rs11708067 — ADCY5 ADCY5 Glucose Signaling Variant

Intronic regulatory variant that reduces ADCY5 expression in pancreatic islets, impairing glucose-stimulated cAMP production and insulin secretion, and raising fasting glucose and type 2 diabetes risk

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ADCY5 — When the Glucose Signal Doesn't Reach Its Destination

Your pancreatic beta cells have a sophisticated system for sensing blood glucose and responding with precisely calibrated insulin release. ADCY5 (adenylate cyclase 5) sits at a critical junction in this signaling chain: it converts a glucose-triggered metabolic signal into cAMP11 cAMP
cyclic AMP — a second messenger molecule that amplifies signals inside cells, in this case activating protein kinase A and Epac proteins to drive insulin granule fusion and secretion, which then drives insulin granule fusion with the cell membrane and release into the bloodstream. The rs11708067 variant near this gene affects how much ADCY5 your islet cells produce — and when that production is reduced, the glucose-to-insulin signal becomes muffled.

The Mechanism

rs11708067 sits in intron 3 of the ADCY5 gene, within what turns out to be a key regulatory enhancer active specifically in pancreatic islets. The A risk allele disrupts this enhancer. Functional studies by Roman and colleagues22 Roman and colleagues
Roman TS et al. A Type 2 Diabetes-Associated Functional Regulatory Variant in a Pancreatic Islet Enhancer at the ADCY5 Locus. Diabetes, 2017 showed that the A allele carries fewer active chromatin marks (H3K27ac) in human islets, has lower transcriptional activity in reporter assays, and increased nuclear protein binding — all signs of a disrupted enhancer. When the equivalent enhancer region was deleted in a beta-cell line, ADCY5 expression fell by 64% and insulin secretion dropped by 39%.

The consequence is selective: Hodson and colleagues33 Hodson and colleagues
Hodson DJ et al. ADCY5 Couples Glucose to Insulin Secretion in Human Islets. Diabetes, 2014 demonstrated that ADCY5 is specifically required for translating elevated glucose concentrations into cAMP production. When ADCY5 is silenced, glucose-stimulated cAMP generation falls nearly threefold and insulin secretion is substantially impaired — but GLP-1-stimulated secretion remains intact because GLP-1 activates other adenylyl cyclase isoforms. Risk allele carriers show approximately twofold lower ADCY5 mRNA expression in islets, particularly in younger male AA carriers. A secondary defect has also been documented: Wagner and colleagues44 Wagner and colleagues
Wagner R et al. Glucose-raising genetic variants in MADD and ADCY5 impair conversion of proinsulin to insulin. PLoS One, 2011 found that A allele carriers show impaired proinsulin-to-insulin conversion, meaning beta cells produce proportionally more of the inactive precursor form.

The Evidence

The original discovery came from a landmark meta-analysis55 landmark meta-analysis
Dupuis J et al. New genetic loci implicated in fasting glucose homeostasis and their impact on type 2 diabetes risk. Nat Genet, 2010 of 21 genome-wide association studies in up to 46,186 non-diabetic participants with follow-up in an additional 76,558 individuals. rs11708067 emerged as one of nine newly discovered fasting glucose loci, with each A allele associated with a +0.027 mmol/L (0.49 mg/dL) increase in fasting glucose (p=7.1×10⁻²²) and OR 1.12 for type 2 diabetes (p=9.9×10⁻²¹). Crucially, the variant was associated with reduced HOMA-B (beta-cell function) but not HOMA-IR (insulin resistance), confirming the effect is specifically on insulin secretion capacity, not insulin sensitivity.

Replication across ethnicities strengthens the evidence. A South Asian study66 South Asian study
Rees SD et al. Effects of 16 genetic variants on fasting glucose and type 2 diabetes in South Asians: ADCY5 and GLIS3 variants may predispose to type 2 diabetes. PLoS One, 2011 in 1,678 cases and 1,584 controls confirmed OR 1.23 (95% CI 1.09–1.39, p=9.1×10⁻⁴). Pathway studies in GWAS of early childhood glucose levels also found ADCY5 rs11708067 among the variants cumulatively raising plasma glucose by 0.053 mmol/L per risk allele from birth onward.

The developmental origin of this risk was confirmed by Aguilera-Venegas and colleagues77 Aguilera-Venegas and colleagues
Aguilera-Venegas A et al. Association of diabetes-related variants in ADCY5 and CDKAL1 with neonatal insulin, C-peptide, and birth weight. Endocrine, 2021 who showed that healthy newborns carrying the A allele had lower cord blood insulin and C-peptide concentrations, independent of maternal glycemia — demonstrating that reduced beta-cell insulin secretion capacity is present from the first moments of life.

