New data indicates inherited risk of early-onset cancer is higher amongst Latino, African American, and Asian/ Pacific Islander families

New data indicates inherited risk of early-onset cancer is higher amongst Latino, African American, and Asian/ Pacific Islander families

June 22, 2021

By Hinde Kast 

Joseph Wiemels, PhD, Cancer Epidemiology Program at the USC Norris Comprehensive Cancer Center. (Photo credit: Richard Carrasco)

Increased risk of cancer due to a genetic predisposition in first- and second-degree relatives is long-established but has previously only been studied in white or European populations.

Now, a new study published in eLife is the first to demonstrate that the inherited risk of early-onset cancer is significantly higher among Latino and African American families for solid tumors, and Asian/Pacific Islander families for blood-based cancers, compared to non-Latino white families in California.

“Cancer clustering within families, meaning the devastating diagnosis of more than one early onset cancer within the same family, usually points to a genetic cause. Interestingly, family cancer clustering has only been examined previously at the population level in white, or European origin population studies,” says study author Joseph Wiemels, PhD, a member of the Cancer Epidemiology Program at the USC Norris Comprehensive Cancer Center, and professor of Preventive Medicine at the Keck School of Medicine of USC. “In this study, we looked at clustering of cancer cases in young family members in California over the past 30 years within non-white populations andcompared it, for the first time, to white populations. We found that family-based cancer clustering occurs more frequently among minority populations.”

Researchers used California population-based health registries to evaluate the relative cancer risk among parents, siblings and children of patients diagnosed with cancer by the age of 26. Between 1989 and 2015, they identified 29,632 early onset cancer patients and then examined cancer incidence in 62,863 healthy family members. They found that overall, mothers and siblings of those cancer patients had a higher relative risk of early onset cancer. But when they looked at the role of race and ethnicity in genetic predisposition, they found that for patients with solid tumors, the familial cancer risk was significantly higher for Latino and non-Latino Black mothers and siblings compared to non-Latino white families. Asian/Pacific Islanders had a higher familial risk for blood-based cancers compared to non-Latino whites.

This study demonstrates the need for increased scrutiny on familial cancer clustering in minority populations. This information could help health care providers and genetic counselors offer more precision-based care and advice, particularly in the multiethnic populations that reside in Los Angeles County. 

About this study:

In addition to Dr. Joseph Wiemels, the study’s other authors include Qianxi Feng, MPH, USC Keck School of Medicine; Eric Nickels, MD, USC Keck School of Medicine and Children’s Hospital Los Angeles; Ivo S. Muskens, MD, USC Keck School of Medicine; Adam J. de Smith, PhD, USC Keck School of Medicine; W. James Gauderman, PhD, USC Keck School of Medicine; Amy C. Yee, MPH, USC Keck School of Medicine; Charite Ricker, MS, CGC, USC Norris Comprehensive Cancer Center; Thomas Mack, MD, USC Keck School of Medicine; Andrew D. Leavitt, MD, University of California, San Francisco; and Lucy A. Godley, MD, PhD, University of Chicago.

This work was funded by the V Foundation (Grant FP067172). Additionally, this study was supported by the California Department of Public Health, the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program, and the Centers for Disease Control and Prevention’s National Program of Cancer Registries.

Caryn Lerman, PhD, director of the USC Norris Comprehensive Cancer Center, named president of the Association of American Cancer Institutes

Caryn Lerman, PhD, director of the USC Norris Comprehensive Cancer Center, named president of the Association of American Cancer Institutes

June 10, 2021

As president, she will focus on leadership development in oncology, with a focus on diversity, equity and inclusion.

LOS ANGELES – Caryn Lerman, PhD, director of the USC Norris Comprehensive Cancer Center, part of Keck Medicine of USC, has been named president of the Association of American Cancer Institutes (AACI).

Lerman joined the AACI Board of Directors in 2019 and was elected vice president/president-elect in 2020. 

“This is a time of rapid change in not only cancer research, education and patient care, but also in terms of social justice issues that we must tackle as we elevate the national cancer program to the next level,” said Lerman, who also serves as associate dean for cancer programs and the H. Leslie and Elaine S. Hoffman Chair in Cancer Research at the Keck School of Medicine of USC. “I am looking forward to collaborating with AACI cancer centers to embrace change and address issues that matter most to them, including cancer equity and the diversification of the nation’s oncology leadership pipeline.”

