Evidence of an association between early-life adversity and heightened risk of chronic disease in adulthood has been found, but the optimal biomarkers for identifying vulnerable or resilient individuals remain unclear.¹ Global trends, including widening socioeconomic disparities, the refugee crises, and climate change, increasingly sculpt trauma exposure and call for scalable early-risk identification and treatment strategies. Pediatricians often serve on the frontline of early identification and treatment of at-risk children, intervening during crucial windows of opportunity to prevent longer-term bioembedding that confers risk of disease across the life course. However, problems of scale need solutions that scale, which is one reason why the discoveries by Rasmussen et al,² reported in this issue, represent a promising step forward. Using high-quality assessments of multidomain, multireporter adversity exposure, these investigators present prospective, longitudinal evidence from a large, socioeconomically diverse sample that soluble urokinase plasminogen activator receptor (suPAR) may be a useful immune biomarker of early-life adversity, having a stronger and more exposure-specific association than current clinical markers, such as C-reactive protein. This type of rigorous epidemiologic “big data” work, complemented with “deep data,” will accelerate biomarker discovery for clinical diagnosis and treatment of early risk and resilience profiles and provide the foundation for precision medicine strategies in pediatrics.

已经发现早期患病与成年后慢性病风险增加之间存在关联的证据，但是用于识别脆弱或有韧性的个体的最佳生物标志物仍不清楚。¹全球趋势，包括不断扩大的社会经济差距，难民危机和气候变化，越来越多地塑造了创伤暴露的轮廓，并呼吁采用可扩展的早期风险识别和治疗策略。儿科医生经常在高危儿童的早期识别和治疗的第一线工作，在至关重要的机会之窗进行干预，以防止在生命周期中可能导致疾病风险的长期生物嵌入。然而，规模问题需要规模化的解决方案，这就是Rasmussen等人²发现的原因之一。本期报道，代表着向前迈出的光明的一步。这些研究人员使用多域，多报告者逆境暴露的高质量评估，从大量不同的社会经济方面的样本中获得了前瞻性的纵向证据，表明可溶性尿激酶纤溶酶原激活物受体（suPAR）可能是早期逆境中有用的免疫生物标志物，具有更强的抵抗力。与目前的临床标志物（例如C反应蛋白）相比，具有更多的暴露特异性关联。这种严格的流行病学“大数据”工作与“深层数据”相辅相成，将加快生物标志物的发现，以用于临床诊断和早期风险和适应力分析的治疗，并为儿科精准医学策略提供基础。