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Inhibition of PDE4 leads to high levels of cAMP, which in turn, activates PKA resulting in phosphorylation of transcription factors, such as cAMP Response Element-binding protein (CREB) and activating transcription factor-1 (ATF-1)

The results showed that healing rates at 24 months were 94% in the BMP-2 group compared to 83% in the iliac crest bone graft group, with the BMP-2 cohort demonstrating improvements in angiogenesis, operation duration, intraoperative blood loss, and length of hospital stay [397]

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