Practical Actions

The ADCY5 glucose-signaling deficit operates specifically on the glucose→cAMP pathway. This creates a specific therapeutic relevance: because GLP-1 stimulated secretion is ADCY5-independent, GLP-1 receptor agonists (semaglutide, liraglutide) and DPP-4 inhibitors work through a preserved pathway in risk allele carriers. For AA homozygotes with elevated fasting glucose or impaired glucose tolerance, these incretin-based approaches may be particularly rational choices to discuss with a physician.

Dietary strategies that blunt the glucose spike — lower glycemic load meals, slower carbohydrate absorption — reduce the demand on the already-reduced ADCY5-mediated secretion capacity. Continuous glucose monitoring can reveal whether postprandial responses are adequate despite the secretion deficit. Given the proinsulin conversion defect, fasting proinsulin:insulin ratio can serve as a sensitive early marker of beta-cell stress in high-risk individuals.

Interactions

ADCY5 rs11708067 sits within a broader beta-cell function locus. The neighboring SNP rs2877716 (C allele) tags the same ADCY5 risk haplotype and is often genotyped in parallel studies. Co-carriage of rs11708067 risk alleles with SLC30A8 rs13266634 (zinc transporter 8) compounds beta-cell secretory dysfunction through independent mechanisms — ZnT8 affects insulin granule maturation while ADCY5 affects the upstream glucose-to-cAMP signal. Individuals carrying risk alleles at both loci show a convergent impairment in glucose-stimulated insulin release. TCF7L2 rs7903146 risk alleles further compound risk through a third mechanism involving incretin signaling and beta-cell development; population studies of early childhood glucose levels found ADCY5 and TCF7L2 variants among the most consistently replicated contributors to cumulative fasting glucose elevation.

Genotype Interpretations

What each possible genotype means for this variant.

GG Optimal Glucose Signaling Beneficial

Two protective alleles — full ADCY5 expression and optimal glucose-to-insulin coupling

With both copies of the ADCY5 enhancer intact, your beta cells maintain full ADCY5 expression and efficient glucose-to-cAMP signaling. Glucose-stimulated insulin secretion operates at its genetically maximal level, and proinsulin conversion proceeds normally. Large GWAS studies use GG as the reference genotype against which the A allele's risk effect is measured.

Note that GG is extremely rare in European-ancestry populations (~4%) but is the dominant genotype in East Asians — where the G allele frequency exceeds 99.8% — consistent with the lower type 2 diabetes genetic load from this particular locus in East Asian populations.

AG Mildly Reduced Insulin Capacity Intermediate

One copy of the risk allele — mild glucose-to-insulin signaling impairment

With one disrupted ADCY5 enhancer (from the A allele) and one intact copy (from the G allele), beta cells produce intermediate ADCY5 levels. The insulin secretion deficit is correspondingly partial — glucose-stimulated cAMP production and insulin release are mildly reduced but not as severely compromised as in AA homozygotes. Proinsulin conversion may also be mildly affected. The additive inheritance pattern means the heterozygous genotype confers a risk increment roughly half that of AA.

At the population level, the AG genotype is clinically significant primarily in the context of other risk factors. Additional beta-cell stressors (weight gain, concurrent diabetes risk SNPs, aging) interact with this partial deficit.

AA Reduced Insulin Secretion Capacity High Risk

Two copies of the risk allele — impaired glucose-to-insulin signaling and modestly elevated type 2 diabetes risk

The AA genotype at rs11708067 means both copies of the ADCY5 enhancer carry the disrupting A variant, leading to the greatest reduction in ADCY5 mRNA expression in islet tissue. Studies in human islets show ADCY5-deficient beta cells generate nearly threefold less cAMP in response to elevated glucose, directly impairing the amplitude and kinetics of glucose-stimulated insulin secretion. This is selective: GLP-1 responses are spared, because GLP-1 activates alternative adenylyl cyclase isoforms that don't require ADCY5.

A secondary defect documented in non-diabetic individuals at T2D risk is impaired proinsulin-to-insulin conversion (p=0.002 in 1,782 high-risk participants). This results in elevated proinsulin:insulin ratios — a sensitive marker of beta-cell stress and early dysfunction. Neonatal data confirm the deficit begins in utero: healthy newborns with the A allele have lower cord blood insulin and C-peptide independent of maternal glycemia.

The absolute risk added by AA genotype remains modest at a population level (OR ~1.25 over GG), but beta-cell secretory capacity is finite and additional stressors (obesity, aging, concurrent risk alleles at SLC30A8, TCF7L2, or CDKAL1) interact additively with this underlying deficit.