
Michael J. Welsh
University of Iowa

Jesús González
formerly at Vertex Pharmaceuticals

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.
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.
Acceptance remarks
Acceptance Remarks: Michael Welsh
I feel tremendously honored to accept this award. On reading the list of previous recipients, I also feel deeply humbled, for it includes so many people that I have long admired.
I grew up in the rolling hills of rural Iowa. My father dropped out of 10th grade to serve in the Marines, fought in World War II, returned wounded, and worked in a foundry during the day and a bakery at night. My mother raised four children, tended a large garden, canned vegetables, and made many of our clothes. Saying that someone was a “hard worker” was high praise, and I followed my parent’s example, from milking the cow to raising runt pigs that farmers gave me.
My mother taught me empathy, so many times asking me, “How would you feel if …,” and then giving an example.
My education included an elementary school that had two classrooms – each had four grades. My class was the largest – it had 5 students. I entered college with no plan but loved humanities and science.
Although I had no knowledge of medicine or research, I applied to medical school at the University of Iowa. Why did I choose the physician path? The reason was simple – I thought it must be a job worth doing. In this decision, I was profoundly influenced by President John F. Kennedy. I remember sitting on the floor in front of the television inspired by his exhortation to go beyond oneself and contribute to society.
During medical school and residency, I was impressed by physician-scientists for their clinical skills and their discussion of research advances. I did a clinical pulmonary fellowship at UCSF. After working hard for a year in the lab, I realized that I had no original thoughts. I considered quitting the lab and just doing clinical medicine because I liked it, it was a worthwhile challenge, and I thought I was good at it.
Instead, I moved to UT Houston and studied intestine to learn more advanced physiology. During the day, I worked on intestine. Then, when animal labs were finishing experiments for the day, I collected the lungs to study the trachea. One night, I saw a surprising electrophysiological response. I went home at 3 or 4 AM, couldn’t sleep, and over the next 2-3 months, I became completely obsessed with trying to understand what I had seen. I thought about my experiments while I was at the grocery store, while I was at a movie, all the time. When I discovered the answer, I was overwhelmed by an incredible sense of peace.
I knew then, that both a physician and a scientist would be my life’s work.
Acceptance Remarks: Jesús (Tito) González
I’m deeply honored to be included in this award for pivotal contributions to the discovery of life-changing CF drugs. Discovering, developing, and making available these drugs is an amazing achievement. It required basic science, therapeutic discovery, pharmaceutical, and clinical advances that spanned decades. This would not have been possible without the important contributions and sacrifices of countless scientists, colleagues, drug developers, clinicians, and patients.
Translating basic research into promising innovative drug candidates is challenging, risky and not well-defined. In this case, it required fundamental biological insight, enabling technology and an environment to rapidly generate pharmacological proof-of-concept. This bridging data is critical to garner the interest of pharmaceutical companies with the resources and expertise to take on the long and difficult next steps. It is important to support the science, people, and mechanisms that are essential for this intermediate step; so that more transformative medicines can be realized.
In discussions with people about scientific research, I’ve learned to recognize phrases or statements that are inadvertent indications that some work has been very successful. They may say something like it is so clear, or logical, or even straightforward. When I hear these types of comments, I always smile inside.
In hindsight, scientific progress appears logical, advancing monotonically, and in some ways straightforward. While this may be the way it is written in textbooks, I can attest that this was not the case for the discovery of these CFTR modulators. In the beginning, the idea of screening small molecule libraries to identify drug leads for different mutations was not widely accepted as a promising or even feasible approach. Out of a combination of inspired optimism and naivete, we pursued this new approach.
I’m truly grateful to have helped pioneer this CF discovery path with my talented and passionate colleagues. To up-and-coming scientists working on big challenges today, I encourage you to follow your instincts and seek fundamentally new approaches that can make the needle jump. There will be many obstacles and failures, this is normal. Explore, collaborate, and apply your discoveries to better the lives of those around you.
Acceptance Remarks: Paul Negulescu
I am honored to receive the Lasker-DeBakey Clinical Medical Research Award with Mike Welsh and Tito Gonzelez for contributions to the discovery of CFTR modulators to treat cystic fibrosis. I’m also honored to represent decades of work by my colleagues at Vertex to discover, develop and bring these medicines to patients.
I did not always intend to be a scientist. But as a history major, I took a physiology class from future Nobel Laureate Roger Tsien. I was fascinated by his lectures on the kidney and how it regulated sodium and chloride in our blood. I never looked at salt the same way after that.
I became interested in research and was a graduate student when the CFTR gene was discovered in 1989. I remember thinking “wow”, now someone can find a therapy to treat this disease. I had no idea that I might someday be involved.
My chance to be part of the CF story came a decade later. Initial gene therapy efforts were stalled, and we had an opportunity to try a different approach. Rather than replace the gene, the idea was to repair the defective CFTR protein with a drug. This had never been done and most people thought it was impossible. But we saw the situation differently. Mike Welsh’s work showed that CFTR was a chloride channel that was faulty in people with CF, so we knew what needed to be fixed. And new technologies such as the dyes Tito had invented allowed us to screen for compounds to restore CFTR function. I thought we should try.
Over the next twenty-five years, I discovered a passion for the collective effort required to discover and develop medicines, and dedicated myself to it. I’m grateful for the support of the CF community, including the many people with CF who participated in our clinical trials. It is thrilling and rewarding that our work may benefit about 90% of people with CF, and it inspires us to work toward effective therapy for all.
My path was influenced by inspiring teachers and the ripples from important discoveries like the CF gene and the invention of technologies. I’ve come to think about science as a flowing river. We can observe it from the bank, jump in and be carried along, and if we’re lucky and persistent, we have a chance to guide where the river goes.
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