Before the company, before the clinical programs, before the acquisition, there was a failed pitch. In 2016, Sekar Kathiresan and collaborators entered One Brave Idea, a competition organized around a $75 million promise to pursue a cure for coronary disease. Their proposal centered on a single dose of gene-editing medicine meant to keep harmful cholesterol low for years. It did not reach the final round. Kathiresan later described himself as “bitterly disappointed.” The rejection could have put the idea back into a folder. Instead, it gave him a sharper question: if a prize committee would not fund the work, was there another way to build it?
For almost two years, a small group met on Fridays to answer that question. They examined the intellectual property, the editing technology, the delivery system, the financing, and the reasons the whole thing might fail. The working name was Endcadia Therapeutics, a label with all the cheer of a medical billing code. Eventually it became Verve Therapeutics. The name improved before the odds did.
The Friday meetings are the useful part of the founding myth. They were not victory laps for a beloved idea. They were an extended attempt to expose its weak joints. This is how a scientific founder behaved before he knew the rituals of venture capital: make a hypothesis, recruit people who understand the parts you do not, and keep asking whether the evidence still deserves the effort.
A career in three chapters
Kathiresan has a clean way of describing an untidy career. Chapter one was learning medicine. Chapter two was learning human genetics. Chapter three was turning that knowledge into medicines. The plot sounds inevitable when compressed into three sentences. It was anything but.
Born in the village of Viramathi in southern India, he spent part of his early childhood apart from his parents while his father studied in Pittsburgh. In 1980, he and his older brother flew from Mumbai to New York on their own, watched over by an airline attendant. Their first American meal was McDonald’s french fries. He asked for another serving. His father explained that the family could not afford it.
The family settled outside Pittsburgh. Kathiresan moved between weekly prayers at a Hindu temple and weekend football games in a mostly white suburb. At North Allegheny Senior High School, he became valedictorian. At the University of Pennsylvania, he chose history, graduated summa cum laude, and briefly considered finance. Medicine won because, as he later put it, it offered “a sense of purpose and a mission.”
Harvard Medical School, then internal medicine and cardiology training at Massachusetts General Hospital.
Human genetics at the Broad Institute and Framingham Heart Study, followed by an academic laboratory.
Verve Therapeutics, clinical development, and a new operating scale inside Eli Lilly.
He received his M.D. from Harvard Medical School in 1997 and trained at Massachusetts General Hospital, serving as chief resident in internal medicine. A postdoctoral period followed from 2003 to 2008, split across the Broad Institute and the Framingham Heart Study. The timing mattered. The human genome sequence had recently been completed, and genetics was beginning to offer a different way of choosing which biological targets deserved attention.
Nature had already run the experiment
Drug development usually begins with a proposed mechanism and years of testing. Human genetics can reverse the order. Some people are born with variants that reduce the function of a gene. Their lives become natural experiments, offering clues about what might happen if a medicine reproduced that effect. Kathiresan’s research focused on blood lipids and coronary disease, using large populations to separate signals that merely traveled together from those more likely to be causal.
One result confronted a piece of received wisdom: higher HDL, commonly called “good cholesterol,” did not appear to cause protection from coronary events. The association was real, but the causal story was shakier. “But correlation does not mean causation,” Kathiresan said. The distinction is elementary on a whiteboard and expensive in a pharmaceutical pipeline. His group’s 2012 work helped redirect attention away from simply raising HDL.
Other natural experiments pointed toward genes such as ANGPTL3. People whose copies of the gene did not function could have very low lipid levels. That observation became a target-selection clue. The founder’s insight was less about inventing biology from scratch than about paying close attention to the edits nature had already tested.
In 2008, Kathiresan started his own lab at MGH and the Broad. He would later direct the Broad’s Cardiovascular Disease Initiative and the MGH Center for Genomic Medicine, while becoming a professor at Harvard Medical School. The lab trained more than 60 researchers. Kiran Musunuru, one of Kathiresan’s early postdoctoral fellows, became an independent investigator and later a Verve co-founder. Mentor became collaborator, which is one of academia’s better tricks.
The beginner in the chief executive’s chair
Academic prestige did not confer fluency in biotech operations. When Kathiresan began the transition, he had never heard the abbreviation CMC, industry shorthand for chemistry, manufacturing, and controls. He was not an expert in messenger RNA or lipid nanoparticles, both central to Verve’s approach. He had never assembled an investor syndicate, developed a drug, or taken a company public.
Colleagues noticed that he did not disguise those gaps. Musunuru described a leader willing to ask questions, defer to expertise, and surround himself with people strong in areas where his own experience was thin. In a sector that sometimes treats confidence as a renewable resource, this was a practical form of ego control.
The laboratory had already taught him several transferable jobs: raising money, choosing a direction, recruiting a team, developing careers, and keeping people aligned when the answer remained uncertain. Verve added manufacturing, regulation, public markets, and the unforgiving clock of clinical development.
GV incubated the company and led its initial $59 million financing. Kathiresan became chief executive in July 2019. Verve went public in 2021, and in 2022 its first program moved into human testing. The company’s operating idea stayed legible through the technical detail: use in vivo base editing, delivered to the liver, to alter a selected gene through a single treatment. The programs remained experimental, and each step demanded evidence on safety, durability, and benefit.
There is a business lesson hiding inside that product constraint. Verve did not begin by asking what its platform could possibly do. It began with a sharply framed clinical ambition and worked backward toward the tools needed to pursue it. The machinery could evolve. The promise had to remain understandable.
Acquisition as a scale change
In 2023, Verve established a global collaboration with Eli Lilly on a program targeting lipoprotein(a). Two years later, Lilly agreed to acquire the company. The transaction offered Verve shareholders $10.50 per share in cash plus a contingent value right worth up to $3 per share. Lilly completed the acquisition on July 25, 2025, making Verve a wholly owned subsidiary.
Kathiresan joined Lilly as a senior vice president and said Verve would continue its Boston operations and its focus on gene-editing medicines. By 2026, Relay Therapeutics, where he serves as a director, listed his Lilly title as Senior Vice President, Cardiometabolic Research. The founder’s third chapter had acquired a larger binding.
An acquisition is often narrated as a finish line because finance likes a crisp ending. For a clinical-stage biotech, it is closer to a transfer between vehicles. Experimental medicines still face trials, regulators, manufacturing questions, and the problem of reaching people at a sensible cost. Capital and infrastructure can widen the road. They do not shorten the evidence.
Kathiresan’s path offers a more durable idea about ambition. A career can change disciplines without becoming incoherent. History gave way to medicine; clinical practice to genetics; the academic lab to a startup; the startup to a global pharmaceutical company. Each move asked him to become a beginner again. The continuity lived in the problem rather than the title.
What builders can borrow
First, look for the natural experiment. The best product insight may already exist in the behavior of the world, waiting to be noticed and tested. Second, treat rejection as information with a narrow scope. Losing the One Brave Idea competition meant the proposal lost that competition. It did not prove the company should not exist.
Third, make ignorance discussable. A first-time executive who can name what he does not know has a chance to hire the person who does. Fourth, keep the strategy simple enough to repeat. Verve’s science required a glossary. Its ambition fit in a sentence.
And finally, choose the question more carefully than the job title. Kathiresan calls his career a sequence of three phases. Another reading is that he has spent decades asking one question through increasingly powerful institutions. The Friday meeting after the rejected pitch was not a detour from the work. It was the moment the work found its next form.