Combined antibiotic therapy, particularly Rifampicin/Fusidic acid, is a well-tolerated and effective means of eradicating MRSA in patients with cystic fibrosis.

Intestinal fibrosis and stricture formation is an aggressive complication of Crohns disease (CD), linked to increased morbidity and costs. This study investigates the contribution of Wnt signalling to intestinal fibrogenesis, considers potential crosstalk between Wnt and TGFβ signalling pathways and assesses the therapeutic potential of small-molecule Wnt inhibitors.β-catenin expression was explored by immunohistochemistry in FFPE tissue from patient-matched non-strictured (NSCD) and strictured (SCD) intestine (n=6 pairs). Functional interactions between Wnt activation, TGFβ signalling and Collagen-I expression were explored in CCD-18Co cells and primary CD myofibroblast cultures established from surgical resection specimens (n=16) using small molecule Wnt inhibitors and molecular techniques, including siRNA-mediated gene knockdown, immunofluorescence, Wnt gene expression arrays and western blotting. Fibrotic SCD tissue was marked by an increase in β-catenin positive cells. In vitro, activation of Wnt-β-catenin signalling increased Collagen-I expression in CCD-18Co cells. Conversely, ICG-001, an inhibitor of β-catenin signalling, reduced Collagen-I expression in cell lines and primary CD myofibroblasts. TGFβ increased β-catenin protein levels but did not activate canonical Wnt signalling. Rather, TGFβ up-regulated WNT5B, a non-canonical Wnt ligand, and the Wnt receptor FZD8, which contributed directly to the up-regulation of Collagen-I through a β-catenin-independent mechanism. Treatment of CCD-18Co fibroblasts and patient-derived myofibroblasts with the FZD8 inhibitor 3235-0367 reduced extracellular matrix expression. Our data highlight small-molecule Wnt inhibitors of both canonical and non-canonical Wnt signalling, as potential anti-fibrotic drugs to treat SCD intestinal fibrosis. They also highlight the importance of the crosstalk between Wnt and TGFβ signalling pathways in CD intestinal fibrosis.

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