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Editorial
November 4, 2019

Immune Biomarkers of Early-Life Adversity and Exposure to Stress and Violence—Searching Outside the Streetlight

Author Affiliations
  • 1Center for Health and Community, Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco
  • 2Division of Developmental Medicine, Department of Pediatrics, University of California, San Francisco
  • 3Division of Cardiology, Department of Medicine, University of California, San Francisco
JAMA Pediatr. Published online November 4, 2019. doi:https://doi.org/10.1001/jamapediatrics.2019.3882

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.

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    1 Comment for this article
    Pulling the Bodies from the River
    Edward Schor, MD | Stanford University School of Medicine
    Although it would no doubt be a biomedical breakthrough to identify biomarkers for childhood adversity, societies resources would be better spend preventing those potentially adverse experiences. While we don't yet have the research to reliably identify biomarkers, we have long known what is needed to reduce disparities and protect children from most of the social factors that lead to poor long term health and well-being. It is ironic that more and more research is being done, yet we are not applying what we know.
    CONFLICT OF INTEREST: None Reported
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