Stocks/GUTS

GUTS

Fractyl Health, Inc. Common Stock
Healthcare·Biotechnology
$0.81
$58M market cap
Claude Rating
2/10SHORT
Revenue
$0.0M
Free Cash Flow
$-87.8M
Rev Growth
+0.0%
FCF Margin
0.0%
P/FCF
--
EV/FCF
--
Fwd EV/EBITDA
--
Fair Value
$0.35
Upside
-56.8%

Fractyl Health, Inc., a metabolic therapeutics company, develops therapies for the treatment of type 2 diabetes (T2D) and obesity. The company develops Revita DMR System (Revita), an outpatient procedural therapy designed to durably modify duodenal dysfunction, a pathologic consequence of a high fat and high sugar diet, which can initiate T2D and obesity in humans. It also develops Rejuva, a novel virus delivered pancreatic gene therapy platform that is designed to enable long-term remission of

2-Year Price History

$0.91-85.2%
$1.0$2.0$3.0$4.0$5.0$6.0volJun 24Oct 24Jan 25May 25Sep 25Jan 26May 26

Quarterly Financials & Projections

Quarterly Waterfall ($ M)
PeriodRevEBITDAOpInNIOCFFCFCapExCashDebtSharesROICIntCovEV/EBITDA
Est2028-Q13.0-15.0---15.9---13.5-1.14.7----------
Est2027-Q42.0-15.0---16.0---14.0-1.018.2----------
Est2027-Q31.0-16.0---17.0---15.0-0.832.2----------
Est2027-Q20.5-17.5---18.0---16.0-0.547.2----------
Est2027-Q10.00.0--0.0--0.0-0.063.2----------
Est2026-Q40.00.0--0.0--0.0-0.063.2----------
Est2026-Q30.00.0--0.0--0.0-0.063.2----------
Est2026-Q20.00.0--0.0--0.0-0.063.2----------
Act2026-Q10.0-20.5-20.89.2-22.5-22.5-0.063.260.875.8-22.7%----
Act2025-Q40.0-23.0-23.3-43.7-21.3-21.3-0.081.561.775.8-25.9%----
Act2025-Q30.0-45.3-22.7-45.6-22.7-22.7-0.077.762.264.7-25.8%----
Act2025-Q20.0-25.8-26.1-27.9-21.2-21.3-0.122.361.749.0-30.6%----
Act2025-Q10.0-24.5-24.8-23.7-25.1-25.5-0.542.161.448.9-26.8%----
Act2024-Q40.0-25.0-25.2-25.0-17.0-17.3-0.267.562.548.8-25.3%----
Act2024-Q30.0-23.6-23.8-23.2-18.0-18.3-0.284.762.948.0-22.3%----
Act2024-Q20.0-22.8-23.0-17.2-18.7-19.0-0.3102.461.247.9-20.4%----
Act2024-Q10.0-21.5-21.5-3.3-11.7-12.8-1.1121.460.547.9-18.3%----
Act2023-Q40.0-12.9-13.0-19.2-10.6-10.7-0.133.5373.747.6-13.9%----
Act2023-Q30.0-13.8-13.9-15.8-11.0-11.2-0.244.555.547.6-16.2%----
Act2023-Q20.1-11.8-11.9-30.2-11.7-11.7-0.127.737.547.8-126.6%----
Act2023-Q10.0-12.0-12.1-11.9-9.6-9.6-0.00.00.047.9-19.2%----
Act2022-Q40.0-11.3-11.4-10.9-12.5-12.5-0.049.3306.847.6-14.9%----
Act2022-Q10.0-13.1-13.2-12.3-12.0-12.0-0.095.50.047.6-207.0%----
Historical Valuation

Multiples vs the company's own history — cheap or rich relative to itself? Historical fiscal years, then TTM, then forward projections (E). Forward rows hold today's price against projected earnings, so the multiple compresses if the company grows into it.

YearPriceRev GrEBITDA %EBITDAEV/EBITDAEV/FCFP/EP/S
2023-42099.2%-51
20242.06-22.5%-99843.0%-93n/mn/mn/m>999×
20252.20-100.0%-119n/mn/mn/m
TTM0.81-100.0%-1150.0×0.0×0.0×
2027E0.81-13.9%-00.0×0.0×0.0×0.0×

EBITDA in reporting-currency $M. Historical multiples use year-end market cap (split-adjusted price history); TTM & forward years use today's.

AI Analysis

LLM Evaluations

Claude2/10SHORTFV: $0.35

Fractyl Health is a pre-revenue clinical-stage biotech facing existential risk on multiple fronts: going concern doubt, Nasdaq delisting, 8.6-month cash runway, massive accumulated deficit ($512M+), predatory debt terms (13.25%+ floating rate with PIK and exit fees), and a single-asset pipeline whose midpoint data has already disappointed. The REMAIN-1 pivotal readout in Q4 2026 is a pure binary event, but even in a positive scenario, the company must raise capital at deeply distressed levels with 41.5M warrants already outstanding and 224% annual dilution. The competitive landscape is increasingly hostile as oral GLP-1s emerge, potentially eliminating the need for an invasive endoscopic procedure. The risk/reward is severely skewed to the downside: probability-weighted fair value is well below the current share price given ~55% bankruptcy odds within 8 quarters and massive dilution even in survival scenarios.

