B2A peptide bone graft substitute: literature review, biology and use for hindfoot fusions

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Bone healing that is orchestrated by osteoblasts and osteoclasts is regulated by a complex interaction between biochemical factors such as cytokines and growth factors. Some of the more important biomechanical factors that have an influence on bone healing are bone morphogenetic proteins (BMPs) that bind BMP receptors (BMPRs) and induce osteoblast proliferation and differentiation to enhance bone healing. B2A is a bioactive-designed peptide that acts on BMPRs of osteoblast precursor cells to augment osteodifferentiation by amplifying the cell response to BMPs. Recently B2A-coated ceramic granules have been developed as an implantable orthopaedic device used to augment arthrodesis (joint fusion). This approach has been applied in animal and clinical studies to promote spinal fusion and fusion of the hindfoot. This review provides an update on B2A technology and examines the clinical use and most recent literature regarding efficacy of the use of B2A-coated ceramic granules as a safe alternative to autogenous bone graft for hindfoot fusion operations. Last, the surgical procedure of subtalar arthrodesis is described as an example of how B2A-coated ceramic granules may be used for the surgical treatment of end-stage hindfoot arthritis.

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