There are four isoforms of the ␣ subunit (␣1-4) and three isoforms of the  subunit (1-3) of Na,K-ATPase, with distinct tissue-specific distribution and physiological functions. ␣2 is thought to play a key role in cardiac and smooth muscle contraction and be an important target of cardiac glycosides. An ␣2-selective cardiac glycoside could provide important insights into physiological and pharmacological properties of ␣2. The isoform selectivity of a large number of cardiac glycosides has been assessed utilizing ␣11, ␣21, and ␣31 isoforms of human Na,K-ATPase expressed in Pichia pastoris and the purified detergent-soluble isoform proteins. Binding affinities of the digitalis glycosides, digoxin, -methyl digoxin, and digitoxin show moderate but highly significant selectivity (up to 4-fold) for ␣2/␣3 over ␣1 (K D ␣1 > ␣2 ؍ ␣3). By contrast, ouabain shows moderate selectivity (≈2.5-fold) for ␣1 over ␣2 (K D ␣1 < ␣3 < ␣2). Binding affinities for the three isoforms of digoxigenin, digitoxigenin, and all other aglycones tested are indistinguishable (K D ␣1 ؍ ␣3 ؍ ␣2), showing that the sugar determines isoform selectivity. Selectivity patterns for inhibition of Na,K-ATPase activity of the purified isoform proteins are consistent with binding selectivities, modified somewhat by different affinities of K ؉ ions for antagonizing cardiac glycoside binding on the three isoforms. The mechanistic insight on the role of the sugars is strongly supported by a recent structure of Na,K-ATPase with bound ouabain, which implies that aglycones of cardiac glycosides cannot discriminate between isoforms. In conclusion, several digitalis glycosides, but not ouabain, are moderately ␣2-selective. This supports a major role of ␣2 in cardiac contraction and cardiotonic effects of digitalis glycosides.