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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Ophthalmol.</journal-id>
<journal-title>Frontiers in Ophthalmology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Ophthalmol.</abbrev-journal-title>
<issn pub-type="epub">2674-0826</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fopht.2023.1208805</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Ophthalmology</subject>
<subj-group>
<subject>Brief Research Report</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Syntaxin 3 is haplosufficient for long-term photoreceptor survival in the mouse retina</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Perez-Hurtado</surname>
<given-names>Mariajose</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="author-notes" rid="fn003">
<sup>&#x2020;</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Dao</surname>
<given-names>Calvin</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="author-notes" rid="fn003">
<sup>&#x2020;</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/2314286"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Saenz</surname>
<given-names>Amanda E.</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/2313745"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Heidelberger</surname>
<given-names>Ruth</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="author-notes" rid="fn001">
<sup>*</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/20521"/>
</contrib>
</contrib-group>
<aff id="aff1">
<sup>1</sup>
<institution>Department of Neurobiology and Anatomy, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth Houston)</institution>, <addr-line>Houston, TX</addr-line>, <country>United States</country>
</aff>
<aff id="aff2">
<sup>2</sup>
<institution>The University of Texas MD Anderson Cancer Center, UT Health Houston Graduate School of Biomedical Sciences</institution>, <addr-line>Houston, TX</addr-line>, <country>United States</country>
</aff>
<author-notes>
<fn fn-type="edited-by">
<p>Edited by: Judith Mosinger Ogilvie, Saint Louis University, United States</p>
</fn>
<fn fn-type="edited-by">
<p>Reviewed by: David M. Sherry, University of Oklahoma Health Sciences Center, United States; Ulrike Gr&#xfc;nert, The University of Sydney, Australia</p>
</fn>
<fn fn-type="corresp" id="fn001">
<p>*Correspondence: Ruth Heidelberger, <email xlink:href="mailto:ruth.heidelberger@uth.tmc.edu">ruth.heidelberger@uth.tmc.edu</email>
</p>
</fn>
<fn fn-type="equal" id="fn003">
<p>&#x2020;These authors have contributed equally to this work and share first authorship</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>14</day>
<month>06</month>
<year>2023</year>
</pub-date>
<pub-date pub-type="collection">
<year>2023</year>
</pub-date>
<volume>3</volume>
<elocation-id>1208805</elocation-id>
<history>
<date date-type="received">
<day>19</day>
<month>04</month>
<year>2023</year>
</date>
<date date-type="accepted">
<day>24</day>
<month>05</month>
<year>2023</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2023 Perez-Hurtado, Dao, Saenz and Heidelberger</copyright-statement>
<copyright-year>2023</copyright-year>
<copyright-holder>Perez-Hurtado, Dao, Saenz and Heidelberger</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p>
</license>
</permissions>
<abstract>
<p>Biallelic loss-of-function mutations in the syntaxin 3 gene have been linked to a severe retinal dystrophy in humans that presents in early childhood. In mouse models, biallelic inactivation of the syntaxin 3 gene in photoreceptors rapidly leads to their death. What is not known is whether a monoallelic syntaxin 3 loss-of-function mutation might cause photoreceptor loss with advancing age. To address this question, we compared the outer nuclear layer of older adult mice (&#x2248; 20 months of age) that were heterozygous for syntaxin 3 with those of similarly-aged control mice. We found that the photoreceptor layer maintains its thickness in mice that are heterozygous for syntaxin 3 relative to controls and that photoreceptor somatic counts are comparable. In addition, dendritic sprouting of the rod bipolar cell dendrites into the outer nuclear layer, which occurs following the loss of functional rod targets, was similar between genotypes. Thus, syntaxin 3 appears to be haplosufficient for photoreceptor survival, even with advancing age.</p>
</abstract>
<kwd-group>
<kwd>STX3</kwd>
<kwd>syntaxin 3B</kwd>
<kwd>SNAREopathy</kwd>
<kwd>retinal degeneration</kwd>
<kwd>retinal dystrophy</kwd>
<kwd>EOSRD</kwd>
<kwd>age-related</kwd>
<kwd>ribbon synapse</kwd>
</kwd-group>
<contract-num rid="cn001">R01EY012128., P30EY028102</contract-num>
<contract-sponsor id="cn001">National Eye Institute<named-content content-type="fundref-id">10.13039/100000053</named-content>
</contract-sponsor>
<counts>
<fig-count count="2"/>
<table-count count="0"/>
<equation-count count="0"/>
<ref-count count="27"/>
<page-count count="5"/>
<word-count count="2091"/>
</counts>
<custom-meta-wrap>
<custom-meta>
<meta-name>section-in-acceptance</meta-name>
<meta-value>Retina</meta-value>
</custom-meta>
</custom-meta-wrap>
</article-meta>
</front>
<body>
<sec id="s1" sec-type="intro">
<title>Introduction</title>
