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# AnaCardio's €62.5M Series B Bets a Safer Inotrope Can Reopen Heart Failure
- URL: https://nexi.fund/anacardio-heart-failure-series-b-2026/
- Published: 2026-10-01T12:30:11.000Z
- Updated: 2026-10-01T12:30:11.000Z
- Description: AnaCardio closed a €62.5M Series B co-led by Novo Holdings to move AC01 toward Phase 3. A 58-patient Lancet study showed a clean safety signal and better cardiac output — not yet the outcomes that decide whether a heart drug works.
- Author: Nexi.fund Labs
- Tags: Biotech & Health, #mode-1, #hook-number, #track-A

Sixty-two and a half million euros is not a large number by biotech standards. For AnaCardio, a small company in Stockholm, it is the money that decides whether an abandoned class of heart drugs gets a second life.

Heart failure with reduced ejection fraction is one of medicine's stubborn problems. The muscle cannot push enough blood forward, and the outlook after diagnosis is poor. The standard treatment is a stack of drugs that slow the decline — beta-blockers, ARNIs, MRAs, SGLT2 inhibitors — and none of them make the heart pump harder.

Drugs that do make it pump harder exist. They are called inotropes. Hospitals use them, and they shorten lives.

🎯

**A safe oral inotrope is the entire bet.**  
  
AnaCardio's AC01 raised cardiac output and ejection fraction in a 58-patient Phase 1b/2a study, published in The Lancet, without the arrhythmia and hypotension that closed the previous generation of these drugs.  
  
The €62.5 million does not buy an approval. It buys one Phase 2b trial, and a 2028 deadline to show the effect was more than a small study and a supportive placebo arm. 

€62.5M Series B round 

#### Co-led by Novo Holdings and the Ljungström family office

About $70 million, to fund a single Phase 2b trial. · *AnaCardio, 2026*

+4.8 ejection-fraction points 

#### Gain at day 28 on the 3 mg dose

Measured against a placebo gain of 1.6 points in the same trial. · *The Lancet, 2026*

## The class medicine quit

Inotropes work. Dobutamine and milrinone push a failing heart toward a better output within hours, and they have been in hospital formularies for decades. The trouble arrives later. They raise the risk of arrhythmia, drop blood pressure, and in several trials they increased mortality. The drugs keep patients alive through a crisis, then quietly work against them.

Levosimendan is the closest relative to AC01\. It is a calcium sensitiser — it makes the muscle respond to the calcium it already has, rather than flooding it with more. That mechanism avoids some of the toxicity, and it is used across Europe. It is still given by infusion, in a hospital, to acute patients.

AC01 borrows the mechanism and changes the delivery. It is an oral ghrelin-receptor agonist that raises calcium sensitivity, taken as minitablets twice a day, and it was licensed from the Swiss group Helsinn in 2022\. The pitch is a chronic drug, not a rescue drug: something a stable patient takes at home to keep the heart contracting.

That difference is the reason the round exists. A chronic oral therapy for heart failure would sit next to the existing pill stack, not compete with it.

> The data confirm what we have seen across preclinical and clinical studies: AC01 improves cardiac function with a clearly differentiated safety profile.— Patrik Strömberg, chief executive, AnaCardio

## What the trial showed, and what it did not

The evidence is the Phase 1b/2a GOAL-HF1 study, registered as NCT05642507: fifty-eight patients with reduced ejection fraction, randomised, double-blind, placebo-controlled, run across European heart-failure centres. It finished in October 2025 and was published in The Lancet on 25 June 2026.

The safety signal was clean. No serious adverse events linked to the drug, no deaths, no discontinuations. No tachycardia, no sustained arrhythmias, no ischaemia, no symptomatic hypotension. For a drug class defined by exactly those side effects, that is the headline.

The efficacy signal was directional. At the 3 mg dose, cardiac output rose 29.5% on day one and 22.0% by day 28, and left-ventricular ejection fraction gained 4.8 absolute points over four weeks, against 1.6 points on placebo — all on top of optimised guideline therapy.

Then the caveats. Fifty-eight patients is a signal, not a proof. The cohort was small, older and largely male, and the study was not powered to detect anything except safety and dose behaviour. The endpoints that matter — death, hospitalisation — were not measured at scale.

As we wrote in [September](https://nexi.fund/novartis-pelacarsen-lpa-phase3-2026), Novartis lowered Lp(a) in more than 8,000 patients and cardiovascular events did not move. A stronger pump is not the same thing as a longer life. AnaCardio's Phase 2b has to close that gap.

## Who wrote the check

The round, announced on 30 September, was co-led by Novo Holdings and the Ljungström family office. The originator Helsinn came back in, alongside existing investors Pureos Bioventures, Sound Bioventures, Industrifonden, Flerie and LLD Nybohov Invest, and one new name, Innovestor Life Science.

| Parameter        | Detail                                                                                     |
| ---------------- | ------------------------------------------------------------------------------------------ |
| **Round**        | €62.5 million (about $70 million) Series B                                                 |
| **Co-leads**     | Novo Holdings; Ljungström family office                                                    |
| **Returning**    | Helsinn, Pureos Bioventures, Sound Bioventures, Industrifonden, Flerie, LLD Nybohov Invest |
| **New investor** | Innovestor Life Science                                                                    |
| **Use of funds** | Fully fund Phase 2b of AC01 (GOAL-HF2)                                                     |

Round structure. Source: AnaCardio, 30 September 2026

Two names carry more weight than the rest. Novo Holdings is the holding company behind Novo Nordisk, and its presence in a cardiovascular round is a statement about the therapeutic area, not just the company. The Ljungström family office is the vehicle of Fredrik Ljungström, an early and repeated backer who has followed AnaCardio across four previous financings.