Lerman will formally announce her presidential initiatives at the 2021 AACI annual meeting held October 19-21.

An elected member of the National Academy of Medicine, Lerman has served as a member of the National Cancer Institute Board of Scientific Advisors, the National Human Genome Research Advisory Council and the National Institutes on Drug Abuse Advisory Council. A cancer population scientist, she has received numerous awards for her work, including the American Cancer Society Cancer Control Award, the American Society of Preventive Oncology Joseph Cullen Award, the Alton Ochsner Award Relating Smoking and Health and the National Institutes of Health Matilda White Riley Award.

USC Norris Comprehensive Cancer Center to establish the Cancer Wellness HUBs with Lazarex Cancer Foundation grant

USC Norris Comprehensive Cancer Center to establish the Cancer Wellness HUBs with Lazarex Cancer Foundation grant

May 21, 2021

The Cancer Wellness HUB will address cancer health disparities and improve cancer health outcomes in the greater Los Angeles community across the continuum of care, from prevention through treatment and clinical trials

The Lazarex Cancer Foundation, founded by Dana Dornsife, has provided a $200,000 grant to the USC Norris Comprehensive Cancer Center (USC Norris) to establish Cancer Wellness HUBs in the greater Los Angeles area. The Cancer Wellness HUBs will be situated within the diverse communities we serve.  USC Norris staff will enhance community engagement and provide a local resource for cancer-related education and navigation support for cancer services, ranging from prevention to survivorship. Dr. Lourdes Baezconde-Garbanati, associate director for Community Outreach and Engagement at USC Norris will lead this program in collaboration with Dr. Marya Shegog, health equity and diversity coordinator at the Lazarex Cancer Foundation.

“The wellness community Hubs will bring vital information about clinical trials and cancer support services directly to communities most impacted by cancer,” says Dr. Baezconde-Garbanati. “Resources will be available in their own neighborhood without having to go far to get information or be connected to what they need. “

USC Norris will utilize a “pop up” model for the Cancer Wellness HUBs, making use of existing facilities such as churches, schools, YMCA locations, community centers, and health clinics within the community. Services offered at the USC Norris Cancer Wellness HUBs include conversations with cancer healthcare providers, cancer education workshops, as well as cancer support groups, cancer survivorship toolkits, and information on how to reduce cancer risk, engage in cancer screening, and participate in clinical trials.  USC Norris will also employ cancer care companions from local medical and community organizations to address the informational and support needs of community members. Neighborhood health ambassadors will serve as the bridge from the local neighborhoods to the Cancer Wellness HUBs.

“We are very grateful to the Lazarex Foundation for their continued support of our mission at USC Norris,” says Dr. Caryn Lerman, director of the USC Norris Comprehensive Cancer Center, associate dean for Cancer Programs and H. Leslie and Elaine S. Hoffman Chair in Cancer Research at the Keck School of Medicine of USC. “These neighborhood hubs will transform how we engage our community to reduce the burden from cancer for patients and families.”

Chanita Hughes-Halbert to advance cancer equity at USC Norris Comprehensive Cancer Center

Chanita Hughes-Halbert to advance cancer equity at USC Norris Comprehensive Cancer Center

May 3, 2021

National Academy of Medicine member also appointed to Preventive Medicine at Keck School of Medicine of USC

Chanita Hughes-Halbert, PhD, will join USC Norris Comprehensive Cancer Center as associate director for cancer equity, a newly created position, and the Keck School of Medicine of USC as a professor and vice chair of research in the Department of Preventive Medicine. Her appointment begins July 1, 2021.

Hughes-Halbert will join USC from the Medical University of South Carolina, where she is a professor of psychiatry and behavioral sciences, co-leader of the Cancer Control Program, holder of the AT&T Distinguished Endowed Chair at the Hollings Cancer Center and associate dean for assessment, evaluation and quality improvement at the College of Medicine.

She is a nationally recognized leader in cancer prevention and minority health research. She has dedicated her career to reducing the disparities in cancer outcomes that affect patients from underrepresented communities, with a primary focus on African American communities. Among her many achievements, she has identified sociocultural, psychological, genetic and environmental determinants of cancer health disparities and translates this information into interventions to improve health equity among racially and ethnically diverse populations, as well as other medically underserved groups.

