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Introduction: Dupuytren's disease (DD) is an ill-defined fibroproliferative disorder affecting the palms of the hands of certain patient groups. Whether changes in DD fibroblasts are due to genetic alterations alone or related to metabolic dysregulation has not yet been investigated. Hypotheses: 1. DD is a disease of several networks rather than of a single gene. 2. DD may be investigated more effectively by employing systems biology. 3. Strict definition of cell passage number is important for the revelation of any DD phenotype. 4. Some of the differences between DD and healthy tissues reside in a difference in their respiratory metabolism. 5. Any such differences are akin the Warburg effect noted for tumour cells in the literature. Methods: We induced hypoxia in healthy and disease cells to test whether the difference in disease cell types and healthy is the same as the difference in control fibroblasts cultured in normoxia and hypoxia. We investigated both at the metabolic level (intracellular and extracellular) and at the transcript level. This study also employed Fourier transform infrared spectroscopy to permit profiling of cells: (1) DD cords and nodules against the unaffected transverse palmar fascia (internal control), (2) those (1) with carpal ligamentous fascia (external controls) (3) those in (1) against DD fat surrounding the nodule, and skin overlying the nodule. We then compared metabolic profiles of the above to determine the effect of serial passaging by assessment of reproducibility. Subsequently, a novel protocol was employed in carefully controlled culture conditions for the parallel extraction of the metabolome and transcriptome of DD-derived fibroblasts and control at normoxic and hypoxic conditions to investigate this hypothesis. Gas chromatography-mass spectrometry combined with microarrays was employed to identify metabolites and transcript characteristic for DD tissue phenotypes. The extracellular metabolome was also studied for a selected subset. The metabolic and transcriptional changes were then integrated employing a network approach. Results: Carefully controlled culture conditions combined with multivariate statistical analyses demonstrated metabolic differences in DD and unaffected transverse palmar fascia, in addition to the external control. Differences between profiles of the four DD tissue phenotypes were also demonstrated. In addition early passage (0-3) metabolic differences were observed where a clear separation pattern in clusters was observed. Subsequent passages (4-6) displayed asynchrony, losing distinction between diseased and non-diseased sample phenotypes. A substantial number of dysregulated metabolites involved in amino acid metabolism, carbohydrate metabolism and also metabolism of cofactors and vitamins including downregulated cysteine and aspartic acid have been identified from the integrative analyses. Metabolic and transcriptional differences were revealed between fibroblast cell samples (passage number 3) cultured in 1% and 21% oxygen. The hypothesis that the difference in disease and healthy cells maybe akin to the differences in healthy cells in normoxia and hypoxia was rejected as only a very small number of significant molecules from these studies coincided in perturbed fascia and disease samples. No lactic acid was observed and little difference in the pyruvate concentrations. Yet, upon perturbation several of these transcripts and metabolites involved in the afore-mentioned pathways were significantly dysregulated. Conclusion: Early, but not late, passage numbers of primary cells provide representative metabolic and transcript fingerprinting for investigating DD. A unique parallel analysis of transcript and metabolic profiles of DD fibroblasts and control, enabled a robust characterization of DD and correlation of parameters across the various levels of systemic description. The tools that should facilitate our understanding of these complex systems are immature, but the pleiotropy of the difference between healthy and DD tissue suggest the aetiology of a network-based disease.

L’hémochromatose HFE est une maladie du métabolisme du fer liée au gène HFE dont la principale mutation est C282Y. L’objectif général de ce travail était d’étudier l’influence de facteurs génétiques et non génétiques sur l’expression phénotypique de patients atteints d’hémochromatose HFE. Cette étude prospective incluait les patients C282Y/C282Y etC282Y/H63D inclus en protocole de saignées entre janvier 2004 et décembre 2011 au centre de santé brestois de l’EFS-Bretagne. Dans un premier temps, nous avons étudié l’influence du génotype C282Y/H63D sur la survenue d’une surcharge en fer. Nous avons confirmé que le variant H63D doit être considéré comme un facteur de susceptibilité dont l’expression est liée à la présence de co-facteurs responsables d’une hyper ferritinémie. Ensuite, nous avons étudié le rôle des grossesses et de l’alimentation sur l’expression phénotypique du génotype C282Yhomozygote. Nous avons montré qu’il existe bien une différence d’expressivité clinique liée au sexe chez les patients C282Y/C282Y. Cependant, nos données n’ont pas confirmé l’effet protecteur typiquement attribué aux grossesses pour expliquer la plus lente accumulation de fer chez les femmes. Cette étude a également mis en évidence une association modérée entre la consommation d’aliments riches en fer et le degré de surcharge en fer des patients C282Yhomozygotes traités par phlébotomies. Ce travail contribue à mieux comprendre l’hétérogénéité phénotypique observée dans l’hémochromatose HFE. La finalité est de pouvoir repérer précocement les sujets les plus à risque de développer les surcharges en fer les plus sévères et par conséquent des complications cliniques. / HFE hemochromatosis is a disorder of iron metabolism related to the HFE gene whose mainmutation is C282Y. The overall aim of this study was to investigate the influence of genetic and non genetic factors on phenotypic expression of patients with HFE hemochromatosis. This prospective study included the C282Y/C282Y and C282Y/H63D patients enrolled in a phlebotomy program between 2004 and 2011 in a blood centre of western Brittany (Brest, France). First, weassessed the weight of the C282Y/H63D genotype in the occurrence of iron overload. We confirmed that H63D is a discrete genetic susceptibility factor whose expression is most visible in association with other co-factors responsible for hyper ferritinemia. Then we investigated the effect of pregnancies and iron-rich diet on phenotypic expressivity of the C282Y/C282Y genotype. We have shown that there is a difference in clinical expression related to gender in C282Y/C282Ypatients. However our findings did not confirm that pregnancies protect against iron accumulationin women. This study established a moderate link between dietary iron intake and the degree of iron overload in HFE hemochromatosis patients who come to medical attention. This work contributes to a better understanding of the phenotypic heterogeneity observed in HFE hemochromatosis. The purpose is to identify precociously subjects the most at risk of developing iron overload and therefore clinical complications.

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This diploma thesis entitled "The impact of acne on everyday life of students in a selected high school" is divided into two main parts. The first theoretical part is focused on the characteristics of the disease and on the impact of this disease on the quality of life of patients. There is a brief characterization of skin structure, it provides information about pathogenesis of acne and triggering factors, its clinical manifestations and clinical picture. In this part we can also find the diagnosis and treatment options for acne and an overview of other selected facial dermatoses. This part includes the effect of acne on patients' quality of life and an overview of the most common myths about acne. The second part is practically oriented. I used an online questionnaire to find out the impact of acne on everyday life of students in a selected high school. The results of my questionnaire survey show that 12 students (37,5 %) out of 32 respondents suffering from acne (100 %) reached the limit set by me, which determined whether their lives are affected by this disease or not. The first partial goal of the work was to determine the students' knowledge of this disease. I found out that the success rate (evaluated by the number of correct answers) of students in the knowledge part of the questionnaire...