Catalyst REMAIN-1 pivotal trial 6-month primary endpoint data readout in early Q4 2026 is the sole near-term catalyst. A statistically significant result showing ≥50% reduction in weight regain vs. sham could temporarily re-rate the stock, but would still require massive dilutive financing to commercialize.
Risk Trial failure on REMAIN-1 pivotal data would result in near-total equity value destruction given zero revenue, depleted cash, and no viable alternative pipeline asset.
Trend
STABLE
Mgmt
4/10
Quarter
4/10
Exp. Move
-3.0%

Latest Earnings Call

Transcript Summary

Fractyl Health’s Q1 2026 earnings call focused on the progression of its Revita and Rejuva platforms. CEO Dr. Harith Rajagopalan highlighted Revita's role as a durable solution for patients discontinuing GLP-1 therapies, addressing the widespread issue of weight rebound. The REMAIN-1 pivotal trial completed randomization, with 6-month primary endpoint data anticipated in early Q4 2026 and an FDA De Novo submission targeted for late Q4 2026. Management emphasized strong clinical validation from DDW and favorable regulatory developments, including the CMS/FDA RAPID pathway which could streamline reimbursement. Additionally, the Rejuva gene therapy platform reached a clinical milestone with the authorization of its first Phase I/II study in the Netherlands for RJVA-001. First-in-human dosing is expected in H2 2026. Financially, Fractyl reported $63.2 million in cash, providing a runway into early 2027. The CEO firmly committed to not raising capital before the pivotal data readout, utilizing the current cash to reach major catalysts. The company remains focused on delivering three clinical data readouts by year-end, positioning 2026 as a transformative year for its metabolic disease pipeline.

Valuation & Metrics

Market Stats

Price$0.81
Market Cap$58M
Enterprise Value$56M
P/S Ratio0.0x
P/FCF--
EV/FCF--
FCF Margin (TTM)0.0%
FCF Yield-150.9%
Dividend Yield (TTM)--
Annual Dilution55.2%
CurrencyUSD

TTM Financial Snapshot

Revenue$0.0M
Net Income$-108.0M
Free Cash Flow$-87.8M

Revenue Growth (YoY)+0.0%
EBITDA Margin0.0%
Net Margin0.0%
FCF Margin0.0%
CapEx % of Revenue0.0%
SBC % of Revenue0.0%
ROIC-26.3%
WC Change % Rev0.0%
Interest Coverage--

DCF Fair Value Estimate

$-0.38
-146.9% upside
Fair Enterprise Value$-287M
− Net Debt$-2M
= Fair Equity$-29M
Revenue Growth0.0% → 1.0%
FCF Margin0.0% → 0.0%
Discount Rate18.0%
Terminal EV/FCF6.0x

Forward Outlook & Risk

Short Interest

Short % of Float10.2%
Short Shares3.0M
Days to Cover1.6
Change (vs Prior)-22.7%
Short % Float History
10.20%+1.10pp
10.0%20.0%30.0%40.0%50.0%04-3007-1509-1511-1401-1504-30

Forward Projections & Estimates

NTM Revenue Growth+0.0%
Forward FCF Margin0.0%
Forward EBITDA Margin0.0%
Forward P/FCF--
Forward EV/FCF--
Forward Int. Coverage--
Model Risk Score10/10
Bankruptcy Odds55%
Est. Borrow Rate85.0%
Terminal EV/FCF6.0x
LT Growth0.0%
LT FCF Margin0.0%

Employees

Headcount107
Revenue / Employee$0
Gross Profit / Employee$-2,710
2023: 102 → 2024: 107 → 2025: 100 (-1% CAGR)

Cash Runway

8.6months
CRITICAL

Institutional Ownership

Headline & net flow

NET SELLING

In Q1 2026 so far (quarter still filing), institutions are net sellers — bought 29.6% of float, sold 143.2%. 16 filers moved >1% of shares (2 buying, 14 selling).

Net flow · Q1 2026still filing
-113.6% of float (net)
Bought 29.6% · Sold 143.2%
83 filers reported (last quarter: 98)

Ownership composition

Active
43.7%(+6.2% YoY)
72 filers
hedge / family / endowment
Retail funds
Fidelity, Schwab, 401(k)
Passive
7.4%(-1.2% YoY)
7 filers
Vanguard, iShares, SPDR
Market makers
0.2%(+0.0% YoY)
3 filers
Citadel, Susquehanna
Insiders
7.4%
Form 4 — latest per insider
0%25%50%75%100%2024-032024-092025-032025-092026-03
ActiveRetail fundsPassiveMarket makersRetail direct

Top holders

Fund$ valueCost basisΔ QoQΔ YoYα lifeFund AUM
Nantahala Capital Management, LLC$6.1M$1.40+$1.2M+$6.1M-2.3%$1.60B
683 Capital Management, LLC$3.1M$2.24+$311K+$2.8M-2.1%$1.02B
Pale Fire Capital SE$2.7M$1.40+$1.2M+$2.7M+0.8%$1.14B
VANGUARD CAPITAL MANAGEMENT LLCPassive$2.5M$0.46+$2.5M+$2.5M$4.04T
Catalio Capital Management, LP$2.5M$1.64+$0+$2.4M+3.6%$479M
General Catalyst Group Management, LLC$2.2M$1.62+$0+$2.2M-2.5%$184M
Deer Management Co. LLC$2.2M$7.40+$0+$0-4.4%$622M
MAVERICK CAPITAL LTD$1.8M$7.40−$125K−$125K-1.3%$8.60B
Woodline Partners LP$1.0M$1.85−$1.5M+$790K-0.1%$26.43B
BlackRock, Inc.Passive$980K$2.36+$26K−$145K-0.2%$5.69T
M28 Capital Management LP$850K$7.40+$0+$0-6.8%$53.8M
SILVERARC CAPITAL MANAGEMENT, LLC$779K$1.68−$3.7M+$670K-0.1%$843M
UBS Group AG$743K$1.41+$233K+$711K-0.3%$562.11B
GEODE CAPITAL MANAGEMENT, LLCPassive$657K$2.41+$78K+$421K+2.3%$1.61T
CM Management, LLC$641K$1.19+$275K+$641K-4.4%$120M
Ikarian Capital, LLC$504K$1.59+$0+$504K-8.8%$698M
Logos Global Management LP$458K$1.92−$46K+$458K-1.6%$1.94B
MARSHALL WACE, LLP$372K$2.02−$2.3M+$372K+0.6%$92.71B
VANGUARD FIDUCIARY TRUST COPassive$278K$0.46+$278K+$278K$395.83B
Burkehill Global Management, LP$229K$1.59+$0+$229K+5.0%$1.91B
Cost basis is a volume-weighted estimate from accumulation periods within our 13F history; holders who built their position before our window started will show a stale basis. % above the cost basis is the unrealized gain at the current price.

