Michael J. Welsh

Michael J. Welsh

University of Iowa

Jesús (Tito) González

Jesús González

formerly at Vertex Pharmaceuticals

Paul A. Negulescu

Paul A. Negulescu

Vertex Pharmaceuticals

For their key roles in developing a novel treatment for cystic fibrosis—a triple-drug combination that saves the lives of people with this lethal genetic disease

The 2025 Lasker~DeBakey Clinical Medical Research Award honors three scientists for their roles in developing a novel, life-saving treatment for cystic fibrosis (CF). Michael J. Welsh (University of Iowa) illuminated how the protein that underlies this lethal genetic disease normally works and what goes wrong in people with the illness. These discoveries broke open the possibility of finding small molecules that could correct the misbehaving protein. Jesús (Tito) González (formerly at Vertex Pharmaceuticals) pioneered a system used to screen chemical libraries for promising compounds, and Paul A. Negulescu (Vertex Pharmaceuticals) led and championed the CF project, which culminated in a triple-drug combination that has transformed CF into a manageable condition.

While conducting autopsies in the 1930s, pathologist Dorothy Andersen noticed that the pancreases of some children diagnosed with celiac disease contained fluid-filled cysts. She realized that she was looking at a distinct malady and, in 1938, named it “cystic fibrosis of the pancreas.” Cystic fibrosis, as it is now called, progressively damages multiple organs, including the lung, liver, and intestines. It interferes with nutrient absorption and cultivates thick mucus buildup that provides a breeding ground for harmful bacteria, which often spawn life-threatening lung infections. In Andersen’s time, most people with CF did not survive early childhood. Since then, symptomatic treatments have improved prognoses, but in 2010, about half of affected individuals were expected to die before age 40. Despite this progress, living with the illness meant a persistent cough, wheezing, exercise intolerance, disruptive regimens aimed at clearing the lungs, and long hospital stays.

In the mid 1980s, researchers showed that epithelial cells in sweat glands, nasal passages, and trachea of people with CF transport chloride ions poorly. These observations reflected the excessively salty sweat that researchers had turned into a diagnostic “sweat test” decades earlier—and they suggested a unified explanation for the disease’s effects on varied organs. By that time, scientists had recognized CF as an autosomal recessive condition: sick children inherit a corrupt version of the gene from both parents. In 1989, Lap-Chee Tsui (Hospital for Sick Children, Toronto), Francis Collins (University of Michigan), and colleagues identified and sequenced this gene, which they called cystic fibrosis transmembrane conductance regulator (CFTR). They also defined the most common genetic error—a missing phenylalanine at position 508, ΔF508 for short—which is carried by almost 90% of people with CF.

Cooling down, igniting progress

Welsh, in collaboration with Alan Smith (Genzyme) put the CFTR gene into airway epithelial cells from people with CF; it restored the flow of chloride ions, whereas ΔF508 CFTR did not. These observations, reported in 1990, unambiguously connected the protein with the ailment’s epithelial-cell hallmarks.

Amid lively speculation about how CFTR works, Welsh proposed the simplest idea—that it serves as an ion channel. If so, altering amino acids in its predicted membrane-spanning region would change its relative ability to allow different ions to move. In 1991, he deployed this experimental tactic and demonstrated channel activity.

In the meantime, Smith had shown that ΔF508 CFTR fails to mature properly within cells. Normally, a sugar is affixed to the protein in the endoplasmic reticulum, and that sugar is embellished as CFTR transits through the Golgi en route to the cell surface—but ΔF508 CFTR acquires only the first sugar modification. Smith’s results suggested that a quality-control system recognizes the protein’s deformity and traps it in the endoplasmic reticulum before destroying it, such that ΔF508 CFTR never shows up at the cell surface (Figure 1, left and middle).

