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Anti-glutamic acid decarboxylase antibody-positive gestational diabetes mellitus with autoimmune type 1 diabetes mellitus in the early postpartum period: a case report and literature review

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A 28-year-old woman exhibited a spiking fever, arthritis, and liver disfunction when she was 22 weeks pregnant. She was diagnosed with adult-onset Still's disease (AOSD). As her condition was resistant to corticosteroid therapy, tocilizumab (TCZ) was selected. The TCZ treatment was effective, and she delivered a healthy child while receiving TCZ treatment. Cases in which AOSD first arises during pregnancy are rare, and there have been no reports of TCZ treatment for AOSD being initiated during pregnancy. Although the safety of TCZ treatment during pregnancy has not been established, it may be effective against severe AOSD that develops during pregnancy.

Time-lapse incubators have become increasingly popular in assisted reproductive technology, allowing for the observation of the developmental process, which may be useful in the selection of human embryos suitable for transplantation. Dynamic morphological changes of chromosomes and the cytoskeleton occur during early embryonic development, including in humans, and abnormalities such as embryonic chromosomal aneuploidy occur when development does not proceed normally. Chromosome and cytoskeletal dynamics are difficult to observe with time-lapse bright field monitoring. However, in recent years, live-cell imaging techniques have been used to analyse these dynamics by injecting fluorescently labelled cytoskeletal proteins or mRNA encoding fluorescein probes. These require complicated procedures and necessitate mechanical invasion of cells. Here, we introduced a fluorescence-labelled probe with cell-membrane permeability that specifically adheres to DNA and to the cytoskeleton as imaged in an incubator-integrated time-lapse confocal laser microscope observation system. This platform enabled us to analyse, in detail, the dynamics of chromosomes, microtubules, and microfilaments from the fertilized pronuclear zygote, through first cleavage, to 2-cell stage embryo. This method is simple and does not require genetic manipulation, and its application can be expected to provide novel insights into embryonic development in many mammals, including humans.