<p>Syntaxin 3 is a N-ethylmaleimide-sensitive factor attachment protein receptor (SNARE) protein that catalyzes fusion between vesicles and their target membranes (<xref ref-type="bibr" rid="B1">1</xref>). In the retina, syntaxin 3 is expressed exclusively by photoreceptors and bipolar cells (<xref ref-type="bibr" rid="B2">2</xref>&#x2013;<xref ref-type="bibr" rid="B5">5</xref>), where it is required for neurotransmitter release (<xref ref-type="bibr" rid="B4">4</xref>, <xref ref-type="bibr" rid="B6">6</xref>, <xref ref-type="bibr" rid="B7">7</xref>). Recently, biallelic loss-of-function mutations in the human retinal-specific syntaxin 3 spliceform, syntaxin 3B (<italic>STX3B</italic>), have been linked to an early-onset severe retinal dystrophy in young children (<xref ref-type="bibr" rid="B8">8</xref>). Furthermore, biallelic postnatal inactivation of the syntaxin 3 gene (<italic>Stx3</italic>) in mouse photoreceptors has shown to result in the rapid degeneration of photoreceptors and a dramatic thinning of the outer nuclear layer (ONL) of the retina (<xref ref-type="bibr" rid="B8">8</xref>, <xref ref-type="bibr" rid="B9">9</xref>). Thus, in addition to catalyzing the exocytic release of neurotransmitter release that underlies chemical synaptic transmission at photoreceptor and bipolar cell synaptic terminals (<xref ref-type="bibr" rid="B4">4</xref>, <xref ref-type="bibr" rid="B6">6</xref>, <xref ref-type="bibr" rid="B7">7</xref>), <italic>Stx3</italic> also has an essential role that is necessary for photoreceptor survival.</p>
<p>A cellular hallmark of many inherited disorders of vision is the progressive loss of photoreceptors with age. Given the rapidly devastating consequences of biallelic <italic>STX3/stx3</italic> loss-of-function in both humans and mice, we wondered whether monoallelic <italic>Stx3</italic> loss-of-function might lead to retinal degeneration later in life. As a first step towards addressing this possibility, we examined the outer nuclear layer of older adult mice that were heterozygous for <italic>Stx3</italic> with those of age-matched controls. Analysis of outer nuclear layer thickness, number of photoreceptor somata and sprouting of bipolar cell dendrites into the outer nuclear layer (ONL) indicated that inactivation of a single allele of <italic>Stx3</italic> does not drive age-related photoreceptor loss in the mouse retina.</p>
</sec>
<sec id="s2" sec-type="materials|methods">
<title>Materials and methods</title>
<sec id="s2_1">
<title>Animals</title>
<p>Animal procedures conformed to National Institutes of Health guidelines and were approved by the Animal Welfare Committee of the University of Texas Health Science Center at Houston. Male and female mice globally heterozygous for <italic>Stx3</italic> (e.g. <italic>Stx3<sup>+/-</sup>
</italic> and <italic>Stx3<sup>f/-</sup>
</italic>) and control mice (e.g. <italic>Stx3<sup>wt</sup>
</italic>, <italic>Stx3<sup>f/f</sup>
</italic>, <italic>Stx3<sup>f/+</sup>
</italic>) with a C57Bl6/J background were obtained by the breeding of mouse lines that we developed and characterized previously (<xref ref-type="bibr" rid="B8">8</xref>, <xref ref-type="bibr" rid="B10">10</xref>). In contrast to the embryonic lethality of global <italic>Stx3</italic> inactivation in mice, mice that are heterozygous for <italic>Stx3</italic> are viable and fertile (<xref ref-type="bibr" rid="B10">10</xref>). Genotyping was performed by PCR using DNA isolated from tail snips (<xref ref-type="bibr" rid="B10">10</xref>, <xref ref-type="bibr" rid="B11">11</xref>) and independently confirmed at least once. Founder lines were negative for the retinal degeneration mutations <italic>Rd1</italic> and <italic>Rd8</italic> (<xref ref-type="bibr" rid="B8">8</xref>). Mice were kept under standard housing conditions with unlimited access to food and water and with a 12 h light/dark cycle and euthanized by cervical dislocation followed by decapitation at 14-26 months of age. The mean age and age range was comparable between groups (control: 22 &#xb1; 1 months (range 14-26 months), n=15; <italic>Stx3</italic> het: 20 &#xb1; 2 months (range 17-26 months), n=7; p = 0.6922).</p>
</sec>
<sec id="s2_2">
<title>Tissue preparation and immunolabeling</title>
<p>Following euthanasia, eyes were enucleated and lenses removed. The eyes were fixed in 4% para-formaldehyde in 0.1M sodium phosphate buffer (RT, 1h). After fixation, eyes were rinsed and cryoprotected in 30% sucrose (PBS, overnight, 4&#xb0;C), embedded in OCT embedding medium (Tissue-Tek, Torrance, CA), fast-frozen, and sectioned into 14-16 &#xb5;m cryostat sections. Sections from the central retina were collected on Superfrost Plus Gold microscope slides (Fisherbrand, Pittsburgh, PA) and stored at &#x2212; 20&#xb0;C until use. For immunolabeling, sections were thawed and incubated in blocking solution (5% normal donkey serum and 0.3% Triton X-100 in PBS) for 1 h, and primary antibodies were applied overnight at room temperature. After washing, secondary antibodies were applied for 2 h at room temperature. Sections were rinsed and cover-slipped in ProLong Gold antifade mounting medium with DAPI (Invitrogen, Eugene, OR). The retinal distribution of Stx3B was visualized with monoclonal antibody 12E5 raised against stx3 (MilliporeSigma, Burlington, MA, United States) (<xref ref-type="bibr" rid="B12">12</xref>), which we characterized further in Campbell et&#xa0;al., 2020, Supplementary Figure&#xa0;1 (<xref ref-type="bibr" rid="B13">13</xref>). Rabbit monoclonal PKC alpha (ab32376, Abcam, Cambridge, UK) was used to label rod bipolar cells and their dendritic processes (<xref ref-type="bibr" rid="B14">14</xref>, <xref ref-type="bibr" rid="B15">15</xref>). Secondary Cy3 conjugated donkey anti-mouse IgG (MilliporeSigma, Burlington, MA, United States), and Alexa Fluor 488 donkey anti-rabbit IgG (Jackson ImmunoResearch, West Grove, PA) were used for visualization. All antibodies were used at a 1:200 dilution.</p>
