Akanksha Garg

The applications of Artificial intelligence (AI) have exponentially increased in all aspects of life, including within Assisted Reproductive Technologies (

Hypertensive disorders of pregnancy (HDP) including haemolysis, elevated liver enzymes and low platelet count (HELLP) and pre-eclampsia are one of the leading causes of maternal mortality. There is significant overlap between the acute clinical presentation of such HDP and other medical conditions with thrombotic microangiopathy such as acute fatty liver of pregnancy, catastrophic antiphospholipid antibody syndrome, acute systemic lupus erythematosus, atypical haemolytic uraemic syndrome and thrombocytopenic thrombotic purpura. This can make timely clinical diagnosis and treatment challenging. Here, we present a complex case of severe pre-eclampsia and HELLP with concerns for a thrombotic microangiopathy, where accurate clinical diagnosis of overlapping pathologies posed a clinical challenge, and share our key reflections and learning points in the context of current evidence. We discuss diagnostic tests to aid diagnosis and review the cardinal presenting features and pathophysiology of possible causes of thrombotic microangiopathy in pregnancy.

Mitochondrial unfolded protein stress response (mtUPR) plays a critical role in regulating cellular and metabolic stress response and helps maintain protein homeostasis. Caseinolytic peptidase P (CLPP) is one of the key regulators of mtUPR and promotes unfolded protein degradation. Previous studies demonstrated that global deletion of Clpp resulted in female infertility, whereas no impairment was found in the mouse model with targeted deletion of Clpp in cumulus/granulosa cells. These results suggest the need to delineate the function of Clpp in oocytes. In this study, we aimed to further explore the role of mtUPR in female reproductive competence and senescence using a mouse model. Oocyte-specific targeted deletion of Clpp in mice resulted in female subfertility associated with metabolic and functional abnormalities in oocytes, thus highlighting the importance of CLPP-mediated protein homeostasis in oocyte competence and reproductive function.