We're excited to have you with us as we take a closer look at our company, our innovative product platforms, and the passionate people driving our success. This series is designed to give you a deeper understanding of how we're delivering value to veterinarians and to our shareholders. At Zomedica, our mission is to deliver innovative diagnostic and therapeutic technologies that empower veterinarians to focus on what they love most, enhancing pet care and improving pet parent satisfaction. Equally important, we help vets with what they need most, streamlining workflow, increasing cash flow, and boosting practice profitability. At Zomedica, our mission is guided by what we call our five pillars. These are core objectives that shape every decision we make about products and innovation. First and foremost, we aim to improve the quality of care for the pets.
Equally important is enhancing the satisfaction of the pet parent, ensuring they feel confident and comfortable with the care provided. Our solutions also focus heavily on improving the veterinarian's daily workflow, helping veterinary practices operate smoothly and efficiently. Additionally, we are committed to positively impacting veterinarian cash flow, making sure our offerings are financially accessible and beneficial. Finally, our ultimate goal is to increase veterinarian profitability, providing products and solutions that help veterinary clinics grow and thrive financially. As you hear about today's studies, keep the five pillars in mind, because each study connects to how a practice cares for patients and runs its business. Now let's hear from Larry Heaton, Zomedica's Chief Executive Officer.
Hello, everyone, and welcome. I'm Larry Heaton, Chief Executive Officer of Zomedica. Thank you for joining us for another Fourth Friday at Four webinar. Whether you're an investor, an analyst, a veterinary professional, or someone following our progress, we appreciate you taking the time to be with us today. Today's session focuses on Zomedica's clinical program and how evidence drives adoption. Veterinarians make decisions based on evidence. They want to know that a product performs, that it performs consistently, and that it fits the way they practice. Yet many veterinary products reach the clinic with little or no published data behind them. We believe that gap is an opportunity, and it shapes how we go to market. Our approach is to build the evidence before we sell and to build it with the veterinarians who use our products in practice.
Studies led by practicing veterinarians give us credible data, defensible claims, and clinical advocates who can speak to their peers. For a clinic, a study gives a lasting reason to buy a product or to use a product it already owns more often. For Zomedica, we believe that supports adoption, utilization, and recurring revenue. This work rests on real capabilities. We continue to invest in research and development in a professional veterinary services team that works alongside practicing veterinarians, and in the systems that carry results from the study to the field through publications, conferences, continuing education, and sales training. Today, you will see studies across several product lines, the PulseVet Shock Wave System, the VETGuardian PLUS Monitor, and the TRUFORMA Immunoassay platform. Each study is presented by a member of our clinical research and professional veterinary services teams, and for each one, we ask the same questions.
What do the studies show? What does it change for the practices that use our products? You will also see how those results reach customers. As always, the results shared today are limited to those that have been published or cleared for external release. Our goal is to give you a clear review of how clinical evidence supports quality of care, customer value, and long-term growth. With that, let us get started.
This is Zomedica's clinical program and how evidence drives adoption. Veterinarians buy on evidence, and Zomedica builds it into every product line. Today's studies cover three product lines, the PulseVet Shock Wave System, the VETGuardian PLUS Monitor, and the TRUFORMA Immunoassay platform. First, why clinical studies matter. In a clinical market, a product is only as credible as the data behind it. Veterinarians buy on evidence, and many veterinary products do not have published data at all. That is why a study is a commercial asset, and what it does depends on the kind of product. For a device, a study can show that the treatment works. It can also support adding new indications, and each new indication gives a practice another reason to use the device it already owns.
For a diagnostic, a study can show how closely a test agrees with the reference laboratory, and it can expand the test menu. A broader menu means more tests run on the same platform, which increases cartridge utilization. In both cases, the sales impact follows the same path. Evidence builds credibility. It differentiates a product from the alternatives. It creates key opinion leaders, often called KOLs, who advocate for the product among their peers. It gives the company claims it can defend, and it supports higher utilization. Today's studies span three product lines. For the PulseVet Shock Wave System, we will look at three studies. The first, by Dr. Beau Whitaker, is titled Extracorporeal Shock Wave Therapy of the Thorax for the Treatment of Mild-to-Moderate Equine Asthma Syndrome. The second, led by Dr. Laszlo Hunyadi, looks at shockwave therapy at the coronary band to stimulate hoof growth in horses.
The third, from Colorado State University, led by Dr. Felix Duerr, is titled High Energy Focused Shock Wave Therapy Accelerates Bone Healing, and it follows dogs after TPLO surgery. For the VETGuardian PLUS Monitor, we will look at an internal performance evaluation that compares touchless physiological monitoring with a wearable collar. And for the TRUFORMA Immunoassay platform, we will look at two studies. The first, by Dr. Mark Peterson and colleagues, was published in the American Journal of Veterinary Research. It evaluates a novel, sensitive thyroid-stimulating hormone assay as a diagnostic test for thyroid disease in cats. The second by Dr. Kelsey Hart and colleagues at the University of Georgia was recently published in the Journal of Veterinary Internal Medicine and validates a point-of-care assay for simultaneous quantification of equine ACTH and CLIP.
Each study follows the same five steps: the investigator, the clinical problem, the study design, the key results, and the commercial impact. Keeping the order the same lets you compare one study with the next. In the commercial impact step, we will use three words you may remember from our September session. Land means the evidence wins a first purchase or opens a new type of practice. Deepen means the evidence adds uses for a product the practice already owns. Expand means the evidence carries a second brand into an existing account. First, we turn to why clinical studies matter. Leading today's discussion is Dr. Ashley Wood, Vice President of Research and Development at Zomedica. Dr. Wood will explain why veterinarians look for published data and how Zomedica decides which products need a study. Then, Zomedica veterinarians will walk us through each study, one study at a time.
Hi, I'm Ashley Wood, the Vice President of Research and Development at Zomedica. In this role, I have the privilege of overseeing both our product development initiatives and our clinical study efforts. Today, I'm excited to share some of the recent studies we've supported and what we've learned from them. Veterinarians want to provide the best possible care for their patients. To do that, they need confidence in the tools that they use to make clinical decisions and provide treatment. When they're considering a new technology, the first question they ask is usually, does it work? Clinical studies provide the data needed to answer that question with confidence. While factors like workflow, cost, and ease of adoption are also very important, none of those discussions matter if we can't first demonstrate performance. Solid clinical evidence is what opens the door to meaningful conversations about bringing new technologies into a practice.
Clinical studies can also help drive greater utilization of products that are already in use within a practice. Whether it's introducing a new assay or a new diagnostic capability, or expanding a therapeutic product into a new indication, veterinarians are much more likely to engage when the conversation starts with data. Clinical evidence provides confidence that a new application is both safe and effective. A new indication supported by strong clinical data is exciting, and it creates an opportunity for adoption. Without that data, however, it can feel like an unnecessary risk, making it difficult to capture a veterinarian's interest or trust. A great example of a study that has changed how veterinarians practice is one that was conducted by Dr. Mark Peterson using our TRUFORMA Feline-Optimized TSH Assay.
You'll hear more details about this study later in the webinar from Dr. Marzin, but it's one of my favorite examples of how clinical research can advance veterinary medicine. Traditionally, veterinarians have relied on total T4 as the primary screening test for feline hyperthyroidism. In human medicine, however, TSH is commonly used as a first-line screening tool for hyperthyroidism. Historically, that approach wasn't practical in cats because the TSH assays that were available didn't measure low enough to distinguish a low normal TSH result from a truly hyperthyroid result. When we introduced the TRUFORMA Feline-Optimized TSH Assay, many feline practitioners began incorporating it into their diagnostic workup. However, it was often used as a follow-up test after receiving an abnormal total T4 result rather than initial screening tools.
Dr. Peterson's study demonstrated that not only that the TRUFORMA Feline-Optimized TSH Assay was more sensitive than previously available feline TSH tests, but that it was actually more sensitive than total T4 for identifying hyperthyroidism in cats. Those findings helped establish confidence in TSH as a valuable screening tool. Since publication of the study, we've seen increasing use of TSH as a first-line screening test for feline hyperthyroidism rather than solely as a secondary confirmatory test. This is a great example of how clinical evidence can change practice patterns, improve patient care, and ultimately increase utilization of innovative diagnostic tools. The study generated data that is helping veterinarians diagnose hyperthyroidism earlier and with greater confidence while also demonstrating the value of the TRUFORMA assay in everyday clinical practice.