Antimicrobial agent illustration

FIGURE 1: Pharmaceutical synergy
In a healthy cell that lines the airway (top), CFTR is processed correctly in the endoplasmic reticulum (ER) and the Golgi (not shown). From there, it travels to the cell surface, where it allows chloride ion (Cl-) to flow across the membrane. This process leads to a proper salt/water balance that cultivates normal mucus. Potential pathogens are subject to attack by the body’s antimicrobial agents and clearance by the combined activities of the mucus and nearby ciliated cells that brush the interlopers out of the airway. In an epithelial cell with the common ΔF508 flaw in CFTR (bottom-left), defective CFTR cannot fold properly; consequently, it gets stuck in the ER and is sent to the cell’s quality-control incinerator for destruction (red X on arrow). The absence of chloride ion flow through CFTR disrupts the salt/water balance and the resulting thick and sticky mucus captures rather than clears pathogens. Loss of CFTR activity also leads to impairment of the body’s antimicrobial agents. These conditions foster chronic bacterial infections that elicit profuse inflammation. In the presence of the triple-combination drug Trikafta® (bottom-right), the correctors elexacaftor and tezacaftor help ΔF508 CFTR fold normally. The protein reaches the cell’s surface, where the potentiator ivacaftor reverses ΔF508 CFTR’s gating deficiency: It opens the channel sufficiently for chloride ions to flow and thus restores the salt/water balance that supports normal mucociliary clearance and antibacterial functions.
Illustration: Michael J. Welsh

Welsh seized on a curious observation: ΔF508 CFTR in frog eggs and insect cells retains some function. Those cells are grown at lower temperatures than are mammalian cells, and Welsh wondered whether cool conditions might allow ΔF508 CFTR to reach the surface of human cells. To probe this possibility, he tracked the protein as it travels, using the handy sugar tags from the endoplasmic reticulum and the Golgi, both of which enlarge CFTR in defined ways.

Cooling down cells allowed ΔF508 CFTR to escape the endoplasmic reticulum and complete its processing. When Welsh measured chloride ion flow at the surface of these cells, he found that the channels opened, albeit inefficiently. These results, reported in 1992, were inspiring: ΔF508 CFTR was not completely broken. Maybe it could be prodded to work better.

Opening a channel to new medicines

After scientists found the gene, they envisioned replacing flawed versions of it with operational ones to correct the disease at its root, but a decade later, that endeavor was floundering. Robert Beall, the mover-and-shaker president of the Cystic Fibrosis Foundation, was getting impatient. A different strategy seemed imperative.

Emerging technologies promised to revolutionize drug discovery. The 1980’s cloning bonanza had produced a long list of targets; combinatorial chemistry could synthesize large numbers of compounds cheaply and quickly; and advances in robotics enabled rapid, automated screening.

The biotech company Aurora Biosciences spearheaded this enterprise. The late Roger Tsien (University of California, San Diego; 2008 Nobel Prize in Chemistry) had co-founded Aurora to develop high-throughput assays that would identify small molecules that adjust protein behavior, which pharmaceutical companies would then turn into medicines.

In 1998, Beall contacted Negulescu, then Aurora’s Director of Cell Biology, and they discussed the possibility of harnessing Aurora’s approach for CF. Their goal: a pill that would restore CFTR function, body-wide, in people with the most common mutation, fixing both of ΔF508’s defects. They imagined “correctors” of protein processing that would help trapped CFTR reach the cell surface and “potentiators” of channel activity that would enhance chloride-ion migration through membrane-dwelling CFTR. The Foundation funded Aurora to explore this vision.

Exciting fluorophores, emitting hope

To screen for such compounds, they needed a fast assay that would gauge CFTR activity in a biologically meaningful context and lend itself to miniaturization so that thousands of compounds could be tested in a day. A novel way to measure ion flow lay at the heart of their system. As a postdoctoral fellow in Tsien’s lab, González had invented perfectly suited sensors for the job, which work in pairs to survey voltage changes across membranes. He brought these fluorescent dyes and his expertise about how to use them to Aurora, parlaying them from a basic-research tool into a powerful engine for drug discovery. González loaded two sensors onto the outer edge of the cell membrane. When zapped with light, one of these—the donor—absorbs energy and transfers it to its partner that lies nearby. Thus excited, this “acceptor” molecule emits light of a particular wavelength—in this case, orange. If chloride ions flow out of the cell, as occurs in healthy lung epithelial cells, the inside of the cell becomes more positive. Because the acceptor carries a negative charge, it scurries to the inner edge of the membrane. Now it is no longer close enough to capture energy discharged by the donor, which instead emits its own characteristic wavelength of light—in this case, blue. This scenario unfolds when a cell bearing faulty CFTR comes under the influence of a chemical that reverses the glitch. A detector registers the fluorescence and, when integrated into a sophisticated scanning device, can pinpoint even slight color shifts toward blue. The technology, an application of Fluorescence Resonance Energy Transfer (known as FRET), provides a sensitive and robust way to measure channel activity inside cells in real time. González and his team optimized the methodology for use in CF studies—and then he collaborated with Aurora engineers to incorporate the features that would allow them to screen thousands of compounds a day. To assess chemicals for CFTR-modulating effects, the investigators needed cells that would replicate all steps of CFTR production, including membrane delivery, when the protein was rescued. Welsh supplied cells that possess these features and that harbor ΔF508.