</sec>
<sec id="s2_3">
<title>Imaging and image analysis</title>
<p>Image acquisition and data analysis were conducted in similar manner to that described previously (<xref ref-type="bibr" rid="B13">13</xref>). Rod spherules and cone pedicles in retinal sections were identified by their characteristic appearance and respective locations within the outer plexiform layer (OPL) and by immunolabeling for Stx3 (<xref ref-type="bibr" rid="B2">2</xref>, <xref ref-type="bibr" rid="B3">3</xref>, <xref ref-type="bibr" rid="B13">13</xref>, <xref ref-type="bibr" rid="B16">16</xref>). Images (Z-stacks) were acquired on a Zeiss 800 confocal microscope (Carl Zeiss Microscopy GmbH, Oberkochen, Germany). Analysis of images was performed blinded to genotype. Measurement of outer nuclear layer thickness and photoreceptor somata number was performed in ImageJ (<xref ref-type="bibr" rid="B17">17</xref>). The thickness (&#x3bc;m) of the outer nuclear layer (ONL) was measured in maximum intensity projections using the Image J straight tool. Photoreceptor nuclei were quantified in an 800 &#xb5;m<sup>2</sup> region of the ONL using the &#x201c;grid&#x201d; function of Image J and counted using the &#x201c;multi-point&#x201d; tool. Measurement of rod bipolar cell dendrite length was performed in Fiji/ImageJ2 (<xref ref-type="bibr" rid="B17">17</xref>, <xref ref-type="bibr" rid="B18">18</xref>). Dendritic lengths were calculated in maximum intensity projections using the free hand line tool. Dendrites were traced from the border between the outer plexiform layer and outer nuclear layer to their terminal ends in the outer nuclear layer. For each measure, 1-4 histological sections were analyzed per mouse and results averaged together to produce a single value per animal for each measure. Data were compiled in Excel (Microsoft, Redmond, WA, United States), and statistical analyses were performed in Prism 7 (GraphPad Software, Inc., San Diego, CA, United States) using the Mann Whitney Test. Figure images are displayed as maximum intensity projections. Results are represented as mean &#xb1; SEM, where &#x201c;n&#x201d; represents the number of mice.</p>
</sec>
</sec>
<sec id="s3" sec-type="results">
<title>Results</title>
<p>In this study, we asked whether having only a single functional <italic>Stx3</italic> allele might be a risk factor for age-related photoreceptor death. To address this question, we examined and compared the retinae of older adult mice that were heterozygous for <italic>Stx3</italic> with those of similarly-aged controls (control: 22 &#xb1; 1 months, n=15; <italic>Stx3</italic> het: 20 &#xb1; 2 months, n=7; p = 0.6922). In the representative confocal images shown in <xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1A</bold>
</xref> and in the compiled data from multiple animals (<xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1B</bold>
</xref>), ONL thickness was not diminished in mice that were heterozygous for <italic>Stx3</italic> when compared to controls (control: 63 &#xb1; 2 &#xb5;m, n=15; <italic>Stx3</italic> het: 73 &#xb1; 3 &#xb5;m, n=7; p = 0.0164). Furthermore, there was no difference in the number of photoreceptor somata per unit area between groups (<xref ref-type="fig" rid="f1">
<bold>Figures&#xa0;1A, C</bold>
</xref>; control: 70.5 &#xb1; 2.9, n=15; <italic>Stx3</italic> het: 73.2 &#xb1; 2.8, n=7; p = 0.6173). Together, these results indicate that the outer nuclear layer (ONL) in mice heterozygous for <italic>Stx3</italic> is comparable to that of control mice (<xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1</bold>
</xref>).</p>
<fig id="f1" position="float">
<label>Figure&#xa0;1</label>
<caption>
<p>Outer nuclear layer (ONL) thickness and photoreceptor number are not reduced by <italic>Stx3</italic> heterozygosity in the aged mouse retina. <bold>(A)</bold> A representative pair of confocal images from an older adult mouse heterozygous for <italic>Stx3</italic> and an older adult control mouse show that the ONL was preserved in the <italic>Stx3</italic> het mouse and comparable to that of the control. Stx3 (red), PKC (green), and DAPI (nuclear marker, blue). Scale bar 10&#xb5;m. IS Inner segments, ONL outer nuclear layer, OPL outer plexiform layer. <bold>(B)</bold> The average thickness of the ONL was similar between groups, although it was slightly larger in the <italic>Stx3</italic> het mice (p: 0.0164). <bold>(C)</bold> The number of nuclei in an 800 &#xb5;m<sup>2</sup> area of the ONL was not different between groups (p: 0.6173). For <bold>(B, C)</bold>, <italic>Stx3</italic> hets, n= 7 mice and for controls, n=15 mice. * denotes p value &lt;0.05 and ns denotes p value is not significant.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fopht-03-1208805-g001.tif"/>
</fig>
<p>When rod photoreceptors die and/or their ribbon-style synapses become non-functional, rod bipolar cells extend their dendrites beyond the outer plexiform layer (OPL) and into the ONL (<xref ref-type="bibr" rid="B19">19</xref>&#x2013;<xref ref-type="bibr" rid="B23">23</xref>). We therefore measured and compared the length of PKC-labeled rod bipolar cell dendrites as a proxy of rod photoreceptor loss in older adult mice heterozygous for <italic>Stx3</italic> and in similarly-aged control mice. Results show that dendritic lengths were virtually identical amongst the two groups, with each group having a similar percentage of dendritic length distributions that included the occasional longer ONL sprout (<xref ref-type="fig" rid="f2">
