IMDX Submits GraftAssureDx for FDA Review and Reports Q4 2025 Results

IMDX Submits GraftAssureDx for FDA Review and Reports Q4 2025 Results IMDX Submits GraftAssureDx for FDA Review and Reports Q4 2025 Results GlobeNewswire March 26, 2026

NASHVILLE, Tenn., March 26, 2026 (GLOBE NEWSWIRE) -- Insight Molecular Diagnostics Inc., iMDx, (Nasdaq: IMDX), today published the following letter to shareholders in conjunction with its fourth quarter results:

Fellow shareholders,

We are pleased to share that GraftAssureDx has become, to our knowledge, the first ever kitted dd-cfDNA assay to be submitted to the FDA for regulatory review. Our FDA submission this week represents the culmination of 12 years of clinical development and three years of highly focused technical product development.

We see many positive signals that the transplant community is ready for GraftAssureDx.

In the past three months, we have doubled the number of transplant centers interested in what we are building. We are now engaged with 37 centers in the U.S. and 11 internationally, through our research-use-only assay as well as through our registry study. The 37 centers that we are engaged with in the U.S. include 28 transplant centers that want to join our registry trial, which we discuss in more detail under “2026 goals.”

We are thrilled to be able to share such a significant improvement in market access since our last update. The 37 centers in the U.S. with which we are engaged represent more than 25% of all transplants performed annually in the United States. We look forward to engaging with more centers over the coming quarters as word continues to spread about the advantages of our technology.

We expect that our test kits will deliver new value in the roughly $2 billion addressable market for regulated transplant rejection testing. We believe we are delivering the right product to the right market, at the right time, and that we are in the first stages of a dramatic shift in patient management, positioning ourselves to lead.

It's clear to us that market demand for regulated and decentralized molecular testing is growing. At the same time, more head-to-head data has emerged showing the reliability of our GraftAssure technology in field, and new peer-reviewed publications are highlighting the benefits of our assay.

For the remainder of this letter, we will cover:

Regarding timelines on FDA submission and authorization:

Looking forward, the FDA guides to a 150-day review process for de novo submissions like ours, and therefore we continue to plan for an FDA-authorized product this year. To note, when the FDA has a question, it can stop the clock relative to its 150-day guidance. Consequently, our teams are working to anticipate and prepare for FDA reviewer questions so that we may respond quickly and remain on track in the review process.

We have made a review-ready submission with sufficient analytical data and clinical evidence to support that our assay is safe and effective for using the fractional measurement of dd-cfDNA to assess the likelihood of transplanted organ rejection.

As we’ve previously discussed, we will continue to collect clinical samples to add incremental claims associated with our assay including absolute measurements of dd-cfDNA (copies per milliliter) and our combination score (CM-score). Supplementary data collection is a standard practice in IVD submissions and does not affect the expected approval timeline of our initial submission.

We are grateful to our clinical trial partners for helping to advance the science of transplant patient management. We are also grateful for the support of Bio-Rad Laboratories, which not only invested in our equity for a fourth time in February, but also provided in-kind support and a team of scientists who worked tirelessly alongside us to support a timely FDA submission.

Finally, iMDx leadership is proud of its broader team’s ability to manage complexity and coordinate with multiple stakeholders, including our kit manufacturer, software vendor, the clinical trial sites, and our strategic partner, Bio-Rad.

Our 2026 Goals:

We believe that 2026 represents our transition from a product development-stage company into a commercialization-stage company, and accordingly, we are making controlled investments in sales and marketing to support our kidney transplant assay. Our goals for 2026 include the following:

Favorable head-to-head data

In February, at the Cutting Edge of Transplantation (CEoT) conference in Scottsdale, Ariz., a leading American transplant hospital presented its head-to-head study findings comparing our flagship organ transplant assay technology with a leading industry competitor providing centralized testing. In medical diagnostics, a head-to-head study is the highest level of comparison one can conduct, involving the same sample tested by two separate tests. The hospital’s independent conclusion was favorable for our assay, and the researcher presenting the data shared that his hospital seeks to implement in-house testing because of their assessment.

The above study represents the second head-to-head comparison between GraftAssure and other technologies on the market. In June 2025, we announced separate favorable head-to-head data that was presented at the European Society of Organ Transplantation (ESOT) Congress in London as well as at the European Renal Association (ERA) meeting. Notably, the study showed high diagnostic concordance between the two assays for rejection.

We expect more head-to-head data to emerge as more researchers and institutions engage and begin to utilize our technology. The emergence of this data is a positive development ahead of commercial launch of the FDA-authorized product, as it builds confidence with clinicians before choosing to switch to in-house testing.

