Combinatorial adapter targeting enables AND-gate activation of AdCAR T cells in pancreatic cancer but reveals donor-dependent activation thresholds

Abstract

Pancreatic ductal adenocarcinoma (PDAC) remains a lethal malignancy with limited therapeutic options, underscoring the need for innovative treatments. Chimeric antigen receptor (CAR) therapy has transformed hematologic malignancies but faces key challenges in solid tumors, particularly on-target/off-tumor toxicity and antigen heterogeneity. Adapter CAR (AdCAR) platforms offer enhanced control by decoupling antigen recognition from CAR activation, enabling controllable, reversible, and multi-antigen targeting. Recent studies suggest AdCARs can function as an AND-gate using combinations of adapter molecules at controlled surface densities. This defines activation thresholds, termed the Surface Activation Matrix, that restricts full activation to tumor cells overexpressing the target antigen combination, thereby reducing off-tumor toxicity. In this study, we evaluated its applicability to PDAC using adapters targeting CD318, TSPAN8 and CD66c. We systematically evaluated single and combinatorial adapter dosing in co-culture assays with AsPC1 cells, in a donor-dependent manner. Low concentrations of individual adapters were non-cytotoxic, whereas combining them at identical sub-threshold doses restored potent tumor killing, demonstrating that AdCAR activation depends on cumulative adapter density rather than total amount. However, the activation threshold required for AND-gate cytotoxicity varied between donors, highlighting the need for patient-specific titration to achieve selective tumor killing. These findings validate that AdCAR T cell activity in PDAC can be finely tuned through adapter concentration and combinatorial targeting, enabling selective tumor recognition while minimizing on-target/off-tumor toxicity. This flexible, safety-oriented strategy supports targeting heterogeneous PDAC tumors, though donor-dependent variability remains a critical consideration for clinical implementation.