<bold>Figure&#xa0;2</bold>
</xref>). Taken together, these results demonstrate that one functional <italic>Stx3</italic> allele is sufficient to maintain long-term photoreceptor viability.</p>
<fig id="f2" position="float">
<label>Figure&#xa0;2</label>
<caption>
<p>Rod bipolar cell dendritic length is not altered by <italic>Stx3</italic> heterozygosity in the older adult mouse retina. <bold>(A)</bold> A representative pair of confocal images through the outer plexiform layer (OPL) of an older adult heterozygous <italic>Stx3</italic> mouse and an older adult control mouse were labeled with antibodies against Stx3 (red) and PKC (green), show similar dendritic lengths. Scale bar 20 &#xb5;m. OPL outer plexiform layer. <bold>(B)</bold> The amplitude distributions (by percentage) of dendritic lengths of rod bipolar cells in older adult mice heterozygous for Stx3 and aged control mice were virtually identical and not statistically different. <italic>Stx3</italic> hets, n= 7 mice and for controls, n=15 mice.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fopht-03-1208805-g002.tif"/>
</fig>
</sec>
<sec id="s4" sec-type="discussion">
<title>Discussion</title>
<p>Syntaxin 3 is the only plasma membrane syntaxin known to be expressed by photoreceptors (<xref ref-type="bibr" rid="B2">2</xref>, <xref ref-type="bibr" rid="B3">3</xref>, <xref ref-type="bibr" rid="B24">24</xref>). In humans, biallelic loss-of-function mutations in syntaxin 3A, a syntaxin 3 splice form expressed widely throughout the body outside of the retina, gives rise to a devastating gastrointestinal disorder that presents in infancy (<xref ref-type="bibr" rid="B8">8</xref>, <xref ref-type="bibr" rid="B25">25</xref>, <xref ref-type="bibr" rid="B26">26</xref>). If the mutations are located in exons that are conserved between syntaxin 3A and the retinal-specific syntaxin 3 spliceform, syntaxin 3B (<xref ref-type="bibr" rid="B5">5</xref>, <xref ref-type="bibr" rid="B8">8</xref>), the children additionally exhibited an early onset severe retinal dystrophy (<xref ref-type="bibr" rid="B8">8</xref>). In mice, the global inactivation of <italic>Stx3</italic> is embryonic lethal (<xref ref-type="bibr" rid="B10">10</xref>), while inactivation of <italic>Stx3</italic> selectively in photoreceptors produced a rapid loss of photoreceptors and a dramatic reduction in ONL thickness (<xref ref-type="bibr" rid="B8">8</xref>, <xref ref-type="bibr" rid="B9">9</xref>). Thus, in addition to its role in synaptic transmission at retinal ribbon-style synapses (<xref ref-type="bibr" rid="B4">4</xref>, <xref ref-type="bibr" rid="B6">6</xref>, <xref ref-type="bibr" rid="B7">7</xref>), syntaxin 3 is also required for photoreceptor survival.</p>
<p>In this study, we examined the effects of deletion of a single <italic>Stx3</italic> allele on the outer retina. We found no difference in the thickness of the outer nuclear layer between older adult controls and older adult mice that were heterozygous for <italic>Stx3</italic>. In addition, we did not observe a decrease in the number of photoreceptor somata per unit measure or an increase in the sprouting of rod bipolar cell dendrites. The latter might be expected if rods had died or retracted their spherules at a higher rate in older adult <italic>Stx3</italic> heterozygous mice relative to age-matched controls or if the <italic>Stx3</italic> heterozygous rod to rod bipolar cell synapses were non-functional (<xref ref-type="bibr" rid="B19">19</xref>, <xref ref-type="bibr" rid="B21">21</xref>&#x2013;<xref ref-type="bibr" rid="B23">23</xref>). We did note that most of the rod bipolar cell dendrites in older adult <italic>Stx3</italic> heterozygous mice appropriately contacted rod terminals, suggesting that the primary reason for a lack of exuberant dendritic sprouting is that the dendritic targets, the rod terminals, demarcated by Stx3 immunolabeling, were still present and located close to the OPL/ONL border.</p>
<p>One of the motivations for conducting this study was to predict whether loss-of-function mutations in one <italic>STX3</italic> allele might increase the risk of photoreceptor loss in human subjects later in life. Our results suggest that <italic>Stx3</italic> is haplosufficient for photoreceptor survival, even at older ages. However, the situation could be very different if, rather than a loss-of-function mutation, there were a monoallelic dominant negative mutation. Indeed, SNAREopathies have been reported in which dominant mutations in one gene negatively affect the functionality of the wild-type transcript (<xref ref-type="bibr" rid="B27">27</xref>). Interestingly, of the identified human <italic>STX3</italic> mutations associated with visual impairment to-date, all have been biallelic loss-of-function mutations (<xref ref-type="bibr" rid="B8">8</xref>). Thus, for these patients, the introduction of a wild-type gene could be sufficient to rescue the remaining photoreceptors and prevent further photoreceptor loss.</p>
</sec>
<sec id="s5" sec-type="data-availability">
<title>Data availability statement</title>
<p>The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.</p>
</sec>
<sec id="s6" sec-type="ethics-statement">
<title>Ethics statement</title>