When evaluating which studies to support, the first and most important question we ask is whether the study is likely to increase adoption or utilization of our products. While there are many interesting and worthwhile research opportunities out there, our investment in clinical studies must be aligned with Zomedica's strategic objective of driving growth and supporting our path to profitability. We then assess whether the study addresses a meaningful clinical question that veterinarians will find relevant, informative, and actionable in practice. As a result, studies focused on broad, impactful clinical applications are prioritized over more niche research projects. Finally, we consider the level of support required. Many of the clinical studies we support require only a modest investment from Zomedica. In some cases, providing study materials is sufficient to enable an investigator to answer an important clinical question.
For example, in the study on feline hyperthyroidism conducted by Dr. Peterson that I mentioned previously, Zomedica's primary contribution was supplying TRUFORMA cartridges while Dr. Peterson and his team carried out the study activities. This is not only an efficient use of Zomedica's resources, but it also allows researchers to maintain ownership of the scientific process, resulting in findings that are often viewed as more independent and impactful by the veterinary community. Veterinarians make decisions based on evidence. By generating clinical data both internally and through independent investigators, Zomedica provides the scientific support veterinarians need to confidently adopt and utilize our technologies. The veterinary community places significant value on peer experience and published research, particularly when it comes from respected key opinion leaders. Independent studies are especially powerful because they help eliminate concerns about potential bias, and they provide objective validation of a product's performance and clinical utility.
Many veterinary products on the market have limited published evidence supporting their performance claims. By investing in clinical research, Zomedica can differentiate itself from competitors and demonstrate a commitment to scientific rigor. For example, our PulseVet technology is supported by more than 15 years of research demonstrating its safety and effectiveness. This extensive body of evidence gives veterinarians confidence that they are adopting a technology with a strong scientific foundation. By continuing to support clinical studies across PulseVet and our broader product portfolio, Zomedica reinforces its commitment to delivering innovative, evidence-based solutions that help veterinarians provide the highest standard of care for their patients. Today, our professional service veterinarians will share six studies that Zomedica has recently supported involving PulseVet, VETGuardian, and TRUFORMA.
Their close relationships with veterinarians and firsthand knowledge of clinical challenges make our internal veterinarians invaluable in helping determine which studies we pursue and how we communicate the resulting data to the veterinary community. These studies demonstrate how we use clinical research to support growth by building confidence in our technologies, validating their performance, and identifying new use cases that create additional value for our customers.
Let's begin with the PulseVet Shock Wave System and a study in horses with asthma. Equine asthma is a common respiratory disease in horses, and it can limit athletic performance. Today, it is managed mainly with drugs and management changes. The study was conducted in 2022 and 2023 by Dr. Beau Whitaker, a veterinarian at Salado Equine Medical Center in Salado, Texas. All of the horses received treatment with no untreated control group. Dr. T.J. Barclay will walk through the study design in a moment. Outcomes were tracked four ways: weekly owner ratings, a mucus score on endoscopy, lung fluid cytology, and veterinary clinical scores. Owner ratings improved by 69% on average, a statistically significant change, and 74% of horses improved by at least 50%. For cough during exercise, 15 of the 23 horses improved by 90%-100%.
On endoscopy, 77% of horses improved by at least one grade in tracheal mucus score, an average of 1.3 grades, and no horse got worse. Improvement did not differ significantly by season, although the winter months showed the least. Not every measure moved. Lung fluid cytology was mixed and did not track with clinical improvement. Veterinary clinical scores did not change, although the horses had no symptoms at rest to begin with, and asthma symptoms were only present upon exercise. The positive results from this study led to the creation of an equine asthma registry, which tracks clinical outcomes and safety data from veterinarians using PulseVet shock wave therapy to treat equine asthma. The registry is ongoing and continues to strengthen the body of evidence supporting this novel therapeutic application. Dr. T.J. Barclay, Senior Professional Services Veterinarian at Zomedica, joins us to discuss the equine asthma study.
I'm T.J. Barclay. I'm the Senior Professional Services Veterinarian with Zomedica. I joined the company in 2023, and prior to that, I had about an 18-year career in equine practice in Texas. Equine Asthma Syndrome is fairly similar to asthma in humans. It's characterized by chronic coughing and poor performance. These cases can be pretty challenging to treat. Treatment usually involves some combination of environmental changes and pharmaceuticals. The environmental component is usually stabling and dietary changes to eliminate dust and allergens. These changes can be difficult to implement on some farms, and the prescription drugs are used to control inflammation and open up the lower airways. These drugs that require frequent administration can have some significant side effects, and decreased efficacy over time. In the case of inhaled therapies, will require the horse owner to invest in some expensive equipment.
In all, the treatment for asthma can be pretty expensive, time-consuming, and variably effective. This study was performed by Dr. Beau Whitaker in Central Texas, and it was performed over about an 18-month period, and there were a total of 23 horses enrolled. These were horses presented for typical symptoms consistent with mild to moderate equine asthma, and the diagnosis was then confirmed by examination, upper airway endoscopy, and laboratory diagnostics. These horses received two serial shockwave treatments of the lungs, performed two weeks apart, and response to therapy was monitored using a previously validated scoring system by both the veterinarian and the owner throughout the study period, with final evaluation two weeks after the second treatment. In addition, endoscopy and laboratory diagnostics were repeated after that second treatment.
To me, the most meaningful outcome from this study was the significant improvement in the visual analog scores as reported by the horse owners. You have to remember that since the symptoms of asthma mostly manifest themselves during exercise, it's the owner who's going to see that, and over 90% of these horses had a reduction in coughing. That means that these horses, who are, for the most part, barrel racers, are able to return to training and competition. Well, after seeing the results from Dr. Whitaker's study and hearing from many other veterinarians who have used shockwave very successfully in asthma patients, I wholeheartedly recommend it. I tell colleagues and customers daily that it's very safe and there's not really any reason not to use it in an asthma case.
This is a deepened study. A new indication means the opportunity for more treatments per installed PulseVet device with no new equipment sale required. It also makes a device easier to justify for new customers with lighter orthopedic caseloads. It speaks to quality of care of the pet as well because the study addresses a condition that is managed mainly with drugs today. Every indication a study supports is a new reason to use a device the practice already owns. From the lungs to the hoofs. The next study asks whether shockwave can influence hoof growth. Slow hoof growth delays recovery from hoof defects and from laminitis, a painful and serious condition of the hoof. The study was led by Dr. Laszlo Hunyadi and followed 10 healthy barefoot pasture-kept horses in Hawaii, 20 front feet in all.
The horses were randomized between shockwave and a sham treatment, five horses in each group. The farrier and the veterinarian reading the radiographs did not know which horses were treated. Over 24 weeks, there were four visits, six weeks apart. The first six weeks served as each horse's own untreated baseline. The treated group then received two shockwave treatments at the coronary band, 1,200 pulses per foot, six weeks apart. The team measured the hoof externally and on radiographs and counted a hoof as a success if it grew more during a treatment interval than during its own baseline. The results are currently under peer review for publication. Treatment was well-tolerated with light sedation. After one treatment, there were no significant differences between the groups.
After the second treatment, sole depth was a success in 100% of the shockwave hoofs, compared with 50% of the sham hoofs, a statistically significant difference. The other measures, including hoof wall length, external measurements, and the distance between horn and lamellae, showed no significant differences. This was a small study of 10 horses, and the results reflect that. The authors note that further work is needed in a larger population. Dr. Barclay also joins us for the second study.
The old adage that says, "No hoof, no horse" is very true, and hoof problems are dealt with daily by veterinarians and farriers. One common problem that we see in hoofs is thin soles. Whenever there's a situation where wear to the solar surface of that foot outpaces its growth, you wind up with thin soles that can't adequately protect the bone and sensitive tissues within that hoof. That results in a lame horse, and if left untreated, can cause permanent damage to the bone. In this study performed by Drs. Laszlo Hunyadi and Emily Sundman, both external and radiographic hoof measurements were obtained at six-week intervals. Measurements after the initial six-week period were compared to those taken at enrollment to get a baseline value for hoof growth in each horse. Then two shockwave treatments were performed on the front feet at six-week intervals.
