Our Approach
Developing
breakthrough
products.
We have a robust pipeline of programs to prevent disease progression, improve outcomes and protect against organ damage in cardiorenal diseases.

Pipeline
Pipeline
Therapeutic Areas
We have developed a robust portfolio of products that act by activating multiple cytoprotective pathways. Learn more about our approach and the conditions we are treating below.
CABG the most common cardiothoracic surgical procedure in the US accounts for $6.5 billion in health care costs annually making it one of the most expensive surgical procedures in the United States.
ICU is a standard component of postoperative care following cardiothoracic surgery however the longer the patient stays in ICU results in increased hospital morbidity and mortality, poor long-term prognosis, increased hospital stays, and consequently increased cost and expenses. Most ICU therapies post cardiothoracic surgery are only supportive and therefore may not individually result in improved outcomes.
Cardiac surgery techniques have improved considerably however up to 36% of patients undergoing cardiothoracic surgery are still exposed to a high risk of postoperative complications.
These postoperative complications include longer patient days in the intensive care unit (ICU), increase ventilator days, acute kidney injury and an increase in the 30-day hospital readmission rate.
– More than 36% of patients undergoing cardiac surgery have a long (> 36 hours) postoperative stay in ICU.
– This results in failure of some organs and an increase in the mortality rate.
Failure to rescue (FTR) is defined as patient mortality after a post cardiothoracic surgery complication that occurred before hospital discharge.
– Early failure to rescue increases as the number of postoperative complications increased 7.5%, 28.1%, and 51.5% for one, two, and three or more complications, respectively.
– FTR rates were highest among those with combined prolonged ventilation and renal failure at 38.4%.
– Length of intensive care unit stay varied by number of postoperative complications with the median number of intensive care unit hours ranging from 38 hours for patients with no complications to 358.5 hours for patients with at least three complications.
– Overall median length of stay ranged from 7 days for patients with no complications to 22.5 days for patients with at least three complications.
The average cost of CABG surgery without complications is approximately $36,580.
The additive cost effects of complications after cardiothoracic surgery are:
– Prolonged ventilation (>24 h) +$33,840
– Renal failure +$33,847
– Reoperation +$35,239
Prolonged ventilation incurs the highest health system expenditures given its high incidence and the accumulation of multiple complications increase costs exponentially.
– Almost one out of every 7 adults 30-64 years of age is expected to develop CKD during their lifetime
– While dialysis-dependent CKD accounts for only 0.5% of the U.S. population, fee-for-service expenditures for Medicare beneficiaries with dialysis-dependent CKD exceeded 30 billion dollars in 2013, or over 7% of the Medicare paid claims cost
– Escalation in healthcare expenditures associated with CKD starts prior to the requirement for dialysis and treatment cost escalate as non-dialysis dependent CKD progresses
– CKD is a significant unmet medical need, and the financial burden has reached insurmountable proportions for patients and the U.S. healthcare system. In 2018, Medicare costs were $119 billion, and similar public cost burdens likely exist in the EU and Asia.
Publications
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- A Phase 2 Randomized, Double-Blind, Placebo-Controlled, Multi-Center Trial of RBT-1 Evaluating Cytoprotective Biomarkers & Post-Operative Outcomes in Patients Undergoing Elective Coronary Artery Bypass Graft and/or Valve Surgery on Cardiopulmonary BypassAndre Lamy, MD MSc
- Oxidant- induced preconditioning: A pharmacologic approach for triggering renal ‘self defense’Richard A Zager
- Inhibition of Heme Oxygenase-1 Protects Against Tissue Injury in Carbon Tetrachloride Exposed LiversChristian Eipel, Ph.D., Michaela Eisold, Harald Schuett, and Brigitte Vollmar, M.D., Institute of Experimental Surgery, University of Rostock, Rostock, Germany
- Combined iron sucrose and protoporphyrin treatment protects against ischemic and toxin-mediated acute renal failureRichard A. Zager, MD, Ali CM Johnson, BS, and Kirsten B. Frostad, BS, The Fred Hutchinson Cancer Research Center, and the University of Washington, Seattle, WA
- Parenterial Iron Sucrose- Induced Renal Preconditioning: Differential Ferritin Heavy and Light Chain Expression in Plasma, Urine, and Internal OrgansAli C Johnson, MS, Ted Gooley, PhD, Alvaro Guillem, PhD, Jeff Keyser, PhD, Henrik Rasmussen, MD, Bhupinder Singh, MD§, Richard A Zager, MD, The Fred Hutchinson Cancer Research Center, Seattle WA, the University of Washington, Seattle WA, Renibus Therapeutics, Dallas, TX, and University of California, Irvine
- Heme oxygenase-1 inhibitor tin-protoporphyrin improves liver regeneration after partial hepatectomyMonica Pibiri, Vera Piera Leoni, Luigi Atzori, Department of Biomedical Sciences, Oncology and Molecular Pathology Unit, University of Cagliari, Via Porcell, 09124 Cagliari, Italy
- Quercetin and tin protoporphyrin attenuate hepatic ischemia reperfusion injury: role of HO-1Yara Atef & Hassan M. El-Fayoumi & Yousra Abdel-Mottaleb & Mona F. Mahmoud
- Marked protection against acute renal and hepatic injury following Nitrited- Myoglobin + Tin Protoporphyrin AdministrationRichard A. Zager, MD The Fred Hutchinson Cancer Research Center, Seattle, WA and the University of Washington, Seattle, WA
- Serum Iron Protects from Renal Postischemic InjuryArticle in Journal of the American Society of Nephrology · August 2017
- Preconditioning with tin-protoporphyrin IX attenuates ischemia/reperfusion injury in the rat kidneyTakashi Kaizu, Tohru Tamaki, Mitsuko Tanaka, Yasushi Uchida, Sei-ichiro Tsuchihashi, Akio Kawamura, and Akira Kakita
- Quercetin and tin protoporphyrin attenuate hepatic ischemia reperfusion injury: role of HO-1Yara Atef & Hassan M. El-Fayoumi & Yousra Abdel-Mottaleb & Mona F. Mahmoud
- Inhibition of Heme Oxygenase-1 Protects Against Tissue Injury in Carbon Tetrachloride Exposed LiversChristian Eipel, Ph.D., Michaela Eisold, Harald Schuett, and Brigitte Vollmar, M.D.