Trading behavior

Smart-money alpha (lifetime, %/qtr)NEUTRAL
Holders
-1.61%
avg per quarter
Holders (ex-self)
-1.45%
excl. this stock
Buyers (this Q)
-0.42%
14 buyers · $0.00B in
Sellers (this Q)
-0.22%
28 sellers · $0.08B out
alpha coverage: 91% of $ has a lifetime-alpha record
Holder behavior on this stocksource: stock
On big dips (−10%+)
+5.4%
how holders react when this stock falls
On quiet Qs
+7.4%
−10% to +10% baseline
On rallies (+10%+)
+18.6%
how they react when this stock rises
Holders' portfolio flow this Q
+6.6%
inflows — adds are organic
Sellers' portfolio flow this Q
+10.0%
Sellers grew AUM elsewhere — opinionated cut of this stock.
▸ Compare to holder-profile behavior (across all their stocks)
Holder dip (any stock)
-1.3%
Holder mid (any stock)
-6.9%
Holder rally (any stock)
-10.9%

Top Holders Over Time

5-year share-count history (top 10 holders by peak, incl. exited) + price

013.5M27.0M40.5M53.9M$0.46$2.19$3.93$5.66$7.402024-032024-092025-032025-092026-03
hover the chart for per-quarter detailprice (right axis)
Deer Management Co. LLC4.8MHCC Manager LLCMAVERICK CAPITAL LTD4.0MNantahala Capital Management, LLC13.4MSILVERARC CAPITAL MANAGEMENT, LLC1.7MM28 Capital Management LP1.9M683 Capital Management, LLC6.7MMARSHALL WACE, LLP808KCITADEL ADVISORS LLC48KWoodline Partners LP2.2M

Analyst Coverage

Analyst Coverage
Price Targets
Last Year (2 analysts)$5.0052020.0%
Current Price$0.81
Analyst Ratings
2
1
Buy: 2Hold: 1Consensus: Buy
Consensus Estimates
QuarterRevenueEBITDANet IncEPSEPS Range# Analysts
2028 Q38M2M-8M$-0.10$-0.10 – $-0.101
2028 Q411M2M-8M$-0.10$-0.10 – $-0.101
2029 Q117M3M-5M$-0.06$-0.06 – $-0.061
2029 Q221M4M-3M$-0.04$-0.04 – $-0.041
2029 Q321M4M-3M$-0.04$-0.04 – $-0.041
2029 Q425M5M-3M$-0.04$-0.04 – $-0.041
2030 Q136M7M2M$0.02$0.02 – $0.021
2030 Q245M9M4M$0.05$0.05 – $0.051
2030 Q344M9M3M$0.04$0.04 – $0.041
2030 Q452M10M5M$0.06$0.06 – $0.061

Corporate

Executive Compensation (2023-2025)

Direct Pay$9.6M
Incentive & Other$24.8M
Total Compensation$34.4M
% of Revenue16548.3%

Insider Trading (last 12mo)

Open-market only (Form 4 P-Purchase + S-Sale). Excludes grants, option exercises, tax withholding, gifts.
Officers & directors
Buys ($, 12mo)
$20K
1 txn · 1 insider · 10,416 sh
Sells ($, 12mo)
$0
0 txns · 0 insiders · 0 sh
Recent transactions
DateSideInsiderTitleSharesPriceDollarsOwned $
2025-12-04BUYRajagopalan Harithdirector, officer: Chief Executive Officer10,416$1.92$20K$963K

Order Flow (FINRA, ~3w lag)

60.9%retail-0.5pp
8.9%dark-0.7pp
week of 2026-04-13
0%20%40%60%24-1125-0225-0525-0825-1126-0226-04retail (non-ATS)dark (ATS)
Off-exchange volume from FINRA. Retail = non-ATS (wholesaler PFOF + broker internalization). Dark = ATS (dark-pool crossing networks, institutional). Lit-exchange = remainder.

Filing Risk Analysis

Filing Risk Scores

Fractyl Health, Inc.: Paper Profits Mask a Liquidity Death Spiral

Overall Risk
9/10
Fraud
3/10
Dilution
10/10
Insolvency
10/10
Earnings Overstated
8/10
Hidden Liabilities
6/10
Legal
4/10
Audit Warnings
10/10
Hidden Upside
2/10
Contextually Acceptable
2/10

Counter-Thesis

Counter-Thesis & Recent News

📰 Recent News

Fractyl Health (GUTS) experienced a catastrophic 67% share price collapse on January 29, 2026, following news that it requested FDA feedback to pivot its Revita regulatory strategy from a Premarket Approval (PMA) to a 'De Novo' pathway. While management framed this as an 'optimized' route, the market viewed the shift as a major red flag regarding the treatment's clinical efficacy. More recently, in May 2026, the company reported a Q1 2026 adjusted EBITDA loss of $18 million. Despite claiming a cash runway into early 2027, the stock remains pinned near all-time lows around $0.75 (Investing.com, Stock Titan).