<p>The animal study was reviewed and approved by Animal Welfare Committee of the University of Texas Health Science Center at Houston.</p>
</sec>
<sec id="s7" sec-type="author-contributions">
<title>Author contributions</title>
<p>RH conceived and directed the project. MP-H and AS performed the experiments. MP-H, CD, and RH analyzed data. All authors contributed to data interpretation. RH and MH-P prepared the first draft. All authors contributed to the article and approved the submitted version.</p>
</sec>
</body>
<back>
<sec id="s8" sec-type="funding-information">
<title>Funding</title>
<p>This work was supported by R01EY012128 (RH) and P30EY028102. Additional funding was provided by the Vale-Asche Foundation via the Frederic B. Asche endowment (RH).</p>
</sec>
<ack>
<title>Acknowledgments</title>
<p>We thank Steve Massey and Vision Core Grant P30EY028102 for providing us with access to a state-of-the-art confocal microscopy facility.</p>
</ack>
<sec id="s9" sec-type="COI-statement">
<title>Conflict of interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec id="s10" sec-type="disclaimer">
<title>Publisher&#x2019;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
<ref-list>
<title>References</title>
<ref id="B1">
<label>1</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Rizo</surname> <given-names>J</given-names>
</name>
<name>
<surname>Sudhof</surname> <given-names>TC</given-names>
</name>
</person-group>. <article-title>The membrane fusion enigma: SNAREs, Sec1/Munc18 proteins, and their accomplices&#x2013;guilty as charged</article-title>? <source>Annu Rev Cell Dev Biol</source> (<year>2012</year>) <volume>28</volume>:<fpage>279</fpage>&#x2013;<lpage>308</lpage>. doi: <pub-id pub-id-type="doi">10.1146/annurev-cellbio-101011-155818</pub-id>
</citation>
</ref>
<ref id="B2">
<label>2</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Morgans</surname> <given-names>CW</given-names>
</name>
<name>
<surname>Brandstatter</surname> <given-names>JH</given-names>
</name>
<name>
<surname>Kellerman</surname> <given-names>J</given-names>
</name>
<name>
<surname>Betz</surname> <given-names>H</given-names>
</name>
<name>
<surname>Wassle</surname> <given-names>H</given-names>
</name>
</person-group>. <article-title>A SNARE complex containing syntaxin 3 is present in ribbon synapses of the retina</article-title>. <source>J Neurosci</source> (<year>1996</year>) <volume>16</volume>(<issue>21</issue>):<page-range>6713&#x2013;21</page-range>. doi: <pub-id pub-id-type="doi">10.1523/JNEUROSCI.16-21-06713.1996</pub-id>
</citation>
</ref>
<ref id="B3">
<label>3</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Sherry</surname> <given-names>DM</given-names>
</name>
<name>
<surname>Mitchell</surname> <given-names>R</given-names>
</name>
<name>
<surname>Standifer</surname> <given-names>KM</given-names>
</name>
<name>
<surname>du Plessis</surname> <given-names>B</given-names>
</name>
</person-group>. <article-title>Distribution of plasma membrane-associated syntaxins 1 through 4 indicates distinct trafficking functions in the synaptic layers of the mouse retina</article-title>. <source>BMC Neurosci</source> (<year>2006</year>) <volume>7</volume>:<fpage>54</fpage>. doi: <pub-id pub-id-type="doi">10.1186/1471-2202-7-54</pub-id>
</citation>
</ref>
<ref id="B4">
<label>4</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Curtis</surname> <given-names>L</given-names>
</name>
<name>
<surname>Datta</surname> <given-names>P</given-names>
</name>
<name>
<surname>Liu</surname> <given-names>X</given-names>
</name>
<name>
<surname>Bogdanova</surname> <given-names>N</given-names>
</name>
<name>
<surname>Heidelberger</surname> <given-names>R</given-names>
</name>
<name>
<surname>Janz</surname> <given-names>R</given-names>
</name>
</person-group>. <article-title>Syntaxin 3B is essential for the exocytosis of synaptic vesicles in ribbon synapses of the retina</article-title>. <source>Neuroscience</source> (<year>2010</year>) <volume>166</volume>(<issue>3</issue>):<page-range>832&#x2013;41</page-range>. doi: <pub-id pub-id-type="doi">10.1016/j.neuroscience.2009.12.075</pub-id>
</citation>
</ref>
<ref id="B5">
<label>5</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Curtis</surname> <given-names>LB</given-names>
</name>
<name>
<surname>Doneske</surname> <given-names>B</given-names>
</name>
<name>
<surname>Liu</surname> <given-names>X</given-names>
</name>
<name>
<surname>Thaller</surname> <given-names>C</given-names>
</name>
<name>
<surname>McNew</surname> <given-names>JA</given-names>
</name>
<name>
<surname>Janz</surname> <given-names>R</given-names>
</name>
</person-group>. <article-title>Syntaxin 3b is a t-SNARE specific for ribbon synapses of the retina</article-title>. <source>J Comp Neurol</source> (<year>2008</year>) <volume>510</volume>(<issue>5</issue>):<page-range>550&#x2013;9</page-range>. doi: <pub-id pub-id-type="doi">10.1002/cne.21806</pub-id>
</citation>
</ref>
<ref id="B6">
<label>6</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Datta</surname> <given-names>P</given-names>
</name>
<name>
<surname>Gilliam</surname> <given-names>J</given-names>
</name>
<name>
<surname>Thoreson</surname> <given-names>WB</given-names>
</name>
<name>
<surname>Janz</surname> <given-names>R</given-names>
</name>
<name>
<surname>Heidelberger</surname> <given-names>R</given-names>
</name>
</person-group>. <article-title>Two pools of vesicles associated with synaptic ribbons are molecularly prepared for release</article-title>. <source>Biophys J</source> (<year>2017</year>) <volume>113</volume>(<issue>10</issue>):<page-range>2281&#x2013;98</page-range>. doi: <pub-id pub-id-type="doi">10.1016/j.bpj.2017.08.012</pub-id>