Anticipating emerging clinical utility

We believe that over the next three years, the organ transplant rejection testing market is likely to shift from one that is primarily dominated by tests used to avoid biopsies in for-cause patients to tests that actively manage patients post-transplant. Importantly, we believe this will enable a new era of surveillance, prophylaxis and therapy monitoring: Clinicians will be trying to catch organ rejection as early as possible so that kidneys express less damage and stay in patients longer.

Monitoring the health of a transplanted organ is important, because everyone – from patient to clinician to donors at the time that they selflessly opt into organ donation – wants the donated organ to support another person’s second shot at life. For this reason, transplanted organ rejection is a major and heartbreaking tragedy.

Our assay is designed to help clinicians monitor the health of the patient’s transplanted organ. It does this by measuring donor-derived cell-free DNA (dd-cfDNA), which is fragments of DNA from the transplanted organ that circulate in the patient’s bloodstream. When the organ is healthy, these fragments are present at low, stable levels. And when the organ is under stress or being rejected, more organ cells are injured and release higher amounts of this DNA into circulation. By measuring this signal through a simple blood draw, dd-cfDNA testing provides a non-invasive readout of organ health. This type of testing is already available on the market via a test-send-out model from centralized labs. We are seeking to enable transplant centers to perform this type of testing in-house.

What we are finding is that our assay may offer unique benefits beyond simply enabling in-house testing with shorter turnaround times. We believe that the unique design of our assay is also poised to expand the clinical usefulness of dd-cfDNA testing, for reasons we discuss below.

Our assay can measure both the absolute quantities of the donated organ’s DNA fragments as well as their relative quantities. One historical limitation of dd-cfDNA testing has been that it works well in finding antibody-mediated rejection (AMR), but not so well with finding t-cell mediated rejection (TCMR). Recent work done with our research partners, built on the recent publication by Vaulet et al., referenced below, shows how well our assay’s CM-score performed (p=0.0158) at finding TCMR-related activity. One explanation may be, per the paper, “that infiltrating recipient immune cells undergo cell death within the graft during TCMR, contributing substantially to circulating total cfDNA levels and thereby diluting the relative dd-cfDNA fraction when expressed as a percentage. … [O]ur findings for the first time provide a plausible mechanistic explanation for why low-grade TCMR is difficult to detect when dd-cfDNA is expressed as a percentage alone.”

In layman’s terms, it looks like TCMR may be self-masking. By putting more recipient DNA into the blood, TCMR throws off the fractional measurement of dd-cfDNA, making the signal harder to see. Because our assay was designed to also quantify the absolute amount of dd-cfDNA, which is unaffected by the increase in recipient DNA, these data suggest that our assay may allow for a more accurate measure of the likelihood of transplanted organ rejection.

Later this year, we expect to see more publications coming out that show how combining the relative and absolute measure (CM-score) improves the positive predictive value of dd-cfDNA testing. Meaning, using our assay has the potential benefit of fewer false positives, and therefore helping clinicians to potentially avoid unnecessary biopsies. We expect this will become more important as the market for dd-cfDNA shifts from for-cause testing to ongoing monitoring, or screening.

We believe that screening organs will only increase in importance as new and more effective ways to treat organ rejection emerge. In recent quarters, better pharmaceutical solutions to organ rejection are starting to gain a foothold – including in the form of anti-CD38 drugs, which are immunotherapies that were developed to treat cancer. We are starting to see signs that 2026 could be the year that anti-CD38 drugs such as felzartamab and daratumumab start to enter routine clinical practice in treating transplanted organ rejection.

Multiple studies are on-going and results that show effective management of AMR are likely to build on the excitement that was generated with the publication of the phase 2 study of felzartamab in the New England Journal of Medicine (NEJM). As a reminder, our assay was used in monitoring the transplanted organ health in the ground-breaking NEJM study published in 2024, which led to the FDA’s Breakthrough Therapy Designation of felzartamab in October 2024.

Finally, and even more favorably, GraftAssure’s ability to pick up on low levels of signal – known as sensitivity – may also play a role in expanding the clinical utility of dd-cfDNA testing. We have demonstrated analytical sensitivity for dd-cfDNA quantification at low levels and the lowest relative change value (RCV), defined as the difference between the two values to signify meaningful change, both critical for recurrence monitoring. GraftAssure can quantify lower levels of dd-cfDNA and pick up meaningful longitudinal trends well before the moment of pathogenesis and graft deterioration.