Capturing the caftors illustration

FIGURE 2: Capturing the caftors
Negulescu, González, and colleagues screened more than a million small molecules with the FRET-based assay to find compounds that boost channel activity in the CFTR ΔF508 mutant. The fewer than 100 confirmed active compounds that passed this hurdle were subjected to secondary tests, a subset of which are listed above. After hits passed through these additional filters, only 15 or so compounds remained. Medicinal chemists then synthesized thousands of compounds through iterative cycles to determine which structural features improved the functional properties. This process eventually produced drug candidates in each class (correctors, which help defective CFTR mature properly and get to the cell surface; and potentiators, which open the CFTR channel once it has arrived at its destination) that led to the FDA-approved drugs ivacaftor, lumacaftor, and tezacaftor. This new class of CFTR modulator medicines was named CaFToR. The final combination, Trikafta®, is comprised of ivacaftor, tezacaftor, and a different corrector—elexacaftor—that emerged from a separate screen and optimization, with about 10,000 molecules as the starting point, that aimed to identify a drug that augmented CFTR function in the presence of ivacaftor and tezacaftor.
Illustration: Cassio Lynm / © Amino Creative

Negulescu’s team devised two strategies, each of which pointed at a particular type of drug. For “potentiators,” which rouse channel activity, they exploited Welsh’s finding that cool conditions allow some ΔF508 CFTR to reach the surface and conduct chloride ions. They incubated cells at a temperature that would promote CFTR trafficking and then screened for chemicals that boost ion flow. To find “correctors,” which help ΔF508 get to the cell surface, they incubated at higher, body temperature to accumulate CFTR that got stuck in the ER unless it received assistance. They screened more than a million compounds in two years. Encouraging results spurred the Cystic Fibrosis Foundation to supply another bolus of financial support to fuel the venture. At around the same time, in 2001, Vertex Pharmaceuticals acquired Aurora and continued the quest, adding key capabilities in drug development. As González churned through chemicals and generated initial hits, Frederick Van Goor and his biology group ran them through secondary tests that assessed, for example, efficacy and potency, and they checked whether the agents acted directly on CFTR (Figure 2). Van Goor developed and refined additional experimental systems, such as monolayers of cells collected from CF patients during lung transplants that simulate crucial aspects of the human airway; this tool fulfilled a critical need, as animal models of CF did not exist. Vertex chemists, led by Sabine Hadida, worked in concert with the biologists to convert compounds into drugs, tweaking structures and iteratively improving them while scrutinizing attributes that would render them suitable or unsuitable for pursuit.

Bull’s eye for targeted therapies

In 2009, Negulescu and colleagues reported that compound VX-770 fostered channel opening from cells that carry a very rare CFTR mutation called G551D. Unfortunately, cells containing the most frequent—ΔF508—mutation did not respond to this potentiator, presumably because of their trafficking problem. Although the researchers prioritized ΔF508, they weren’t going to snub a potential CF drug. Clinical studies showed that VX-770 rapidly improved lung function in people with G551D. For the first time, an agent that aimed at the underlying cause of CF had benefited humans. Negulescu and colleagues dubbed this new class of drugs “CaFToRs. In 2012, the U.S. Food and Drug Administration (FDA) approved this first member of the family, which they named ivacaftor. In the meantime, the investigators persevered on their corrector crusade. Eventually they produced lumacaftor, which enhances processing of ΔF508 CFTR and its movement to the cell surface. Addition of ivacaftor to lumacaftor-treated cells strengthens ion transport. Clinical studies showed that the pair performed better than did either one alone. In 2015, the FDA approved this medicine, Orkambi®, the first drug that directly ameliorates the ΔF508 defect. Unfortunately, lumacaftor induces an enzyme that breaks down ivacaftor, so the team replaced lumacaftor with its relative tezacaftor, which provided similar benefits, but left its pharmacological mate intact. The ivacaftor/tezacaftor combination, Symdeko®, gained FDA approval in 2018. Negulescu’s team cheered the triumph: The scientists had created a drug for the approximately 50% of people with CF who possess two copies of ΔF508. But they weren’t done. Neither of the correctors worked as well for people with ΔF508 as did ivacaftor for G551D. The gap beckoned. They synthesized thousands more molecules to unearth a new class of corrector that dramatically augments the effects of ivacaftor and tezacaftor. One of these new-generation correctors, elexacaftor, hit the mark; when added to the ivacaftor/texacaftor mixture, it tripled chloride transport (Figure 1). In individuals with two copies of ΔF508 or one copy of ΔF508 and a second, different CFTR mutation, the triple combination demonstrated numerous benefits, including lung function improvement and weight gain, and was generally well tolerated. The FDA approved this three-drug combination, Trikafta®, in 2019. Since then, Negulescu and colleagues have extended its use to the hundreds of people in the world who carry ultra rare CFTR mutations that respond to Trikafta®. This blockbuster drug, given orally, twice daily, is delivering profound impacts. For example, it has slashed the number of lung transplants and infection-related hospital visits, and it has uplifted quality of life; no longer are people with CF exhausted and spending hours each day trying to shake loose the gunk in their lungs. Furthermore, people who begin the therapy as children or adolescents are expected to have near-normal lifespans. Until 2012, not a single person with CF was receiving therapy that targets its molecular cause. Now, greater than 90% of the 40,000 people with the disease in the United States and at least 100,000 worldwide are eligible for such treatments; about 75,000 individuals are already taking them. Welsh, González, and Negulescu’s achievements are affording people with CF the chance to thrive now and to plan vibrant futures.