For her many contributions, Hughes-Halbert was elected to the National Academy of Medicine in 2017.

“I am honored to join the exceptional faculty in the Department of Preventive Medicine and the Norris Comprehensive Cancer Center at the University of Southern California,” Hughes-Halbert said. “I am excited about working with the institutional leaders at USC to expand and enhance the breadth, depth and impact of health promotion and disease prevention in diverse populations through new research initiatives with academic health centers, community-based organizations and public health providers.”

“We are thrilled to have recruited Dr. Hughes-Halbert to USC Norris and the Keck School of Medicine, as reducing cancer disparities in our region and nationally is core to the mission of our NCI-Designated Comprehensive Cancer Center,” said Caryn Lerman, PhD, Director of the USC Norris Comprehensive Cancer Center, Associate Dean for Cancer Programs and the H. Leslie and Elaine S. Hoffman Professor in Cancer Research. “She is a distinguished scientist and in her USC Norris leadership role she will heighten our ongoing efforts to ensure that our high impact research and personalized patient care benefits all people, including those who have historically not had access to new revolutions in cancer prevention and treatment.”

At her current post, Hughes-Halbert directs the Transdisciplinary Collaborative Center in Precision Medicine and Minority Men’s Health. This program is dedicated to harnessing advances across an array of scientific fields to develop new medical strategies for minority men that are tailored to the specific social, genetic and environmental factors affecting each person’s health, with a focus on cancer.

In addition to her election to the National Academy of Medicine, Hughes-Halbert received the American Cancer Society’s Cancer Control Award in 2010. President Barack Obama appointed her to the National Cancer Institute’s Board of Scientific Advisors in 2012, and in 2014 she joined the National Advisory Council of the National Human Genome Research Institute. The American Association for Cancer Research named her chair of its Minorities in Cancer Research Council the same year, and she received the AACR Distinguished Lecture Award on the Science of Cancer Health Disparities, funded by the Susan G. Komen Foundation, in 2018.

Before her time at the Medical University of South Carolina, Hughes-Halbert was on the faculty at Georgetown University and the University of Pennsylvania. She earned her master’s and doctoral degrees from Howard University after graduating summa cum laude from Hampton University.

John D. Carpten elected fellow of AACR Academy

John D. Carpten elected fellow of AACR Academy

March 29, 2021

By Wayne Lewis

American Association for Cancer Research honors distinguished USC Norris Comprehensive Cancer Center scientist

John D. Carpten, PhD, founding chair for the Department of Translational Genomics in the Keck School of Medicine of USC, has been named to the 2021 class of fellows of the American Association for Cancer Research’s AACR Academy. He is the holder of the Royce and Mary Trotter Chair in Cancer Research and co-leader of the Translational and Clinical Sciences Program at USC Norris Comprehensive Cancer Center.

The mission of the AACR Academy is to recognize and honor distinguished scientists whose major scientific contributions have propelled significant innovation and progress against cancer, and to leverage the expertise of the global brain trust of fellows of the AACR Academy to advance the mission of the AACR to prevent and cure all cancers through research, education, communication and collaboration.

“John Carpten has an extraordinary record of impact and an uncompromising vision of science that makes a difference in outcomes for people facing cancer,” said Caryn Lerman, PhD, director of the Norris cancer center and USC’s H. Leslie and Elaine S. Hoffman Professor in Cancer Research. “This recognition is well-deserved, and the AACR Academy will gain substantially from the participation of such a talented, collaborative researcher.”

Carpten, who also serves as professor and founding chair of translational genomics and founding director of the USC Institute of Translational Genomics, is an internationally recognized leader in cancer genomics and precision oncology, as well as a pioneer in investigating the biology behind disparities in cancer outcomes among populations.

The AACR has honored him previously, with its 2014 Distinguished Lectureship on the Science of Cancer Health Disparities. In 2016, the National Human Genome Research Institute invited him to deliver the Jeffrey M. Trent Lecture in Cancer Research, named in honor of the institute’s original scientific director and given by “a prominent cancer researcher who brings the kind of energy, creativity and enthusiasm to cancer research that Dr. Trent has exemplified throughout his career.”

