Heritable pulmonary arterial hypertension (HPAH) is a serious lung vascular disease caused by heterozygous mutations in the bone morphogenetic protein (BMP) pathway genes, BMPR2 and SMAD9. One noncanonical function of BMP signaling regulates biogenesis of a subset of microRNAs. We have previously shown that this function is abrogated in patients with HPAH, making it a highly sensitive readout of BMP pathway integrity. Ataluren (PTC124) is an investigational drug that permits ribosomal readthrough of premature stop codons, resulting in a full-length protein. It exhibits oral bioavailability and limited toxicity in human trials. Here, we tested ataluren in lung-or bloodderived cells from patients with HPAH with nonsense mutations in BMPR2 (n ¼ 6) or SMAD9 (n ¼ 1). Ataluren significantly increased BMP-mediated microRNA processing in six of the seven cases. Moreover, rescue was achieved even for mutations exhibiting significant nonsense-mediated mRNA decay. Response to ataluren was dose dependent, and complete correction was achieved at therapeutic doses currently used in clinical trials for cystic fibrosis. BMP receptor (BMPR)-II protein levels were normalized and ligand-dependent phosphorylation of downstream target Smads was increased. Furthermore, the usually hyperproliferative phenotype of pulmonary artery endothelial and smooth muscle cells was reversed by ataluren. These results indicate that ataluren can effectively suppress a high proportion of BMPR2 and SMAD9 nonsense mutations and correct BMP signaling in vitro. Approximately 29% of all HPAH mutations are nonsense point mutations. In light of this, we propose ataluren as a potential new personalized therapy for this significant subgroup of patients with PAH.Keywords: pulmonary arterial hypertension; nonsense mutation; ataluren; bone morphogenetic protein signaling Pulmonary arterial hypertension (PAH) is a potentially fatal disorder of the lung vasculature in which proliferation of endothelial and smooth muscle cells progressively obliterates the pulmonary arterioles. This causes a sustained elevation in pulmonary artery pressure and can lead to right heart failure. Current treatments slow disease progression and alleviate symptoms, but do not cure the disease. PAH may be idiopathic or associated with an underlying condition. About 6% of patients have a positive family history, where the disease is inherited as an autosomal dominant trait with an estimated 27% penetrance (1). All patients with familial disease and/or an identifiable mutation are now grouped together as heritable PAH (HPAH) (2, 3).The primary genetic predisposition to PAH is a heterozygous mutation of one of four genes in the bone morphogenetic protein (BMP) signaling pathway, most commonly BMPR2, which encodes a type II BMP receptor (BMPR-II). Mutations in the BMPR2 gene have been found in up to 80% of affected families (3-6) and 10-40% of patients with apparently sporadic idiopathic PAH (5,7,8). Mutation-positive patients with idiopathic PAH may represent either de novo mutations or inhe...