Hoof growth post-treatment was compared to the pre-treatment growth for each horse. In the study, treatment success was defined as having more growth in a post-treatment period than in the baseline period. For sole growth, 100% of the shockwave-treated group were defined as successes, while only 50% of the sham group were. Practices that specialize in dealing with lameness issues and podiatry are going to see more of these cases. But really, this is something that applies to pretty much any equine practice because all equine veterinarians are going to see horses with this issue.
This is a land study. Sole growth data supports a potential new use of PulseVet shockwave in podiatry practices, a segment beyond the current base. For a practice, that is a new service it can offer, which connects to veterinarian profitability. Laminitis, the condition behind slow hoof recovery, returns later in this session from a different direction. Now we move to companion animals and a surgery that practices perform every week. TPLO, or tibial plateau leveling osteotomy, is one of the most common orthopedic surgeries in dogs, and it is used to treat cranial cruciate ligament disease. Recovery depends on how well the bone heals, and that takes weeks of restricted activity for the dog and for the pet parent. This study was conducted at Colorado State University with Dr. Felix Duerr as the corresponding author and published in 2015.
In this study, client-owned dogs between two and nine years old that had TPLO surgery were randomized to shockwave therapy or to a sham treatment. 42 dogs with 50 stifles were included in the analysis. The shockwave group received electrohydraulic focused shockwave therapy, 1,000 shocks, right after surgery and again at about two weeks. At eight weeks, three board-certified radiologists who did not know which dogs had been treated scored bone healing on X-rays using both a five-point scale and a 10-point scale. At eight weeks, the shockwave group had significantly higher median healing scores than the sham group. Both scales agreed, and both differences were statistically significant. No major complications were observed, and all of the osteotomies healed uneventfully.
The authors concluded that the results support shockwave therapy as a way to speed bone healing after canine osteotomies, and they noted that more studies are needed for fractures and delayed healing. Dr. Roderick Richards, Director of Clinical Research and International Business at Zomedica, joins us to discuss this study.
Hello, everyone. Dr. Roderick Richards here, Director of Clinical Research and International Sales at Zomedica. I've had about 30 years of experience with shockwaves, both as a user in clinical practice in equine medicine and also in development at different stages of the shockwave story. TPLO, or tibial plateau leveling osteotomy, is a procedure which has been developed in relatively recent years to change the angulation within the canine knee to prevent and reduce the likelihood of trauma or, in fact, rupture to the cranial cruciate ligament. The procedure actually requires cutting the tibia with a bone saw, or a saw osteotomy as it's called, and realigning the head of the tibia so that the cruciate ligament is greatly relieved of excessive pressure and strain.
The fragment is reattached to the remaining long stem of the tibia with a plate and screws, and the procedure is carried out routinely and quickly these days. During the recovery phase, of course, in the first few weeks, certainly the first four weeks post-surgery, the animal has to be carefully exercised in hand. Typically, dogs that have the surgery tend to be younger, very active dogs, so this is a challenging period for the family around the dog. The exercise is carefully monitored also by the veterinarians to make sure that not excessive, but enough pressure is put on the leg, which actually stimulates bone healing. So in the study by Felix Duerr and colleagues, the TPLO healing study was carried out on 42 healthy dogs between the ages of two and nine, for a total of 50 stifles.
The dogs were treated immediately post-surgery during recovery, then once again two weeks later. The bone healing was scored using two phases. In the first phase, the authors used a 10-point scoring scheme which they developed specifically for scoring TPLO bone healing, in the second phase, they used a previously described and more commonly used until then five-point scoring system. The dogs were radiographed at six weeks, as reported in the paper. At this point, there were dramatic differences between the shockwave-treated and untreated dogs. The treated dogs were scoring around seven out of 10, whereas the untreated dogs were scoring around three out of 10, which is, I think, a much greater difference than was expected. The radiologists who were scoring the radiographs had no idea which dogs were which, so their scoring was unbiased.
Of course, in studies like this is a very important part of the procedure that the people assessing don't know previously which animals have had which treatment. I would say that the first adopters will be specialist orthopedic practices or bigger practices with at least one specialist orthopedic surgeon. It all fits into their workflow much more easily than, say, a smaller clinic that only does TPLO procedure every now and again. There is some good evidence in the medical literature that shows clearly that saw osteotomies heal much more slowly and with poorer microscopic quality than traumatic fractures. Interestingly, one of the mechanisms in a traumatic fracture of a long bone for stimulating the healing response is the shockwave that the fracturing actually releases through the tissue.
By using a saw, a vibrating saw, not of any sort, we're not giving that shockwave stimulus to the bone and the tissue to mount the appropriate healing response. Clearly, electrohydraulic shockwave therapy seems to enhance that in the case of an osteotomy saw bone defect.
This is another deepened study. Every TPLO a practice performs becomes an opportunity for two shockwave treatments, a routine post-surgical use for a PulseVet device the practice already owns. TPLO is a surgery practices perform every week, so a study that supports faster healing turns every case into a treatment opportunity. It also ties back to quality of care of the pet, since recovery is what the dog and the pet parent experience. From the operating room to the overnight ward, our next study tests the VETGuardian PLUS Monitor against a wearable collar. Clinics need reliable monitoring for patients who are unattended, they want it without leads or wearables on the patient. 10 dogs were monitored at the same time with the VETGuardian PLUS Monitor, which is touchless and radar-based, and with a wearable collar. The study compared heart rate and respiratory rate.
Temperature was left out because the collar reports it only as normal or fever. Each collar reading, sent every two minutes, was matched to the closest VETGuardian PLUS Monitor value and time. The team measured the average error between the two devices for each dog and overall and ran a Bland-Altman analysis, a standard method for comparing two measurement tools. The two devices agreed closely on respiratory rate, with a mean absolute error of 2.44 breaths per minute and a small average bias of 0.77 breaths per minute. There was also strong agreement for heart rate between the two devices, where the mean absolute error was 4.79 beats per minute, with the VETGuardian monitor reading about 4 beats per minute lower than the collar on average. Dr. Kelli Puccio, Professional Services Veterinarian at Zomedica, led this internal study.
Hi, I'm Dr. Kelli Puccio, and I am a Professional Services Veterinarian with Zomedica. Prior to coming to work for Zomedica two years ago, I was a practicing small animal practitioner here in Denver, Colorado. Monitoring vital signs such as temperature, pulse, and respiration is very important in veterinary medicine. The reason is because small changes in these parameters can indicate problems with our patients, such as an elevated temperature can indicate either a worsening fever or a developing fever. It's most important in monitoring our patients' vital signs in, I would say, two scenarios. One is going to be post-operatively. In the first three hours after a patient is taken off of general anesthesia, that is the most important time where we see the most anesthetic-related deaths in our canine and feline patients.
Continuous monitoring is vital during that period of time to decrease the chances of death in that period of time. The second is going to be our debilitated patients in ICU, such as our patients with severe pancreatitis or DKA. Again, small changes in their temperature, pulse, and respiration can indicate a serious problem that's going on. So zero-touch contactless monitoring affects many aspects of veterinary medicine, such as workflow and efficiency, patient stress, and safety. The way that it's going to help with workflow and efficiency is that in our small animal hospitals, oftentimes we are understaffed, and therefore, our workflow is a lot harder on our staff. By having a device that is taking care of TPR when we're understaffed, it allows our technicians and our staff to be participating in more advanced tasks and things of that nature.
As far as patient stress, not having to have a technician go in every 10 minutes and take a temperature and a pulse and touch the patient and to rearrange them while they're recovering from anesthesia or if they're very sick, it also helps with patient stress. Also, you have your patients that are your angry patients, your anxiety or fearful patients, and going in and constantly having to touch them every 10 minutes is very stressful for them, as well as that goes into safety. When we're having to deal with these patients that don't like to be touched, it's safer for them as well as for our staff to have to do that less frequently. Having a contactless monitor allows us to have that freedom to do that.
The study that was done regarding VETGuardian PLUS, what it was doing is it was comparing the technology of VETGuardian PLUS versus the PetPace wearable collar. What they were looking at is trying to see about the accuracy between the two and how they compared with each other. What the study found is that there was very strong agreement between the VETGuardian PLUS and the PetPace wearable collar. What that means is that instead of having to put something on the patient, whether it be your alligator clips, whether it be things that you stick on there, wires, and all these contacts, all these things that touch the patient and cause more stress for the patient and are less safe for the patient, you can have a contactless technology that will give you comparable results that work just as well.
A zero-touch monitoring device adds the most value for veterinary practices, particularly again in that post-op period of time. That is the most important time when we need to be monitoring our patients. Oftentimes, we're doing one surgery right after another, and having this contactless monitor adds value in the sense that it frees up our technicians' time. They're not doing routine menial tasks constantly, where they can be helping to set up the next patient for anesthesia, get the surgery suite cleaned and things that they can do, things that they need to be doing. That adds value to the device because it allows our technicians to be doing things that are more profitable for the hospitals. What it means is that we now have a better technology that is safer for our staff and our pets.
It allows us to have more freedom to do the other things that we need to do in the hospital, and it allows us to have a better workflow and better efficiency within our hospitals by adapting these new technologies that are coming out in veterinary medicine.
This is a land study. A monitor is only worth buying if the clinic trusts the numbers, and accuracy is the first question every buyer asks. Data that answers it removes the main objection and shortens the path to a first purchase. It also supports veterinarian workflow because the clinic can monitor patients without attaching leads or wearables. The next two studies come from the TRUFORMA platform, beginning with cats. Hyperthyroidism is the most common endocrine disease in older cats, and waiting on reference laboratory results can slow treatment decisions. The study included 169 untreated hyperthyroid cats, confirmed by thyroid scintigraphy, a form of nuclear imaging, and grouped from subclinical to severe. It also included 53 cats previously treated with radioiodine, 12 cats with chronic kidney disease, and 78 healthy cats.
Each cat's serum was tested three ways: with a T4 test, with the standard reference laboratory TSH test, and with the TRUFORMA Platform TSH assay, which can measure TSH at levels about 4x lower. The team measured sensitivity, specificity, and predictive values for diagnosing hyperthyroidism and for diagnosing hypothyroidism caused by radioiodine treatment. The study was published in the American Journal of Veterinary Research in 2024 by Dr. Mark Peterson with co-authors Eric Dougherty and Mark Rishniw. For diagnosing hyperthyroidism, the TRUFORMA Platform TSH assay outperformed the reference laboratory TSH test, and every difference was statistically significant. Sensitivity was 90.5%, compared with 79.9% for the reference lab test. Specificity was 98.9%, compared with 76.7%, and positive predictive value was 86.9%, compared with 21.7%. The advantage was greatest in early disease in subclinical and mild hyperthyroidism, where T4 is often still normal or only slightly high.
For hypothyroidism after radioiodine treatment, both TSH tests detected 100% of cases, compared with 45.5% for T4. Positive predictive value was 100% for the TRUFORMA Platform assay, compared with 81.2% for the reference laboratory TSH test and 71.9% for T4. The author's conclusion was that TRUFORMA Platform TSH, alone or with T4, is a highly sensitive and specific test for both hyperthyroidism and post-radioiodine hypothyroidism in cats. Dr. Kristin Marzin, Professional Services Veterinarian at Zomedica, joins us to discuss this study.
My name is Dr. Kristin Marzin. I am a Professional Services Veterinarian with Zomedica. My background is in small animal general practice. An overactive thyroid or hyperthyroidism is one of the most common diseases we see in older cats, and to help diagnose it, vets often measure a hormone called T4 and then another one called TSH. The problem is that the TSH test that the reference lab and the other point-of-care devices use for cats was actually designed for dogs. It can't measure very low TSH levels, and very low TSH is exactly what we expect to see in a hyperthyroid cat. That test can't reliably tell a healthy cat from a sick one. Dr. Mark Peterson, one of the leading experts in feline thyroid disease, wanted to know whether the TRUFORMA feline TSH, which can measure much lower levels, would do a better job.
His team tested both side by side on the same samples from about 300 cats. TRUFORMA outperformed the lab test on every key measure. It caught about 91% of hyperthyroid cats, compared to about 80%, and it correctly cleared almost 99% of healthy cats, compared to 77%. With the old test, a low result only meant about a one in five chance that the cat was actually hyperthyroid, whereas with TRUFORMA, a low result means a nearly nine in 10 chance. Now veterinarians can be more confident about their diagnosis. The study also looked at cats after radioiodine, which is a treatment for hyperthyroidism. Some of these cats end up with the opposite problem, an underactive thyroid, which can harm their kidneys if it's missed. TRUFORMA identified every single one of those cats, whereas a standard T4 test caught fewer than half.
The authors concluded that the TSH test, particularly the TRUFORMA Feline-Optimized TSH, should be considered a first-line screening test along together with a T4. TRUFORMA TSH can add value for vets in many different ways. It can help with early diagnosis. For example, in cats with early disease, T4 often still looks normal. In this study, T4 actually missed half of those early disease cats, whereas a sensitive TSH test like the TRUFORMA TSH will flag those cats so we can watch them more closely. It also can instill confidence in the veterinarian. When TRUFORMA says a cat's TSH is normal or abnormal, we can trust it, which means fewer unnecessary rechecks, less worry for owners. Another added benefit is speed.
It runs right in the clinic in less than 20 minutes, so we can make decisions during the visit instead of waiting days for lab results. Thyroid disease becomes part of a cat's care as it ages. It starts with wellness screening, adding TSH alongside a T4 to catch those problems early. If a cat shows signs like weight loss despite a good appetite or increased thirst, we can test then. Cats with borderline results are going to get rechecked over time to see if disease is developing. After treatment, we do testing to make sure the thyroid is staying in a healthy range, not too high, not too low. A single cat will likely need TSH testing many times throughout its senior years.
This is a deepened study. A broader feline thyroid menu adds tests to a platform the practice already runs, and monitoring cats over the course of treatment creates recurring test revenue. A cat with thyroid disease is not tested once. It is rechecked throughout treatment, and each of those tests can run in the clinic. That is veterinarian cash flow in practice, and it drives recurring TRUFORMA platform cartridge utilization. Our second TRUFORMA study moves from cats to horses. Pituitary pars intermedia dysfunction, known as PPID, or equine Cushing's disease, and insulin dysregulation both drive laminitis. Testing for them matters, and the samples are sensitive to shipping. The study was led by Dr. Kelsey Hart at the University of Georgia and was just published this month in the Journal of Veterinary Internal Medicine. It included 28 horses, 13 with PPID and 15 healthy horses.
Blood was sampled in every season over one year, and each sample was tested on both the TRUFORMA platform point-of-care assay and the reference laboratory test. The TRUFORMA platform assay measures ACTH and CLIP separately. CLIP is a related peptide that the referenced laboratory test also picks up. The team measured correlation and bias against the reference laboratory test, along with precision and linearity. Overall, the TRUFORMA platform assay showed strong agreement with the reference laboratory test, a correlation of 0.95 with an average bias of 17 pg per milliliter. In horses with PPID, agreement held with a correlation of 0.93 and an average bias of 30 pg per milliliter. Bias was larger in autumn, about 34 pg-36 pg per milliliter, compared with 2 pg-11 pg in other months. Autumn is the season when ACTH runs naturally high. Bias also grew at higher hormone concentrations.
Precision was 8.5% variation within a run and 14.1% between runs, and linearity was excellent, with an R- squared of 0.991. Dr. Kimberly Keeton, Professional Services Veterinarian at Zomedica, joins us to discuss this study.
I am Dr. Kim Keeton, a Professional Services Veterinarian with Zomedica. I joined the company after more than 20 years in clinical practice with experience in general medicine and reproduction in the United Kingdom. During the last decade of my clinical career, I focused primarily on integrated performance horse medicine, specializing in the diagnosis and management of lameness and poor performance in elite sport horses. Dr. Hart's independent validation study demonstrated that the TRUFORMA assay is accurate during all times of the year and allowed the Equine Endocrinology Group to make the recommendation that TRUFORMA is accurate year-round for horses with PPID as well as those without PPID. Veterinarians are trained to question and verify. Our natural skepticism is actually a strength. We are relying on our resourcefulness to interpret what our patients cannot tell us, but we have to trust tools that have proven merit.
