Glo AA-10 injection, 20ML is an infusion offering essential amino acids with Glycine and Sorbitol. It is used in the delivery of parenteral nutrition in patients who cannot tolerate or take oral nutrition.

Each ampoule provides

Nitrogen 0.262 gm equivalent to 1.64 gms of High Biological Value Protein Total
Amino Acid – 1.828 gm
Total Essential Amino Acid – 1.628 gm
Sorbitol 50 mg/ml – Provides immediate energy
Osmolarity – 1000 mOsmol/L
pH – Neutral

Sorbitol

Sorbitol acts as instant energy source and hence has Protein sparing effect (otherwise AA would be broken down for energy production)

BIOLOGICAL FUNCTIONS AND THERAPEUTIC POTENTIAL OF AMINO ACIDS USED IN GLO AA-10

L-Arginine

Arginine is a non-essential amino acid and is abundant in protamines and histones both proteins associated with nucleic acids. New-borns may produce this amino acid too slowly and for them Arginine should be seen as an essential amino acid.

Biological Functions of L-Arginine

• Necessary for wound healing.
• Assists with regeneration of damaged liver.
• Increases the size and activity of the thymus gland, which manufactures T cells, crucial components of the immune system
• Necessary for production and release of growth hormone
• Increases release of insulin and glucagon.
• Arginine is the most potent amino acid in releasing insulin
• Assists in healing through collagen synthesis
• Precursor to GABA, an important inhibitory neurotransmitter
• Aids in wound healing
• Necessary for spermatogenesis

Therapeutic Uses Of L-Arginine

• Considered “The Natural Viagra” by increasing blood flow to the penis
• Retards the growth of tumours and cancer by enhancing the immune system
• Aids in liver detoxification by neutralizing ammonia
• Reduces the effects of chronic alcohol toxicity
• Used in treating sterility in men by increasing sperm count
• Aids in weight loss because it facilitates an increase in muscles and reduction of body fat
• Assists the release of growth hormones, which is crucial for “optimal” muscle growth and tissue repair
• Is a major component of collagen which is good for arthritis and connective tissue disorders

L-Histidine

Histidine is an essential amino acid, synthesized in sufficient quantities in adults, but children may at some time have a shortage of this. It is one of the basic (reference to pH factor) amino acids due to its aromatic nitrogen-heterocyclic imidazole side chain.

This amino acid is metabolized into the neurotransmitter histamine and the set of genes that produce the enzymes responsible for histidine synthesis.

Biological Functions of L-Histidine

• Found in high concentrations in haemoglobin.
• It’s needed for the production of both red and white blood cells
• Important for the maintenance of the myelin sheaths, which protect nerve cells
• It is essential for the growth and repair of tissues
• Precursor to histamine.
• Associated with allergic response and has been used to treat allergy
• Assists in maintaining proper blood pH.
• Lowers blood pressure

Therapeutic Uses of L-Histidine

• It has been used in the treatment of rheumatoid arthritis, allergies and ulcers
• Useful in treating anemia due to deficiency of haemoglobin.
• Has been used to treat rheumatoid arthritis.
• Histidine protects the body from radiation damage
• It aids in the removal of heavy metals from the body; aids in sexual arousal

L-Isoleucine

Isoleucine is an essential amino acid and is part of the three “branched chain amino acids (BCAA) – the other two being leucine and valine. This amino acid cannot be synthesized in the body, and needs to be supplied in the diet.

Biological Functions of L-Isoleucine

• Plays an important role in muscle strength, endurance, and muscle stamina.
• Readily taken up and used for energy by muscle tissue.
• Required in the formation of haemoglobin.
• BCAA levels are significantly decreased by insulin.
• Stabilizes and regulates blood sugar.

Therapeutic Uses of Isoleucine

• Isoleucine is valuable to athletes because it aids in the healing and repair of muscle tissue, skin and bones.
• Used to prevent muscle wasting in debilitated individuals.
• It has been found to be deficient in people suffering from certain mental and physical disorders and hence may be helpful when given in a supplement

L-Leucine

Leucine is an essential amino acid, which cannot be synthesized in the body and is part of the three branched-chain-amino-acids. Supplements and protein powders that contain leucine are used extensively by bodybuilders and other athletes to promote muscle recovery, although it has not produced significant change in body composition.

