Refractory Angina

Chest pain from angina can feel like a heart attack. In refractory angina, the symptoms continue despite treatment and can limit physical activity, impact mood and state of mind, and result in a significantly poorer quality of life.

Angina is a type of chest pain or pressure caused by reduced blood flow and oxygen reaching the heart. It is typically associated with coronary artery disease and may occur when the heart is working harder than usual, such as during exercise. In refractory angina, the symptoms continue despite treatment and can limit physical activity, depress mood, and result in a significantly poorer quality of life.

The chronic nature of refractory angina means that the feeling of having a heart attack can happen at any time, and many people living with angina worry that a real heart attack or even death will eventually follow. The fear of the next episode of angina can result in mental and emotional distress, and in a decrease in physical activity, even to the point of persons becoming homebound.

Refractory angina is currently treated with prescription medicines and interventional procedures. The medicines typically prescribed such as nitrates, beta blockers and calcium channel blockers work by either increasing blood flow to the heart or reducing the heart’s workload. A more invasive technique, percutaneous coronary intervention (PCI), is a surgical procedure in which mesh wire stents are implanted to increase blood flow by holding the heart’s arteries open.

While all of the current treatments address the hemodynamics of refractory angina, none of them address the underlying problem in the heart muscle itself.

The Imbria Solution

Our approach at Imbria is to improve the heart’s ability to manufacture the energy it needs so that it can maintain a more normal workload.

Under normal circumstances, a mix of both sugars (glucose) and fats (fatty acids) provides fuel for cardiac cells to create energy. This cellular metabolism is crucial to generating the energy required for the heart to pump effectively.

When blood flow is reduced and oxygen levels available to heart cells are lower than usual, as in patients with refractory angina, the use of fats for energy increases but this is an inefficient process since in these conditions, heart cells may need 10-to-15% more oxygen to generate the same amount of energy from fat versus from sugar. With fat as a primary energy source in a reduced oxygen environment, less energy is generated per molecule of oxygen resulting in a less oxygen efficient contraction of the heart muscle.

We are developing IMB-101 as a treatment for refractory angina. It is designed to bring the balance of fuels back towards normal equilibrium by decreasing fat metabolism and increasing glucose metabolism in the heart, resulting in more efficient energy production per molecule of oxygen consumed. We believe that more efficient energy production will enable the heart to carry a greater workload.

We believe that IMB-101 can be used in conjunction with current standards of care since it should not alter blood pressure or heart rate.