In sum, we believe that our assay’s positive predictive value and analytical performance both position GraftAssure well to be the technology of choice in this emerging clinical environment.

References:

Progress since our November shareholder letter:

Fourth Quarter and Full Year 2025 Financial Overview

Webcast and Conference Call Information

Live Zoom Call and Webcast on Thursday, March 26, 2026, at 2:00 p.m. PT / 5:00 p.m. ET.

Those interested may access the live Zoom call by registering here: iMDx Q4 2025 Earnings Webinar

Once registered, a confirmation email will be sent with instructions.

A replay of the Zoom call will be available on the company’s website shortly after the call.

iMDx Transplant Products and Product Candidates in Development

iMDx’s flagship transplant testing technology quantifies a molecular biomarker known as donor-derived cell-free DNA (dd-cfDNA). The company’s scientists in Germany and the U.S. have played a critical role over the past decade in developing the science that helped establish dd-cfDNA as a trusted biomarker of transplant rejection. iMDx is commercializing this technology using a market-disruptive business strategy. Under the GraftAssure™ brand, iMDx’s transplant diagnostics include the following:

About Insight Molecular Diagnostics, Inc.

Insight Molecular Diagnostics is a pioneering diagnostics technology company whose mission is to democratize access to novel molecular diagnostic testing to improve patient outcomes. Investors may visit https://investors.imdxinc.com/ for more information.

GraftAssureCore™, GraftAssureIQ™, GraftAssureDx™, GraftAssure™, DetermaIO™, and DetermaCNI™ are trademarks of Insight Molecular Diagnostics Inc.

Forward-Looking Statements

Any statements that are not historical fact (including, but not limited to, statements that contain words such as “will,” “believes,” “plans,” “anticipates,” “expects,” “estimates,” “may,” and similar expressions) are forward-looking statements. These statements include those pertaining to, among other things, demand for iMDx’s products and what the company is building, the expectation that decentralized testing will deliver new value in the roughly $2 billion-plus addressable market for kitted transplant rejection testing, the company’s competitive advantage and path to supplying the world’s most widely used dd-cfDNA assay, iMDx’s expectations for FDA review and authorization and its 2026 goals (including but not limited to commercial, regulatory and R&D goals), management’s thoughts on where transplant patient management is headed and why the company is well-positioned, emerging clinical utility of dd-cfDNA testing, the belief that democratizing access to transplanted organ rejection testing creates a rapidly growing, high-margin, recurring business model, and other statements about the future expectations, beliefs, goals, plans, or prospects expressed by management. Forward-looking statements involve risks and uncertainties, including, without limitation, risks inherent in the development and/or commercialization of diagnostic tests or products, uncertainty in the results of clinical trials or regulatory approvals, the capacity of Insight Molecular Diagnostics’ third-party supplied blood sample analytic system to provide consistent and precise analytic results on a commercial scale, potential interruptions to supply chains, the need and ability to obtain future capital, maintenance of intellectual property rights in all applicable jurisdictions, obligations to third parties with respect to licensed or acquired technology and products, the need to obtain third party reimbursement for patients’ use of any diagnostic tests Insight Molecular Diagnostics or its subsidiaries commercialize in applicable jurisdictions, and risks inherent in strategic transactions such as the potential failure to realize anticipated benefits, legal, regulatory or political changes in the applicable jurisdictions, accounting and quality controls, potential greater than estimated allocations of resources to develop and commercialize technologies, or potential failure to maintain any laboratory accreditation or certification. Actual results may differ materially from the results anticipated in these forward-looking statements and accordingly such statements should be evaluated together with the many uncertainties that affect the business of Insight Molecular Diagnostics, particularly those mentioned in the “Risk Factors” and other cautionary statements found in Insight Molecular Diagnostics’ Securities and Exchange Commission (SEC) filings, which are available from the SEC’s website. You are cautioned not to place undue reliance on forward-looking statements, which speak only as of the date on which they were made. Insight Molecular Diagnostics undertakes no obligation to update such statements to reflect events that occur or circumstances that exist after the date on which they were made, except as required by law.

