title: Changing characteristics of the TDx digoxin II assay in detecting bufadienolides in a traditional Chinese medicine: for better or worse?
abstract: In 1992, apparent digoxin concentrations determined by the Abbott TDx II assay 5 hours after the ingestion of 10 pills of traditional Chinese medicine containing toad secretions (chan su) by 7 volunteers, yielded results that were equimolar to bufalin measured by 2 in-house bufalin radioimmunoassays (RIAs). Recently, a 17-year-old Chinese female unintentionally took 100 (instead of 10) of these pills for a sore throat but suffered no ill effects. The blood bufalin concentration at 3 hours by 1 of the 2 RIAs was 10.93 nmol/L, which was commensurate with the dose. However, the apparent digoxin measured by a TDx II assay produced in 2004 was only 3.08 nmol/L, which probably reflects the change in the specificity of the polyclonal digoxin antisera used in the assay over the years. In 1989, the TDx assay was commended for its ability to detect poisoning from plant and animal cardenolides, a property that seems to be waning and, thus, bad news for those wishing to use the assay to detect alternative cardenolides. But, on the other hand, it possibly eliminates the "specter" of digoxin-like immunoreactive substance (DLIS) that has afflicted some digoxin assays, which can only be good news.
authors.affiliation: From the Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. nspanesar@cuhk.edu.hk
authors.forename: Nirmal S
authors.initials: NS
authors.lastname: Panesar
authors.forename: Kam W
authors.initials: KW
authors.lastname: Chan
authors.forename: Lap K
authors.initials: LK
authors.lastname: Law
mesh_terms: D000293:Adolescent; D002018:Bufanolides / Q000097:blood*; D003429:Cross Reactions; D004077:Digoxin / Q000097:blood*; D005260:Female; D016231:Fluorescence Polarization Immunoassay / Q000379:methods*; D006801:Humans; D008516:Medicine, Chinese Traditional
chemical_list: D002018:Bufanolides; D004077:Digoxin; C022777:bufalin