the primary endpoint of the study will be based on the fix activity level achieved following the administration of etranacogene dezaparvovec , and the secondary endpoints will measure annualized fix replacement therapy usage , annualized bleed rates and safety . patients enrolled in the hope-b trial will be tested for the presence of pre-existing neutralizing antibodies to aav5 but will not be excluded from the trial based on their titers . in january 2019 , we dosed the first patient in our phase iii hope-b hemophilia b pivotal trial and in september 2019 , we completed the enrollment of approximately 60 patients in the lead-in phase of the trial . in august 2018 , we initiated a phase iib dose-confirmation study of etranacogene dezaparvovec . the phase iib study is an open-label , single-dose , single-arm , multi-center trial being conducted in the united states . the objective of the study was to evaluate the safety and tolerability of etranacogene dezaparvovec and confirm the dose based on fix activity at six weeks after administration . three patients with severe hemophilia were enrolled in this study and received a single intravenous infusion of 2x10 13 gc/kg . in february , may , july and december 2019 , we presented updated data from the phase iib dose-confirmation study of etranacogene dezaparvovec . data from the phase iib study of etranacogene dezaparvovec show that all three patients experienced increasing and sustained fix levels after a one-time administration of etranacogene dezaparvovec , with two of the three patients maintaining fix activity in the normal range . mean fix activity was 41 % of normal at 52 weeks of follow-up , exceeding threshold fix levels generally considered sufficient to significantly reduce the risk of bleeding events . the first patient achieved fix activity of 50 % of normal . fix activity in the second patient was 31 % of normal and in the third patient was 41 % of normal . the second and third patients previously screen-failed and were excluded from another gene therapy study due to pre-existing neutralizing antibodies to a different aav vector . based on the data obtained through october 24 , 2019 , no patient experienced a material loss of fix activity , reported any bleeding events or required any infusions of fix replacement therapy for bleeds . one patient underwent hip surgery due to a pre-existing condition and was treated perioperatively with short-acting factor replacement . this was reported by the investigator as a serious adverse event unrelated to etranacogene dezaparvovec . amt-060 in december 2019 , we also presented four-year follow-up data related to our first-generation hemophilia b program . amt-060 , which incorporated a wild-type fix gene . all 10 patients enrolled in the phase i/ii study continue to show long-term meaningful clinical impact , including sustained increases in fix activity and improvements in their disease state as measured by reduced usage of fix replacement therapy and decreased bleeding frequency . at up to four years of follow-up , amt-060 continues to be well-tolerated , with no new serious adverse events and no development of inhibitors since the last reported data . all five patients in the high dose cohort of 2x10 13 gc/kg continue to be free of routine fix replacement therapy at up to three and a half years after treatment . based on the last six months of data collected during the fourth year of follow-up , the mean annualized bleeding rate was zero compared to an average of four bleeds during the year prior to treatment , representing a 100 % reduction . steady state mean yearly fix activity at three and a half years was 7.5 % compared with 7.1 % in the first year , 8.4 % in the second and 7.9 % in the third year . 64 ​ huntington 's disease program ( amt-130 ) amt-130 is our novel gene therapy candidate for the treatment of huntington 's disease . amt-130 utilizes our miqure tm proprietary , gene-silencing platform and incorporates an aav vector carrying a mirna specifically designed to silence the huntingtin gene and the potentially highly toxic exon 1 protein fragment . amt-130 has received orphan drug and fast track designations from the fda and orphan medicinal product designation from the ema . in january 2019 , our ind application for amt-130 was cleared by the fda , thereby enabling us to initiate our planned phase i/ii clinical study . the phase i/ii protocol is a randomized , imitation surgery-controlled , double-blinded study conducted at three surgical sites , and multiple referring , non-surgical sites in the u.s. the primary objective of the study is to evaluate the safety , tolerability and efficacy of amt-130 at two doses . in the fourth quarter of 2019 , we initiated patient screening . additionally , cgmp clinical material has been manufactured at our lexington facility and has been released for shipment . in january 2019 , the u.s. patent and trademark office issued u.s. patent 10,174,321 and in may 2019 the european patent office issued ep 3237618 , both with granted claims that cover the rna constructs specifically designed to target exon1 and the embedding of these huntington 's disease rna sequences into the mir451 scaffold , which we exclusively license from cshl . the claims also cover certain expression cassettes comprising the rna constructs and the use of gene therapy vectors including aav vectors encompassing the described expression cassettes . in february 2019 , we presented new preclinical data at the 14th annual chdi huntington 's disease therapeutics conference that illustrated the therapeutic potential of amt-130 to restore the function of damaged brain cells in huntington 's disease and provide a sustained reduction of mutant huntingtin protein . story_separator_special_tag historically , our assumptions , judgments and estimates relative to our critical accounting policies have not differed materially from actual results . ​ adoption of asc 842 leases on january 1 , 2019 ​ on january 1 , 2019 , we adopted asc 842 , “ leases ( topic 842 ) ” . we adopted the standard using the modified retrospective approach with an effective date as of the beginning of the fiscal year , january 1 , 2019 , to operating leases that existed on that date . prior year comparative financial information was not recast under the new standard and continues to be presented under asc 840. we elected to utilize the package of practical expedients available for expired or existing contracts which allowed us to carryforward historical assessments of ( 1 ) whether contracts are or contain leases , ( 2 ) lease classification , and ( 3 ) initial direct costs . we performed an assessment and identified the lease facilities as material leases to be accounted for under asc 842 as of january 1 , 2019. the impact of implementing asc 842 is summarized below : ​ - recognized a $ 19.0 million operating right-of-use asset and a $ 28.1 million operating lease liability in relation to the facilities leased at the amsterdam and lexington sites in the consolidated balance sheet as of january 1 , 2019 ; - presented deferred rent of $ 9.1 million as of december 31 , 2018 , as a reduction of the right-of-use asset as from january 1 , 2019 onwards in the consolidated balance sheet and as a change within operating cash flows within accrued expense , other liabilities and operating leases ; we measured the lease liability at the present value of the future lease payments as of january 1 , 2019. we used an incremental borrowing rate to discount the lease payments . we derived the discount rate , adjusted for differences such as in the term and payment patterns , from our hercules loan which was refinanced immediately prior to the january 1 , 2019 adoption date in december 2018. we valued the right-of-use asset at the amount of the lease liability reduced by the remaining december 31 , 2018 balance of lease incentives received . we subsequently measure the lease liability at the present value of the future lease payments as of the reporting date with a corresponding adjustment to the right-to-use asset . absent a lease modification we will continue to utilize the january 1 , 2019 , incremental borrowing rate . we will continue to recognize lease cost on a straight-line basis and will continue to present these costs as operating expenses within our consolidated statements of operations and comprehensive loss . we will continue to present lease payments and landlord incentive payments within cash flows from operations within our consolidated statements of cash flows . 69 ​ ​ adoption of asc 606 revenue recognition on january 1 , 2018 ​ on january 1 , 2018 we adopted new revenue recognition policies in accordance with asc 606. the new revenue recognition policies replace the existing policies in accordance with asc 605. we elected to implement asc 606 by applying it to active collaboration arrangements as of january 1 , 2018 and to record a cumulative adjustment of revenue previously recognized to our accumulated loss as of december 31 , 2017. the impact of implementing asc 606 is summarized below : - recognized $ 7.5 million of license revenue during the twelve months ended december 31 , 2018 , related to the collaboration with bms compared to $ 4.2 million that would have been recognized in accordance with the previous revenue recognition policies ; - continued to present revenue recognized during the twelve months ended december 31 , 2017 , in accordance with the previous revenue recognition policies ; - decreased the accumulated loss by $ 24.9 million as of january 1 , 2018 and decreased deferred revenue as of the same date by $ 24.9 million . in accordance with the previous revenue recognition policies we had concluded that the bms collaboration agreement consisted of three performance obligations , ( i ) technology ( license and target selections ) , know-how and manufacturing in the field of gene therapy and development and active contribution to the development through the joint steering committee participations , ( ii ) provision