{ "docId": "019dd923-622c-750b-8b9a-3bcd52c6e583", "docSlug": "f06b0b5d2079", "documentTitle": "Soleno Therapeutics (SLNO)", "authorId": "58_Scorpion_Capital", "authorName": "Scorpion Capital", "documentKindSlug": "activist-deck", "documentKindLabel": "Activist deck", "sourceTypeSlug": "short_seller", "sourceTypeLabel": "Short seller", "presentationDate": "2025-08-15 00:00:00", "orientation": "landscape", "aspectRatio": 1.3333334, "pageNumber": 152, "pageCount": 415, "prevPage": 151, "nextPage": 153, "slideType": "preempt_rebuttal", "function": "preempt_rebuttal", "density": "overcrowded", "nDataPoints": 1, "notes": "The slide uses direct quotes from a KOL to build a case against the safety of a drug (Vykat) in the PWS population.", "elementsJson": [ "paragraph", "quote_block", "callout_box" ], "metadataConfidence": 0.95, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/152", "deckHref": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckJsonHref": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-152", "components": [ { "bbox": { "h": 0.03, "w": 0.4, "x": 0.07, "y": 0.41 }, "kind": "callout", "text": "Highly concerned about cardiac risk due to edema", "attrs": null, "subkind": "primary", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "12d84837-ad9b-4d82-abcd-1cfcd7af99cf", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.03, "w": 0.5, "x": 0.07, "y": 0.63 }, "kind": "callout", "text": "Concern about edema, compounded by diuretics; “heart arrhythmia, muscle spasms, and seizures”", "attrs": null, "subkind": "primary", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "c45ce96a-0233-4099-9680-374d8edc5aed", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.67 }, "kind": "paragraph", "text": "“Therefore, it’s going to certainly impact how you regulate your sodium, potassium, and magnesium in your body. When your magnesium is not working, guess what happens? If you’re a doctor, the patient comes in with unexplained seizures and can’t talk to you. They’re in a seizure. No one else knows. You got the EMT’s brought them in. You have no history, right? First thing, you give that patient a bolus of magnesium. Because sometimes, low magnesium can cause seizures or muscle spasms or heart irregularity. I suspect it’s probably related to the magnesium transportation. And 1 in 4 —those genes involved making transporter proteins for iron and selenium and magnesium that keeps all equilibrium in our body so our electrolytes are normalized. But I can see that could be a problem. One in 4, particularly when they’re restricting their diet for some reason or other, maybe they’re on a diuretic. When you’re on a diuretic, you’re losing your fluid, you’re losing your potassium. To avoid potassium problems, you have to overload them with potassium pills or eat bananas. More information than you need to know. But yes, I’m concerned about the edema that is a risk. Those 1 in 4 that may have the ATP-sensitive potassium channel, which this drug works in that channel and that regulates our electrolytes in our body, particularly magnesium, and therefore, it can interfere. Without magnesium, you get heart arrhythmia, muscle spasms, and seizures.” - Trial investigator and physician; one of the leading KOL’s in the PWS field", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "7aaa5430-1841-4b3c-9c8b-df759db04cb4", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.22 }, "kind": "paragraph", "text": "whose interview in a separate chapter highlighted severe channelopathy defect risks in PWS genetic subtypes – “...interference with potassium, sodium, calcium, magnesium – all these...keep the heart functioning normally...that’s why I said I wanted to hold off [on Vykat]...and see what happens”; “low magnesium can cause seizures or muscle spasms or heart irregularity...I can see that could be a problem...when you’re on a diuretic...you’re losing your potassium... yes. I’m concerned about the edema...heart arrhythmia, muscle spasms, and seizures.”", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "ee8b452e-3ed5-4925-871f-af16d28a165b", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.45 }, "kind": "paragraph", "text": "Q: “So, you think this could potentially present cardiac risk in a quarter of patients?”\nA: “Cardiac is a big muscle, isn’t it? It can. Right? Potassium, yeah. It can be in edema itself. It might be related to not [being] able to keep the right amount of salt and water in your bloodstream, and therefore you’re leaking out your liquid into your lower legs because your cell membranes aren’t pliable enough because of the interference with potassium, sodium, calcium, magnesium — all these make your muscle work and keep the heart functioning normally. It’s a big player. That’s why I said that I wanted to hold off...and see what happens.” - Trial investigator and physician; one of the leading KOL’s in the PWS field", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "fcee71de-5117-4cf6-b4dd-a34e9108f6ab", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "quote", "text": "“...interference with potassium, sodium, calcium, magnesium – all these...keep the heart functioning normally...that’s why I said I wanted to hold off [on Vykat]...and see what happens”; “low magnesium can cause seizures or muscle spasms or heart irregularity...I can see that could be a problem...when you’re on a diuretic...you’re losing your potassium... yes. I’m concerned about the edema...heart arrhythmia, muscle spasms, and seizures.” — Trial investigator and physician; one of the leading KOL’s in the PWS field", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd953-64ce-7561-b2a3-1b89ec7d3056", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.02, "w": 0.25, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "subkind": null, "toolName": null, "toolSlug": null, "confidence": null, "componentId": "3c167f10-d3df-46aa-9139-7c151402d397", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "title", "text": "However, diuretics in the context of PWS may exacerbate cardiac events and cause neurological ones like seizures, according to one of the most prominent, published, and influential authorities in the field", "attrs": null, "subkind": "headline", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "7fb6a121-c397-4a85-983d-44e93c06eea5", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [ { "name": "authority-citation", "slug": null, "matchId": "a13f32a9-d110-4090-8767-4f4af25f823b", "evidence": "Uses quotes from a 'leading KOL' to validate the argument.", "confidence": 0.9 } ], "arcBeats": [], "loops": [], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }