member] \| Tranche A Warrant [Member]
Derivative, unobservable input	0
Measurement Input, Expected Dividend Rate [Member] \| Tranche B Warrant [Member]
Derivative, unobservable input	0
Measurement Input, Expected Dividend Rate [Member] \| Contingent Earnout Shares [Member]
Derivative, unobservable input	0	0
Measurement Input, Expected Term [Member] \| Contingent Earnout Shares [Member]
Derivative, unobservable input	2.25	3
Measurement Input, Expected Term [Member] \| Minimum [Member] \| New Avenue Warrant [Member]
Derivative, unobservable input	0.58
Measurement Input, Expected Term [Member] \| Minimum [Member] \| Tranche A Warrant [Member]
Derivative, unobservable input	0.75
Measurement Input, Expected Term [Member] \| Minimum [Member] \| Tranche B Warrant [Member]
Derivative, unobservable input	1.46
Measurement Input, Expected Term [Member] \| Maximum [Member] \| New Avenue Warrant [Member]
Derivative, unobservable input	4.75
Measurement Input, Expected Term [Member] \| Maximum [Member] \| Tranche A Warrant [Member]
Derivative, unobservable input	0.0271
Measurement Input, Expected Term [Member] \| Maximum [Member] \| Tranche B Warrant [Member]
Derivative, unobservable input	7
Measurement Input, Probability of Change of Control [Member] \| New Avenue Warrant [Member]
Derivative, unobservable input	5
Measurement Input, Probability of NDA Acceptance [Member] \| Tranche A Warrant [Member]
Derivative, unobservable input	0.30
Measurement Input, Probability of NDA Approval [Member] \| Tranche B Warrant [Member]
Derivative, unobservable input	0.225
Measurement Input, Probability of Dissolution [Member] \| New Avenue Warrant [Member]
Derivative, unobservable input	0.60
Measurement Input, Probability of Dissolution [Member] \| Tranche A Warrant [Member]
Derivative, unobservable input	0.60
Measurement Input, Probability of Dissolution [Member] \| Tranche B Warrant [Member]
Derivative, unobservable input	0.715
Measurement Input, Probability of Fundamental Transaction [Member] \| Tranche A Warrant [Member]
Derivative, unobservable input	0.05
Measurement Input, Probability of Fundamental Transaction [Member] \| Tranche B Warrant [Member]
Derivative, unobservable input	0.05
Measurement Input, Probability of Other Outcome [Member] \| New Avenue Warrant [Member]
Derivative, unobservable input	0.35
Measurement Input, Probability of Other Outcome [Member] \| Tranche A Warrant [Member]
Derivative, unobservable input	0.05
Measurement Input, Probability of Other Outcome [Member] \| Tranche B Warrant [Member]
Derivative, unobservable input	0.01

