WNT4 and Myocardial fibrosis: Serum Wnt2 and Wnt4 are elevated in patients with acute ischemia.367 The upregulation of these Wnt ligands activates Wnt/β-catenin signaling, resulting in p65 nuclear translocation, NF-κB signaling activation, fibroblast migration, and ultimately myocardial fibrosis.367 In the inflammatory heart tissue of patients with AMI and obese rats, increased expression of β-catenin induced NF-κB activation and nuclear localization, resulting in myocardial fibrosis and apoptosis368,369 (Fig. 9b).