Carpten’s current work focuses on personalizing cancer therapy to most effectively address the specific biochemical details of each patient’s disease. He studies the entire DNA and RNA sequences of tumors using next-generation instrumentation, in search of biochemical vulnerabilities that can be targeted with new or existing therapies.

With over 190 peer-reviewed publications and more than a dozen patents to his credit, Carpten has generated a number of landmark findings. He was one of the lead authors on the first study to probe the entire genome for inherited prostate cancer genes. Another key investigation resulted in the first identification of a true hereditary prostate cancer gene, labeled HOXB13.

He was also the lead author on a high-profile study that identified a novel oncogenic mutation in a gene called AKT1 that plays a role in the development of breast, colorectal and ovarian cancers. For multiple myeloma — which disproportionately affects African Americans — his lab has produced seminal research profiling common mutations in one genetic pathway and conducted the first study to comprehensively compare molecular alterations in tumors between Black and white patients.

Previous to his 2016 recruitment to USC’s faculty, Carpten served as deputy director of basic sciences and professor and division director of integrated cancer genomics at the Translational Genomics Research Institute in Arizona. Before that, he was a tenure-track independent investigator at the National Human Genome Research Institute, where he had pursued his postdoctoral training after earning his doctorate from Ohio State University. He received his baccalaureate degree from Lane College in Tennessee.

CHLA, Keck School, Keck Medicine and USC Norris partner on cell therapy program as construction on new facility begins

CHLA, Keck School, Keck Medicine and USC Norris partner on cell therapy program as construction on new facility begins

March 12, 2021

By Landon Hall

the cGMP facility space before construction. From left: Mohamed Abou-el-Enein; Tom Buchanan; Alan S. Wayne; Caryn Lerman; Nikos Carli
In the cGMP facility space before construction. From left: Mohamed Abou-el-Enein; Tom Buchanan; Alan S. Wayne; Caryn Lerman; and Nikos Carli. (Photo/Sergio Bianco)

The essence of translational medicine is taking an idea from the drawing board and “translating” it into a real-world treatment that helps patients. The winding road of that process takes plenty of time, money and expertise, so it makes sense to place it all under one roof.

USC and Children’s Hospital Los Angeles (CHLA) are doing just that: Through a partnership among CHLA, the Keck School of Medicine of USCKeck Medicine of USC, and the USC Norris Comprehensive Cancer Center, construction has begun on a facility located on the USC Health Sciences Campus, where a multidisciplinary team of scientists will be studying, developing, manufacturing and testing cell-based treatments for a wide range of diseases and disorders. The new facility is part of a larger program, the USC/CHLA Cell Therapy Program, which will advance the science and translation of cell therapies at both institutions.

“Our vision is to advance cell therapy research at USC and CHLA so they can be leading centers and a hub for this type of research,” said Mohamed Abou-el-Enein, MD, PhD, MSPH, Executive Director of the USC/CHLA Cell Therapy Program. The new facility, a key component of the joint program, is scheduled to be completed in 2022, and Abou-el-Enein will serve as its Director.

“Having it established here will be a great enabler for all the scientific concepts being developed to really move forward into the clinic and treat hundreds of patients with incurable diseases,” he added.

Details on the high-tech facility

The planned 3,184-square-foot facility is being constructed in the basement of the Harlyne Norris Research Tower at the USC Norris Comprehensive Cancer Center. It’s called a cGMP, which stands for Current Good Manufacturing Practice facility. The designation was created by the Food and Drug Administration to regulate the production of pharmaceuticals and other treatments, such as cell therapies, under controlled conditions so they would be safe and efficacious. The USC/CHLA cGMP facility will feature six individual “clean rooms” on a dedicated manufacturing floor to produce multiple products without the potential of cross-contamination.

The underground facility will include six “clean” rooms. From left: Alan S. Wayne; Tom Buchanan; Nikos Carli; Mohamed Abou-el-Enein; and Caryn Lerman. (Photo/Sergio Bianco)

The products to be made at the cGMP facility will be mainly cell therapeutics, which can be thought of as “living drugs” because they are living cells modified to treat disease. The goal is to tailor cells and tissues to treat individual patients based on their condition/medical needs.