Note 13 - Capital Stock (Details Textual) - USD ($)				1 Months Ended		3 Months Ended		9 Months Ended		12 Months Ended
Note 13 - Capital Stock (Details Textual) - USD ($)	Mar. 03, 2023	Apr. 14, 2022	Dec. 30, 2020	Jun. 30, 2023	Oct. 31, 2022	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022	May 31, 2021
Common Stock, Shares Authorized (in shares)						300,000,000		300,000,000		150,000,000
Common Stock, Par or Stated Value Per Share (in dollars per share)			$ 0.0001			$ 0.0001		$ 0.0001		$ 0.0001
Preferred Stock, Shares Authorized (in shares)						1,000,000		1,000,000
Preferred Stock, Par or Stated Value Per Share (in dollars per share)						$ 0.0001		$ 0.0001
Common Stock, Shares, Issued (in shares)						128,411,981		128,411,981		74,759,591
Preferred Stock, Shares Issued (in shares)						0		0		0
Class of Warrant or Right, Number of Securities Called by Warrants or Rights (in shares)						105,432,083		105,432,083		4,477,045
Proceeds from Issuance of Common Stock								$ 0	$ 132,000
Payments of Stock Issuance Costs								(0)	100,000
Gain (Loss) on Issuance of Equity						$ 0	$ 0	$ (14,840,000)	$ 0
Common Stock, Shares, Outstanding (in shares)						128,411,981		128,411,981		74,759,591
Preferred Stock, Shares Outstanding (in shares)						0		0		0
Lincoln Park Capital Fund, LLC [Member]
Stock Issued During Period, Shares, New Issues (in shares)	332,668
Purchase Agreement, Commencing Period (Month)	36 months
Purchase Agreement, Regular Purchase (in shares)	75,000
Purchase Agreement, Regular Purchase, Shares, Closing Price One (in shares)	100,000
Purchase Agreement, Closing Price One (in dollars per share)	$ 1
Purchase Agreement, Regular Purchase, Shares, Closing Price Two (in shares)	150,000
Purchase Agreement, Closing Price Two (in dollars per share)	$ 2
Purchase Agreement, Regular Purchase, Shares, Closing Price Three (in shares)	200,000
Purchase Agreement, Closing Price Three (in dollars per share)	$ 4
Purchase Agreement, Accelerated Purchase, Maximum Percentage of Regular Purchase	300.00%
Purchase Agreement, Accelerated Purchase, Maximum Percentage Of Prior Day Volume	30.00%
Purchase Agreement, Additional Accelerated Purchase, Maximum Percentage of Regular Purchase	300.00%
Purchase Agreement, Additional Accelerated Purchase, Maximum Percentage of Prior Day Volume	30.00%
Purchase Agreement, Price Discount of Additional Purchases	97.00%
Purchase Agreement, Additional Commitment Shares (in shares)	166,334
Purchase Agreement, Shares Sell Limitation (in shares)	15,310,115
Purchase Agreement, Shares Sell Limitation, Percentage Of Outstanding Shares	19.99%
Percentage of Common Stock Beneficial Ownership	4.99%
Derivative, Notional Amount						$ 0		$ 0
Lincoln Park Capital Fund, LLC [Member] \| Maximum [Member]
Purchase Agreement, Amount Of Shares Commit To Purchase	$ 25,000,000
Percentage of Common Stock Beneficial Ownership	9.99%
Lincoln Park Capital Fund, LLC [Member] \| Minimum [Member]
Purchase Agreement, Minimum Average Price Per Share To Avoid Sell Limitation (in dollars per share)	$ 1.2404
Lincoln Park [Member] \| Purchase Agreement [Member]
Stock Issued During Period, Shares, New Issues (in shares)						0		400,000
Proceeds from Issuance or Sale of Equity								$ 400,000
Offering Agreement [Member]
Stock Issued During Period, Shares, New Issues (in shares)					10,723,926
Shares Issued, Price Per Share (in dollars per share)					$ 1.01
Proceeds from Issuance of Common Stock					$ 10,800,000
Payments of Stock Issuance Costs					$ 25,000
Underwriting Agreement [Member] \| Canaccord [Member]
Payments of Stock Issuance Costs				$ 200,000
Unit Issued During Period, Units, New Issues (in shares)				50,000,000
Unit Issued, Price Per Unit (in dollars per share)				$ 0.8
Each Unit, Number of Common Stock (in shares)				1
Proceeds from Issuance or Sale of Equity				$ 40,000,000
Payment for Underwriting Fees and Commissions				2,400,000
Gain (Loss) on Issuance of Equity				$ (14,800,000)
ATM Facility [Member]
Stock Issued During Period, Shares, New Issues (in shares)						0	40,000	2,895,090	40,000
Proceeds from Issuance of Common Stock							$ 100,000	$ 4,500,000	$ 100,000
Aggregate Offering Price		$ 50,000,000
Fixed Commission Rate Percentage		3.00%
Payments for Commissions								$ 100,000
Commitment Shares [Member] \| Lincoln Park [Member] \| Purchase Agreement [Member]
Stock Issued During Period, Shares, New Issues (in shares)								2,893
Warrants with Tranche 2 of 2021 Avenue Loan [Member]
Class of Warrant or Right, Number of Securities Called by Warrants or Rights (in shares)											115,851
Warrants Originally Issued by Tottenham Acquisition I Limited [Member]
Class of Warrant or Right, Number of Securities Called by Warrants or Rights (in shares)			2,407,500
Class of Warrant or Right, Number of Securities Called by Each Warrant or Right (in shares)			0.5
Class of Warrant or Right, Exercise Price of Warrants or Rights (in dollars per share)			$ 0.01
Class of Warrant or Right, Redemption, Threshold Stock Price Trigger (in dollars per share)			$ 16.5
Class of Warrant or Right, Redemption, Threshold Consecutive Trading Days (Day)			20 days
Class of Warrant or Right, Redemption, Threshold Trading Days (Day)			30 days
Class of Warrant or Right, Exercised During Period (in shares)								0		0
Chardan Unit Purchase Option [Member]
Class of Warrant or Right, Number of Securities Called by Warrants or Rights (in shares)			24,583
Class of Warrant or Right, Number of Securities Called by Each Warrant or Right (in shares)			0.5
Class of Warrant or Right, Exercised During Period (in shares)								0		0
Warrants Originally Issued by Clene Nanomedicine [Member]
Class of Warrant or Right, Number of Securities Called by Warrants or Rights (in shares)			1,929,111
Class of Warrant or Right, Number of Securities Called by Each Warrant or Right (in shares)			1
Warrants with Tranche 2 of 2021 Avenue Loan [Member]
Class of Warrant or Right, Exercised During Period (in shares)								0
New Avenue Warrant [Member]
Class of Warrant or Right, Number of Securities Called by Warrants or Rights (in shares)				3,000,000
Class of Warrant or Right, Exercised During Period (in shares)								0
Tranche A Warrant [Member]
Class of Warrant or Right, Number of Securities Called by Warrants or Rights (in shares)				50,000,000
Class of Warrant or Right, Number of Securities Called by Each Warrant or Right (in shares)				1
Class of Warrant or Right, Exercised During Period (in shares)								0
Tranche A Warrant [Member] \| Canaccord [Member]
Class of Warrant or Right, Number of Securities Called by Each Warrant or Right (in shares)				1
Class of Warrant or Right, Exercise Price of Warrants or Rights (in dollars per share)				$ 1.1
Each Unit, Number of Warrant (in shares)				1
Tranche B Warrant [Member]
Class of Warrant or Right, Number of Securities Called by Warrants or Rights (in shares)				50,000,000
Class of Warrant or Right, Number of Securities Called by Each Warrant or Right (in shares)				1
Class of Warrant or Right, Exercised During Period (in shares)								0
Tranche B Warrant [Member] \| Canaccord [Member]
Class of Warrant or Right, Number of Securities Called by Each Warrant or Right (in shares)				1
Class of Warrant or Right, Exercise Price of Warrants or Rights (in dollars per share)				$ 1.5
Each Unit, Number of Warrant (in shares)				1