</citation>
</ref>
<ref id="B7">
<label>7</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Hays</surname> <given-names>CL</given-names>
</name>
<name>
<surname>Grassmeyer</surname> <given-names>JJ</given-names>
</name>
<name>
<surname>Wen</surname> <given-names>X</given-names>
</name>
<name>
<surname>Janz</surname> <given-names>R</given-names>
</name>
<name>
<surname>Heidelberger</surname> <given-names>R</given-names>
</name>
<name>
<surname>Thoreson</surname> <given-names>WB</given-names>
</name>
</person-group>. <article-title>Simultaneous release of multiple vesicles from rods involves synaptic ribbons and syntaxin 3B</article-title>. <source>Biophys J</source> (<year>2020</year>) <volume>118</volume>(<issue>4</issue>):<page-range>967&#x2013;79</page-range>. doi: <pub-id pub-id-type="doi">10.1016/j.bpj.2019.10.006</pub-id>
</citation>
</ref>
<ref id="B8">
<label>8</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Janecke</surname> <given-names>AR</given-names>
</name>
<name>
<surname>Liu</surname> <given-names>X</given-names>
</name>
<name>
<surname>Adam</surname> <given-names>R</given-names>
</name>
<name>
<surname>Punuru</surname> <given-names>S</given-names>
</name>
<name>
<surname>Viestenz</surname> <given-names>A</given-names>
</name>
<name>
<surname>Strauss</surname> <given-names>V</given-names>
</name>
<etal/>
</person-group>. <article-title>Pathogenic STX3 variants affecting the retinal and intestinal transcripts cause an early-onset severe retinal dystrophy in microvillus inclusion disease subjects</article-title>. <source>Hum Genet</source> (<year>2021</year>) <volume>140</volume>(<issue>8</issue>):<page-range>1143&#x2013;56</page-range>. doi: <pub-id pub-id-type="doi">10.1007/s00439-021-02284-1</pub-id>
</citation>
</ref>
<ref id="B9">
<label>9</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kakakhel</surname> <given-names>M</given-names>
</name>
<name>
<surname>Tebbe</surname> <given-names>L</given-names>
</name>
<name>
<surname>Makia</surname> <given-names>MS</given-names>
</name>
<name>
<surname>Conley</surname> <given-names>SM</given-names>
</name>
<name>
<surname>Sherry</surname> <given-names>DM</given-names>
</name>
<name>
<surname>Al-Ubaidi</surname> <given-names>MR</given-names>
</name>
<etal/>
</person-group>. <article-title>Syntaxin 3 is essential for photoreceptor outer segment protein trafficking and survival</article-title>. <source>Proc Natl Acad Sci U S A</source> (<year>2020</year>) <volume>117</volume>(<issue>34</issue>):<page-range>20615&#x2013;24</page-range>. doi: <pub-id pub-id-type="doi">10.1073/pnas.2010751117</pub-id>
</citation>
</ref>
<ref id="B10">
<label>10</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Sanchez</surname> <given-names>E</given-names>
</name>
<name>
<surname>Gonzalez</surname> <given-names>EA</given-names>
</name>
<name>
<surname>Moreno</surname> <given-names>DS</given-names>
</name>
<name>
<surname>Cardenas</surname> <given-names>RA</given-names>
</name>
<name>
<surname>Ramos</surname> <given-names>MA</given-names>
</name>
<name>
<surname>Davalos</surname> <given-names>AJ</given-names>
</name>
<etal/>
</person-group>. <article-title>Syntaxin 3, but not syntaxin 4, is required for mast cell-regulated exocytosis, where it plays a primary role mediating compound exocytosis</article-title>. <source>J Biol Chem</source> (<year>2019</year>) <volume>294</volume>(<issue>9</issue>):<page-range>3012&#x2013;23</page-range>. doi: <pub-id pub-id-type="doi">10.1074/jbc.RA118.005532</pub-id>
</citation>
</ref>
<ref id="B11">
<label>11</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Li</surname> <given-names>S</given-names>
</name>
<name>
<surname>Chen</surname> <given-names>D</given-names>
</name>
<name>
<surname>Sauve</surname> <given-names>Y</given-names>
</name>
<name>
<surname>McCandless</surname> <given-names>J</given-names>
</name>
<name>
<surname>Chen</surname> <given-names>YJ</given-names>
</name>
<name>
<surname>Chen</surname> <given-names>CK</given-names>
</name>
</person-group>. <article-title>Rhodopsin-iCre transgenic mouse line for cre-mediated rod-specific gene targeting</article-title>. <source>Genesis</source> (<year>2005</year>) <volume>41</volume>(<issue>2</issue>):<fpage>73</fpage>&#x2013;<lpage>80</lpage>. doi: <pub-id pub-id-type="doi">10.1002/gene.20097</pub-id>
</citation>
</ref>
<ref id="B12">
<label>12</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Zulliger</surname> <given-names>R</given-names>
</name>
<name>
<surname>Conley</surname> <given-names>SM</given-names>
</name>
<name>
<surname>Mwoyosvi</surname> <given-names>ML</given-names>
</name>
<name>
<surname>Stuck</surname> <given-names>MW</given-names>
</name>
<name>
<surname>Azadi</surname> <given-names>S</given-names>
</name>
<name>
<surname>Naash</surname> <given-names>MI</given-names>
</name>
</person-group>. <article-title>SNAREs interact with retinal degeneration slow and rod outer segment membrane protein-1 during conventional and unconventional outer segment targeting</article-title>. <source>PloS One</source> (<year>2015</year>) <volume>10</volume>(<issue>9</issue>):<elocation-id>e0138508</elocation-id>. doi: <pub-id pub-id-type="doi">10.1371/journal.pone.0138508</pub-id>
</citation>
</ref>
<ref id="B13">
<label>13</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Campbell</surname> <given-names>JR</given-names>