🐻 Bear Case

The core bear case centers on Revita's underwhelming clinical performance. In January 2026, Morgan Stanley downgraded GUTS to 'Equal-weight' and slashed its price target from $8.00 to $2.00, citing randomized six-month results that 'fell short of expectations' and raised serious questions about Revita's ability to actually maintain weight loss after GLP-1 discontinuation. Furthermore, GUTS is a 'single-asset' story; if the REMAIN-1 pivotal data (expected Q4 2026) fails to show a significant and durable advantage over sham procedures, the company has no viable revenue stream, as its current revenue is negligible or zero (Morgan Stanley, KoalaGains).

🚩 Red Flags

Significant red flags include a formal investigation by DJS Law Group for potential securities law violations related to misleading disclosures about the FDA pathway (January 2026). Financially, the company carries a staggering accumulated deficit of over $512 million and suffers from persistent 'going concern' risk. Frequent dilutive financing is a recurring issue; a $20 million offering in August 2025 caused a 47% one-day drop. Additionally, a $20.2 million non-cash warrant liability revaluation recently contributed to a massive $43.7 million quarterly net loss, signaling a complex and fragile capital structure (Business Wire, Griffonomics, TipRanks).

⚔️ Competitive Threats

Fractyl faces an almost insurmountable 'GLP-1 wall.' Blockbuster drugs like Mounjaro and Ozempic have set an incredibly high bar for efficacy with a non-invasive, self-administered profile. While Fractyl targets patients who *stop* these drugs, the imminent arrival of next-generation oral GLP-1s from Eli Lilly and Novo Nordisk could render an invasive endoscopic procedure like Revita obsolete. Payers and patients are increasingly likely to opt for a second-line pill rather than an outpatient surgical procedure with uncertain long-term durability (KoalaGains, Seeking Alpha).

💬 Customer Sentiment

Sentiment is bifurcated and skeptical. While the company reports 'strong physician demand' for its clinical trials, the broader market sentiment is decidedly negative, reflected by a 'Hold/Sell' consensus among major institutions. Skeptics argue that the 'medical tragedy' of weight regain after GLP-1 cessation is real, but patients who already experienced 'GLP-1 burnout' or side effects are unlikely to trust a gut-altering procedure that Morgan Stanley notes has yet to prove its efficacy in a rigorous randomized setting (InvestingPro, Griffonomics).