“Cell therapies harness the sophisticated biology of cells, which have evolved over millions of years, to create treatments that can be precisely targeted to specific diseases and tailored to each individual patient,” said Tom Buchanan, MD, Professor of Medicine and Vice Dean for Research at the Keck School of Medicine. “Cells are taken from the patient, modified in the cGMP facility, and returned to the patient. In some cases, they are designed to kill harmful cells, for example cancer cells. In other cases, they can replace missing cells like cartilage in people with arthritis. It is all done with great precision that only cells can provide. This is truly precision medicine.”

Cell therapy has many applications

Cell therapies have potential application to many specialties of medicine, including cancer, ophthalmology, orthopedics, neurology and pediatrics, among many others.

“This new facility will allow us to develop and deliver new therapies to cure and treat children and adults with a wide variety of life-threatening diseases and conditions,” said Alan S. Wayne, MD, Director of the Cancer and Blood Disease Institute at CHLA. “We are extremely excited about the future, as these new cell therapies will allow us to treat diseases in completely new ways, bringing hope for the children we treat at Children’s Hospital Los Angeles and around the globe.”

“We are thrilled to have this new facility,” added Caryn Lerman, PhD, Director of the USC Norris Comprehensive Cancer Center. “It is going to transform cancer research at USC Norris, enabling us to develop the next cures for patients with cancer. It will also help us to bring this therapeutic revolution to patients across Los Angeles County and beyond.”

Nikos Carli, Associate Administrator of Strategy and Cancer Services at Keck Medicine, said: “This new state-of-the-art facility furthers the impact of our clinicians and researchers in fulfilling USC Norris’s goal of making cancer a disease of the past. It’s very exciting to think scientific breakthroughs originating here will benefit the care of cancer patients across the globe.”

The USC Norris Comprehensive Cancer Center provided the space for the facility and contributed to the hiring of Abou-el-Enein, who focuses on translational development of cell therapies for clinical trials. Rongfu Wang, PhD, Director of Cell Therapy Research in the Division of Hematology-Oncology at CHLA, and Professor of Pediatrics and Medicine at USC, will lead the pre-clinical development of cell therapies, with an emphasis on cancer.

The facility and overarching cell therapy program have been in development since 2018, when the first meeting among stakeholders was held. Its planning, execution and funding have been a collaborative effort across departments, disciplines and institutions.

“Our model is to create strong and meaningful partnerships with different researchers and scientists,” said Abou-el-Enein, who is a physician by training but has worked to master the intricacies of cell manufacturing for clinical research. “Of course, it takes more time, energy and manpower, but it ensures the success of translation, because usually scientists will be doing what they know best, and for them, translation is a huge task. And it is indeed huge.”

Mohamed Abou-el-Enein named Executive Director of USC/CHLA Cell Therapy Program

Mohamed Abou-el-Enein named Executive Director of USC/CHLA Cell Therapy Program

January 27, 2021

Mohamed Abou-el-Enein, MD, PhD, MSPH, has joined the USC Norris Comprehensive Cancer Center, the Keck School of Medicine, and Children’s Hospital Los Angeles as the inaugural Executive Director of the Joint USC/CHLA Cell Therapy Program. He began his post Jan. 4.

Mohamed Abou-el-Enein

Abou-el-Enein will also serve as Medical Director of the new cGMP facility for cell and gene therapy that is under construction in the Norris Research Tower on the Health Sciences Campus, scheduled for completion in 2022.

In these roles, Abou-el-Enein will work closely with institutional leadership to provide vision and to oversee the development of a “one-stop-shop” translational platform that aims to assist investigators in bringing their basic work in cell and gene therapies into clinical testing.

Abou El-Enein has a primary faculty appointment as associate professor of clinical medicine in the Department of Medicine (oncology), with joint appointments in the Departments of Pediatrics and Stem Cell Biology and Regenerative Medicine. He is also a member of the Norris Comprehensive Cancer Center.

The Cell Therapy Program and cGMP facility are part of a joint venture of the Keck School, Children’s Hospital Los Angeles, and Keck Medicine of USC.