by Evelyn Strauss

Selected Publications – Michael J. Welsh

Rich DP, Anderson MP, Gregory RJ, Cheng SH, Paul S, Jefferson DM, McCann JD, Klinger KW, Smith AE, and Welsh MJ. (1990). Expression of cystic fibrosis transmembrane conductance regulator corrects defective chloride channel regulation in cystic fibrosis airway epithelial cells. Nature. 347, 358-363.

Anderson MP, Gregory RJ, Thompson S, Souza DW, Paul S, Mulligan RC, Smith AE, and Welsh MJ. (1991). Demonstration that CFTR is a chloride channel by alteration of its anion selectivity. Science. 253, 202-205.

Anderson MP, Berger HA, Rich DP, Gregory RJ, Smith AE, and Welsh MJ. (1991) Nucleoside triphosphates are required to open the CFTR chloride channel. Cell. 67, 775-784.

Anderson MP and Welsh MJ. (1992). Regulation by ATP and ADP of CFTR chloride channels that contain mutant nucleotide-binding domains. Science. 257, 1701-1704.

Denning GM, Anderson MP, Amara JF, Marshall J, Smith AE, and Welsh MJ. (1992) Processing of mutant cystic fibrosis transmembrane conductance regulator is temperature-sensitive. Nature. 358, 761-764.

Welsh MJ and Smith AE. (1993). Molecular mechanisms of CFTR chloride channel dysfunction in cystic fibrosis. Cell. 73, 1251-1254.

Selected Publications – Jesús E. (Tito) González

González JE and Tsien RY. (1995). Voltage-sensing by fluorescence resonance energy transfer in single cells. Biophys. J. 69, 1272-1280.

González JE and Tsien RY. (1997). Improved indicators of cell membrane potential that use fluorescence resonance energy transfer. Chem. & Biol. 4, 269-277.

González JE, Oades K, Leychkis Y, Harootunian A, and Negulescu PA. (1999). Cell-based assays and instrumentation for screening ion-channel targets. Drug Discov. Today, 4, 431-439.

González JE and Maher MP. (2002). Cellular fluorescent indicators and voltage/ion probe reader (VIPR TM): Tools for ion channel and receptor drug discovery. Recept. Channels. 8, 283-295.

Huang C-J, Harootunian A, Maher MP, Quan C, Raj CD, McCormack K, Numann R, Negulescu PA, and González JE. (2006). Characterization of voltage-gated sodium-channel blockers by electrical stimulation and fluorescence detection of membrane potential. Nat. Biotechnol. 24, 439-446.

González JE, Worley J, and Van Goor F. Expression and analysis of recombinant ion channels: From structural studies to pharmacological screening. Chapter 8. In: Ion channel assays based on ion and voltage-sensitive fluorescent probes. Edited by J.J. Clare, and D.J. Trezise. 2006. Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim, Germany. pp 187-211.

Selected Publications – Paul A. Negulescu

González JE and Negulescu PA. (1998). Intracellular detection assays for high-throughput screening. Curr. Opin. Biotechnology. 9, 624-631.