University-validated point-of-care testing helps us to move from curiosity to confidence by providing independent research that supports clinical decision-making. In-house validation helps demonstrate value, absolutely. Independent university research takes confidence to the next level by providing the objective evidence that we are seeking when evaluating new diagnostic tools. Dr. Kelsey Hart not only presented her findings to the national meeting of the American Association of Equine Practitioners last December, those findings were also accepted by the Equine Endocrinology Group, which is an esteemed international panel of experts on equine endocrinology disease, finding that TRUFORMA is as accurate or equivalent to reference lab testing for diagnosing PPID. It was also most recently accepted for publication in the "Journal of Veterinary Internal Medicine," which is one of the most respected peer-reviewed journals in veterinary medicine.
When I think about one particular horse that had stood out of my career as one that we managed PPID and insulin dysregulation, I certainly have one very high-performance junior hunter in mind who walked and talked like a PPID horse. He was an air fern. He had a long hair coat, crusty neck, all the clinical signs of PPID and insulin dysregulation. With that particular animal, we were very careful with how we managed his osteoarthritis, how we managed his day-to-day care.
He had a lot of acupuncture and a lot of shockwave and medical manipulation to keep him as comfortable as possible so that we could avoid drugs and medications that might kick off a flare of laminitis because that can be career-ending for horses like that, and certainly challenging to manage in the long term if you end up with a bout of laminitis because it often becomes chronic and affects that horse for the rest of its career and certainly for the rest of its life. Because veterinarians are inherently skeptical and evidence-driven, questions about novel test results are both expected and valuable. This leads to great collegial conversations across the world with different people treating the same endocrine diseases in equids, be it donkeys, horses, performance horses, backyard horses.
Being able to share this university-validated research from Dr. Hart and paired testing outcomes with reference labs helps provide the scientific context that veterinarians need to strengthen confidence and support adoption of the TRUFORMA platform in clinics across the world. PulseVet customers have already demonstrated confidence in a technology backed by years of research and clinical validation. That established trust in both the science and Zomedica creates a natural pathway to introduce TRUFORMA. The same horses being treated for lameness, performance, or age-related conditions with PulseVet are often candidates for metabolic testing, such as PPID and insulin dysregulation. With TRUFORMA, these veterinarians can obtain reference lab-quality endocrine results in about 20 minutes, allowing them to diagnose, discuss, and begin treatment during the same visit while creating a new source of recurring diagnostic revenue.
This is the expand study. Equine endocrine testing gives the TRUFORMA platform an entry into equine practice, and equine practices that already treat with PulseVet devices are the first place it goes. That shared base is where accounts expand. It also connects to the hoof growth study. Laminitis is the same clinical risk, now addressed from the diagnostic side. A study creates value when it reaches the practice. To show how that happens, here is Dr. Tanja Buchmann, senior product manager for upstream.
Hello, I'm Dr. Tanja Buchmann, and I'm the Senior Upstream Product Manager at Zomedica. A claim gets a vet's attention, but to change how they practice, they want to see it works in real patients, ideally from colleagues they respect. A study turns "Trust us" into "Here is the evidence." And when vets trust the evidence, they use the product with more confidence day after day. Before a launch, we ask what evidence a vet will need to trust a product from day one. That helps us to land the first purchase. For a product already in the field, vets keep asking new questions, like a new patient type or a new use. Studies help us answer those, and that depends how much the practice uses the product. In both cases, the question starts with what the vet needs to see.
The investigators run the science and share it with their peers. Take one of today's studies. A university specialist compared our in-clinic test with an established laboratory method across the seasons, presented the findings at the national conferences for equine vets, and has since given a Zomedica University webinar on testing. That's how evidence reaches practices through publications, conferences, and continuing education, and our PSVs bring it into daily conversations with the vets. In my role upstream, I work with R&D and the PSV and sales teams to agree what evidence matters most to the vet, and I make sure the results can reach the right people in a form they can use. It's a loop. Field questions go up, evidence comes back down. When a practice trusts the evidence behind one product, it's open to more. That's where we expand.
A second product in the same practice built around the same vet, and that's the pattern you've seen across today's studies.
Tanja Buchmann is a familiar voice from our September session, and her upstream role sits at the start of this pipeline. A study pays off when it leaves the lab and reaches the practice. Results travel through four channels: publications, conferences, continuing education, and sales training. Each one carries the evidence closer to the customer. The veterinarians who ran the studies become the peers who present them. As key opinion leaders, they bring their results to colleagues through conferences and continuing education, which is how evidence becomes adoption, and adoption becomes recurring use. To close today's session, here is Larry Heaton, Chief Executive Officer of Zomedica.
Thank you to everyone who contributed to today's session, including Ashley Wood and the veterinarians who shared their work with us. Let me bring today's discussion together. Veterinarians buy on evidence, and we build that evidence before we launch. Across several product lines, today's studies point to one consistent model. Evidence supports adoption supports utilization, and utilization supports recurring consumable revenue. You also saw the three phases we use to describe how evidence turns into commercial results. The first is land. Evidence can win a first purchase or open a new type of practice. The hoof growth study points to podiatry practices and farriers, and the VETGuardian PLUS Monitor remote monitor accuracy study speaks to the first question every buyer asks. The second phase is deepen. Evidence can add uses for a product a practice already owns.
The equine asthma study and the study of bone healing after TPLO surgery each add a use for the PulseVet Shock Wave System, and the feline thyroid study adds recurring tests to the TRUFORMA platform. The third phase is expand. Evidence can carry a second brand into an existing account. Equine endocrine testing brings the TRUFORMA platform into equine practices that already use PulseVet devices. We also showed you the other half of the story. A study creates value when it reaches the practice, and that happens through publications, conferences, continuing education, and sales training, with the investigators themselves becoming the peers who present the results. What we believe matters most is this: each study adds a lasting reason to buy or use a Zomedica product, and the evidence base compounds over time rather than resetting each quarter.
We remain focused on quality, clinical outcomes, and operational discipline, and we will continue to invest in the evidence that supports our customers and our growth. Thank you again for joining us for this Fourth Friday at Four webinar. We appreciate your time and your interest in Zomedica. Dr. Wood and members of our clinical studies team are with me now, and we're ready to take your questions. Let's get started.
We'll now move into the live Q&A section. If you have a question, please drop it into the chat box now. We're here to help. If you have questions later, you can contact us with the contact information shown on your screen.
Good afternoon. Almost good evening. This was a little longer than we normally take on the prepared remarks, but I think we've got a lot going on, and to do it justice took just a bit longer. I'll extend the Q&A period to make sure that we get to all of your questions. Before we go further on this one, though, I'll just mention that in November, since the fourth Friday in November is Black Friday, and everyone will be still moving slowly from all the turkey we ate on Thanksgiving, we're going to do the fourth Friday on the third Friday in November. Our next webinar will be the third Friday. That's November 20th, and it will cover the human resources at Zomedica. You've met many of the people, but you'll meet some more then. That'll be November.
We will, as we did last year, we will not have a Fourth Friday session in December. We have given everyone the Christmas holiday off. With that, let me get to your questions. First, I appreciate those that have provided questions when you registered. Those we will get to first. Let me just see what those are. The first one is, "Will Zomedica dual- list on the Canadian exchange and the OTC? If not, why?" Another one, "Do we have a plan for being relisted on the NYSE?" To both of those questions, I would say that we definitely would very much like to up-list from the OTC. There are requirements for the exchanges. Mike Zuehlke has covered those before. We have a plan.
We meet all the requirements except for share price. Either we address the capital structure in some way, or we just grow like heck and be patient so that the market cap gets to the point where, with 1 billion shares outstanding, we have the price per share that will allow us to up-list. We meet all the other requirements, so we definitely are pursuing that as appropriate and timely. Are we still on track to be cash flow positive by the end of this year? There is another one, are we still planning on getting to profitability in 2027? I will just say, yes. The plan is for us to be cash flow positive, not by a huge amount, in the fourth quarter.
