Apolipoprotein J-mediated hepato-renal crosstalk drives renal injury in chronic kidney disease

Chronic kidney disease (CKD) is characterized by multi-organ dysfunction and the systemic accumulation of toxic metabolites. Apolipoprotein J (ApoJ), a stress-responsive chaperone primarily synthesized in the liver, has emerged as a biomarker of disease severity; however, its mechanistic role in CKD pathogenesis remains unclear. Here, we identify ApoJ as a mediator of pathological hepato-renal crosstalk. ApoJ was markedly increased in experimental and human CKD and was closely associated with transcriptional signatures regulated by the aryl hydrocarbon receptor (AhR). Mechanistically, ApoJ stabilized AhR by preventing its ubiquitination, thereby enhancing renal tubular AhR activation, oxidative injury, and epithelial-mesenchymal transition. In the liver, ApoJ induced sulfotransferase 1A1 expression, promoting overproduction of the uremic tryptophan metabolite indoxyl sulfate, which further aggravated kidney injury. Hepatocyte-specific ApoJ deletion or pharmacologic blockade with the ApoJ antagonist peptide MK53 attenuated renal damage, suppressed tubular AhR signaling, and reduced hepatic uremic toxin generation. In human CKD specimens, tubular ApoJ accumulation correlated with injury, and mediation analyses indicated that circulating ApoJ amplifies the nephrotoxic impact of tryptophan metabolites. These findings identify ApoJ as a pathogenic driver of CKD that coordinates toxicological signaling between liver and kidney, and they highlight ApoJ inhibition as a potential therapeutic strategy.