<?xml version="1.0" encoding="UTF-8"?>

  <!-- Example transcribed/adapted from ISO 11238 Implementation Guide §D.5.2.1
     (Table D.1 — Mipomersen sodium). Demonstrates the new SubstanceDefinition
     nucleic-acid backbones added for FHIR-57660. Sequence chemistry is the
     published Mipomersen 20-mer antisense oligonucleotide; identifiers are
     illustrative. -->
<SubstanceDefinition xmlns="http://hl7.org/fhir">
  <id value="mipomersen"/>
  <identifier>
    <system value="http://example.europa.eu/fhir/SMSId"/>
    <value value="MIPO78654S"/>
  </identifier>
  <status>
    <coding>
      <system value="http://hl7.org/fhir/publication-status"/>
      <code value="active"/>
    </coding>
  </status>
  <classification>
    <coding>
      <system value="http://example.europa.eu/fhir/SubstanceType"/>
      <code value="nucleic-acid"/>
      <display value="Nucleic Acid"/>
    </coding>
  </classification>
  <domain>
    <coding>
      <system value="http://example.europa.eu/fhir/Domain"/>
      <code value="human"/>
      <display value="Human use"/>
    </coding>
  </domain>
  <description value="Mipomersen sodium — a synthetic second-generation 2'-methoxyethyl antisense oligonucleotide that inhibits the molecular target apolipoprotein B-100 (APOB-100). 20-mer phosphorothioate-linked sequence with 2'-MOE wing chemistry."/>
  <code>
    <code>
      <coding>
        <system value="http://example.europa.eu/fhir/Substance"/>
        <code value="MIPO78654S"/>
      </coding>
    </code>
  </code>
  <name>
    <name value="Mipomersen Sodium"/>
    <preferred value="true"/>
    <language>
      <coding>
        <system value="urn:ietf:bcp:47"/>
        <code value="en"/>
        <display value="English"/>
      </coding>
    </language>
    <official>
      <authority>
        <coding>
          <system value="http://hl7.org/fhir/substance-name-authority"/>
          <code value="INN"/>
          <display value="INN"/>
        </coding>
      </authority>
      <status>
        <coding>
          <system value="http://hl7.org/fhir/publication-status"/>
          <code value="active"/>
          <display value="Active"/>
        </coding>
      </status>
    </official>
  </name>
  <nucleicAcid>
    <sequenceType>
      <coding>
        <system value="http://hl7.org/fhir/substance-sequence-type"/>
        <code value="complete"/>
        <display value="Complete"/>
      </coding>
    </sequenceType>
    <numberOfSubunits value="1"/>
    <oligoNucleotideType>
      <coding>
        <system value="http://hl7.org/fhir/oligo-nucleotide-type"/>
        <code value="antisense"/>
        <display value="Antisense oligonucleotide"/>
      </coding>
    </oligoNucleotideType>
    <subunit>
      <subunit value="1"/>
      <sequence value="GCCUCAGTCTGCTTCGCACC"/>
      <length value="20"/>
      <fivePrime>
        <coding>
          <system value="http://hl7.org/fhir/nucleotide-terminus"/>
          <code value="G"/>
          <display value="Guanosine"/>
        </coding>
      </fivePrime>
      <threePrime>
        <coding>
          <system value="http://hl7.org/fhir/nucleotide-terminus"/>
          <code value="C"/>
          <display value="Cytidine"/>
        </coding>
      </threePrime>
      <linkage>
        <connectivity/>
        <substance>
          <concept>
            <coding>
              <system value="http://example.europa.eu/fhir/LinkageSubstance"/>
              <code value="phosphorothioate"/>
              <display value="Phosphorothioate linkage"/>
            </coding>
          </concept>
        </substance>
        <residueSite value="1-19"/>
      </linkage>
      <sugar>
        <substance>
          <concept>
            <coding>
              <system value="http://example.europa.eu/fhir/SugarSubstance"/>
              <code value="2-MOE"/>
              <display value="2'-O-(2-methoxyethyl) ribose"/>
            </coding>
          </concept>
        </substance>
        <residueSite value="1-5,16-20"/>
      </sugar>
      <sugar>
        <substance>
          <concept>
            <coding>
              <system value="http://example.europa.eu/fhir/SugarSubstance"/>
              <code value="deoxyribose"/>
              <display value="2'-deoxyribose"/>
            </coding>
          </concept>
        </substance>
        <residueSite value="6-15"/>
      </sugar>
    </subunit>
    <gene>
      <sequenceOrigin>
        <coding>
          <system value="http://hl7.org/fhir/gene-sequence-origin"/>
          <code value="human"/>
          <display value="Human"/>
        </coding>
      </sequenceOrigin>
      <gene>
        <concept>
          <coding>
            <system value="http://www.genenames.org"/>
            <code value="APOB"/>
            <display value="apolipoprotein B"/>
          </coding>
        </concept>
      </gene>
    </gene>
  </nucleicAcid>
  <relationship>
    <substanceDefinitionCodeableConcept>
      <coding>
        <system value="https://www.uniprot.org"/>
        <code value="P04114"/>
        <display value="apolipoprotein B-100"/>
      </coding>
    </substanceDefinitionCodeableConcept>
    <type>
      <coding>
        <system value="http://hl7.org/fhir/substance-relationship-type"/>
        <code value="TherapeuticTarget"/>
        <display value="Therapeutic target"/>
      </coding>
    </type>
    <interaction>
      <coding>
        <system value="http://hl7.org/fhir/substance-interaction-type"/>
        <code value="inhibition"/>
        <display value="Inhibition"/>
      </coding>
    </interaction>
  </relationship>
</SubstanceDefinition>