SEISMIC Pharmaceuticals

Transforming Early Cardiogenic Shock with First-in-Class Calcitropes

Istaroxime and second generation Calcitropes for Cardiogenic Shock, Acute and Chronic Heart Failure

Hero Graphic

Heart Failure Spectrum & Mortality

Acute HF Icon

Acute HF (AHF)

Rapid onset or worsening of HF requiring urgent hospitalization

1.2 million annual hospitalizations (US)

Mortality

4–10% in-hospital

15% 1-year

Heart Failure Icon

Worsening (HF)

Rapid onset or worsening of HF that does not require hospitalization)

0.6 million patients (US) Every patients who developed HF (6 million in the USA) starts with an episode of Acute or Worsening HF

Mortality

6–10% 1-year

25–30% 5-year

Cardiogenic Shock Icon

Cardiogenic Shock (CS)

Most extreme type of Acute HF Critical state of systemic hypoperfusion and low blood pressure impairing the function of vital organs.

>150k patients annually (US)

Mortality

30–50% in-hospital

Solution:

Istaroxime - First-in-Class Calcitrope
Dual Inotropy and Lusitropy Without Adrenergic Overdrive

Dual MoA Istaroxime
  • Inhibition of sarcolemma Na+/K+-ATPase
    → Cystosolic Ca increased in systole
SEISMIC 101
  • Activation of SERCA2a promoting the reuptake of cytosolic Ca2+ in the SR, with
    → Cytosolic Ca decreased in diastole with subsequent ↑ Ca release from sarcoplasmic reticulum at each systole
Pipeline
  • SEISMIC 101 – Same dual mechanism of action, oral bioavailable, in pre-clinical more effective. First follow up in IND enabling studies
  • SEISMIC 102 – Pure SERCA 2a
Istaroxime Mechanism Diagram

Three calcitrope assets span Acute to Chronic HF

Lead asset is Phase 3 with over 300 patients worth of data; 101/102 are follow-on upside enabled by the same biology.

Asset Where it plays Stage
Istaroxime
Early cardiogenic shock / low-BP Acute HF; IV hospital use In Phase 3
SEISMIC 101
Acute/Worsening HF With Low EF – transition to chronic therapy
Similar mechanism as Istaroxime – Focused on advanced HF and HF with reduced EF
Preclinical
SEISMIC 102
Acute/Worsening HF with preserved/mid-range EF – transition to chronic therapy
Oral SERCA2a-focused follow-on
Preclinical
SEISMIC 103
Group 1 PAH; oral add-on across risk strata; disease-modifying intent; First pan-SERCA oral agent Preclinical

Multiple programs with staged near-term readouts offer repeated opportunities for partnering, acquisition, or IPO

Development Timeline

2026 2027 2028
Q3Q4 Q1Q2Q3Q4 Q1Q2Q3Q4
Istaroxime 1st-gen Calcitrope
Phase 3  ·  600 patients  ·  Early Cardiogenic Shock (SCAI B-C)  ·
Marketing Authorization
Ph3 Interim
SEISMIC101 Dual IV + Oral
(2nd-gen, same
mechanism as Ista.)
Preclinical POC + CMC
IND-enabling Studies
101 IND
Phase 1/2  ·  IV + Oral  ·  AHF / Advanced HF
Phase 3 →
SEISMIC102 Pure SERCA2a
(2nd-gen)
Preclinical + HF Model POC + CMC
IND-enabling Studies
102 IND
Phase 1/2  ·  IV + Oral  ·  HFpEF + Diastolic
Phase 3 →
SEISMIC103 Pan-SERCA
Pulmonary Arterial Hypertension (PAH)  ·  PC POC + CMC
IND-enabling Studies
102 IND
Phase 1/2  ·  IV + Oral  ·  PAH
Phase 3 →

Development & Regulatory Strategy

Istaroxime Phase 3 study

600-patient global study  ·  Early CS (SCAI B-C)  ·  48h IV treatment
Population
  • Early cardiogenic shock, SCAI B-C
  • Low BP / cardiac dysfunction without full collapse
  • Largest addressable HF-CS cohort
Primary Endpoints
  1. Dyspnea improvement to 24h (USA/China registration)
  2. Hierarchical composite: Death, LVAD, HF Readmission/WHF, QoL to Day 2 (EU/USA)
Secondary Endpoint
  1. Length of hospital stay
Exploratory Endpoints
  1. End-organ function (renal, hepatic)
  2. Quality of life (EQ-5D) at Day 30
  3. Hemodynamic parameters at 6 & 24h
600 patients provides power for all co-primary endpoints based on effect sizes observed in Phase 2

FDA agreed on the overall design

Some discussions are ongoing on whether the QoL endpoint will be stand alone or part of hierarchical endpoint, other issues on endpoints agreed.