Investor Contact:
Alexandra Grossman
LifeSci Advisors LLC
alex@lifesciadvisors.com

Tables Follow

INSIGHT MOLECULAR DIAGNOSTICS INC.
CONSOLIDATED BALANCE SHEETS
(In thousands)

  December 31,
   2025   2024 
ASSETS    
CURRENT ASSETS    
Cash and cash equivalents $11,583  $8,636 
Accounts receivable, net of allowance for credit losses of $11 and $16, respectively  1,128   1,613 
Inventories  446   410 
Deferred financing costs     279 
Restricted cash, current  729    
Prepaid expenses and other current assets  1,420   821 
Total current assets  15,306   11,759 
NONCURRENT ASSETS    
Right-of-use operating and financing lease assets, net  2,815   2,757 
Machinery and equipment, net, and construction in progress  6,435   3,567 
Intangible assets, net     14,607 
Restricted cash, noncurrent  607   1,700 
Other noncurrent assets  593   691 
TOTAL ASSETS $25,756  $35,081 
     
LIABILITIES AND SHAREHOLDERS’ DEFICIT    
CURRENT LIABILITIES    
Accounts payable $2,544  $1,641 
Due to related party  2,780   638 
Accrued compensation  2,461   1,939 
Accrued royalties  1,116   1,116 
Accrued expenses and other current liabilities  939   418 
Operating and financing lease liabilities, current  1,807   1,295 
Contingent consideration liabilities, current  428   228 
Total current liabilities  12,075   7,275 
NONCURRENT LIABILITIES    
Operating and financing lease liabilities, noncurrent  1,690   2,369 
Contingent consideration liabilities, noncurrent  43,455   37,711 
TOTAL LIABILITIES  57,220   47,355 
     
Commitments and contingencies    
     
SHAREHOLDERS’ DEFICIT    
Preferred stock, no par value, 5,000 shares authorized; no shares issued and outstanding      
Common stock, no par value, 230,000 shares authorized; 28,683 and 17,453 shares issued and outstanding at December 31, 2025 and 2024, respectively  369,211   338,244 
Accumulated other comprehensive income  86   21 
Accumulated deficit  (400,761)  (350,539)
Total shareholders’ deficit  (31,464)  (12,274)
TOTAL LIABILITIES AND SHAREHOLDERS’ DEFICIT $25,756  $35,081 
     


INSIGHT MOLECULAR DIAGNOSTICS INC.
UNAUDITED CONSOLIDATED STATEMENTS OF OPERATIONS
(In thousands, except per share data)

  Three Months Ended
December 31,
 Years Ended
December 31,
   2025   2024   2025   2024 
Net revenue $1,139  $1,486  $4,055  $1,881 
         
Cost of revenues  643   869   1,750   1,053 
Cost of revenues – amortization of acquired intangibles     22   7   88 
Gross profit  496   595   2,298   740 
         
Operating expenses:        
Research and development  5,829   2,257   15,900   9,839 
Sales and marketing  2,291   1,202   6,343   3,944 
General and administrative  2,326   2,559   10,633   10,204 
Change in fair value of contingent consideration  (1,115)  (13,696)  5,946   (4,275)
Impairment losses  14,600   41,900   14,600   41,900 
Impairment loss on held for sale assets           169 
Total operating expenses  23,931   34,222   53,422   61,781 
         
Loss from operations  (23,435)  (33,627)  (51,124)  (61,041)
         
Other (expenses) income:        
Interest expense  (26)  (30)  (109)  (84)
Other income, net  506   146   1,011   462 
Total other income, net  480   116   902   378 
         
Loss before income taxes  (22,955)  (33,511)  (50,222)  (60,663)
         
Income taxes            
         
Net loss $(22,955) $(33,511) $(50,222) $(60,663)
         
Net loss per share:        
Net loss attributable to common stockholders - basic and diluted $(22,955) $(33,511) $(50,222) $(60,926)
Net loss attributable to common stockholders per share - basic and diluted $(0.72) $(1.93) $(1.65) $(4.66)
         
Weighted average shares outstanding - basic and diluted  32,065   17,382   30,476   13,071 


INSIGHT MOLECULAR DIAGNOSTICS INC.
UNAUDITED CONSOLIDATED STATEMENTS OF CASH FLOWS
(In thousands)

  Three Months Ended
December 31,
 Years Ended
December 31,
   2025   2024   2025   2024 
CASH FLOWS FROM OPERATING ACTIVITIES:        
Net loss $(22,955) $(33,511) $(50,222) $(60,663)
Adjustments to reconcile net loss to net cash used in operating activities:        
Depreciation and amortization expense  563   541   2,190   1,476 
Amortization of intangible assets     22   7   88 
Stock-based compensation  721   499   2,219   1,753 
Equity compensation for bonus awards and consulting services  38   50   164   160 
Change in fair value of contingent consideration  (1,115)  (13,696)  5,946   (4,275)
Impairment losses  14,600   41,900   14,600   41,900 
Impairment loss on held for sale assets           169 
Unrealized foreign currency losses (gains)  15   (33)  185   (4)
Changes in operating assets and liabilities:        
Accounts receivable  (870)  (1,404)  485   (1,129)
Inventories  25   (178)  (36)  (410)
Prepaid expenses and other assets  (102)  (77)  (226)  (430)
Accounts payable and accrued liabilities  3,555   704   2,646   967 
Operating lease assets and liabilities  (20)  (168)  (142)  (291)
Net cash used in operating activities  (5,545)  (5,351)  (22,184)  (20,689)
         