</name>
<name>
<surname>Li</surname> <given-names>H</given-names>
</name>
<name>
<surname>Wang</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Kozhemyakin</surname> <given-names>M</given-names>
</name>
<name>
<surname>Hunt</surname> <given-names>AJ</given-names>
<suffix>Jr.</suffix>
</name>
<name>
<surname>Liu</surname> <given-names>X</given-names>
</name>
<etal/>
</person-group>. <article-title>Phosphorylation of the retinal ribbon synapse specific t-SNARE protein Syntaxin3B is regulated by light via a Ca(2 +)-dependent pathway</article-title>. <source>Front Cell Neurosci</source> (<year>2020</year>) <volume>14</volume>:<elocation-id>587072</elocation-id>. doi: <pub-id pub-id-type="doi">10.3389/fncel.2020.587072</pub-id>
</citation>
</ref>
<ref id="B14">
<label>14</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Zhou</surname> <given-names>ZY</given-names>
</name>
<name>
<surname>Wan</surname> <given-names>QF</given-names>
</name>
<name>
<surname>Thakur</surname> <given-names>P</given-names>
</name>
<name>
<surname>Heidelberger</surname> <given-names>R</given-names>
</name>
</person-group>. <article-title>Capacitance measurements in the mouse rod bipolar cell identify a pool of releasable synaptic vesicles</article-title>. <source>J Neurophysiol</source> (<year>2006</year>) <volume>96</volume>(<issue>5</issue>):<page-range>2539&#x2013;48</page-range>. doi: <pub-id pub-id-type="doi">10.1152/jn.00688.2006</pub-id>
</citation>
</ref>
<ref id="B15">
<label>15</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Haverkamp</surname> <given-names>S</given-names>
</name>
<name>
<surname>Wassle</surname> <given-names>H</given-names>
</name>
</person-group>. <article-title>Immunocytochemical analysis of the mouse retina</article-title>. <source>J Comp Neurol</source> (<year>2000</year>) <volume>424</volume>(<issue>1</issue>):<fpage>1</fpage>&#x2013;<lpage>23</lpage>. doi: <pub-id pub-id-type="doi">10.1002/1096-9861(20000814)424:1&lt;1::AID-CNE1&gt;3.0.CO;2-V</pub-id>
</citation>
</ref>
<ref id="B16">
<label>16</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Liu</surname> <given-names>X</given-names>
</name>
<name>
<surname>Heidelberger</surname> <given-names>R</given-names>
</name>
<name>
<surname>Janz</surname> <given-names>R</given-names>
</name>
</person-group>. <article-title>Phosphorylation of syntaxin 3B by CaMKII regulates the formation of t-SNARE complexes</article-title>. <source>Mol Cell Neurosci</source> (<year>2014</year>) <volume>60</volume>:<fpage>53</fpage>&#x2013;<lpage>62</lpage>. doi: <pub-id pub-id-type="doi">10.1016/j.mcn.2014.03.002</pub-id>
</citation>
</ref>
<ref id="B17">
<label>17</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Schneider</surname> <given-names>CA</given-names>
</name>
<name>
<surname>Rasband</surname> <given-names>WS</given-names>
</name>
<name>
<surname>Eliceiri</surname> <given-names>KW</given-names>
</name>
</person-group>. <article-title>NIH Image to ImageJ: 25 years of image analysis</article-title>. <source>Nat Methods</source> (<year>2012</year>) <volume>9</volume>(<issue>7</issue>):<page-range>671&#x2013;5</page-range>. doi: <pub-id pub-id-type="doi">10.1038/nmeth.2089</pub-id>
</citation>
</ref>
<ref id="B18">
<label>18</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Schindelin</surname> <given-names>J</given-names>
</name>
<name>
<surname>Arganda-Carreras</surname> <given-names>I</given-names>
</name>
<name>
<surname>Frise</surname> <given-names>E</given-names>
</name>
<name>
<surname>Kaynig</surname> <given-names>V</given-names>
</name>
<name>
<surname>Longair</surname> <given-names>M</given-names>
</name>
<name>
<surname>Pietzsch</surname> <given-names>T</given-names>
</name>
<etal/>
</person-group>. <article-title>Fiji: An open-source platform for biological-image analysis</article-title>. <source>Nat Methods</source> (<year>2012</year>) <volume>9</volume>(<issue>7</issue>):<page-range>676&#x2013;82</page-range>. doi: <pub-id pub-id-type="doi">10.1038/nmeth.2019</pub-id>
</citation>
</ref>
<ref id="B19">
<label>19</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Dick</surname> <given-names>O</given-names>
</name>
<name>
<surname>tom Dieck</surname> <given-names>S</given-names>
</name>
<name>
<surname>Altrock</surname> <given-names>WD</given-names>
</name>
<name>
<surname>Ammermuller</surname> <given-names>J</given-names>
</name>
<name>
<surname>Weiler</surname> <given-names>R</given-names>
</name>
<name>
<surname>Garner</surname> <given-names>CC</given-names>
</name>
<etal/>
</person-group>. <article-title>The presynaptic active zone protein bassoon is essential for photoreceptor ribbon synapse formation in the retina</article-title>. <source>Neuron</source> (<year>2003</year>) <volume>37</volume>(<issue>5</issue>):<page-range>775&#x2013;86</page-range>. doi: <pub-id pub-id-type="doi">10.1016/S0896-6273(03)00086-2</pub-id>
</citation>
</ref>
<ref id="B20">
<label>20</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Liets</surname> <given-names>LC</given-names>
</name>
<name>
<surname>Eliasieh</surname> <given-names>K</given-names>
</name>
<name>
<surname>van der List</surname> <given-names>DA</given-names>
</name>
<name>
<surname>Chalupa</surname> <given-names>LM</given-names>
</name>
</person-group>. <article-title>Dendrites of rod bipolar cells sprout in normal aging retina</article-title>. <source>Proc Natl Acad Sci U S A</source> (<year>2006</year>) <volume>103</volume>(<issue>32</issue>):<page-range>12156&#x2013;60</page-range>. doi: <pub-id pub-id-type="doi">10.1073/pnas.0605211103</pub-id>
