AIDS and Cancer Specimen Resource (ACSR)

Abstract
The ANCHOR Biorepository at the University of Arizona and now formally integrated into the AIDS and
Cancer Specimen Resource (ACSR), is a critical infrastructure supporting translational research on HPV-
associated anal neoplasia. Originating from the NIH-funded Anal Cancer/HSIL Outcomes Research
(ANCHOR) study (NCT02135419), the biorepository contains over 675,673 biospecimens collected
longitudinally from 10,537 participants, including serum, plasma, whole blood, anal swabs, and formalin-
fixed paraffin-embedded (FFPE) tissue blocks. Its unique strength lies in the systematic, longitudinal
collection of biospecimens from screened and randomized participants—including those in the
observational arm—prior to treatment, thus preserving the natural history of HSIL progression to cancer
or regression, respectively. The ANCHOR study successfully demonstrated that treatment of HSIL
prevents progression to cancer resulting in the release of new guidelines for anal cancer screening.
However, the lack of physicians skilled in anal high resolution anoscopy (HRA), a technique to diagnose
and treat HSIL, requires further optimization of current screening, diagnostic and treatment guidelines.
The ANCHOR Biorepository is an integral resource of the ANCHOR Correlative Science Studies
addressing critical gaps in our understanding of the pathobiology of anal cancer, particularly among
persons living with HIV (PLWH), as well as HIV-negative individuals disproportionately affected by anal
cancer, especially women. In the context of public health, all people regardless of HIV status will benefit
from optimized strategies for anal cancer screening and prevention, especially people with oropharyngeal
cancer and women with cervical cancer. For the grant year 2025-2026, over 50,000 specimens have
already been approved for use, with at least 20,000 more in planning. Operationally, the biorepository is
maintained under strict GLP and CAP-accredited protocols. Stewardship activities include temperature-
and humidity-controlled cold storage (47 active and backup units), rigorous QA/QC procedures, and
comprehensive informatics through Freezerworks. Sample distribution is governed by project specific
SOPs, LOI approvals by several committee including NIH-CTEP, and Material Transfer Agreements
(MTAs). An integral initiative of the biorepository is the development of a digital pathology library, which
will be offspring of over 4,000 FFPE tissue blocks to create a slide repository for remote pathology review,
AI-driven diagnostics, and deep annotation of histopathologic features. By providing high-quality, deeply
annotated biospecimens, the ANCHOR Biorepository advances research on anal HSIL and anal cancer
across populations. It represents a gold-standard model for biobanking in HPVrelated malignancy
research and will continue to be a cornerstone for future discovery in screening, prevention, and
therapeutic strategies.

Grant Number: 3UM1CA181255-10S5
NIH Institute/Center: NIH
Principal Investigator: Jeffrey Bethony