of employees , goods and services for research , and ( iii ) clinical and commercial manufacturing . we determined that these three performance obligations are substantially identical with the performance obligations in accordance with our new revenue recognition policies : ( i ) providing access to our technology and know-how in the field of gene therapy as well as actively contributing to the target selection , the collaboration as a whole , the development during the target selection , the pre-clinical and the clinical phase through participating in joint steering committee and other governing bodies ( “ license revenue ” ) ; ( ii ) providing pre-clinical research activities ( “ collaboration revenue ” ) ; and ( iii ) providing clinical and commercial manufacturing services for products ( “ manufacturing revenue ” ) . license revenue we generate license revenue from a $ 60.1 million upfront payment recorded on may 21 , 2015 , as well as $ 15.0 million received in relation to the designation of the second , third and fourth collaboration target in august 2015. we are also entitled to an aggregate $ 16.5 million in target designation payments upon the selection of the fifth to tenth collaboration target . we will also be eligible to receive research , development and regulatory milestone payments of up to $ 254.0 million for a lead candidate target ( which has been amt-126 ) and up to $ 217.0 million for each of the other selected targets , if milestones are achieved . we will include the variable consideration related to the

net cash used in operating activities ​ net cash used in operating activities was $ 98.7 million for the annual period ended december 31 , 2019 , and consisted of a net loss of $ 124.2 million adjusted for non-cash items , including depreciation and amortization expense of $ 6.7 million , share-based compensation expense of $ 17.5 million , fair value loss of derivative financial instruments of $ 2.5 million , unrealized foreign exchange loss of $ 0.9 million , and a decrease in unamortized deferred revenue of $ 5.0 million . net cash used in operating activities also included changes in operating assets and liabilities of $ 2.9 million . these changes primarily related to a net increase in accounts receivable and accrued income , prepaid expenses and other current assets of $ 4.8 million and a net increase in accounts payable , accrued expenses , other liabilities and operating leases of $ 7.7 million primarily related to our etranacogene dezaparvovec and amt-130 clinical trials . ​ net cash used in operating activities was $ 76.0 million for the annual period ended december 31 , 2018 , and consisted of a net loss of $ 83.3 million adjusted for non-cash items , including depreciation and amortization expense of $ 12.4 million , share-based compensation expense of $ 10.7 million , fair value gain of derivative financial instruments and contingent consideration of $ 4.1 million , unrealized foreign exchange gain of $ 5.5 million , deferred tax of $ 0.2 million , a decrease in lease incentives of$ 0.3 million , and a decrease in unamortized deferred revenue of $ 8.5 million .


 Write a concise suspicious activity report of the following text delimited by triple backquotes. Return your response as a formal report which covers the key points highlighting the location,dates,entity names and account holder information in chronological order of the text.
     ```net cash used in operating activities ​ net cash used in operating activities was $ 98.7 million for the annual period ended december 31 , 2019 , and consisted of a net loss of $ 124.2 million adjusted for non-cash items , including depreciation and amortization expense of $ 6.7 million , share-based compensation expense of $ 17.5 million , fair value loss of derivative financial instruments of $ 2.5 million , unrealized foreign exchange loss of $ 0.9 million , and a decrease in unamortized deferred revenue of $ 5.0 million . net cash used in operating activities also included changes in operating assets and liabilities of $ 2.9 million . these changes primarily related to a net increase in accounts receivable and accrued income , prepaid expenses and other current assets of $ 4.8 million and a net increase in accounts payable , accrued expenses , other liabilities and operating leases of $ 7.7 million primarily related to our etranacogene dezaparvovec and amt-130 clinical trials . ​ net cash used in operating activities was $ 76.0 million for the annual period ended december 31 , 2018 , and consisted of a net loss of $ 83.3 million adjusted for non-cash items , including depreciation and amortization expense of $ 12.4 million , share-based compensation expense of $ 10.7 million , fair value gain of derivative financial instruments and contingent consideration of $ 4.1 million , unrealized foreign exchange gain of $ 5.5 million , deferred tax of $ 0.2 million , a decrease in lease incentives of$ 0.3 million , and a decrease in unamortized deferred revenue of $ 8.5 million .