We do believe that if we perform in the fourth quarter like we have in the last three years' fourth quarter, and have increased revenue, our top revenue of the year, with that, we should be cash flow positive just a bit in the fourth quarter. We also plan on reaching a profitability metric in 2027. What I mean by that is, we would be adjusted EBITDA positive. In other words, not counting (D&A) depreciation and amortization, which are non-cash items. We would reach that milestone in 2027 at least. If we can do better than that, then we will. Getting to GAAP profitability is the ultimate goal, and sustaining that. The nice thing about adjusted EBITDA positive, when you move away from the non-cash items, then that is good evidence that you are going to be cash flow positive for the whole year in 2027.
Those things, I will reiterate. I have a couple of questions from folks who either read the U.S. Patent and Trademark Office journals on a monthly basis or subscribe to their newsletters, and have noted a few trademarks that we have had issued. Also, there is some reporting out of Korea that people have picked up on. Let me just say to that, internally, we are working on a number of projects. We are always working on a number of projects and in particular, we have a number of different projects that we are working on that we expect to deploy either late this year or in 2027. These are certainly non-public, but they are not necessarily material in and of themselves. Anything that we engage in that is material to the company performance overall, we disclose publicly as we are obligated to do. I think you get that.
If we haven't disclosed something publicly, then it's not in and of itself material to the overall company performance, and so it doesn't require disclosure. We could disclose it, we could talk about it, but if we don't, if we haven't and we're not, it's because we have a reason, and that reason almost always is we don't want to disclose information that other companies would use as competitive intelligence and give them a jump on our plans. That's all I have to say about that at this point. I would say that folks that might have seen something that would allude to us doing something in December, we would more than likely be in a position to talk about that in our November webinar. All right?
But I would hope that you would see as shareholders that it wouldn't make a lot of sense for us to tell competitors about what our plans are going to be. I do, however, applaud those of you that have ferreted this out. It just shows you're doing a lot of diligence on the company, and that makes, I think, more informed shareholders are, I think, better shareholders, right? If you know what we're doing, then you're more likely than not to continue as shareholders, and I appreciate that. There's a question about are there any acquisition talks happening? If that's us acquiring other companies, everything I just said would apply. We certainly wouldn't want to talk about it before anything was done. An acquisition of a material acquisition would require disclosure.
You would hear about it the same time every other person in the public would hear about it. That's the whole idea of fair disclosure regulations, which we religiously adhere to. If you're talking about us being acquired, then not only do we have, if it's material, but we have a fiduciary responsibility to take that to the board, to review it, and in almost all cases, to disclose it to the public. So the answer to that is, therefore, no, because we would have already disclosed it. We have a question on the adoption rate for TRUFORMA. People know that, again, this is something that we regard as competitive intelligence. What I can tell you is that overall, our TRUFORMA installed base increases quarter-over-quarter. It has since we launched the product. We continue to make gains, and install devices in more and more accounts every quarter.
Recently, over the last year or so, as we saw an opportunity in equine and we launched several important assays over the last year and a half in equine, we've seen this very significant growth in placements in equine. Our recent collaboration with BI, Boehringer Ingelheim, in the United States and in Canada then later, has had a very significant impact. That organization has done a really nice job of communicating with their customers the benefits of the device. You've seen the clinical data behind it before. I will tell you that it's certainly the fastest-growing segment, and may actually even be. I'd have to look at the numbers, but I wouldn't be surprised if we're getting to a higher percentage penetration in equine.
But that's not because we have more absolute placements in equine, but simply that the denominator in that ratio is much smaller in equine. You have about 2,400 equine-only accounts in the United States versus 34,000 small animal accounts. The other thing I would say is that, and if you're on LinkedIn, you might see posts from people, social media posts talking about TRUFORMA and how they're using it at their hospital or how another hospital is using it. Then you look at the names and you go, "Whoa, that's not even in the United States," because we're now selling TRUFORMA in several other countries. Have been now for a bit. That adoption rate is increasing. We'll continue to, of course, disclose revenue.
I think you can gauge from the fact that TRUFORMA revenue, I think the last reported report that we released, we were up almost 100% or maybe even more year-over-year in TRUFORMA. That comes from a combination of new indications, but also primarily from new placements. Let's see, what else do we have here? Cash buyback or stock buybacks. I get it. It would be a nice thing to do. We have said before, and we continue to stick with this, our principles haven't changed, and that is that we will consider a stock buyback as a step towards addressing the capital structure once we are cash flow positive.
Until then, we're going to retain the capital and use it for continuing to grow the company or just to have it on the balance sheet so that shareholders see that we're solid and so on and so forth. Having said that, it would take a lot of cash to buy back the shares that we would need to. That's not something that's going to have a, quote, "immediate impact." That's going to be something that'll be done gradually over time once we are cash flow positive for that. There are a couple of questions on that. Let's see, what else? From here. Okay. Oops. I like this one.
"I'm a big sports fan, and when I see my favorite teams deal with player injuries such as hamstrings, muscle strains, et cetera, I wonder if PulseVet could make a positive impact on an athlete's recovery and his or her return to action from these types of injuries much quicker than they currently do now." I think you're right about that. My recommendation is that your marketing team make a concerted effort to meet with locker room trainers or professional sports team, college sports teams, et cetera, to trial the PulseVet as part of their team's treatment regimen. If successful, this could be a huge revenue contributor. Remember, Pulse Veterinary Technologies, which we acquired, was itself spun out of a human company called SANUWAVE. SANUWAVE then used the money to go and get FDA clearance for their device for diabetic fasciitis.
I guess something that affects the feet of people. When I first joined Zomedica, and we acquired Pulse Veterinary Technologies, actually on the same day I joined, I went to a meeting. It was a big equine veterinarian meeting. I was asking the veterinarians there about PulseVet, tell me about it, because I was new and so on. One guy in particular said exactly that, his brother-in-law played for the NFL, I won't say what team. Whenever he came to visit, he always made the vet give him a shockwave treatment. Then one year, they were in the playoffs, and he called and wanted that vet to fly out and treat him there. I said, "Did you do it?" He goes, "No, this is a veterinarian machine.
That's a human being." I remember thinking at the time, boy, you want to make sure you have good data before you start doing anything to a professional athlete that has millions of USD riding on him all the time. Bottom line is for us to get FDA clearance for the device would be an expenditure that we're not prepared to take at this time. As I mentioned before, we're focused on the animal market. I will also say that right now, sort of a hot topic in human health, but not FDA-regulated health are a number of shockwave machines that companies are marketing with no sort of health claims, just saying it'll maybe help you feel good or something like that. There are people out there that are doing that.
If you happen to know somebody that's a sports person and wants to take a chance on a shockwave, there's no shortage of people, primarily chiropractors or physiotherapists that buy the machines and then turn them into a really good income stream for them. Let's see. This one was about a thing I already talked about. Assay development timeline. First on equine assays, we said we had targeted four new assays, but a recent webinar, as we mentioned, only three will launch in Q4 due to a delay in materials. Has the fourth assay been pushed to 2027 or was it canceled? We haven't canceled any that we have planned to do, and we will be launching three, well, two new assays at the upcoming AAEP meeting, which is the first week or so, maybe second week of December. We will be launching three equine assays.
One of them will not be available to ship until January. I believe at the time, I forget exactly when that question was asked, but the fourth, we're also this year going to announce a new variation on a current assay for the small animal market. That'll make up a fourth one, if you will. Then we have several feline assays that we have planned for next year. Regarding a feline pharma partner, you mentioned your science team is in the early evaluation phase with a potential feline partner. Probably more than I should say, my head of R&D, who, well, is smiling right now, has said, "Hey, you shouldn't talk about that stuff. We don't know how it's going to go out." The reason I mention it is simply because we do have. I think the question was, are there a variety?
There are a variety of people that we are talking to. It is sort of the epitome of forward-looking statements to now be on a clock for that. Certainly not material. Anything that would be, we would let you know if it was not going to harm us from a competitive position. But then you have another question, which is, how long does the evaluation take, and then do they count towards a cycle to build them? I would say, it depends if the evaluation is robust and it is proof of concept to see if the machine can actually pick up the assay, if there are antibodies available, and all the rest of that stuff, then that evaluation would count. Because when you start from scratch to do an assay, those are things that you have to determine right up front.