Approval endpoints - all Istaroxime Phase 2 studies

Patients treated at target dose 0.5-1.0 mcg/Kg/min (pooled analysis)

Improved early symptoms - Dyspnea
(Stabilized AHF pts.)
Phase 2 Chart 1
Improved 30 days Quality of Life
(Early Cardiogenic shock)
Phase 2 Chart 2
Reduced Length of hospital stay
(early cardiogenic shock)
Phase 2 Chart 3
Reduced congestion (Weight, early Cardiogenic shock)
Phase 2 Chart 4
Directional reduction in WHF/death events through Day 30 in dose-optimized patients treated ≥24–60h
(exploratory; not powered, n=204)
Phase 2 Chart 5
Mortality assessed in Phase II; supports phase III
(n = 204)
Phase 2 Chart 6

101/102 Extend:

Extend the acute Stabilization Thesis into Oral chronic Care

Stable HF Patients

Stable HF patients on GDMT have materially lower annual event risk than patients after an Acute/Worsening HF episode.

Worsening / Acute HF Risk

Patients developing Worsening or Acute HF face a 30% risk of readmission or death during the first year after the event, mostly in the first 90 days – and up to 15% mortality in the first 6 – 12 months.

Unmet Medical Need

No therapy has been shown to improve 6 to 12-month outcomes in worsening or Acute HF. Rapid uptitration of GDMT remains the only available option — leaving a critical therapeutic gap.

Seismic 101 & 102 Solution

Seismic 101 and 102, administered IV and orally, are specifically developed to reduce adverse outcomes after Worsening or Acute HF events — enabling IV-to-oral transition to long term chronic care.

101/102 Upside:

Franchise Upside After Istaroxime Validates Biology

Istaroxime

Lead asset in early cardiogenic shock; Phase 3 readiness and FDA alignment drive near-term value.

SEISMIC 101

IV/oral follow-on concept for systolic / advanced HF overarching acute to chronic or chronic therapy;

Biological effect value shown in small animal models,

Large animal HF models POC pending, IND-enabling, safety and label clarity.

SEISMIC 102

SERCA2a-focused IV/oral option for diastolic / chronic-care biology if preclinical and clinical validation holds.

Biological effect value shown in small animal models,

HF large animal models POC pending, IND-enabling, safety and label clarity.

Strategic rationale:

Istaroxime is the short-term financing thesis.
101/102 create strategic optionality and support a franchise story once the biology is further validated.

Team:

Highly Experienced in Delivering AHF/CS Positive Studies

Company Leadership

Gad Cotter

Gad Cotter, cardiologist, 25 years experience in leading successful phase 2-3 clinical studies in AHF and CS, leading to changes in guidelines, regulatory approvals and acquisitions by big pharma.

Beth Davison

Beth Davison PhD, biostatistician and executive with >25 years clinical research experience in acute cardiovascular conditions with trials that led to practice guideline changes and successful M&A transactions.

Jed Latkin

Jed Latkin MBA from Columbia since 2002 has over 28 years in various roles as CEO, investment banker, research analyst, biotech and pharmaceuticals CEO. He has helped get products approved by the FDA and healthcare companies public.

Board of Directors

Ameet Nathwani

Ameet Nathwani, Cardiologist, Biotech CEO, Pharma Executive. 30+ years of leadership and CV drug development at GSK, Novartis and Sanofi incl. development of multiple Heart Failure therapies (carvedilol, valsartan and Entresto).

Howard C Dittrich

Howard C Dittrich cardiologist, originally of UC San Diego, former CMO of various CV companies. Under his medical leadership, several of these companies gained both US and EU regulatory approval and several have been acquired by big pharma.

Rick Orr

Rick Orr, JD, pharmaceutical and biotechnology executive with >25 years of experience creating and building life science companies that led to multiple successful M&A transactions and drug approvals

Publications

Key Research Papers and Clinical Data

📄

24-Hour Istaroxime Infusion in Acute Heart Failure

⬇ View PDF
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Hemodynamic Effects of Istaroxime in SCAI Stage B Pre-Cardiogenic Shock (SEISMiC)

⬇ View PDF
📄

Safety and Efficacy of Istaroxime in AHF-Related Pre-Cardiogenic Shock (SEISMiC)

⬇ View PDF
📄

Hemodynamic and Echocardiographic Effects of Istaroxime (HORIZON-HF)

⬇ View PDF
📄

Istaroxime and Diastolic Function in Acute Heart Failure (HORIZON-HF)

⬇ View PDF
📄

Istaroxime Infusion in Pre-Cardiogenic Shock for Up to 60 Hours (SEISMiC)

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📄

Dose-Finding Study of Istaroxime in Pre-Cardiogenic Shock (SEISMiC)

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📄

SEISMiC B and C Combined Final Results — JACC Heart Failure 2026

⬇ View PDF

Contact

Get In Touch With SEISMIC Pharmaceuticals

For more information please contact: Gad Cotter ( gadcotter@seismicrx.com )