Full Earnings Call Transcript

Full Earnings Call Transcript — Q1 • 2026-05-12

Operator: Good afternoon, and welcome to Fractyl Health First Quarter 2026 Financial Results and Business Update Call. [Operator Instructions]. I'll now turn the call over to Brian Luque, Head of Investor Relations and Corporate Development at Fractyl. Brian, you may now begin.
Brian Luque: Thank you. This afternoon, we issued a press release that outlines the topics we plan to discuss today. This release is available at www.fractyl.com under the Investors tab. Joining us on the call today are Dr. Harith Rajagopalan, Chief Executive Officer; and Lara Smith Weber, Chief Financial Officer. During this call, we make forward-looking statements, which involve risks and uncertainties that may cause our actual results to differ materially from those expressed or implied by forward-looking statements. A discussion of these risks and uncertainties is included in our filings with the SEC from time to time, including the section titled Risk Factors in our annual report on Form 10-K for the year ended December 31, 2025, and our quarterly report on Form 10-Q filed today, which I encourage you to review. Any forward-looking statements on the call are subject to substantial risks and uncertainties, speak only as of the call's original date, and we undertake no obligation to update or revise any of the statements, even if subsequent events cause our views to change. It is now my pleasure to pass the call over to Harith.
Harith Rajagopalan: Thank you, Brian. Good afternoon, everyone. Tens of millions of Americans are now on GLP-1 therapy and over 1 million people are discontinuing GLP-1s each month in the United States. What happens next is increasingly well characterized, regain of roughly 10% of total body weight in the first 6 months and 15% total body weight by 12 months. Every one of those patients stopping a GLP-1 faces a moment with no durable off-ramp, no alternative to either resuming chronic pharmacotherapy or accepting the risk of the return of the weight they worked so hard to lose. The more weight loss on GLP-1s, the greater the risk of rapid weight and metabolic rebound upon discontinuation. Revita is being built for that moment. On our Q4 earnings call in March, we made 4 commitments to this audience. First, we said that the signal is real, and we understand with greater clarity how Revita works and in whom it works best. Second, we said that the pivotal trial is fully randomized, built to succeed and executing on plan. Third, we said the path from clinical data to commercial value is clear and that we are actively building it. And fourth, we said that we have the financial runway to reach pivotal data without a planned capital raise and that we intend to hold that line. Q1 2026 was a quarter of execution and today, I want to reaffirm these 4 commitments and give you a clear accounting on each of them. Let me take them each in turn. First, the clinical signal is real, the medical community sees it and appreciate its potential. In March, we shared 2 findings from our REMAIN-1 midpoint cohort study that formed a clinical foundation for the pivotal study, a larger treatment effect in participants with higher run-in GLP-1 induced weight loss and a statistically significant dose-dependent treatment effect tied to duodenal ablation length, the right dose in the right patients. In early May, we presented the REMAIN-1 midpoint cohort 6-month data at Digestive Disease Week, or DDW, which is the largest international meeting in gastroenterologists, hepatology and endoscopy. DDW was jointly sponsored by 4 major medical societies and showcases more than 6,000 abstracts on the latest advances in GI research medicine and technology. Ahead of this year's meeting, the DDW program committee selected the REMAIN-1 midpoint cohort for its Press Program, 1 of only 4 studies featured from those 6,000-plus accepted abstracts. This was the first time the dose response analysis and patient selection findings were presented in a peer-reviewed setting to a broad and expert clinical audience. During the meeting, we convened in a clinical advisory board with leading gastroneurologists and metabolic medicine physicians from across the country, and the discussions confirmed their alignment on the mechanism, the procedural rationale and our pivotal study design. Beyond the science, these are the clinicians who, in our view, are best positioned to lead a center of excellence model in bariatric and metabolic endoscopy, pending potential FDA approval of Revita. We already have a strong network of champion physicians who have been part of our clinical trial program over the years, and we are cultivating even more relationships now in parallel with the pivotal study. The enthusiasm among the physician community for a new therapeutic option in metabolic endoscopy and in particular, for a solution for post GLP-1 rebound is real, palpable and growing. When management tells you the clinical signal is real, that is our conviction. When the clinical community, the world's largest GI meeting chooses your study for more than 6,000 abstracts as one of the 4 most newsworthy and engages with the data on its scientific merits, that is external validation. And when we begin lining up the clinical leaders who would deliver this therapy if and when it reaches the market, that is preparation. We have all 3: Conviction, scientific validation and clinical champions. Point number two, the pivotal is executing on plan. Not only does the clinical community appreciate that the Revita clinical signal is real and growing, the REMAIN-1 pivotal cohort completed randomizations in February with more than 300 participants across more than 30 sites across the United States. It's the largest sham-controlled GI endoscopy pivotal trial ever conducted. Every operational metric that predicts pivotal success continues to track favorably. Let's turn to the analytical framework for the pivotal cohort. We have 2 prespecified co-primary endpoints. The first measures the percent total body weight regain at 6 months in Revita participants versus sham after the discontinuation of tirzepatide. This is the endpoint that anchors our early Q4 readout. As I noted earlier, the published trajectory in patients with discontinued GLP-1 therapy is to expect roughly 10% total body weight regain by 6 months. Against that benchmark, a meaningful, statistically significant reduction in regain in the Revita arm versus sham, particularly in patients, participants with longer ablation lengths or higher run-in weight loss is what we believe a successful readout looks like. The second co-primary endpoint is a responder rate at 52 weeks defined as a percentage of Revita treated participants who maintain at least 5% total body weight loss from pre-tirzepatide levels through 1 year. Together, these endpoints test both the magnitude and the durability of the Revita treatment effect. Alongside the co-primaries, we will also evaluate the high run-in weight loss patient selection and dose response as key secondary end points that emerged from the midpoint cohort data analysis. Participant retention in the pivotal study continues to exceed well over 90%. Medication resumption rates remain below our modeled assumptions. The blinded adverse event profile remains consistently reassuring and in line with what we have seen in our prior studies. The study is running as planned. We remain on track as well to deliver top line 6-month primary endpoint data in early Q4 2026. The countdown to last patient 6-month visit in Q3 is clear and well defined. On regulatory progress, we previously reported in March, favorable FDA feedback on our de novo classification request, confirming our review that Revita's safety profile is consistent with a