The other thing I will tell you is that as we intend to be cash flow positive and EBITDA positive for 2027, part of that is not spending as much on R&D as we have previously spent. So I think you can see that our R&D expense for this year is down from last year, and next year, we expect it to be down further as we have completed several projects and are about ready to go to market. So we could produce, Ashley and her team could produce a whole boatload of assays, but each one of those is a sizable investment. So we have to balance the amount of cash we want to spend on that, which is great for growth on an ongoing basis, but would potentially impact our ability to get cash flow positive and profitable, EBITDA positive in the coming year.
Then there are some questions that would like to know a lot of information about our confidential partners in human health and animal health, and I am just not going to be able to answer them. You see the evidence of our work with them as we disclose our financial results. We broke them out into the development services segment. We break that down further into OEM manufacturing and engineering so that you can gain some insight into what we are doing. But as far as who they are and what their plans are and so on and so forth, I really have to keep that confidential, just out of respect for them and also not getting ahead of ourselves. Let us see. Buyback, we did. Buyback. Over the last few earnings, the stock has not really been going up, even when the report is very strong.
Do you know why that is, or what other factors can help drive the price? That is a really good question. If I was inclined to be flip, I would say because fewer people are buying the stock than want to sell it. That is the definition of it. I know that there is a school of thought that say that the market makers are maybe doing something to keep the price at a certain level. I will say that with new investors comes an opportunity to create a higher demand for the stock than sellers are willing to sell, which means the price goes up. You know that I have spoken often about why we believe that institutional investors are attractive to the company, and the only reason is because they bring a higher, deeper pockets, if you will, to the marketplace.
If they are trying to acquire shares, a sizable number of shares, 10 million, 20 million, 30 million, 40 million shares, since we are not allowing them, or we are not engaging with them to make direct investments in the company, which would have us issuing shares. We have the ability to issue an unlimited number of shares by our charter. We have not since I joined in 2021. We have no plans to. When they come, if they cannot get them directly and they really want to invest in the company, then they have to buy it in the open market, and then the share price goes up. That is my feeling, which is why we would like to attract them. You all are familiar with why they might not be here. Until then, we just need to keep doing what we are doing.
Increasing revenue, reducing expenses, not only on a percentage of revenue basis, but on an absolute basis, maintaining strong margins, and building the product line and the customer base that shows you that we have legs. We have a strong future ahead of us. One of the metrics that I think we will probably highlight more, we highlighted it, but maybe even highlight even more, is our consumable revenue. When you see TRUFORMA at the place where it is now, take that forward four quarters, and you can see that it is inevitable growth. Our X-Trode reorders for PulseVet, continuously growing, and that consumable revenue is about 70% of our revenue. I think that is one of the metrics that should help do that. I am just going to skip over the ones that are asking things that I have already answered.
Buyback, is the same answer that I gave before. GAAP profitability has never been a target for 2027. Not when you have $9 million in D&A. As TRUFORMA placements accelerate, our cartridge orders per analyzer are also increasing. What percentage of TRUFORMA revenue now comes from recurring consumables? Cartridge orders per analyzer are increasing as we increase the number of cartridges. The ones we bring out, we have done a lot of diligence to make sure that they are, in fact, high-demand items. Equine is a good example of that. Our initial order there, because they have such high demand for testing, it is coming in very nice. Percentage of TRUFORMA revenue from recurring consumables, 100%. We do not charge for the instrument, and so all of our revenue from TRUFORMA comes at $39 or $42 or $82 per cartridge. The cartridge prices vary.
One after another, those dollars stack up pretty good. As you can see, that is a boatload of cartridges. "Have you ever thought about doing more advertising, maybe reaching out to Instagram pages or other social media for some publicity?" It is a good idea for sure. Emma Callen, who is camera shy today and is not on the video right now, runs our social media outreach. We are on Instagram, we are on Facebook, we are on TikTok, we are on LinkedIn every week. She also runs an influencer program, and that has been picking up as well. As far as advertising in journals and things like that, we do not do that. I came in and talked to the marketing group, "Hey, how many magazines are we going to be advertising in this month?" They looked at me like, "Boy, you are old, are not you?" It is a new day.
Now, we do purchase what they call paid ads. We use Meta and Facebook, and those paid ads generate a lot of leads for us. We turn those leads into sales. We constantly run ROI calculations on those. They're constantly refining those. If anyone has a thought about some forum or some channel where it's especially good and reaches people that you think would be really good targets for us, reach out and we'll take a look at it. But it's generally going to be digital at this point. "Which new product launches will contribute most to 2027 revenue, and when should investors expect the first commercial sales?" I would say that we will let you know when we launch the products. I'm not trying to be any kind of way about that.
I'm just saying we don't want to announce what we're launching until we launch it so that we have a little bit of, A, element of surprise with the splash with the customer base, but also we don't telegraph what we're doing to competitors. We do expect that things that we will launch will have an impact on 2027 revenue. It's part of where we're expecting our growth from. That will take us to the level at which we are EBITDA positive. PIMS update. Yeah, we're in clinics now. We expect to time the full-blown PIMS launch for our existing products and any new products that might need to be PIMS-compatible at AAEP, which is the first week of December 7th or something like that.
Between now and then, we're in clinics today, people using it to say, "Yeah, it's working really well," or, "Hey, I noticed this," or this could be whatever. But for the most part, it's just working really smoothly. We are gathering up as we work down the list of PIMS providers. We're getting the last one signed up. But we've always timed this to be something that we would do in January, but we are jumping the gun in December because we can and because we have an opportunity there with the equine vets that only comes once a year. Their big conference is in December. The status of contract manufacturing is the same as it was. We are manufacturing products for ROM in a couple different product lines, and that's been disclosed publicly, and for another entity, as the need arises. I.E., development and engineering.
I think that's just a continuation of the question about contract manufacturing. Of course, as I mentioned earlier, we report those segments separately and break them down for you. I already talked about the Korean company that maybe disclosed things a little prematurely. You mentioned consumables represent about 70% of revenue. Is that company-wide or PulseVet specifically? How fast is recurring consumables revenue growing year- over- year? It's 70% company-wide. TRUFORMA is 100%. PulseVet, we sell a box for $32,000. We sell the consumables for $2,200 each. An average equine customer will go through three to four. An average small animal vet will go to a couple. If you want to know about how it's growing year-over-year, just read any of our earnings releases, any of them, because we always break out capital and consumables, and we always show the year-over-year comparison.
We report by segment, and then we report also by category, capital and consumables. I would have to look and see what it was. I know what it is for the third quarter, just because we are currently looking at that, but we are not disclosing that until November 4th. It is a good number, though. Really good number. If share price stays about where it is now, are you and any other officers planning to purchase any more shares after release of third quarter earnings in November 26th? Other officers can speak for themselves. There are not any other officers on this call, so I will only speak for myself. Yes, I intend to. It just depends on how much we disclose on November 4th. I have a kind of interest in doing that. Have you considered targeting advertising through VETgirl, VetFolio, and AAEP?
Sponsored educational content and webinars could reach thousands of veterinarians directly, generate qualified leads, and turn clinical research into more product placements? We used to go through VETgirl. The ROI on that did not seem to justify continuing, so we do not now. Do not know about VetFolio, but ask me again in a quarter, and I will have the marketing team take a look at that. AAEP, we are intimately involved with AAEP. As to webinars or whatnot, we host Zomedica University every other week. I should say twice a month. Twice a month, we host a webinar. It offers CE credit to the veterinarians or technicians, I guess, but vets for sure, who attend. The webinars are presented by key opinion leaders, sometimes people that are on this call, the veterinarians here, Dr. Marzin, Dr. Puccio, Dr. Keeton. T.J., have you done one?
Yes, I should say Dr. Barclay as well, have all done these webinars. Most of the time, frankly, it is someone not working for Zomedica. We do those every week, and you are right, they do generate leads for us, which we then turn into sales. It is a good suggestion, and you should be happy to know that we are doing it. How is fourth quarter looking? Good. So far, so good. We are 23 days into it, but we are pretty happy how things are going. Anything new with Assisi Loop or VETIGEL in terms of more interest uptake? Assisi Loop products are sold to veterinarians for use in their practice. They are sold also to retail. Some vets use them in their practice. More often than not, it is the lounges that they use.