González JE, Oades K, Leychkis Y, Harootunian A, and Negulescu PA. (1999). Cell-based assays and instrumentation for screening ion-channel targets. Drug Discov. Today, 4, 431-439.

Huang C-J, Harootunian A, Maher MP, Quan C, Raj CD, McCormack K, Numann R, Negulescu PA, and González JE. (2006). Characterization of voltage-gated sodium-channel blockers by electrical stimulation and fluorescence detection of membrane potential. Nat. Biotechnol. 24, 439-446.

Van Goor F, Straley KS, Cao D, González J, Hadida S, Hazlewood A, Joubran J, Knapp T, Makings LR, Miller M, Neuberger T, Olson E, Panchenko V, Rader J, Singh A, Stack JH, Tung R, Grootenhuis PDJ, and Negulescu P. (2006). Rescue of ΔF508-CFTR trafficking and gating in human cystic fibrosis airway primary cultures by small molecules. Am. J. Physiol. Lung Cell Mol. Physiol. 290, L1117-L1130.

Van Goor F, Hadida S, Grootenhuis PDJ, Burton B, Cao D, Neuberger T, Turnbull A, Singh A, Joubran J, Hazlewood A, Zhou J, McCartney J, Arumugam V, Decker C, Yang J, Young C, Olson ER, Wine JJ, Frizzell RA, Ashlock M, and Negulescu P. (2009). Rescue of CF airway epithelial cell function in vitro by a CFTR potentiator, VX-770. Proc. Natl. Acad. Sci. USA. 106, 18825-18830.

Van Goor F, Hadida S, Grootenhuis PDJ, Burton B, Stack JH, Straley KS, Decker CJ, Miller M, McCartney J, Olson ER, Wine JJ, Frizzell RA, Ashlock M, and Negulescu PA. (2011). Correction of the F508del-CFTR protein processing defect in vitro by the investigational drug VX-809. Proc. Natl. Acad. Sci. USA. 108, 18843-18848.

Award Presentation: Richard Lifton

Five to 10% of people are born with genetic diseases, resulting in substantial morbidity and early death. Mutations that cause thousands of these diseases have been identified. Treating or curing them, however, remains a major challenge. Gene therapy, once expected to solve this problem, has proved far more challenging than hoped, with only a few successes. How else can you overcome the consequences of a broken gene?

The Lasker-Debakey Clinical Research Award recognizes one the most audacious of these efforts – developing oral drugs that reconstruct the defective protein that causes cystic fibrosis. The incredible success of this effort has transformed and extended the lives of 10’s of thousands of people to date. Today we recognize Michael Welsh, Jesus (Tito) Gonzalez and Paul Negulescu for their seminal contributions to this effort. This remarkable achievement puts on full display the incredible power of biomedical science.

Cystic fibrosis affects 40,000 people in the US and 70,000 people abroad. It was described in 1935 by Dorothy Anderson, here in New York City. Features included severe malnutrition, with cysts and scarring of the pancreas, and lung disease featuring recurrent pneumonias with sticky infected mucus blocking the airways. She and Paul di Sant’ Agnese showed that CF is a recessive genetic disease, and that pancreatic enzyme replacement and IV antibiotics improved nutrition and survival in these patients. Arduous daily clapping on the chest and back to dislodge mucus also helped. Nonetheless, by 1980 life expectancy was only 18 years. They also discovered that patients had uniquely salty sweat, providing a non-invasive diagnostic test, and studies by Knowles and Quinton identified impaired efflux of chloride from lung epithelium and its influx into sweat glands, but the cause of these defects remained elusive.

A breakthrough came with the development of positional cloning of disease genes, leading to identification of the CF gene by Lap Chee Choi, Francis Collins, John Riordan, Aravinda Chakravarti and colleagues in 1989. They named the gene CFTR, cystic fibrosis transmembrane regulator, because it encoded a membrane protein that did not resemble any known ion channel. Notably, 85-90% of patients in the US have least one copy of a mutation in CFTR that deletes amino acid phenylalanine at position 508. More than a thousand other mutations have been identified worldwide. CFTR’s function was unknown.

Michael Welsh, a physician-scientist, pursued CFTR’s function. He showed that expressing CFTR in cells produced a Cl- conductance, and that mutating transmembrane domains of CFTR changed the selectivity of ion conductance, proving that CFTR is itself a Cl- selective ion channel and further showed that its regulated by cAMP and requires ATP. Replacing the normal CFTR gene in bronchial epithelial cells from CF patients corrected the Cl- channel defect. Loss of this activity explained the observed defects in lung, pancreas and sweat glands. He characterized the dysfunction of many different mutations that cause CF. Most critically, he showed that the CFTR deltaF508 mutation prevents proper folding of the protein, leading to its degradation at body temperature; however, at cooler temperatures the protein can fold and be delivered to the cell surface. Yet even then the channel still failed to open – demonstrating that this mutation produced two defects that prevent its function.