moderate risk rather than a high-risk device classification. I'm pleased to reaffirm that we are on track for FDA submission in late Q4 2026 with our 6-month pivotal data in hand. Number three, we are actively building the commercial path. The underlying commercial opportunity has only continued to accelerate since we last spoke to you. In early April, FDA approved Foundayo, the first once-daily oral GLP-1 for chronic weight management. This is a meaningful development in its own right and a concrete accelerator of the population that will eventually face post GLP-1 weight regain. And while the advent of oral GLP-1s provides more options for patients, early data suggests that patients are not titrating their oral GLP-1s or refilling them at the expected rates, indicating that the need for a durable alternative will likely still be very large even though the number of GLP-1 initiators only continues to grow. These market dynamics are favorable for Revita's position in the market. On the payer side, public programs are moving to expand low-cost access to GLP-1 therapies for Medicare and Medicaid beneficiaries. The specific policy mechanics for GLP-1 coverage are still being worked out, but the underlying direction is unmistakable. Seniors, a population with among the highest obesity prevalence and among the highest risk of GLP-1 discontinuation, will have meaningfully expanded access to these therapies over the next 18 months. And that matters for Revita for a simple reason. Every additional patient who starts a GLP-1 is another patient who will eventually face the question of what to do when that drug is discontinued. As public payers take on more of the cost of chronic GLP-1 therapy, the economic case for a durable, well-timed alternative gets sharper. Remember, approximately 1 million patients per month are discontinuing GLP-1s and needing a safe and effective off-ramp. The problem of post GLP-1 rebound turns a chronic heterogeneous disease like obesity into an acute problem that mandates an acute solution. Today, the only options are to continue chronic pharmacotherapy or accept the risk of rebound, Revita is being built to be the third answer at that moment of decision. One additional development from the past few weeks deserves special mention as well. In late April, CMS and FDA jointly announced the RAPID coverage pathway designed to align Medicare national coverage with FDA market authorization for eligible breakthrough devices. Under RAPID, CMS issued a proposed national coverage determination on the same day of device received FDA authorization with full national coverage and payment potentially in place within approximately 2 months. We believe Revita may be well positioned to benefit from this pathway. Revita holds FDA breakthrough device designation in both weight maintenance after GLP-1 discontinuation and type 2 diabetes. Our REMAIN-1 pivotal study is an FDA-approved IDE trial measuring clinically meaningful outcomes that we believe are relevant to both FDA review and Medicare coverage. And we have a track record of CMS collaboration. Our prior Revita IDE studies in type 2 diabetes received Medicare coverage of routine costs and study-related expenses. RAPID builds on that foundation. The pathway is still early in implementation, and we are continuing to work through the specifics with our reimbursement experts, but our initial read is that RAPID materially derisks and potentially accelerates the commercialization reimbursement time line for Revita should we reach the market. Beyond RAPID, our broader reimbursement infrastructure continues to advance on schedule. We remain on track to file a Category III CPT code application this summer with a code that would be expected to be effective in the summer of 2027. Transitional pass-through payment from CMS continues to provide a clear, positive pathway to a favorable contribution margin for hospitals should Revita reach the market. And one lesson we are learning from physicians at DDW is that this transitional pass-through payment mechanism has been successfully used in GI endoscopy by centers across the country presenting a compelling option for Revita Centers of Excellence to be able to secure payment soon after launch. And to our knowledge, Revita remains the only potential procedural therapy in development for post GLP-1 weight maintenance. Certainly, it's the only potential post GLP-1 weight maintenance option with pivotal trial data expected within 6 months. Turning briefly to Rejuva, our smart GLP-1 gene therapy platform targeting long-term metabolic remission from a single dose. We recently received authorization from EU regulatory authorities in the Netherlands to initiate the Phase I/II first-in-human study of the RJVA-001 drug candidate, the first clinical candidate from our Rejuva platform. With this authorization, we believe RJVA-001 is a first AAV-based gene therapy candidate to enter clinical development for type 2 diabetes, and Fractyl now advances Rejuva to a clinical stage just as Revita is potentially poised to exit clinical stage and graduate to commercial stage over the coming quarters. RJVA-001 is a onetime beta-cell targeted gene therapy designed to enable nutrient-responsive physiologic GLP-1 expression within the pancreas potentially avoiding the high circulating drug levels that contribute to side effects seen with systemic GLP-1 therapy. The therapy is delivered by a minimally invasive endoscopic ultrasound guided infusion directly into the pancreas, and this authorization reflects years of rigorous translational work, deep engagement with regulators and a disciplined tissue-targeted approach to local AAV gene therapy that we believe differentiates RJVA-001. We also plan to conduct the study at other sites in Europe and in Australia, where a clinical trial application has also been submitted. Regulatory feedback for Australia is expected in the third quarter of this year. Pending site activation, we expect to dose the first patient with RJVA-001 and report preliminary data in the second half of 2026. As a deliberate part of our capital allocation strategy, Rejuva clinical development is funded within our existing cash runway into early 2027, beyond the anticipated REMAIN-1 pivotal data readout, and there is no change to our capital plans. So before I turn to Lara, I want to spend a moment on what the next several months look like. 3 of Revita data readouts lie ahead between now and year-end. The first 2 will provide specific incremental signals about what the pivotal cohort is likely to show and the third is a pivotal data itself. Before I walk through each, let me be specific about what a good result looks like because we get that question often. The published literature predicts that patients who have lost approximately 20% total body weight on GLP-1 and then stop that medicine, regain approximately 15% of their total body weight within a year. Against that benchmark, we would view roughly a 50% reduction in weight regain or 7.5% or less as a strong 12-month result in these studies for patients, clinicians, regulators, payers and investors alike. And based on the dose response and patient selection findings we have already described, we would expect the signal to be even stronger in participants with higher run-in weight loss and longer ablation lengths. The pilot sham control data provides visibility into the right dose in the right patients and the upcoming clinical milestones offer the opportunity to bear that thesis out. Investors have also asked whether we intend to present these upcoming data sets through the same dose response and run-in weight loss lenses we used at Q4 earnings. The answer is yes. The biology has not changed and neither has our view of how to interpret the data. In Q2, we will see 1-year data from the REVEAL-1 cohort, our open-label study. REVEAL-1 enrolled a population with broadly varied run-in GLP-1 exposure and a significant weight loss. Representative of the variation we would expect to see in a real-world GLP-1 discontinuer population. 