Biological Functions of L-Leucine

• Works with Isoleucine and Valine to promote the healing of muscle tissue, skin, and bones
• Potent stimulator of insulin secretion.
• Aids in increasing growth hormone production
• Modulates release of Enkephalins, which are natural pain-reducers.

Therapeutic Uses Of L-Leucine

• Is recommended for those recovering from surgery
• Lowers blood sugar levels
• Helps with bone healing.

L-Lysine

Lysine is an essential amino acid nutrient and is a basic building block of all proteins and was first isolated in 1889 from casein.

Biological Functions of L-Lysine

• L-carnitine is formed from lysine and Vitamin C
• Helps form collagen, the connective tissue presents in bones, ligaments, tendons, and joints.
• Assists in the absorption of calcium.
• Essential for children, as it is critical for bone formation.
• Involved in hormone production.
• Lowers serum triglyceride levels.

Therapeutic Uses of L-Lysine

• Inhibits viral growth and, as a result, is used in the treatment of Herpes simplex,
• Helps in adequate calcium absorption
• Helps maintain a proper nitrogen balance in adults
• Aids in the production of antibodies which have the ability to fight cold sores and herpes outbreaks
• Lowers high serum triglyceride levels.

L-Methionine

Methionine is a sulfur containing essential amino acid and was first isolated in 1922 from casein and belongs to a group of compounds called lipotropics the others in this group include choline, inositol, and betaine. It is important in the process of methylation where methyl group is added to compounds as well as being a precursor to the amino acids’ cysteine and taurine.

Biological Functions of L-Methionine

• Assists in breakdown of fats.
• Precursor of the amino acids Cysteine and Taurine.
• Helps reduce blood cholesterol levels.
• Diminishes muscle weakness; prevents brittle hair
• Reduces the level of histamine in the body which can cause the brain to relay wrong messages
• Antioxidant assists in the removal of toxic wastes from the liver.
• The sulfur-containing amino acids act as anti-oxidants which neutralize free radicals.
• Helps prevent disorder of hair, skin, and nails due to sulfur and anti-oxidant activity.
• Precursor to Carnitine, Melatonin (the natural sleep aid) and Choline (Part of the neurotransmitter, Acetylcholine).
• Involved in the breakdown of Epinephrine, Histamine, and Nicotinic Acid.
• Required for synthesis of RNA and DNA.

Therapeutic Uses of L-Methionine

• Helps prevent disorders of the hair, skin, and nails
• Detoxify harmful agents such as lead and other heavy metals
• Protects against the effects of radiation
• Beneficial for women who take oral contraceptives because it promotes the excretion of estrogen
• Helpful to individuals suffering from schizophrenia.

L-Threonine

Threonine is an essential amino acid, and cannot be manufactured by the body and is found in high concentrations in the heart, skeletal muscles and central nervous system.

Biological Functions of L-Threonine

• Required for formation of collagen.
• Aids in production of antibodies.
• Can be converted to Glycine (a neurotransmitter) in the central nervous system.
• Acts as detoxifier.
• Needed by the gastrointestinal tract for normal functioning.

Therapeutic Uses of L-Threonine

• Helps maintain proper protein balance in the body
• Its important for the formation of collagen, elastin and tooth enamel
• Aids liver and Lipotropic function when combined with Aspartic Acid and Methionine
• Prevents the build-up of fat in the liver; assists metabolism and assimilation.
• Provides symptomatic relief in ALS (Amyotrophic Lateral Sclerosis).
• Threonine is often low in depressed patients. In that group of patients, Threonine is helpful in treating the depression.

L-Tryptophan

Tryptophan is an essential amino acid and is needed to maintain optimum health.

Biological Functions of L-Tryptophan

• Precursor to the key neurotransmitter, serotonin, which exerts a calming effect.
• Effective sleep aid, due to conversion to serotonin.
• Reduces anxiety.
• Effective in some forms of depression.
• Stimulates growth hormone.
• Along with Lysine, Carnitine, and Taurine is effective in lowering cholesterol levels.
• Can be converted into niacin (Vitamin B3).
• Lowers risk of arterial spasms.
• The only plasma amino acid that is bound to protein.
• Tryptophan must compete with 5 other amino acids to pass through the blood brain barrier and enter the brain. Those 5 are: Tyrosine, Phenylalanine, Leucine, Isoleucine, and Valine
• Requires pyridoxal-5-phosphate(P5P), active form of vitamin B6 to convert into serotonin. P5P deficiency will lower serotonin levels, even tryptophan levels are normal.