The single clearest vote is Helsinn's. The company that invented the molecule and licensed it out is putting money back in at a higher price. Originators rarely do that for a mechanism they have stopped believing in.

#### Why the family office keeps writing checks

The Ljungström family has backed AnaCardio since its first Series A in 2022, across a €14.2 million round, a follow-on, and the $19 million Series A extension that closed in January 2025\. Family offices are not required to mark to a fund cycle. They can hold a decade and concentrate on one bet. That patience is the profile a company needs when the next meaningful data point is two years away.

## The oral problem is the hard part

Most peptides and peptide-like molecules do not survive the stomach, and ghrelin is a peptide. AnaCardio's entire commercial claim rests on a small molecule that behaves like one and can be swallowed. The company reports dose-proportional pharmacokinetics and confirmed target engagement, which suggests the drug reaches what it is aimed at. Whether a patient absorbs enough of it, every day, for years, is a manufacturing and formulation question as much as a pharmacological one.

The competition is not another biotech with the same idea. It is the standard-of-care stack that already keeps these patients stable, and the devices — defibrillators, resynchronisation, pumps — that hospitals reach for when pills fail. A new oral drug has to earn a place in a regimen that is already crowded.

The company has the regulatory scaffolding to try. AnaCardio reports aligned scientific advice from both the FDA and the EMA on a development path for chronic heart failure, and holds a US patent covering AC01 into the 2040s.

### What would have to be true for the €62.5 million to look cheap?

🔮

**By 2028, GOAL-HF2 reports a Phase 2b result that moves a clinical outcome — hospitalisation or death — and not only the ejection fraction.**  
  
Probability: 35% — the safety profile is the strongest part of the case, but 58 patients cannot predict an outcome benefit, and the class has failed this exact test before. 

#### Arguments for

The safety data are strong enough to justify a large trial. The mechanism has decades of clinical precedent through levosimendan. An oral route would open the chronic market, which is far larger than acute hospital use. Originator and crossover capital both re-upped.  
  
**Confirmation criteria:** GOAL-HF2 enrols on schedule in late 2026, and an interim look keeps the effect direction consistent.

#### Arguments against

A surrogate endpoint that improves has repeatedly failed to translate into survival in cardiology. The Phase 2b has to be large enough to see events, which is expensive and slow. The drug class carries a mortality memory that regulators and payers will not forget.  
  
**Falsification criteria:** a Phase 2b miss on hospitalisation, or a safety signal that reappears at chronic doses.

📊

**Signals to track**  
  
Whether GOAL-HF2 starts enrolling in the fourth quarter of 2026, as guided.  
  
The trial's size and endpoint — events, or another surrogate.  
  
Any partnership or licensing deal with a large cardiovascular pharma before Phase 3.  
  
Whether Novo Holdings raises its position in a later round. 

### Scenarios

#### 🟢 Bull case (30%)

GOAL-HF2 confirms the safety profile and shows a hospitalisation benefit. AnaCardio becomes the first safe oral inotrope, and a large pharma partner pays for Phase 3.  
  
**Consequence:** a 2028 asset that justifies a valuation many times the private mark.

#### 🟡 Base case (45%)

The drug stays safe and keeps improving the surrogate numbers, but the outcome benefit stays unproven or too small to move guidelines on its own. A partner buys optionality rather than a proven therapy.  
  
**Consequence:** a real asset that needs a bigger company to finish the job.

#### 🔴 Bear case (25%)

The oral formulation underperforms at chronic doses, or a safety signal emerges over months of treatment. The inotrope graveyard gains one more headstone.  
  
**Consequence:** the round marks the high point before a costly Phase 2b miss.

### Sources

[ AnaCardio raises €62.5 million Series B financing The company's own announcement: the investor list, the Phase 2b plan and the 2028 Phase 3-readiness target. AnaCardio / GlobeNewswire ](https://www.globenewswire.com/news-release/2026/09/30/3371523/0/en/anacardio-raises-62-5-million-series-b-financing-to-advance-transformational-novel-therapy-in-heart-failure-towards-phase-3-readiness.html?ref=nexi.fund) 

Primary source for the round. Treat the clinical claims as the company's until the Lancet paper is read directly.

[ GOAL-HF1 results published in The Lancet The peer-reviewed Phase 1b/2a readout that anchors the safety and efficacy claims, with the cardiac-output and ejection-fraction figures. AnaCardio / The Lancet ](https://anacardio.com/anacardios-phase-1b-2a-goal-hf1-study-in-patients-with-heart-failure-and-reduced-ejection-fraction-hfref-published-in-the-lancet?ref=nexi.fund) 

The strongest evidence available. Fifty-eight patients, surrogate endpoints, and a clean safety signal.

[ NCT05642507 — Phase 1b/2a trial of AC01 in HFrEF The registry record: design, 58-patient enrolment, dose arms and the twice-daily oral minitablet dosing. ClinicalTrials.gov ](https://clinicaltrials.gov/study/NCT05642507?ref=nexi.fund) 

Useful for checking the trial design against the reported results.