CASH FLOWS FROM INVESTING ACTIVITIES:        
Proceeds from sale of equipment     4      4 
Machinery and equipment purchases, and construction in progress  (1,479)  (214)  (3,185)  (516)
Net cash used in investing activities  (1,479)  (210)  (3,185)  (512)
         
CASH FLOWS FROM FINANCING ACTIVITIES:        
Proceeds from sale of common shares     10,205   29,143   26,012 
Financing costs to issue common shares     (836)  (487)  (1,374)
Proceeds from sale of common shares under at-the-market transactions     1,784      1,802 
Financing costs for at-the-market sales     (234)     (421)
Redemption of Series A redeemable convertible preferred shares           (5,389)
Contingent consideration liability payments  (2)     (2)   
Taxes paid related to net share settlement of stock-based awards  (72)     (72)   
Repayment of financing lease obligations  (178)  (82)  (510)  (201)
Net provided by financing activities  (252)  10,837   28,072   20,429 
         
Effect of exchange rate changes on cash and cash equivalents  (15)  (3)  (120)  (24)
NET CHANGE IN CASH, CASH EQUIVALENTS AND RESTRICTED CASH  (7,291)  5,273   2,583   (796)
         
CASH, CASH EQUIVALENTS AND RESTRICTED CASH, BEGINNING  20,210   5,063   10,336   11,132 
CASH, CASH EQUIVALENTS AND RESTRICTED CASH, ENDING $12,919  $10,336  $12,919  $10,336 
         


INSIGHT MOLECULAR DIAGNOSTICS INC.
RECONCILIATION OF NON-GAAP FINANCIAL MEASURES
NON-GAAP NET LOSS AND ADJUSTED EBITDA LOSS

In addition to financial results determined in accordance with U.S. generally accepted accounting principles (“GAAP”), this press release also includes non-GAAP financial measures (as defined under SEC Regulation G). We believe that disclosing the adjusted amounts is helpful in assessing our ongoing performance, providing insight into the Company’s core operating performance by excluding certain non-cash and other non-operating items that may obscure the underlying trends in the business. These non-GAAP financial measures, when viewed in a reconciliation to respective GAAP financial measures, provide an additional way of viewing the Company’s results of operations and factors and trends affecting the Company’s business. These non-GAAP financial measures should be considered as a supplement to, and not as a substitute for, or superior to, the respective financial results presented in accordance with GAAP.

The following is a reconciliation of the non-GAAP financial measures to the most directly comparable GAAP measure:

  Three Months Ended
December 31,
 Years Ended
December 31,
   2025  2024(1)  2025  2024(1)
  (unaudited) (unaudited) (unaudited) (unaudited)
  (In thousands)
Net loss (GAAP) $(22,955) $(33,511) $(50,222) $(60,663)
Stock-based compensation  721   499   2,219   1,753 
Change in fair value of contingent consideration  (1,115)  (13,696)  5,946   (4,275)
Impairment losses  14,600   41,900   14,600   41,900 
Impairment loss on held for sale assets           169 
Non-GAAP net loss  (8,749)  (4,808)  (27,457)  (21,116)
Depreciation and amortization expenses  563   563   2,197   1,564 
Interest expense  26   30   109   84 
Other income, net  (506)  (146)  (1,011)  (462)
Income taxes            
Adjusted EBITDA loss, a non-GAAP financial measure $(8,666) $(4,361) $(26,162) $(19,930)
         
Net loss per share (GAAP) $(0.72) $(1.93) $(1.65) $(4.66)
Non-GAAP net loss per share $(0.27) $(0.28) $(0.90) $(1.62)
         
Weighted average shares outstanding  32,065   17,382   30,476   13,071 


(1) The 2024 reconciliation line-items have been presented to conform to the 2025 presentation. The newly titled total “Adjusted EBITDA loss, a non-GAAP financial measure” reported for 2024 is unchanged from the 2024 “Consolidated non-GAAP loss from operations, as adjusted” as previously reported.

A photo accompanying this announcement is available at https://www.globenewswire.com/NewsRoom/AttachmentNg/e0ce40a4-4256-401d-bfee-5688340631a5


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