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 Suspicious Activity Report : the primary endpoint of the study will be based on the fix activity level achieved following the administration of etranacogene dezaparvovec , and the secondary endpoints will measure annualized fix replacement therapy usage , annualized bleed rates and safety . patients enrolled in the hope-b trial will be tested for the presence of pre-existing neutralizing antibodies to aav5 but will not be excluded from the trial based on their titers . in january 2019 , we dosed the first patient in our phase iii hope-b hemophilia b pivotal trial and in september 2019 , we completed the enrollment of approximately 60 patients in the lead-in phase of the trial . in august 2018 , we initiated a phase iib dose-confirmation study of etranacogene dezaparvovec . the phase iib study is an open-label , single-dose , single-arm , multi-center trial being conducted in the united states . the objective of the study was to evaluate the safety and tolerability of etranacogene dezaparvovec and confirm the dose based on fix activity at six weeks after administration . three patients with severe hemophilia were enrolled in this study and received a single intravenous infusion of 2x10 13 gc/kg . in february , may , july and december 2019 , we presented updated data from the phase iib dose-confirmation study of etranacogene dezaparvovec . data from the phase iib study of etranacogene dezaparvovec show that all three patients experienced increasing and sustained fix levels after a one-time administration of etranacogene dezaparvovec , with two of the three patients maintaining fix activity in the normal range . mean fix activity was 41 % of normal at 52 weeks of follow-up , exceeding threshold fix levels generally considered sufficient to significantly reduce the risk of bleeding events . the first patient achieved fix activity of 50 % of normal . fix activity in the second patient was 31 % of normal and in the third patient was 41 % of normal . the second and third patients previously screen-failed and were excluded from another gene therapy study due to pre-existing neutralizing antibodies to a different aav vector . based on the data obtained through october 24 , 2019 , no patient experienced a material loss of fix activity , reported any bleeding events or required any infusions of fix replacement therapy for bleeds . one patient underwent hip surgery due to a pre-existing condition and was treated perioperatively with short-acting factor replacement . this was reported by the investigator as a serious adverse event unrelated to etranacogene dezaparvovec . amt-060 in december 2019 , we also presented four-year follow-up data related to our first-generation hemophilia b program . amt-060 , which incorporated a wild-type fix gene . all 10 patients enrolled in the phase i/ii study continue to show long-term meaningful clinical impact , including sustained increases in fix activity and improvements in their disease state as measured by reduced usage of fix replacement therapy and decreased bleeding frequency . at up to four years of follow-up , amt-060 continues to be well-tolerated , with no new serious adverse events and no development of inhibitors since the last reported data . all five patients in the high dose cohort of 2x10 13 gc/kg continue to be free of routine fix replacement therapy at up to three and a half years after treatment . based on the last six months of data collected during the fourth year of follow-up , the mean annualized bleeding rate was zero compared to an average of four bleeds during the year prior to treatment , representing a 100 % reduction . steady state mean yearly fix activity at three and a half years was 7.5 % compared with 7.1 % in the first year , 8.4 % in the second and 7.9 % in the third year . 64 ​ huntington 's disease program ( amt-130 ) amt-130 is our novel gene therapy candidate for the treatment of huntington 's disease . amt-130 utilizes our miqure tm proprietary , gene-silencing platform and incorporates an aav vector carrying a mirna specifically designed to silence the huntingtin gene and the potentially highly toxic exon 1 protein fragment . amt-130 has received orphan drug and fast track designations from the fda and orphan medicinal product designation from the ema . in january 2019 , our ind application for amt-130 was cleared by the fda , thereby enabling us to initiate our planned phase i/ii clinical study . the phase i/ii protocol is a randomized , imitation surgery-controlled , double-blinded study conducted at three surgical sites , and multiple referring , non-surgical sites in the u.s. the primary objective of the study is to evaluate the safety , tolerability and efficacy of amt-130 at two doses . in the fourth quarter of 2019 , we initiated patient screening . additionally , cgmp clinical material has been manufactured at our lexington facility and has been released for shipment . in january 2019 , the u.s. patent and trademark office issued u.s. patent 10,174,321 and in may 2019 the european patent office issued ep 3237618 , both with granted claims that cover the rna constructs specifically designed to target exon1 and the embedding of these huntington 's disease rna sequences into the mir451 scaffold , which we exclusively license from cshl . the claims also cover certain expression cassettes comprising the rna constructs and the use of gene therapy vectors including aav vectors encompassing the described expression cassettes . in february 2019 , we presented new preclinical data at the 14th annual chdi huntington 's disease therapeutics conference that illustrated the therapeutic potential of amt-130 to restore the function of damaged brain cells in huntington 's disease and provide a sustained reduction of mutant huntingtin protein . story_separator_special_tag historically , our assumptions , judgments and estimates relative to our critical accounting policies have not differed materially from actual results . ​ adoption of asc 842 leases on january 1 , 2019 ​ on january 1 , 2019 , we adopted asc 842 , “ leases ( topic 842 ) ” . we adopted the standard using the modified retrospective approach with an effective date as of the beginning of the fiscal year , january 1 , 2019 , to operating leases that existed on that date . prior year comparative financial information was not recast under the new standard and continues to be presented under asc 840. we elected to utilize the package of practical expedients available for expired or existing contracts which allowed us to carryforward historical assessments of ( 1 ) whether contracts are or contain leases , ( 2 ) lease classification , and ( 3 ) initial direct costs . we performed an assessment and identified the lease facilities as material leases to be accounted for under asc 842 as of january 1 , 2019. the impact of implementing asc 842 is summarized below : ​ - recognized a $ 19.0 million operating right-of-use asset and a $ 28.1 million operating lease liability in relation to the facilities leased at the amsterdam and lexington sites in the consolidated balance sheet as of january 1 , 2019 ; - presented deferred rent of $ 9.1 million as of december 31 , 2018 , as a reduction of the right-of-use asset as from january 1 , 2019 onwards in the consolidated balance sheet and as a change within operating cash flows within accrued expense , other liabilities and operating leases ; we measured the lease liability at the present value of the future lease payments as of january 1 , 2019. we used an incremental borrowing rate to discount the lease payments . we derived the discount rate , adjusted for differences such as in the term and payment patterns , from our hercules loan which was refinanced immediately prior to the january 1 , 2019 adoption date in december 2018. we valued the right-of-use asset at the amount of the lease liability reduced by the remaining december 31 , 2018 balance of lease incentives received . we subsequently measure the lease liability at the present value of the future lease payments as of the reporting date with a corresponding adjustment to the right-to-use asset . absent a lease modification we will continue to utilize the january 1 , 2019 , incremental borrowing rate . we will continue to recognize lease cost on a straight-line basis and will continue to present these costs as operating expenses within our consolidated statements of operations and comprehensive loss . we will continue to present lease payments and landlord incentive payments within cash flows from operations within our consolidated statements of cash flows . 69 ​ ​ adoption of asc 606 revenue recognition on january 1 , 2018 ​ on january 1 , 2018 we adopted new revenue recognition policies in accordance with asc 606. the new revenue recognition policies replace the existing policies in accordance with asc 605. we elected to implement asc 606 by applying it to active collaboration arrangements as of january 1 , 2018 and to record a cumulative adjustment of revenue previously recognized to our accumulated loss as of december 31 , 2017. the impact of implementing asc 606 is summarized below : - recognized $ 7.5 million of license revenue during the twelve months ended december 31 , 2018 , related to the collaboration with bms compared to $ 4.2 million that would have been recognized in accordance with the previous revenue recognition policies ; - continued to present revenue recognized during the twelve months ended december 31 , 2017 , in accordance with the previous revenue recognition policies ; - decreased the accumulated loss by $ 24.9 million as of january 1 , 2018 and decreased deferred revenue as of the same date by $ 24.9 million . in accordance with the previous revenue recognition policies we had concluded that the bms collaboration agreement consisted of three performance obligations , ( i ) technology ( license and target selections ) , know-how and manufacturing in the field of gene therapy and development and active contribution to the development through the joint steering committee participations , ( ii ) provision of employees , goods and services for research , and ( iii ) clinical and commercial manufacturing . we determined that these three performance obligations are substantially identical with the performance obligations in accordance with our new revenue recognition policies : ( i ) providing access to our technology and know-how in the field of gene therapy as well as actively contributing to the target selection , the collaboration as a whole , the development during the target selection , the pre-clinical and the clinical phase through participating in joint steering committee and other governing bodies ( “ license revenue ” ) ; ( ii ) providing pre-clinical research activities ( “ collaboration revenue ” ) ; and ( iii ) providing clinical and commercial manufacturing services for products ( “ manufacturing revenue ” ) . license revenue we generate license revenue from a $ 60.1 million upfront payment recorded on may 21 , 2015 , as well as $ 15.0 million received in relation to the designation of the second , third and fourth collaboration target in august 2015. we are also entitled to an aggregate $ 16.5 million in target designation payments upon the selection of the fifth to tenth collaboration target . we will also be eligible to receive research , development and regulatory milestone payments of up to $ 254.0 million for a lead candidate target ( which has been amt-126 ) and up to $ 217.0 million for each of the other selected targets , if milestones are achieved . we will include the variable consideration related to the