 Therapeutic Uses of L-Tryptophan

• A natural relaxant, helps alleviate insomnia by inducing normal sleep; reduces anxiety and depression and stabilize mood
• Treatment for migraine headaches.
• Help the immune system function properly
• Aids in weight control by reducing appetite
• Enhances the release of growth hormones
• Helps control hyperactivity in children.

L-Valine

Valine is an amino acid obtained by hydrolysis of proteins and was first isolated by the German chemist Emil Fischer in 1901 from casein and is not only an essential amino acid but is also a branched-chain amino acid (the others are isoleucine and leucine) found in high concentration in the muscles.

Biological Functions of L-Valine

• BCAA levels are significantly decreased by insulin. High dietary sugar or glucose intake causes release of insulin, which, in turn, causes a drop in BCAA levels.
• Competes with Tyrosine and Tryptophan in crossing the blood-brain barrier.
• The higher the Valine level, the lower the brain levels of Tyrosine and Tryptophan.

Therapeutic Uses Of L-Valine

• Is needed for muscle metabolism and coordination, tissue repair
• Helps maintain proper nitrogen balance in the body
• Used as an energy source by muscle tissue
• Helpful in treating liver and gallbladder disease
• Promotes mental vigour and calm emotions.

L-Phenylalanine

Phenylalanine is an essential amino acid that is also one of the aromatic amino acids that exhibit ultraviolet radiation absorption properties and is the most commonly found aromatic amino acid.

It can be converted in the body to tyrosine, which in turn is used to synthesize two important neurotransmitters, dopamine and norepinephrine. It is available in three different forms-L, D-and DL The L-form is the most common and the type in which it is incorporated into the body’s proteins. The D. form acts as a painkiller and the DL a combination of the two.

Biological Functions of L-Phenylalanine

• Precursor to Tyrosine, which, in turn, is the precursor to the neurotransmitters: Dopamine and the excitatory neurotransmitters Norepinephrine and Epinephrine.
• Precursor to the hormone, Thyroxine.
• Enhances mood, clarity of thought, concentration, and memory.
• Promotes alertness and vitality; elevates mood; decreases pain
• Suppresses appetite.
• Major part of collagen formation.
• Used in the treatment of Parkinson’s Disease.

Therapeutic Uses of L-Phenylalanine

• Aids memory and learning
• Used to treat arthritis, depression, menstrual cramps, migraines, obesity, Parkinson’s disease, and schizophrenia.
• Powerful anti-depressant.
• DL-Phenylalanine is useful in reducing arthritic pain.

Glycine

Glycine, the simplest of the amino acids, is an essential component of important biological molecules, a key substance in many metabolic reactions, the major inhibitory neurotransmitter in the spinal cord and brain stem, and an anti- inflammatory, cytoprotective, and immune modulating substance.

Biological Functions of Glycine

• Retards muscle degeneration
• Improves glycogen storage, thus freeing up glucose for energy needs
• Promotes a healthy prostate, central nervous system, and immune system
• Glycine is precursor for a variety of important metabolites such as glutathione, porphyrins, purines, haem, and creatine.
• Glycine acts as neurotransmitter in central nervous system and it has many roles such as antioxidant, anti-inflammatory, cryoprotective, and immunomodulatory in peripheral and nervous tissues.

Therapeutic Uses of Glycine

• Useful for repairing damaged tissue and promotes healing
• Taken before bedtime, helps the body reach deep sleep more quickly
• Used for treating schizophrenia, stroke, benign prostatic hyperplasia (BPH), and some rare inherited metabolic disorders.
• It is also used to protect kidneys from the harmful side effects of certain drugs used after organ transplantation as well as the liver from harmful effects of alcohol.

ESSENTIAL AMINO ACIDS

Proteins are the major structural and functional components of all cells in the body. Proteins play an important role in the body’s construction, function, and control. Proteins are divided into two categories: structural (e.g., constituting muscles, organs, glands, ligaments, tendons, nails, hair, bones) and functional (e.g., Hormones, Enzymes, Antibodies, Immunoglobulins).

Proteins and AAs also represent the only source of nitrogen for humans. Since the body has no protein storage, the body’s growth, cellular structure preservation, wound healing, enzymatic, and hormonal heritage depend on the constant quantity and quality of external proteins (or AAs) to compensate daily losses. Twenty AAs differently combined, form proteins.

