{ "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": 412, "pageCount": 415, "prevPage": 411, "nextPage": 413, "slideType": "expose_contradiction", "function": "expose_contradiction", "density": "dense", "nDataPoints": 0, "notes": "The slide uses a Q&A transcript format to validate the claim of trial unblinding.", "elementsJson": [ "paragraph", "quote_block", "footnote" ], "metadataConfidence": 1, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/412", "deckHref": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckJsonHref": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-412", "components": [ { "bbox": null, "kind": "callout", "text": "When we asked if the edema-related treatment unblinded these patients, the physician replied “yes...for sure.”", "attrs": null, "subkind": null, "toolName": "Visual emphasis", "toolSlug": "visual-emphasis", "confidence": null, "componentId": "019dd953-64cf-7128-a315-e6abe2ff7a80", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.38, "w": 0.86, "x": 0.07, "y": 0.51 }, "kind": "list", "text": "Q: “When you said you treated edema in a couple of patients on diazoxide, so you were called in to treat a side effect of the drug?”\nA: “Well, we weren’t sure if it was a side effect of the drug, but that was the presumed mechanism. This is what I do for a living. If I have edema, it’s a saltwater imbalance or it’s a low albumin oncotic pressure problem. If the albumin is low, then the third spacing — they may need a diuretic. If they’re having salt retention due to the hyperphagia, then we still need to put them on a diuretic.”\nQ: “I actually find that quite interesting that two patients on the trial had edema that warranted referral to a specialist who knows how to address it. How old were these patients? How severe was the edema?”\nA: “One patient was about 12 years old, another patient was about eight...in the 12, it was plus-one edema.”\nQ: “Do you think that would have affected these patients HQ-CT scores if they’re in the trial, these patients all know they have edema and hypertrichosis from the drug.”\nA: “They would have for sure if they were honest, for sure.”\nQ: “There must have been some conversation — you would have been asking questions or making statements, like maybe this is diazoxide related.”\nA: “Yes. For sure.” – Nephrologist who manages PWS patients,", "attrs": null, "subkind": "bullet", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "f6a67ec7-8e87-43ce-b7fb-3ec35a0e84fb", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.05, "w": 0.86, "x": 0.07, "y": 0.45 }, "kind": "paragraph", "text": "Nephrologist treated two patients for drug-induced edema during the trial, thereby unblinding those patients; 8 and 12 years old and one with significant “plus-one” edema", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "3a84f201-3f6e-4751-b5c4-7dba3b93caf1", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "quote", "text": "“there were a few patients that were already on Vykat that were referred for edema and proteinuria”; “we weren’t sure if it was a side effect of the drug, but that was the presumed mechanism”; “one patient was about 12 years old, another patient was about 8.” — Nephrologist who manages PWS patients.", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd953-64cf-7128-a315-eb7688274bfd", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.02, "w": 0.3, "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": "f160aecf-cfa6-41c9-ab8e-e64cf4a475b7", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.35, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "title", "text": "The nephrologist provided alarming color about Vykat’s potential to cause edema in even the youngest patients, stating that he treated two patients in the trial for edema, presumably with diuretics, which he and his colleagues presumed was drug-related, which while concerning in and of itself also would have unblinded the parents and physicians and impacted their HQ-CT scores – “there were a few patients that were already on Vykat that were referred for edema and proteinuria”; “we weren’t sure if it was a side effect of the drug, but that was the presumed mechanism”; “one patient was about 12 years old, another patient was about 8.” When we asked if the edema-related treatment unblinded these patients, the physician replied “yes...for sure.”", "attrs": null, "subkind": "headline", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "1c4c1d85-ff25-4408-a5b1-a39d0c482304", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [ { "name": "fraud-exposure", "slug": null, "matchId": "4c1be897-b155-4135-961a-53ee5e5f1dc9", "evidence": "The slide explicitly documents how clinical trial blinding was compromised, suggesting potential data manipulation or invalidation.", "confidence": 0.9 } ], "arcBeats": [], "loops": [], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }