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This letter also requests p Page 4 and 5: An investigator is responsible for Page 6: 20993

While the arachnoid barrier and the BCSFB have moderate permeability in the fetal, neonatal, and adult period, the BBB is the closest structure to the brain cells and hence, is considered the most important barrier (Benz and Liebner, Figure 1)

Peptide Signaling and Cellular Response Peptides function as signaling molecules that bind to receptors and activate intracellular pathways

Future Direction and Call to Action The current evidence gap presents an opportunity for orthopaedic investigators to establish high-quality prospective registries evaluating peptide exposure in real-world musculoskeletal populations