Accelerating development of an innovative approach to heart failure treatment

While the death rate for heart attack and angina patients fell by a third over the two decades through 2004, heart attack survivors often go on to develop congestive heart failure (a condition in which a weakened heart is unable to pump enough blood to the body's organs). In extreme cases patients' lungs and limbs fill up with water, making them feel as if they are drowning. The U.S. spent $37 billion treating congestive heart failure last year.

The drugs for heart failure work, but only for a subset of patients. As many as 30% of patients who take beta blockers or angiotensin-converting enzyme inhibitors die, and another 40% are readmitted to the hospital within six months.

A company called Cytokinetics is tapping a different biological mechanism.  And it was profiled recently in Forbes by writer Kerry Dolan.

Cytokinetics has developed an expertise in the cytoskeleton -- the structural and mechanical system inside cells. Its drug, omecamtiv mecarbil, works by activating proteins inside heart muscle cells to help the heart beat more effectively. "We are working to keep patients alive and functioning longer outside the hospital," says Cytokinetics CEO Robert Blum.

Omecamtiv is intended for higher-risk heart failure patients in stable condition. The drug, given either in IV or oral form, works by activating a protein called cardiac myosin. Myosin is responsible for converting chemical energy into mechanical force, enabling heart muscle contraction. Existing positive inotrope drugs speed up muscle contraction by increasing the amount of calcium inside muscle cells. The increased rate of muscle contraction, however, has been linked to dangerous side effects and death.

Amgen is keen on tapping the heart failure market and announced a partnership with Cytokinetics, so far paying $125 million and covering the cost of the remaining clinical trials, which should take another three to five years.

Blum has grand plans to apply his researchers' knowledge of the cytoskeleton -- and the lessons from the $400 million the company has spent thus far -- to an array of other diseases in which muscles are weakened. Midstage trials on a drug to treat amyotrophic lateral sclerosis (Lou Gehrig's disease) will start this spring.

Other targets on Blum's radar screen include asthma, hypertension and coronary obstructive pulmonary disease.