For example, a hospice that is taking care of pets that are coming approach an end of life, they like to get those because then they can alleviate the pain that they are going through. I was at a conference maybe a few weeks ago, and a vet came over and said, "I have a small and a medium and a large lounge. I need another large." I said, "Okay." We sold him one, and it was, like, $1,400. Sure. I asked him, because that is why I go to these conferences is to interact more with the vets.
I asked him, and he said, "Well, I like to do all my treatments while they're on the lounge because it makes them feel better and keeps them calm and so on." I thought, "That's great." The Assisi Loops, which is most of what we sell for, like, $329, those are primarily sold to pet parents for use at home. We see that increasing on a quarterly basis. It's a retail market, and it's not one that we're focusing on growing a lot, but we like the growth in Assisi. We're pretty happy with it, and you'll see that when we release earnings here shortly.
With VETIGEL, I think you saw, if you were here earlier, you saw some of the highlights of once the physicians start using it, when they have an appropriate need for it, they really like this product because it is really a terrific clinical. It is important part of their clinical armamentarium when they have really good, strong bleeding. "With new products and PIMS launching, what is the biggest obstacle to accelerating growth in 2027 and beyond? What measurable milestone would show investors that Zomedica is successfully scaling?" Revenue growth, maintaining high margin, not letting expenses grow. If we can take the same expense structure from, w e took the expense structure from 2025 and reduced it in 2026 through the first half of the year, and I'm suggesting to you that it's going to continue through the second half of the year.
If we take that now same expense structure, and that's even while we've done some things that some of you have asked about, right? We haven't hesitated to invest where we needed to invest, either in development of products or development of a new product, or in acquiring inventory for sale in the new year. To the extent that we're doing that, I think you'll see that if we can keep that expense structure flat or even better down into the new year while revenue grows and margins maintain consistency, that's the formula to get to EBITDA positive, which is what our plan is. "With TRUFORMA analyzers placed at no charge, how long does it typically take for cartridge revenue to recover the cost of each analyzer? Is that payback period improving?" The payback period is improving. Yeah.
As we see additional assays made available that are higher volume assays, as those increase, then the payback period reduces. "We understand you don't want to do the old IR, but any new venues to tell the story?" Yeah. The old IR, even when you're invited and you don't have to pay for your speaking slot, it still requires travel and so on and so forth. I think there will be opportunities in the new year for us to do a little bit more of that, and so I will. I think you can see by these calls, these webinars that we've been producing, takes effort by the part of all the folks. We're happy to do it. I think that informing our existing shareholder base is super important.
It is not that we are afraid to spend the time, but some of the invitations I get to come and tell the story, it is institutional investors who are not likely to. They will ask questions, they will be polite, but inside I know that they are saying, "Okay, well, let us wait till you address certain issues." The issues are not with the business, by the way. The issues are with our capital structure. "Perhaps you can have someone distribute all these great webinars in a podcast, combining them all and sending to potential investors." I suppose we could do that. Emma, Rich, you might want to think about that. In the meantime, they are all available at www.zomedica.com. Then you go into Zomedica University, and they are all there, every single one of them.
In fact, recently, it used to be that if you did not attend in person, you did not get the CE credit. Now we actually are. Some of them, and as we go forward, we are making it so that vets can come and watch them while recorded and still get the CE credit. They have to pass a test and all that. For investors, what we do now is we steer them to a couple of things. One, we steer them to these webinars. We let them know that these webinars are available. If you are doing diligence on Zomedica and you have questions about pretty much anything, there you go. The only other way, the only way you are going to get more information than that is if you sign a non-disclosure agreement with us.
If you do that, then you are not able to trade the stock until anything that you have heard confidentially becomes public. "Could we accelerate growth by signing nationwide agreements with major veterinary hospital chains like NVA, VetCor, and Mission Pet Health, combining free TRUFORMA placements, PIMS integration, minimum cartridge commitments could scale recurring revenue across hundreds of clinics. Is this being pursued?" In a word, yes. As you know, we hired Adrienne Bricaud just over a year ago. She was the head of corporate accounts doing exactly that for Antech. Antech is a little bigger and maybe a little different situation than we are in. Recently, she scored the agreement with the VMG, Veterinary Management Groups, which has 2,400 hospitals around the country. We have got our reps really busy going out and meeting these accounts in their localities.
Introducing not only our product line, but also the particular programs available only for VMG members. In addition, VMG itself is broken into groups of veterinarians, and those groups get together and meet to meet VMG preferred providers. We are asked to talk about two things. One, what do we have that will help them improve the care to their clientele? Two, what do we have that will improve the care to their practice through economics? We have met with two of them so far. One equine group in early October, and one just like a week or two ago, a small animal group. So, we are doing that. When you go to the very large groups, we hired Adrienne because we felt like we were approaching critical mass.
If the only product you have is one thing and they don't use very much of it, then they're not going to spend a lot of time talking to you. As we move into the new year, we feel that as of the beginning of the year, when we've rolled out everything that we intend to, we will be at critical mass, and we will be in a position to make a difference to some of these large groups on a significant scale. We'll be accelerating that type of activity in 2027. "How much of your expected 2027 profitability improvement will come from revenue growth versus reduced R&D and operating expenses? Can Zomedica sustain profitability while continuing to invest in rapid expansion?" Yes.
For that matter, frankly, we could have produced less of an operating loss this year had we not spent the money that we spent this year to roll some things out for next year. We looked at the balance between the desirability of getting to that milestone versus sustaining growth, not just in 2026, but also 2027 and beyond. We'll continue to seek that balance. We're not cutting R&D. If we were developing a new thing and we were going to spend, say, $1.5 million on it during the course of 2026, that new thing is done and ready to launch, so we don't need to spend that $1.5 million next year. If you take that by two or three different projects, then that sort of adds up. But you still have that R&D function.
R&D's busy in any event, and we still will continue to develop new things, potentially not on the same scale that we did in 2026. I'd hate to think that my comments would be taken to say that we're going to cut out R&D, because we're not. We do think that between some of those things and some other positions that we eliminated during the course of 2026, which we don't intend to bring back in 2027, that that sort of preordains when you get the full year benefit of that restructuring in 2027. We believe we'll have reduced OpEx in 2027. But that alone will not get us to EBITDA positive. That requires revenue growth, and that's why we make the investments we do to continue to drive revenue growth. There's one more that snuck in here. Maybe there's some more. Okay.
There's other questions here seeking some additional detail, and I think the answer is going to be kind of. You're probably tired of hearing me give the same answer again and again, so let me just move beyond that. Anyone have any questions for our veterinarians who have been so patient, waiting for someone to ask a question about a clinical study? I'll ask one. Did you guys enjoy doing this? Yeah? Thumbs up?
Sure.
You got to say yes, right? Sorry, but I know no one really likes sitting there. Dr. Wood, as you all know, is a delightful speaker. I always enjoy listening to her. She hates the sound of her own voice, so she cringes whenever she comes in my office and I'm listening to the video. I know you didn't really enjoy it that much, but I will thank you very much for doing it. I think the folks certainly appreciate your time in doing this. Thank you for that, and I'll end with one more comment here. I'll save the best one for last. Wait, where did it go? Here we go. "Keep up the great work. Thank you for such great communication and transparency with your shareholders. Looking forward to 2027." I know there's no question in that, but it was a real comment in the Q&A.
Again, let me thank you for your participation this afternoon. I appreciate it. As always, if you'd like to go more in-depth on this stuff, not going to be able to share material, non-public information with anyone, but always happy to discuss further. Always get a couple calls or emails, and after last month's session, we did get a couple folks that took me up on the offer to get flyers and hand them out to their vets. I'll just mention that it's not at all out of the question that someone that gets those flyers, if they give me their shirt sizes, that they also are able to sport some fancy Zomedica swag as they're handing out those flyers. With that, thank you very much. Team, I really appreciate you guys doing this and for sticking it out. All right. Thanks, all. You take care.