brane and/or transition fiber regulation might be detrimental for ciliogenesis and correct positioning, resulting in the observed phenotype of the double mutants. Many key questions remain unanswered. Even though MKS1 and MKS3 physically interact, it is unclear how they act to regulate ciliogenesis, cilia length control, or cilia number. In mammals, MKS3 function regulates the number of cilia on the apical membrane in kidney tissues in vivo and in vitro, and loss of MKS3 results in an increased number of cilia. The authors of this study do not comment on cilia numbers, which may reflect a difference between a mammalian and nematode role of MKS3. Along this line, MKS3 might play additional roles in mammals versus nematodes, on the basis of its differential localization. Elucidating the function of MKS3 will also require investigating its potential genetic interaction with other ciliopathy genes, which would give important insights into the understanding of the pathogenesis of the cystic phenotype.Several reports recently provided data indicating that phenotypic severity among MKS and NPHP is a consequence of mutational load, meaning that MKS and NPHP lie within a phenotypic continuum rather than represent multiple distinct clinical entities and that the sum of mutations in ciliary genes define the severity of the phenotype. Further studies of MKS3 in conjunction with other ciliary proteins are now required to unravel how different mutational loads can lead to the clinical variability observed in patients with MKS as well as other ciliopathies and identify further, second-site modifiers.This study by Williams et al. 12 offers a deeper understanding of the importance of mutational load on the presentation and severity of ciliopathies and expands the understanding of the synergistic interactions between ciliopathy genes. Further analysis will hopefully allow targeted therapies to alleviate the morbidity and mortality associated with these devastating diseases. proteins, polycystin-1, polycystin-2, polaris, and cystin, are co-localized in renal cilia.