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Innovations in the ability to probe and better understand biologic systems in the past 30 years1-3 have enabled the medical community to produce new healing agents and change the course of many life-shortening diseases. 4, 5 Despite this success, bridging the gap between promising laboratory observations and the development of effective therapies remains risky and expensive, with fewer than 1 in 10, 000 early translational programs successfully reaching Food and Drug Administration (FDA) authorization, at an expense of practically $1 billion. 6 Most therapeutic development fails in the preclinical phase, which is sometimes described as the "valley of loss of life. "7
For this reason and because therapies for some conditions will have a small eventual market value, the pharmaceutical industry has already been hesitant to initiate early-stage programs to take care of so-called orphan diseases. In recognition of a critical need, federal agencies have developed programs to catalyze innovation and reduce limitations to early progress new therapies. 8 Previously two decades, disease-focused foundations also provide developed a new method to bridging this preclinical gap. Inside a process known as venture philanthropy, such foundations have formed partnerships with industry and federal government agencies to talk about the financial risk of therapeutic development, shorten the early translational pipeline, and advance research with "a concentrate on individual, not financial, return. "9 In addition, foundations and their academic partners have accelerated early development by providing access to patient populations for clinical tests and assistance from disease-specific experts in study design, which has helped in bridging the gap in therapeutic development.
With this review, we will concentrate on about three diseases -- cystic fibrosis, multiple myeloma, and type 1 diabetes mellitus -- to illustrate how collaborations among academic institutions, foundations, and industry partners have evolved to address the therapeutic challenges of these conditions.
CYSTIC FIBROSIS
In 1989, the discovery of the gene that leads to cystic fibrosis and the cystic fibrosis transmembrane conductance regulator (CFTR) protein10, eleven greatly increased interest within the scientific community in this life-shortening genetic disease, which influences approximately 75, 000 patients worldwide. Along with support from the Cystic Fibrosis Foundation (CFF) and the National Institutes of Health (NIH), researchers rapidly expanded knowledge about the biogenesis, maturation, and perform of CFTR, a controlled epithelial anion channel12; such knowledge provided the necessary scientific framework for the development of therapeutic targets. In addition, an international consortium13 recognized more than 1700 mutations and described genotype-phenotype correlations with standard case definitions, 14 which enabled a precision-medicine strategy to therapeutic development. In the 1990s, attempts were created to treat cystic fibrosis by gene-replacement remedy delivered to airway epithelia. Even though early in vitro15 and in vivo studies16 provided proof of concept, many barriers, including a powerful host immune response, were encountered. 17 These barriers ended such initial clinical development programs.
In the decade following your discovery of the cystic fibrosis gene, scientific knowledge expanded but did not lead to a remedy that corrected CFTR function. In 1999, the CFF launched the Therapeutic Development Program (TDP) to attract both academic and industry partners and also to get started high-throughput screening for CFTR modulators. 18, 19 The CFF embraced the concept of venture philanthropy9, 20 to improve the interest of industry in an orphan disease. However, the success of the TDP was based on much more than financial support. 21 The program created a cultural shift that allowed the CFF, academic clinicians and researchers, federal agencies (the NIH and FDA), and industry to create a strong partnership with common goals and timelines.

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