Structure of DLIS

Instead of being a single compound, DLIS may be a class of compounds. Several investigators identified nonesterified fatty acids, phospholipids, and lysophospholipids as DLIS (55,56). When the first anti-digoxin antibody was introduced, it was recognized that most steroids cross-react to some extent with these antibodies. Several investigators reported progesterone, 17-OH progesterone, cortisol, and glycodihydroxy and glycotrihydroxy bile salts as DLIS (57). Shaikh et al. (58) reported that DLIS has a molecular weight of 780 Da comprising one 390-Da aglycone and several sugar moieties. De Angelis et al. (59) characterized DLIS as a single peak by HPLC from human serum with similar retention time as digoxin and concluded that the structure of DLIS was similar to digoxin. Qazzaz et al. reported that subtle structural differences exist between DLIS and digoxin at or near the lactone ring as well as in the nature of sugar. Moreover, deglycosylated congeners of DLIS also exist in human serum (60). Bagrov et al. (61) characterized DLIS as marinobufagenin with a molecular weight of 400 Da. Qazzaz et al. (62) also reported de novo biosynthesis of digoxin-like immunoreactive factors.

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