12-month data from this cohort is our first look at how durable the Revita treatment effect is after a full year of GLP-1 therapy. It will not, on its own, settle the durability question, but it is a critical important first read on the shape of the curve. Remember that REVEAL-1 patients lost more than 20% total body weight on GLP-1 over more than a year on medicine and we would expect a regain of about 15% at 1 year and those who discontinue. We look forward to seeing what the data from REVEAL-1 cohort teach us. The second major data catalyst is in Q3, 12-month randomized sham-controlled data from the REMAIN-1 midpoint cohort. This is the same cohort in which we shared our 6-month randomized data now with 6 additional months of follow-up under a blinded, randomized, sham-controlled design. At 6 months, we observed a compounding monotonically increasing separation between Revita and sham in the optimized patient population. If that trajectory continues, 12-month randomized data will potentially show a durable treatment effect in the same cohort over a period of time that regulatory guidance equates to durability of therapeutic effect. The third major data catalyst is a pivotal itself with top line 6-month data expected in early Q4. By the time this readout arrives, investors will have seen 2 prior data points through 12 months that provide the opportunity to build conviction leading into the definitive pivotal readout. We believe this is a potentially rich and systematic catalyst setup up into the year-end and potential regulatory filing. With 12-month data from the REVEAL-1 and the midpoint cohort and top line 6-month data from the pivotal cohort, the entire clinical profile for Revita in post GLP-1 weight maintenance has the potential to be substantially clarified and defined by Q4 of this year. Layer on top of this, the clinical profile -- layer on top of this clinical profile, the favorable feedback we've already received on our device classification, the breakthrough device designation in GLP-1 weight maintenance, the streamlined reimbursement pathway just announced by CMS and and the vocal support of clinical champions in GI endoscopy, and we believe we are set up for an exciting upcoming set of quarters. Catalyst summary. In Q2, the DDW presentations are now complete. RJVA-001 CTA regulatory feedback has been received, and we will soon see REVEAL-1 12-month open-label data. Q3 REMAIN-1 midpoint cohort 12-month randomized sham-controlled data. Early Q4, top line 6-month randomized data from the REMAIN-1 pivotal cohort and late Q4 potential de novo marketing application submission for Revita in post GLP-1 weight maintenance. In parallel, in H2, we expect to see first-in-human dosing of RJVA-001 and reporting of preliminary data subject to FirstSight activation for Rejuva. Lara?
Lara Weber: Thank you, Harith. Research and development expenses were $15.6 million for Q1 2026 compared to $19.4 million for the same period in 2025. The decrease was primarily related to reduced spending on our Revita and Rejuva programs as well as lower personnel-related expenses. SG&A were stable coming in at $5.2 million for Q1 2026 compared to $5.3 million for the same period in 2025. We reported net income of $9.2 million for Q1 2026 compared to a net loss of $23.7 million for the same period in 2025. The shift was driven by a $30.1 million noncash accounting change in the fair value of our warrant liabilities which does not reflect a change in our underlying operating performance. Our total operating expenses for Q1 2026 were $3.9 million lower than the same period in 2025. Adjusted EBITDA was negative $18 million for Q1 2026 compared with negative $23 million in Q1 of 2025. The decrease was primarily due to a decrease in operating expenses. As of March 31, 2026, we had approximately $63.2 million in cash and cash equivalents. Q1 spend included certain one-off costs, primarily associated with completing REMAIN-1 pivotal cohort randomization and is not representative of our expected run rate for the remainder of the year. Based on current business plans, the cash position is expected to fund operations into early 2027, beyond anticipated REMAIN-1 pivotal data readout in early Q4 2026 and through a potential de novo submission in late Q4 2026. With that, I'll turn it back to Harith.
Harith Rajagopalan: Thank you, Lara. Before we open Q&A, I want to reaffirm our capital posture without ambiguity. Our ATM facility remains closed. We do not plan to raise capital before we have pivotal data in hand. Our runway extends into early 2027. This posture is a deliberate choice, grounded in conviction. We believe the pivotal data will be successful, and we are operating within our existing capital envelope as a signal of management's alignment with shareholders through the most consequential 6 months in this company's history. I want to acknowledge the patients in our pivotal study who trust us with their health and their commitment. The investigators and operators who have executed the trial with skill and rigor, our employees whose focused through a demanding stretch of clinical and operational work has been exceptional, and our shareholders whose conviction in the science makes everything we are building possible. Operator, we're ready to take questions.
Operator: [Operator Instructions]. And our first question comes from the line of Whitney Ijem of Canaccord Genuity.
Angela Qian: This is Angela on for Whitney. Maybe a question to start on Rejuva. Can you just walk us through how you're thinking about enrollment time lines, the target product profile. And then what should we expect to see from the preliminary data set in the second half of the year?
Harith Rajagopalan: Sure. So subject to site activation, there is a several-week run-in period for first patients. Just remember, this is a 3x3 study design. So first patients will be treated at an initial dose. We'll evaluate safety, feasibility and initial PK/PD from those 3 individuals before we consider escalating to the next dosing regime. And what you would expect is that we will -- that each patient will be treated and then there will be a short period of time in between each individual patient is dosed within each cohort. The initial thing that we're obviously looking for and the clear early signal pertains to the safety and the feasibility of the delivery. And that is an answer that we should be able to see within the first 1 to 2 weeks of patients being dosed. But we don't expect to really see preliminary PK and PD signals until roughly 8 weeks afterwards. When the GLP-1 level expression levels should be reaching their target levels. And then the effect on glucose and insulin related physiology will be discernible. And so we'll give you an update after those first patients are enrolled on both initial safety and feasibility, and then you'll get a sense for what we expect to see from an efficacy standpoint.
Operator: And our next question comes from the line of Umer Raffat of Evercore.
Michael DiFiore: This is Mike DiFiore in for Umer. Congrats on all the progress. A few quick ones from me. First one regarding de novo submission rate. My question is, is an all-comer pivotal success required for de novo submission? Or could a dose response or subgroup data influence the regulatory package there. Separately, any updates in the German commercial use? Any insights gained from that? I know it's kind of been a while since that's been going on. And last question is -- yes, I'll just leave it there.