- Interim Results of a Phase 2 Study With RBT-1 Evaluating Postoperative Course in Patients Undergoing Elective CABG/Valve Surgery on Cardiopulmonary BypassAndre Lamy MD, MSc
- Dietary tetrahydrocurcumin reduces renal fibrosis and cardiac hypertrophy in 5/6 nephrectomized ratsWei Ling Lau, Mahyar Khazaeli, Javad Savoj, Kasim Manekia, Maria Bangash, Roshni G. Thakurta, Anhthu Dang, Nosratola D. Vaziri, Bhupinder Singh
- Influence of Tetrahydrocurcumin on Hepatic and Renal Functional
Markers and Protein Levels in Experimental Type 2 Diabetic RatsPidaran Murugan and Leelavinothan Pari - Tetrahydrocurcumin Ameliorates Kidney Injury and High Systolic Blood Pressure in High-Fat Diet-Induced Type 2 Diabetic MiceWeerapon Sangartit, Kyung Bong Ha, Eun Soo Lee, Hong Min Kim, Upa Kukongviriyapan, Eun Young Lee, Choon Hee Chung
- Tetrahydrocurcumin protects against sepsis-induced acute kidney injury via the SIRT1 pathwayLu Lia, Xiaoxi Liua, Shasha Lia, Qingyan Wang, Hongru Wang, Menglu Xua and Yanxin An
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- PO0283 | A Novel Fast-Acting Iron Sucrose Formulation for CKD Patients with Iron Deficiency AnemiaCharles Cook, Bhupinder Singh, Stacey Ruiz, Alvaro Guillem
- Renibus Iron Sucrose Test Results ReviewCMC SQUARED LLC
- Iron sucrose (‘RBT-3’) activates the hepatic and renal HAMP1 gene, evoking renal hepcidin loading and resistance to cisplatin nephrotoxicityRichard A. Zager, Ali C.M. Johnson, and Renibus Therapeutics
- Parenterial iron sucrose-induced renal preconditioning: differential ferritin heavy and light chain expression in plasma, urine, and internal organsAli C. Johnson, Ted Gooley, Alvaro Guillem, Jeff Keyser, Henrik Rasmussen, Bhupinder Singh, and Richard A. Zager
- Long–Term Renal Outcomes after Cisplatin TreatmentSheron Latcha, Edgar A. Jaimes, Sujata Patil, Ilya G. Glezerman, Swati Mehta, and Carlos D. Flombaum
- Natural products: potential treatments for cisplatin-induced nephrotoxicityChun-yan, Da-yong Lou, Li-qin Zhou, Jin-cheng Wang, Bo Yang, Qiao-jun He, Jia-jia Wang and Qin-jie Weng
- Oxidant- induced preconditioning: A pharmacologic approach for triggering renal ‘self defense’Richard A Zager
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- Quercetin and tin protoporphyrin attenuate hepatic ischemia reperfusion injury: role of HO-1Yara Atef & Hassan M. El-Fayoumi & Yousra Abdel-Mottaleb & Mona F. Mahmoud
- Inhibition of Heme Oxygenase-1 Protects Against Tissue Injury in Carbon Tetrachloride Exposed LiversChristian Eipel, Ph.D., Michaela Eisold, Harald Schuett, and Brigitte Vollmar, M.D.
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- Marked protection against acute renal and hepatic injury following Nitrited- Myoglobin + Tin Protoporphyrin AdministrationRichard A. Zager, MD
- Distant Organ Dysfunction in Acute Kidney Injury: A ReviewSul A Lee, M.D., Martina Cozzi, M.D., Errol L. Bush, M.D., and Hamid Rabb, M.D.
- Tin Protoporphyrin Provides Protection Following Cerebral Hypoxia-Ischemia: Involvement of Alternative PathwaysBrad A. Sutherland, Odette M. Shaw, Andrew N. Clarkson, Ian C. Winburn, Adam C. Errington, Christine L. Dixon, George Lees, Ivan A. Sammut, and Ian Appleton
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