</citation>
</ref>
<ref id="B21">
<label>21</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Fernandez-Sanchez</surname> <given-names>L</given-names>
</name>
<name>
<surname>de Sevilla Muller</surname> <given-names>LP</given-names>
</name>
<name>
<surname>Brecha</surname> <given-names>NC</given-names>
</name>
<name>
<surname>Cuenca</surname> <given-names>N</given-names>
</name>
</person-group>. <article-title>Loss of outer retinal neurons and circuitry alterations in the DBA/2J mouse</article-title>. <source>Invest Ophthalmol Vis Sci</source> (<year>2014</year>) <volume>55</volume>(<issue>9</issue>):<page-range>6059&#x2013;72</page-range>. doi: <pub-id pub-id-type="doi">10.1167/iovs.14-14421</pub-id>
</citation>
</ref>
<ref id="B22">
<label>22</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Terzibasi</surname> <given-names>E</given-names>
</name>
<name>
<surname>Calamusa</surname> <given-names>M</given-names>
</name>
<name>
<surname>Novelli</surname> <given-names>E</given-names>
</name>
<name>
<surname>Domenici</surname> <given-names>L</given-names>
</name>
<name>
<surname>Strettoi</surname> <given-names>E</given-names>
</name>
<name>
<surname>Cellerino</surname> <given-names>A</given-names>
</name>
</person-group>. <article-title>Age-dependent remodelling of retinal circuitry</article-title>. <source>Neurobiol Aging</source> (<year>2009</year>) <volume>30</volume>(<issue>5</issue>):<page-range>819&#x2013;28</page-range>. doi: <pub-id pub-id-type="doi">10.1016/j.neurobiolaging.2007.08.017</pub-id>
</citation>
</ref>
<ref id="B23">
<label>23</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Jones</surname> <given-names>BW</given-names>
</name>
<name>
<surname>Kondo</surname> <given-names>M</given-names>
</name>
<name>
<surname>Terasaki</surname> <given-names>H</given-names>
</name>
<name>
<surname>Lin</surname> <given-names>Y</given-names>
</name>
<name>
<surname>McCall</surname> <given-names>M</given-names>
</name>
<name>
<surname>Marc</surname> <given-names>RE</given-names>
</name>
</person-group>. <article-title>Retinal remodeling</article-title>. <source>Jpn J Ophthalmol</source> (<year>2012</year>) <volume>56</volume>(<issue>4</issue>):<fpage>289</fpage>&#x2013;<lpage>306</lpage>. doi: <pub-id pub-id-type="doi">10.1007/s10384-012-0147-2</pub-id>
</citation>
</ref>
<ref id="B24">
<label>24</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Shekhar</surname> <given-names>K</given-names>
</name>
<name>
<surname>Lapan</surname> <given-names>SW</given-names>
</name>
<name>
<surname>Whitney</surname> <given-names>IE</given-names>
</name>
<name>
<surname>Tran</surname> <given-names>NM</given-names>
</name>
<name>
<surname>Macosko</surname> <given-names>EZ</given-names>
</name>
<name>
<surname>Kowalczyk</surname> <given-names>M</given-names>
</name>
<etal/>
</person-group>. <article-title>Comprehensive classification of retinal bipolar neurons by single-cell transcriptomics</article-title>. <source>Cell</source> (<year>2016</year>) <volume>166</volume>(<issue>5</issue>):<fpage>1308</fpage>&#x2013;<lpage>23 e30</lpage>. doi: <pub-id pub-id-type="doi">10.1016/j.cell.2016.07.054</pub-id>
</citation>
</ref>
<ref id="B25">
<label>25</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Wiegerinck</surname> <given-names>CL</given-names>
</name>
<name>
<surname>Janecke</surname> <given-names>AR</given-names>
</name>
<name>
<surname>Schneeberger</surname> <given-names>K</given-names>
</name>
<name>
<surname>Vogel</surname> <given-names>GF</given-names>
</name>
<name>
<surname>van Haaften-Visser</surname> <given-names>DY</given-names>
</name>
<name>
<surname>Escher</surname> <given-names>JC</given-names>
</name>
<etal/>
</person-group>. <article-title>Loss of syntaxin 3 causes variant microvillus inclusion disease</article-title>. <source>Gastroenterology</source> (<year>2014</year>) <volume>147</volume>(<issue>1</issue>):<fpage>65</fpage>&#x2013;<lpage>8 e10</lpage>. doi: <pub-id pub-id-type="doi">10.1053/j.gastro.2014.04.002</pub-id>
</citation>
</ref>
<ref id="B26">
<label>26</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Julia</surname> <given-names>J</given-names>
</name>
<name>
<surname>Shui</surname> <given-names>V</given-names>
</name>
<name>
<surname>Mittal</surname> <given-names>N</given-names>
</name>
<name>
<surname>Heim-Hall</surname> <given-names>J</given-names>
</name>
<name>
<surname>Blanco</surname> <given-names>CL</given-names>
</name>
</person-group>. <article-title>Microvillus inclusion disease, a diagnosis to consider when abnormal stools and neurological impairments run together due to a rare syntaxin 3 gene mutation</article-title>. <source>J Neonatal Perinatal Med</source> (<year>2019</year>) <volume>12</volume>(<issue>3</issue>):<page-range>313&#x2013;9</page-range>. doi: <pub-id pub-id-type="doi">10.3233/NPM-1852</pub-id>
</citation>
</ref>
<ref id="B27">
<label>27</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Verhage</surname> <given-names>M</given-names>
</name>
<name>
<surname>Sorensen</surname> <given-names>JB</given-names>
</name>
</person-group>. <article-title>SNAREopathies: diversity in mechanisms and symptoms</article-title>. <source>Neuron</source> (<year>2020</year>) <volume>107</volume>(<issue>1</issue>):<fpage>22</fpage>&#x2013;<lpage>37</lpage>. doi: <pub-id pub-id-type="doi">10.1016/j.neuron.2020.05.036</pub-id>
</citation>
</ref>
</ref-list>
</back>
</article>