Dr. Abou-el-Enein has extensive training and expertise in the area of cell and gene therapy development. He obtained his Bachelor of Medicine and Surgery (MBBCh) degree from Mansoura University in Egypt in 2005. In 2014, he completed a Masters of Pharmaceutical Sciences and Technologies from the University of Strasburg in France, a Clinical Research Diploma from Harvard Medical School, and a PhD in the Economics of Manufacturing Clinical-Grade Advanced Therapy Medicinal Products from Charité Medical University in Berlin. He obtained an MPH from the London School of Hygiene and Tropical Medicine and a Master in Manufacturing of Advanced Therapy Medicinal Products from the University of Granada in Spain in 2020.

Abou-el-Enein most recently served as Head of the Clinical Development Platform and Head of Translational Research Unit at the BIH Center for Regenerative Therapies and Berlin Center for Advanced Therapies, respectively, both at the Charité Medical University in Berlin. Abou-el- Enein is one of the inaugural Lawrence Goldstein Policy Fellows of the ISSCR, associate Editor-in- Chief of Molecular Therapy – Methods and Clinical Development, served as regional secretary of the International Society of cell and gene therapy as well as on several other organizations and committees.

He has been recognized with multiple honors and awards, including the Max-Rubner Prize for Innovation and the Global Eisenhower Fellowship. His publications reflect global leadership in translational development of cell and gene therapy products in top-tier journals such as Cell Stem Cell, BMJ, Lancet Oncology, Molecular Therapy, Nature Biotechnology, Nature Reviews Clinical Oncology.

Lourdes Baezconde-Garbanati earns AACR Distinguished Lectureship​

Lourdes Baezconde-Garbanati earns AACR Distinguished Lectureship

Lourdes Baezconde-Garbanati earns AACR Distinguished Lectureship

October 29, 2020

Lourdes Baezconde-Garbanati, PhD, MPH, Associate Dean for Community Initiatives, was the recipient of the 2020 American Association for Cancer Research Distinguished Lectureship on the Science of Cancer Health Disparities.

Báezconde-Garbanati presented her award lecture during the opening session of the virtual AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved on Oct. 2. Her lecture was titled “Optimizing engagement to reduce disparities among Hispanic/Latinos/Latinx and other underserved communities.”

This AACR lectureship recognizes an investigator whose novel and significant work has had or may have a far-reaching impact on the etiology, detection, diagnosis, treatment, or prevention of cancer health disparities.

Read the AACR release for more information.

To prevent cancer, USC researchers look beyond traditional risk factors

To prevent cancer, USC researchers look beyond traditional risk factors

September 15, 2020

 

By Sarah Nightingale

Researchers at USC Norris Comprehensive Cancer Center are integrating “big data” related to multiple cancer risk factors to predict cancer occurrence and to help reduce risk in susceptible populations. 

Why me? It’s a question doctors hear all the time when they diagnose people with cancer. If only the answer were simple.

“Cancer — which is the uncontrolled growth of abnormal cells in the body — is a set of different diseases that arise from a complex interplay among environmental, genomic, lifestyle and sociodemographic factors,” said Caryn Lerman, the H. Leslie and Elaine S. Hoffman Cancer Research Chair and associate dean for cancer programs at the Keck School of Medicine of USC. Lerman joined USC in March 2019 as the director of the USC Norris Comprehensive Cancer Center.

“While medical research has considerably advanced our understanding of cancer etiology, there is now a tremendous opportunity to translate this knowledge into precision cancer prevention in different ethnic and racial populations,” she added.

Among the first eight cancer centers to be designated by the National Cancer Institute in 1973, the nationally recognized USC Norris cancer center has been a leader in advancing what we know about cancer — a diagnosis received by 1.7 million Americans each year. USC Norris cancer center researchers have led and contributed to studies demonstrating the role of tobacco, physical activity and diet and obesity, among many other cancer risk factors. USC Norris investigators have also advanced our understanding of the genomic factors contributing to cancer risk.

To read full article on USC News, click HERE. 

AACR Report on Cancer Disparities

AACR Report on Cancer Disparities

This landmark AACR Report on Cancer Disparities was released on September 16, 2020, during a congressional briefing where Dr. John Carpten, co-leader of the USC Norris Translational and Clinical Sciences Program,  delivered the keynote address. Four congressmen delivered remarks, and our USC Norris patient navigator Ghecemy Lopez shared her stories. Additionally, Dr. Mariana Stern, associate director for population sciences at USC Norris,  was a member of the Steering Committee that Dr. Carpten chaired to organize this event.

To read the full report, click HERE.