Because of the heterogeneity of heart failure patients and causes, new drugs to treat heart failure haven't been a huge area of research or business development. Few heart failure drugs are likely to be blockbusters, and there are very few deals around truly novel targets. Biotech start-ups build on known approaches and innovate incrementally, in this market.

In Vivo briefly summarizes the technologies of these recently founded companies: Asuragen, Auxetica, EndGenitor, Genophrenix, Pharmagic, ViewRay.

Recent clinical trial failures in cardiac stem cell therapies have been widely reported as raising more questions than answers in a field which already had many unknowns. But those questions themselves give rise to new strategies spurring the formation of start-ups like those profiled in this issue. While the new companies are ultimately addressing heart failure, they hope to intervene much earlier in the cascade of damage and remodeling, where turning up the body's natural healing responses a notch could help it repair the damage caused by myocardial infarction or ischemia. Many cardiac cell and gene therapy companies are returning to ischemic disease, a field in which, in recent years, the success of device-based revascularization techniques appeared to present a competitive hurdle to cell and gene therapies. Microvessel disease is emerging as a large market in which cell and gene therapies might have advantages over devices.

With rights to a novel gene that it believes will help protect and repair damaged heart tissue and an adeno-associated virus (AAV) gene therapy delivery system, NanoCor Therapeutics is currently developing preclinical data to support the use of its gene therapy to treat chronic heart failure patients awaiting a heart transplant.