Some amino acids are classified as essential (indispensable). Those are amino acids that cannot be synthesized by humans and hence must be provided in the diet or parenteral solution. Non-essential amino acids can be synthesized from other amino acids or from other precursors.

Essential amino acids are Isoleucine, Leucine, Valine, Tryptophan, Phenylalanine, Lysine, Threonine, Methionine, Arginine, and Histidine.

As the body can’t produce EAA and they must be supplemented in different situations requiring amino acids.

Adequate availability of all EAAs (supplied and from protein breakdown) enhances protein synthesis, determining an anabolic state

Essential AA (EAA) recycling in protein turnover. Reported units are arbitrary to explain the differences between the anabolic and catabolic states in the presence or absence of external AA supply.

Adequate availability of all EAAs (supplied and from protein breakdown) enhances protein synthesis, determining an anabolic state.

NITROGEN BALANCE

6.25gm of protein = 1 gm of Nitrogen.

Protein intake < Output (Negative nitrogen balance)

Negative nitrogen balance slows wound healing and causes muscle weakness. If the negative nitrogen balance is not rectified, the morbidity and mortality rates will rise..

Glo AA-10, 20 ml ampoule corrects the nitrogen loss and shortens the recovery period during convalescence.

IMPORTNACE OF AMINO ACIDS IN THE BODY

Amino acids play a variety of roles in the body, including

• Building blocks of body proteins – Blood, WBC, Antibodies
• Source of energy
• Enhances growth
• Helps in Tissue maintenance & repair
• Structural units of Enzyme – Amylase, Lipase, Maltase, Pepsin etc
• Structural units Hormes – Insulin, Thyroxine, Adrenaline, Testosterone etc
• Acts as Neurotransmitters

ROLE OF AMINO ACIDS IN HEALTHY ENDOCRINE FUNCTION

Thyroid

• The various forms of thyroid hormone are all made of amino acids.
• The thyroid gland is our “energy burner” and helps us maintain a normal metabolic rate.
• Too little thyroid hormone and we become exhausted, dull witted, depressed, and sluggish.
• The fuel that thyroid hormone burns is glucose, whose levels are maintained by the hormone insulin which is made by the pancreas.

Pancreas

• Insulin is one of the main hormones made by the pancreas, and is made up of a long chain of amino acids.
• Insulin is essential for maintaining normal levels of blood sugar.
• Problems with insulin can lead either to hypoglycaemia or diabetes.

Adrenal

• The adrenal gland makes a host of hormones among which adrenaline is one of the most important (Adrenaline is made from the amino acid, tyrosine).
• Adrenaline is essential for the fight-or-flight reaction. We need adrenaline in times of real danger.
• Those of us who are chronically stressed have adrenals that are “burning out”. That’s because each episode of stress is handled by the adrenals as if our lives were in danger. One of the important functions of adrenaline is that it “tells” the liver to break down glycogen, our glucose store, so that our body has an immediate rush of energy.

Pituitary

• Human Growth Hormone (HGH) is a major contributor to longevity, vitality, muscle strength and endurance.
• HGH is a long chain of amino acids.

Sex Hormones

• The sex hormones, including estrogen, progesterone, and Testosterone amino acid based.

Thus, Amino acids are crucial to the nervous system and endocrine system. We can correct many abnormalities in these two systems by replacing deficient amino acids.

ROLE OF AMINO ACIDS IN INFECTION

People who are malnourished are more susceptible to infection. Amino acid supplementation strengthens the immune system resulting in a greater response to anti-infective therapy and speedier infection control.

ROLE OF AMINO ACIDS IN CONVALESCENCE

A lack of amino acids might extend recovery time. Body proteins are rapidly broken down after a prolonged sickness, and they are improperly resynthesized due to lack of all essential amino acids.

ROLE OF AMINO ACIDS IN PREGNANCY & LACTATION

Increased Demand: The body’s need for amino acids increases by 65 percent during pregnancy and 52 percent during lactation.

Amino acids play a critical part in the healthy development and growth of the foetus, in the tissue development, increased synthesis of hormones, enzymes, and other processes are all dependent on the body’s amino acid status.

OVERALL HEALTH AND AMINO ACIDS

Amino acids are not only the components of protein which make up our body tissues but also play many other important roles.

Important substances which take part in the regulation of neurological functions like Niacin, epinephrine, norepinephrine, and serotonin are also made from amino acids such as Tyrosine and Tryptophan.

