Defibrotide (Defitelio): A New Addition to the Stockpile of Food and Drug Administration-approved Oligonucleotide Drugs

On 1 April 2016, the Food and Drug Administration approved Defitelio, known for many years as Defibrotide (DF), for marketing in the United States. The indication is severe hepatic veno-occlusive disease (sVOD) following high-dose chemotherapy and autologous bone marrow transplantation, a toxicity of therapy with a high mortality. Defibrotide is not the kind of oligonucleotide drug beloved by molecular biologists and proponents of personalized medicine. Its very complicated mechanism of action, which is still elusive, is without question nonsequence specific, and almost certainly based on the charge-charge interactions of its constituents with biological macromolecules, which are almost certainly proteins.