Note 13 - Capital Stock - Outstanding Warrants (Details) - $ / shares	Sep. 30, 2023	Dec. 31, 2022
Number of shares issuable (in shares)	105,432,083	4,477,045
Common Stock Warrant Exercisable on December 2020, One [Member]
Exercise price (in dollars per share)	$ 11.5
Number of shares issuable (in shares)	2,407,500	2,407,500
Common Stock Warrant Exercisable on December 2020, Two [Member]
Exercise price (in dollars per share)	$ 11.5
Number of shares issuable (in shares)	24,583	24,583
Common Stock Warrant Exercisable on December 2020, Three [Member]
Exercise price (in dollars per share)	$ 1.97
Number of shares issuable (in shares)	0	1,929,111
Common Stock Warrant Exercisable on May 2021 [Member]
Exercise price (in dollars per share)	$ 8.63
Number of shares issuable (in shares)	0	115,851
Common Stock Warrant Exercisable on June 2023, One [Member]
Exercise price (in dollars per share)	$ 0.8
Number of shares issuable (in shares)	3,000,000	0
Common Stock Warrant Exercisable on June 2023, Two [Member]
Exercise price (in dollars per share)	$ 1.1
Number of shares issuable (in shares)	50,000,000	0
Common Stock Warrant Exercisable on June 2023, Three [Member]
Exercise price (in dollars per share)	$ 1.5
Number of shares issuable (in shares)	50,000,000	0

