# These authors contributed equally to this work. Keywords craniofacial development | developmental disorders | 4p-| Wolf-Hirschhorn Syndrome | WHSC1 | WHSC2 | LETM1 | TACC3 | neural crest | disease model 1 Abstract 2 Wolf-Hirschhorn Syndrome (WHS) is a human developmental disorder arising from a 3 hemizygous perturbation, typically a microdeletion, on the short arm of chromosome four. In 4 addition to pronounced intellectual disability, seizures, and delayed growth, WHS presents with 5 a characteristic facial dysmorphism and varying prevalence of microcephaly, micrognathia, 6 40 Wolf-Hirschhorn Syndrome (WHS) is a developmental disorder characterized by intellectual 41 disability, delayed pre-and post-natal growth, heart and skeletal defects, and seizures [1-4]. A 42 common clinical marker of WHS is the "Greek Warrior Helmet" appearance; a facial pattern 43 with a characteristic wide and flattened nasal bridge, a high forehead, drastic eyebrow arches and 44 pronounced brow bones, widely spaced eyes (hypertelorism), a short philtrum, and an undersized 45 jaw (micrognathia). The majority of children with the disorder are microcephalic, and have 46 abnormally positioned ears with underdeveloped cartilage. Comorbid midline deficits can occur, 47 including cleft palate and facial asymmetries [1].
48Craniofacial malformations make up one of the most prevalent forms of congenital defects [5,6], 49 and can significantly complicate palliative care and quality of life [7]. Given the commanding 50 role of cranial neural crest (CNC) cells in virtually all facets of craniofacial patterning, 51 craniofacial abnormalities are typically attributable to aberrant CNC development [6,8]. A 52 striking commonality in the tissues that are impacted by WHS is that a significant number derive 53 from the CNC. Despite this, little is known about how the vast diversity of genetic disruptions 54 that underlie WHS pathology can contribute to craniofacial malformation, and no study has 55 sought to characterize impacts of these genotypes explicitly on CNC behavior.
56WHS is typically caused by small, heterozygous deletions on the short-arm of chromosome 4 57 (4p16.3), which can vary widely in position and length. Initially, deletion of a very small critical 58 region, only partial segments of two genes, was thought to be sufficient for full syndromic 59 presentation [9-13]. These first putative associated genes were appropriately denoted as Wolf-
60Hirschhorn Syndrome Candidates 1 and 2 (WHSC1, WHSC2) [9,11,[14][15][16]. However, children 61 with WHS largely demonstrate 4p disruptions that impact not only this intergenic region between 62 WHSC1 and WHSC2, but instead affect multiple genes both telomeric and centromeric from this 63 locus [17]. Focus was drawn to these broader impacted regions when cases were identified that 64 neglected this first critical region entirely but still showed either full or partial WHS 65 presentation, prompting the expansion of the originally defined critical region to include a more 66 telomeric segment of ...