Harith Rajagopalan: Sure. So the de novo pathway has a different clinical threshold than a PMA. Though, I think we are -- we feel like we are highly confident in the pivotal trial success under any metric, and I don't think that we have anything to worry about there. de novo, because it's deemed moderate risk, and because the FDA thinks about benefit risk ratio, the de novo seeks a reasonable assurance of safety and effectiveness which is often translated to interpret the totality of clinical evidence rather than any one single p-value. And so I do think that there is flexibility there. I don't think we're going to need it. With respect to German commercial use, we are continuing to follow patients -- and we are -- and we have patients who are, as you know, we reported 2-year data last year, continuing to follow up to 5 years. And so we will have an update for you in the coming quarters once a reasonable number of patients have hit 3 years, which hasn't quite happened yet. That's the next major update to come. And we're not giving guidance on exactly when that will be, but you can reasonably expect it to be coming in the coming quarters. Yes, we're excited about what that can show about the durability of effect, obviously, and round out the clinical picture of what the real world use looks like for Revita.
Operator: Our next question comes from the line of Jason Gerberry of Bank of America Securities.
Chi Meng  Fong: This is Chi on for Jason. Maybe just piggyback on the de novo marketing application submission. Would you expect to file to include a 1-year REVEAL-1 cohort data and the 1-year REMAIN-1 midpoint cohort data in the submission package? And to what extent those 1-year data while not in the pivotal cohort, to what extent those 1-year data can support the totality of the data in terms of the de novo marketing application?
Harith Rajagopalan: We'll be submitting all of the data to the FDA and totality of data means totality of data. So we've been working on Revita and establishing the science now for the better part of a decade. We have hundreds of patients that we've treated across a range of different clinical venues, clinical trial sites and patient populations. We do intend to file on the REVEAL-1 data on the REMAIN-1 midpoint cohort data in order to contribute to the totality of that evidence. And I believe that the FDA, based on prior experience with de novo will consider the totality of available evidence when making their marketing authorization decision in the de novo pathway. And I think that, that provides us all of the reassurance and confidence that we are well on our way. The pivotal trial is built to succeed. We have a favorable feedback from the FDA. I think all signs are pointing green for us.
Operator: Our next question comes from the line of Mike Ulz of Morgan Stanley.
Michael Ulz: Maybe just a follow-up on the RJVA-001 study that you're getting underway here. Can you just comment on the first dose cohort? Should we think about that as an active dose? Or is the way to think about it is maybe you started with a lower dose to kind of check the box on safety before you start increasing the dose?
Harith Rajagopalan: Yes, statutory requirement here is that the first dose should be an active dose and patients should be able to benefit from it. That's absolutely our intent with the first dose. This is a first time of performing this route of administration for this disease. And so we are obviously going to want to ensure that we are cautious in our approach and putting patient safety first, but we are optimistic in being able to see active signals, once enough time has transpired after the administration.
Operator: Our next question comes from the line of Jeffrey Cohen of Ladenburg Thalmann & Co.
Jeffrey Cohen: Firstly, could you talk about DDW a little bit in your advisory board and maybe give us a sense of some of the questions, curiosities, pushback, feedback, et cetera, that you received from physicians and clinicians.
Harith Rajagopalan: I love DDW. It's a great meeting for us. The physicians who attend are leaders in GI endoscopy. Many of them are building practices around metabolic and bariatric endoscopy and our leaders in the society as well as in clinical practice around the country. We have been sharing our REMAIN pivotal midpoint cohort data, our REVEAL open-label data. We've been walking through our pivotal study and our commercialization plans and have gotten incredibly positive feedback from folks all over the United States from L.A. to New Hampshire from Seattle, Washington to Miami, Florida. One benefit we have is that the clinical infrastructure that we built to run our pivotal studies, the physician relationships that we've established, the training that we've done all represent the baseline sort of commercial distribution infrastructure with champions who are familiar with the technology, who have enrolled the patients in the study, who have seen how they have done with their own eyes. Their enthusiasm gives us the fuel and fire to continue to proceed in a way that is as optimistic as we are.
Jeffrey Cohen: And then as a follow-up, could you maybe talk about any net material adds or changes to the IP portfolio in the past quarter, including both potentially Rejuva as well. Thank you.
Harith Rajagopalan: We continue to strengthen our IP portfolio. We had in Q1 adds to the strength and breadth of our Revita portfolio, and we've been continuing to focus Rejuva on establishing a strong IP landscape around the device around the procedure and how the device and procedure and the gene therapy product and how they all work together to ensure what we believe will be a safe and feasible administration of the gene therapy. So I don't know if any new patents were issued in the first quarter off the top of my head, but I'm going to find out, and I will get you that answer but we do have a very strong and robust portfolio across both Revita and Rejuva.
Operator: [Operator Instructions]. Our next question comes from the line of Joe Pantginis of H.C. Wainwright.
Unknown Analyst: Hello, everyone. This is [ Lambert ] on for Joe. So for Rejuva, when should we expect regulatory feedback from additional European countries for the Phase I/II trial. And also, can you provide some color on past, current or future interactions with the FDA for the progress of Rejuva in the U.S.
Harith Rajagopalan: Well, we have all of the feedback we need in order to initiate the RJVA-001 study in Europe, and I think that's the most important point. We chose Netherlands because there is an excellent very highly regarded internationally recognized GI endoscopist who does clinical research in the area at an Amsterdam University Medical Center, where we anticipate our first patients in Europe being treated or being enrolled is -- has a track record of conducting high-quality gene therapy study. Our next guidance for you is that we expect Australian -- or feedback from regulatory authorities in Australia in Q3. So that's what I would look to next. With respect to the FDA, while we've had positive repetitive interactions with the regulators in Europe, we have not yet approached the FDA on this topic. And I don't have a guidance for you yet on when we will, but our plan is to secure early safety feasibility data in this first-in-human study before discussing with the FDA.
Unknown Analyst: Awesome. Very helpful. Thank you so much.
Operator: I'd now like to turn the call back to Dr. Rajagopalan for closing remarks.
Harith Rajagopalan: Well, thank you, everyone. We are executing. The science is working. We have 3 major clinical catalysts from REMAIN-1 program coming in the next 6 months with pivotal top line data in early Q4. Thank you for the call.
Operator: This concludes today's conference call. Thank you for participating. You may now disconnect.