'Welcome to ouabain – a new steroid hormone' was the title of the Lancet Editorial in June 1991, published in response to a series of articles by John Hamlyn and co-workers claiming to have conclusively identified the elusive 'endogenous digitalis-like factor' (EDLF) as ouabain or a closely related isomer. The group of drugs known as cardiac glycosides, which includes digoxin, ouabain and other digitalis-like compounds, are members of a class of steroids termed cardenolides, which were originally obtained from plants. The efficacy of cardiac glycosides in the treatment of congestive heart failure led Rein in 1942 to suggest that there may be an endogenous compound which could improve heart contractility (see Goto et al. 1992), although the existence of an EDLF in mammals was proposed as early as 1885 (Ringer 1885). Later, in 1953, Szent-Gyorgyi suggested that cardiac glycosides might replace a deficiency of a natural hormone which acts
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