Imagin Medical Is Bringing Cystoscopy into the 21st Century

Source: Dr. KSS, MD, PhD, for Streetwise Reports   01/21/2021

Dr. KSS, MD, PhD, editor-in-chief of PubBio.co, profiles a small cap that “is poised to bring to clinic a next-generation of must-have cystoscopy equipment.”

BioPub’s single most important criterion for selecting special-situation small cap biotech stocks to showcase at our website is this: will the company’s technology permanently improve the practice of medicine? Will the company’s work leave a mark on a specialty and on its clinics that will be difficult to forget? Will the success of its efforts be viewed as a sea-change in medicine?

We’re optimistic we’ve found a new winner in small and little-known Vancouver, BC, firm Imagin Medical Inc. (IME:CSE; IMEXF:OTCQB), trading in the U.S. over the counter as $IMEXF.

As a gastroenterologist, I’ve spent most of my life steering flexible tubes with sophisticated fiberoptic imaging into esophaguses, stomachs, bile ducts, colons both for diagnosis and for therapy. But gastroenterologists are not medicine’s only endoscopists: pulmonologists use fiberoptic bronchoscopes, ENT surgeons use small endoscopes to examine pharyngeal and sinus structures, and urologists insert small cystoscopies into the urethra to evaluate bladders. Gastroenterology has often been perceived as the most endoscopically advanced, ever invoking tech refinements to make imaging more sensitive and contrive therapies that fix problems without need for open surgery.

As with other forms of endoscopy, gastroenterologists generally use white light, but early in my career I began playing with color…particularly by irrigating certain parts of the GI tract with agents like Lugol’s iodine solution, or methylene blue or iodocyanine green. I realized quickly that such approaches could highlight worrying areas, or make subtle polyps easier to see. Endoscope manufacturers got on the same bandwagon to a degree, offering incident light in modified frequencies to assist with visualization, usually in the form of so-called narrow-band imaging.

It may sound like criticism of my urology colleagues, but is not intended as such….but it had long seemed to me that cystoscopy was not advancing at the pace that other kinds of endoscopy had….to wit, that it was stuck in a rut of using white light and bearing the brunt of those limitations.

Some facts you need to know: bladder cancer is the sixth most prevalent cause of cancer in humans, but in males is the third commonest cancer. Why the gender difference? Generally, when females empty their bladders, they do so almost entirely. Males, on the other hand, even from youth, have a relative bladder outlet obstruction in the form of the prostate gland surround the neck of the bladder outlet. A teenager may boast about being able to pee bark off a tree from five feet away, but the fact is that in doing so, he still never empties his bladder completely at voiding. The male prostate enlarges with age, and so does the so-called post-void residual, the volume of urine remaining in the bladder when the male feels he has completely emptied his bladder.

Urine contains wastes and toxins, and the male bladder forever sloshes about in those, and so a higher incidence of bladder cancer in men withstands reasoning. That risk is higher still in cigarette smokers. Among the patients most at risk for bladder cancer are those born with spina bifida, a kind of forking of the lower spine. Bladder muscle innervation is compromised in this condition, and so the squeeze to empty the bladder isn’t as forceful…..and spina bifida patients can be diagnosed with bladder cancer at a young age.

Once was a time when among the leading causes of bladder cancer on earth was infection with the parasite Schistosoma haematobium, which often contaminated rivers in Asia, Africa and South America. Mostly that problem, borne of forms of the parasite embedding themselves in bladder wall and provoking granulation reactions, has been cleaned up by major national public health initiatives. Yet even in our lifetimes, this problem was once severe enough that men in certain parts of the third world would bleed profusely with urination and were labelled in local colloquial speech as having “male menstruation.”

Here is the crux of the problem urology has long faced: cystoscopy is the standard of care for diagnosing bladder cancer, but cystoscopy relied upon incident white light from the instrument. White light misses 50% of malignant bladder lesions. “Houston we have a problem:” when your standard of care is that compromised, you can see how bladder cancer would cultivate a reputation for being hard to cure.

Imagin, a small Canadian biotech, has been working behind the scenes with genuine thought leaders in urology to improve diagnostic yield at cystoscopy, and now seems to have done so. It has experimented with light frequencies and chromophoric agents to light up tumors. And now is poised to bring to clinic a next-generation of must-have cystoscopy equipment that finally brings bladder endoscopy into the 21st century. We’re reviewed their data, and assert that a time is rapidly approaching when white-light cystoscopy is simply substandard care and the urology system will be forced to upgrade to better equipment to adhere to standard of care and even stave off litigation. White light in the bladder simply doesn’t cut it, and Imagin has the solution.

My good friend NY venture capitalist Michael Bigger and his group of colleagues reviewed Imagin a few weeks ago and were quite excited by what they saw. Bigger called me…what did I think? I had to agree: he was onto something, likely something big, likely something that could easily drive a major device maker to acquire Imagin. And yet the stock was cheap and flying below radar. We interviewed the management team and were impressed by their earnestness, by the dogged commitment they’ve shown to getting this project to work, and by their elite selection of guiding experts.

BioPub held a webcast on Friday, 22 January, that introduces Imagin’s technology and management, who discuss their pioneering imaging and show a video. Special guest Canadian venture capitalist Eden Rahim makes his own independent case for investing in Imagin in collaboration with Michael Bigger.

View the webcast here.

–Dr. KSS

Dr. KSS is the founder and editor-in-chief of BioPub.co. He is an MD with an additional PhD in biochemistry, and for the past 20 years, in addition to practicing, being a researcher, and conducting clinical trials, he has been investing in biotech companies with great success. Dr. KSS earned his degrees at a top 10 U.S. institution, where he was an NIH scholar and graduated with top honors. He has extensive post-doctoral research experience and am board certified in internal medicine and also gastroenterology. His goal is to discuss companies and use discussions of their technology, their drugs or planned drugs, as ways of teaching about physiology and disease states, along with their issues and opportunities.

Disclosure:
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