With lack of success with gene therepy efforts over a decade, alternative therapies were sought. Could one repair the mutated protein? And if so, would it be useful or were the chronically infected airways damaged beyond repair? For these reasons, CF was not a great candidate for drug development by industry.

However the Cystic Fibrosis Foundation, dedicated to curing CF, approached Aurora Biosciences, a biotech startup, and invited a grant application. Aurora was an excellent target, as co-founder Roger Tsien was renowned for discovering and deploying genetically programmable fluorescent tags in living cells for which he would later win the Nobel prize. Aurora conceived an approach to the problem with Paul Negulescu writing a proposal, which was funded by the Foundation and, amazingly, continued for the next 20 years after Aurora’s acquisition by Vertex. Tsien’s postdoc and Aurora colleague Tito Gonzalez developed an ingenious cell – based assay to enable high throughput screens for compounds that restored Cl- channel activity to mutant CFTR. The method brilliantly used Förster resonance energy transfer, FRET to detect membrane potential changes by fixing a fluorescent donor at the cell surface and a fluorescent anion receptor free to migrate to the inner or outer leaflet of the membrane with changes in membrane potential as would occur with opening of the CFTR Cl- channel. When the fluorescent anion was in close proximity to the donor at the cell surface, there was a robust fluorescence from the receptor via FRET, that diminished when it moved to the other side of the membrane with changes in membrane potential. This resulted in a sensitive and scalable method for measuring Cl- channel activity in a high throughput chemical screen.

Negulescu directed the project and hired outstanding biologists and medicinal chemists to puorsue it- Fred van Goor, Peter Grootenhuis, and Sabine Hadida. They screened hundreds of thousands of compounds, and identified hits that increased Cl- conductance. Among these were compounds that improved channel opening without altering folding, including CFTR with a G551D mutation, which is found in 4% of CF patients. This led to the first drug candidate, Ivacaftor. In its phase 3 clinical trial in patients with G551D mutations, drug treatment was safe and effective, increasing the FEV1 (the maximum volume of air expelled in 1 second); reducing the number of pulmonary exacerbations requiring medical attention by more than half, and reducing cough and shortness of breath. It also reduced sweat chloride, an excellent biomarker of channel activity, by half. Ivacaftor received FDA approval in 2012. It is now approved for children with G551D mutations as young as 1 month.

Compounds that increased delivery of the deltaF508 mutant protein to the cell surface were also found in distinct groups that were synergistic with one another and Ivacaftor. A three drug combination, Trikafta, emerged and phase 3 clinical trial results in patients with deltaF508 mutations were reported in 2019. Patients showed dramatically increased FEV1, a 70% reduction in hospitalization, a marked improvement in quality of life measures and sweat Cl- levels were cut nearly in half. Trikafta was quickly approved by the FDA and is now approved for patients as young as 2 years.

A recent real-world study in 16,000 CF patients reinforced clinical trial results and also showed an 87% reduction in lung transplantations and a 74% lower risk of death. Earlier treatment improves clinical outcomes, and it’s estimated that patients starting treatment at age 2 may approach normal life expectancy.

Lastly, The uptake of these novel CF medicines has been remarkable. More than 75,000 of the ~100,000 people in 60 countries with a treatable CF mutation are on medication. Efforts to develop treatment for the 10% of patients with no treatable mutations thus far are underway.

In addition, Van Goor made the surprising discovery these same drugs can restore function to more than 300 different disease-causing missense mutations in CFTR, consistent with these mutations commonly causing misfolding that can be improved by stabilizing the folding of different domains of CFTR. This observation has important implications for the treatment of other genetic diseases.

The CF saga is one of medicine’s great triumphs. The impact of these medicines on patients and families are profound. The synergies among clinicians, academic scientists, NIH, philanthropic organizations and the biotechnology industry make clear why the biomedical ecosystem in the US is so robust and has benefitted so many. This must be sustained. It is thrilling to recognize and thank todays Lasker award recipients and everyone who contributed to this outcome for your remarkable contributions to biomedicine and humanity.

Acceptance remarks

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