Genzyme has broken away from its niche market model in its agreement with Isis Pharmaceuticals for mipomersen, an antisense drug for high-risk cardiovascular (hypercholesterolaemic) patients, for which Genzyme has acquired an exclusive worldwide licence for a headline-grabbing US$1.9 B. The cardiovascular focus of the deal is a move away from liposomal storage disorders, on which Genzyme has relied since its inception in 1983. This article gives an overview of the company, and of the background to Isis#8217; antisense technology. It also discusses the pyramidal process to be adopted for the development of mipomersen, and analyses the financial structure of the deal and the reasoning behind it.