Amino acids are synthesized as well as degraded every day, hence, it is vital to take necessary amino acids from outside in our diet. Almost all the proteins from food are digested to amino acids by the time they reach the liver. Out of 20 amino acids that constitute body proteins, 10 amino acids can be produced from other amino acids or other substances in the body, however remaining 10 amino acids cannot be synthesized in the body. These essential amino acids must be obtained from outside.

Immune system consisting of macrophages provides protection to our body from attack by pathogenic microorganisms. Macrophages do not function properly whenever there is reduction in physical fitness of a person and the person is more prone to infectious diseases such as cold. Arginine and Glutamine support the function of macrophages and other immunological immunocytes. Macrophages must activate and proliferate more than the usual requirement of Arginine and Glutamine when faced with the infiltration of extraneous foreign matter such as virus. Strengthening of immune system by increasing blood amino acid level will make us less prone to contract infectious diseases. Replenishment of amino acids helps make the body more resistant to diseases.

USE OF AMINO ACIDS IN MEDICAL CARE

It was in the year 1956, amino acid infusions were launched in Japan for providing parenteral nutrition to patients before and after surgery. This was the first time in the world when purified amino acids were used in the medical field. Physiological function of each amino acid has been studied. Amino acid production technology, including the fermentation method has made it possible to manufacture high quality amino acids in large quantities.

Although amino acid infusions are mixtures of some types of amino acids, each amino acid in isolation has been found to produce various physiological effects. Glutamic acid is used as an anti-ulcer drug, and its gastrointestinal mucosa repairing function has recently gained attention also.

Arginine exerts an immune enhancing effect not only in healthy persons, but also in postoperative patients with lowered immunological function, patients on intensive treatment, and patients infected with HIV virus.

As nutritional supplement, along with 5% or 10% dextrose or normal saline as the case may be, for adults and infants up to 2 years in the following conditions.

• Intractable diarrhoea with or without vomiting
• Intractable dysentery
• Hyperemesis gravidarum
• Persistent pyrexia
• Severe illness with dehydration
• Pre- and Post-surgical condition with mild to moderate loss of nitrogen
• Burns with fluid loss and mild to moderate loss of nitrogen
• Malnutrition with moderate nitrogen loss

Adults: 1-2 Ampoule with I.V drip

When fluid replacement is attempted and if the fluid in question is to be improved nutritionally, GloAA-10 (20 ml) ampoule is the most suitable presentation. The contents of one ampoule have to be transferred into the infusion bottle and not more than 2 ampoules would be required.

NOTE: For correction of Nitrogen imbalance, Glo AA-10 is the most suitable presentation. The quantity to be infused would depend upon the degree of Nitrogen loss. In any case, the total quantity should not exceed 800 ml per day.

Children: 1 Ampoule/ I.V drip

Neonates & Infants up to 2 years:
In low-birth-weight neonates and infants, the quantity of amino acid would depend on the quantity of Nitrogen requirement.

Dosage calculation for 4 kg infant:

0.20 gms (lower limit of dosage range) X 4 kg – 0.80 gms Each ampoule provides 0.26 g of Nitrogen
No. of ampoules required – 0.80 / 0.26 = 3 ampoules

Proven compatibility with

• Dextrose 5% & 10% in water
• Dextrose 5% and 10% in saline
• Saline solution
• Ringer lactate infusion
• Ringer’s lactate infusion and Electrolytes.

Since one ampoule contains substantial quantity of solution (20 ml) and the solution has a higher osmolarity than blood, injecting it directly into the vein is challenging and not recommended.

As a result, the contents of one ampoule must be transferred to an infusion bottle containing Dextrose, Normal Saline, or any other compatible infusion, depending on the situation.

After infusion with sufficient quantity of 5% dextrose or normal saline or any other compatible infusion, transfer the 20 ml amino acid solution into the bottle. The contents of the second ampoule (if necessary) can be transferred into the bottle when enough fluid has gone into the vein. The objective of administering Glo AA-10, 20 ml in this case, is to nutritionally improve the chosen IV fluid and at the same time correct mild to moderate Nitrogen imbalance, if any.

When an ampoule is opened, the contents should be used immediately, it should not be stored.

1. Nutrients. 2020 Mar; 12(3): 772.

2. Curr Opin Clin Nutr Metab Care. 2011 Jan; 14(1): 75–82.