Note 14 - Net Loss Per Share - Computation of Basic and Diluted Net Income (Loss) Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022	Sep. 30, 2023	Sep. 30, 2022
Net loss	$ (2,418)	$ (25,143)	$ (11,770)	$ (10,976)	$ (4,534)	$ (13,354)	$ (39,331)	$ (28,864)
Weighted average common shares used to compute basic and diluted net loss per share (in shares)	128,405,483			63,508,928			97,026,964	63,234,757
Net loss per share – basic and diluted (in dollars per share)	$ (0.02)			$ (0.17)			$ (0.41)	$ (0.46)

Note 14 - Net Loss Per Share Attributable to Common Stockholders - Antidilutive Securities Excluded from Computation (Details) - shares	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Antidilutive securities (in shares)	136,064,551	24,494,791	136,064,551	24,494,791
Convertible Notes Payable [Member]
Antidilutive securities (in shares)	1,732,703	482,703	1,732,703	482,703
Common Stock Warrants [Member]
Antidilutive securities (in shares)	105,432,083	4,477,045	105,432,083	4,477,045
Share-Based Payment Arrangement, Option [Member]
Antidilutive securities (in shares)	21,517,298	12,173,570	21,517,298	12,173,570
Restricted Stock [Member]
Antidilutive securities (in shares)	790,133	769,139	790,133	769,139
Contingent Earnout Shares [Member]
Antidilutive securities (in shares)	6,592,334	6,592,334	6,592,334	6,592,334

Note 15 - Related Party Transactions (Details Textual) - 4Life [Member] - Supply Agreement [Member]	1 Months Ended
	Aug. 31, 2018
Related Party Transaction, Exclusive License Term (Year)	5 years
Related Party Transaction, Royalty Fee Rate for Revenues	3.00%

Note 15 - Related Party Transactions - Revenue From 4Life Agreement (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Revenue	$ 108	$ 174	$ 484	$ 239
Related Party [Member]
Revenue	107	171	449	227
Product [Member]
Revenue	65	130	355	139
Product [Member] \| Related Party [Member]
Revenue	64	127	320	127
Royalty [Member]
Revenue	43	44	129	100
Royalty [Member] \| Related Party [Member]
Revenue	$ 43	$ 44	$ 129	$ 100

Note 16 - Segment Information - Profit and Loss Information by Reportable Segment (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Revenue from external customers	$ 108	$ 174	$ 484	$ 239
Segment loss from operations	(9,542)	(9,805)	(30,610)	(36,736)
Operating Segments [Member] \| Drugs Segment [Member]
Revenue from external customers	0	0	0	0
Segment loss from operations	(9,622)	(10,073)	(30,945)	(37,012)
Operating Segments [Member] \| Supplements Segment [Member]
Revenue from external customers	108	174	484	239
Segment loss from operations	$ 80	$ 268	$ 335	$ 276

Note 16 - Segment Information - Reconciliation of the Reportable Segments' Loss From Operations to Consolidated (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Segment loss from operations	$ (9,542)	$ (9,805)	$ (30,610)	$ (36,736)
Total other income (expense), net	7,124	(1,171)	(8,721)	7,872
Net loss before income taxes	$ (2,418)	$ (10,976)	$ (39,331)	$ (28,864)

Note 16 - Segment Information - Assets by Reportable Segment (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Total assets	$ 60,433	$ 44,493
Operating Segments [Member] \| Drugs Segment [Member]
Total assets	17,787	20,476
Operating Segments [Member] \| Supplements Segment [Member]
Total assets	268	386
Corporate, Non-Segment [Member]
Total assets	$ 42,378	$ 23,631