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Primary COQ<jats:sub>10<\/jats:sub> deficiency is clinically and genetically a heterogeneous group of mitochondrial disorders caused by defects in the COQ<jats:sub>10<\/jats:sub> synthesis pathway. Its mode of inheritance is autosomal recessive and it is characterized by metabolic abnormalities and multisystem involvement including neurological features. Mutations in 10 genes have been identified concerning this group of diseases, so far. Among those, variants of the <jats:italic>COQ7<\/jats:italic> gene are very rare and confined to three patients with Asian ancestry. Here, we present the clinical features and results of whole\u2010exome sequencing (WES) of three Iranian unrelated families affected by primary COQ<jats:sub>10<\/jats:sub> deficiency. Three homozygous variants in <jats:italic>COQ2<\/jats:italic>, <jats:italic>COQ4<\/jats:italic>, and <jats:italic>COQ7<\/jats:italic> genes were identified. Candidate variants of the <jats:italic>COQ2<\/jats:italic> and <jats:italic>COQ4<\/jats:italic> genes were novel and associated with the cerebellar signs and multisystem involvement, whereas, the known variant in <jats:italic>COQ7<\/jats:italic> was associated with a mild phenotype that was initially diagnosed as hereditary spastic paraplegia (HSP). This variant has already been reported in a Canadian girl with similar presentations that also originated from Iran suggesting both patients may share a common ancestor. Due to extensive heterogeneity in this group of disorders, and overlap with other mitochondrial\/neurological disorders, WES may be helpful to distinguish primary coenzyme Q<jats:sub>10<\/jats:sub> deficiency from other similar conditions. Given that some features of primary coenzyme Q<jats:sub>10<\/jats:sub> deficiency may improve with exogenous COQ<jats:sub>10<\/jats:sub>, early diagnosis is very important.<\/jats:p>","DOI":"10.1002\/ajmg.a.61983","type":"journal-article","created":{"date-parts":[[2020,11,20]],"date-time":"2020-11-20T20:12:43Z","timestamp":1605903163000},"page":"440-452","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Clinical spectrum in multiple families with primary <scp>COQ<sub>10<\/sub><\/scp> deficiency"],"prefix":"10.1002","volume":"185","author":[{"given":"Seyyed S.","family":"Hashemi","sequence":"first","affiliation":[{"name":"Genetics Research Center, University of Social Welfare and Rehabilitation Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davood","family":"Zare\u2010Abdollahi","sequence":"additional","affiliation":[{"name":"Genetics Research Center, University of Social 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