Arginine is a "semi essential" amino acid for protein synthesis, creatine synthesis, and the urea cycle. It was once considered to be a nonessential amino acid but its demand may exceed synthetic rates during growth and critical illness. Arginine is a unique substrate for the biological effector molecule nitric oxide, which is a putative neurotransmitter and cytotoxic effector molecule. Increased plasma levels of arginine leads to enhanced secretion of insulin, glucagon, somatostatin, growth hormone, prolactin, adrenal catecholamines, and many other hormones through involvement with stimulating cholinergic activity. Arginine deficiency can impair the urea cycle causing hyperammonemia and increased orotate excretion. Arginine stimulates wound healing and has a hypotensive effect. Synthesis of nitric oxide is arginine dependent thus would be therapeutic in sepsis as infusion of nitric oxide in would be.

Carnitine/Acetyl-L-Carnitine

Carnitine, beta-hydroxy-gamma-trimethylammonium butyrate, is an amino acid essential for the transport of fatty acids through the mitochondrial matrix for beta oxidation. Acetyl-L-Carnitine (ALC) is formed by acetylation of carnitine via the enzyme carnitine acetyl transferase. ALC transferases the inner mitochondrial membrane providing a transport mechanism for acetyl groups created by beta oxidation of fatty acids while regenerating acetyl-CoA in the cytosol. Acetyl-L-Carnitine is a source of crucial acetyl groups for acetyl-CoA, which facilitates energenic pathways that are not available from simple carnitine. ALC facilitates long chain fatty acid transport through the inner mitochondrial membrane thereby function as an energy carrier, metabolic facilitator, and membrane protectant.

Free Form Amino Acids

Supplementation of free form amino acids is applicable in metabolic signs of catabolism and low nutrient density. Free form amino acids are easily assimilated and supportive systemically for nitrogen retention and growth and repair in degenerative illness.

N-Acetyl Glucosamine/Glucosamine Sulfate

Glucosamine is a glycosaminoglycam, (or amino monosaccharide), produced in the body by the combination of glucose with glutamine through the enzymatic action of glucosamine synthetase. Glucosamine is a substrate for the biosynthesis of proteoglycans, such as chondroitin sulfate and hyaluronic acid, which provide the framework for collagen to follow. Proteoglycans can hold water, giving connective tissue its flexibility and resilience. Glucosamine sulfate (GS) and N-Acetyl Glucosamine (NAG) are components of glycoproteins and glycosaminoglycans, essential for the components of cell membranes and cell surface proteins as well as interstitial structural molecules that hold cells together. Glucosamine sulfate and N-Acetyl Glucosamine play crucial roles in the formation of articular surfaces, tendons, ligaments, synovial fluid, skin, bone, nails, heart valves, blood vessels, and in mucous membranes.

Glutathione

Glutathione, a tripeptide gamma-glutamyl-cysteinyl-glycine, is the most prevalent cellular thiol and most abundant low molecular weight protein in cells. It functions in catalysis, metabolism, and transport participating in reactions involving the synthesis of proteins and nucleic acids and those that detoxify free radicals and peroxides. Glutathione appears to offer myocardial protection and functions in the transfer of cysteine as part of a pathway for membrane transport of cyst(e)ine.

Taurine

Taurine is an amino-sulfonic acid and is dissimilar to other amino acids in that it is abundant in its free form and is incorporated into proteins. The intracellular concentration for taurine is actually higher than that of all other amino acids except glutamine. Taurine functions as a modulator of cation flux, especially for calcium by its ability to sequester membrane calcium during depletion of electrolytes. It acts as an oxidant scavenger stemming from its amino group, which reacts with hypochlorous acids to form nontoxic monochlorotaurine. Taurine administered as a preoperative rapid intravenous infusion prior to human myocardial revascularization and significantly decreased the percentage of damaged mitochondria. Taurine is a neuromodulator indirectly depressing neuroexcitation through its control over glutamate, mediates contractility in the cardiac muscle, and decreases aggravation sensitivity in platelets.