BACKGROUND
an ideal drug should tackle the disease-causing processes in the most selective way, i.e.
with no harm for the healthy cells.
to our knowledge, such a perfectly selective drug does not exist.
in fact, administrated chemicals can trigger at least secondary consequences  in the organism or in host cells
<cit> .
in case of anti-parasitic drugs, side-effects on the metabolism of host cells may arise from the binding to homologous proteins that share a long evolutionary history with the parasite
<cit> .
to minimize such side-effects, analyses on the performance of multiple networks and the consequences of enzymatic homologous inhibitions may be useful.
ideally, this analysis should be based on detailed mechanistic models of the metabolic networks of the parasite and the host cell pathways
<cit> .
however, all the kinetic information needed for the creation of such models is rarely available.
therefore, alternative modeling frameworks, such as monte carlo simulations
<cit>  and flux balance analysis
<cit> , have been developed for the simulation of the cellular metabolism.
these methods allow the simulation of genome-scale networks, do not require kinetic enzymatic knowledge and are suited to test the outcome of gene deletions
<cit> .
genome-scale metabolic models of pathogens are extensively exploited to predict putative drug targets with fba frameworks
<cit> .
furthermore, recent network-based analyses integrate host and pathogen models to describe more accurately the metabolic interactions and to improve the search of putative drug targets.
for example, the topology of automatically inferred networks of plasmodium falciparum and its human host are studied to identify essential enzymes
<cit> .
the metabolic network of mycobacterium tubercolosis is integrated with a human alveolar macrophage to describe three degrees of infection
<cit> .
similarly, a metabolic model of plasmodium falciparum is embedded in a red blood cell model to simulate its intra-erythrocytic developmental stage
<cit> .
furthermore, the selectivity of enzymatic drug targets is already extensively predicted with large-scale metabolic networks of human cancer cells
<cit> .
thus, it is reasonable to assess the selectivity of enzymatic drug targets in host-pathogen metabolic interactions with genome-scale networks.
the aim of this study was the prediction of selective enzymatic inhibitions with genome-scale networks of plasmodium falciparum  and the human hepatocyte
<cit> .
although the intra-erythrocytic plasmodial phase is still extensively investigated, the intra-hepatic phase of development is the first infection site and, thus, a promising stage of treatment
<cit> .
to predict feasible metabolic phenotypes, for each model a set of metabolic objectives was assembled with extensive literature search.
this set described the cellular composition that is specific to the modeled cell type.
then, computational methods were applied to predict the selectivity of antimalarials in absolute and in relative sense.
to predict the enzymatic inhibitions in absolute terms, in silico gene deletions of homologous enzymes were performed.
alternatively, the concept of reduced fitness was applied to homologous essential enzymes to assess inhibitions in relative terms.
while in silico gene deletions predicted scenarios where the enzyme is fully disrupted , the second approach better described the possibility of residual enzymatic activity.
the latter is more appropriate for the administration of enzymatic inhibitors that only gradually reduce the enzyme activity.
the set of experimental antimalarial targets, that were tested in this work, were a merged and pruned list of published “gold standards”.
the merged list contained  <dig> enzymes, out of which  <dig> were selected.
these enzymes are known to be essential for plasmodium falciparum metabolic homeostasis and growth
<cit> .
to test the selectivity of these enzymes, in silico gene deletions of the enzymatic set were simulated.
twenty-four enzymes were found to be essential only for the parasite and did not compromise the host metabolic performance.
twelve enzymes were essential for both models and were investigated with the concept of reduced fitness
<cit> , to identify which network could be more sensitive to an enzymatic impairment.
then, the fitness-based selectivity score predicted that  <dig> enzymes out of this last set were more sensitive for the host, as their in silico perturbations had a larger impact on the achievement of host metabolic objectives .
0lethal with block of the alternative reaction q <dig>  ec  <dig> .
<dig> .
1to activate the enzyme in the reference state, the import of dihydroorotate should be blocked.
2lethal with block of thetrahydrofolate recharging.
block of r <dig> q <dig> r <dig> r <dig> r <dig> r <dig>
3triacylglycerol is imported, instead to be exported, to compensate the inhibition consequences .
4lethal with external depletion of glycerol,  <dig> -diacyl glycerol, sn glycerol  <dig> phosphate, phosphatidylcholine, phosphatidylserine, phosphatidylethanolamine.
5lethal with external depletion of adenosine, adenine, hypoxanthine, inosine.
6acceptors of the respiratory electron chain are ubiquinone and cytochrome c , lethal if also complex iii is blocked.
7lethal with external depletion of spermidine.
8lethal with external depletion of phosphatidylcholine.
9lethal with external depletion of 5’-methylthioinosine, xanthine, hypoxanthine, inosine.
10lethal with external depletion of spermidine.
11off-target effects due to the enzymatic role during host invasion.
12lethal with external depletion of guanine and guanosine.
13lethal with external depletion of putrescine, spermidine and blocked agmatinase , in plasmodium bergheii but not yet charaterized in plasmodium flaciparum).
14topologically not essential, synthetically lethal with inhibition of glucose 6p isomerase .
15lethal with external depletion of phosphatidylcholine and choline.
16off-target effects due to cytoskeleton association of the enzyme.
17rf score = selectivity score predicted with the concept of reduced fitness.
x = essential enzyme; o=non essential enzyme; ∙=conditional essential enzyme.
hn = hepatonet1; pn=plasmonet; rf50=reduced fitness at 50% of enzyme inhibition.
RESULTS
the gene-deletion approach divided the set of drug targets in three groups :  enzymes that are essential in both networks,  enzymes that are essential only in plasmonet and  enzymes that are dispensable in both networks.
the largest set of experimental drug targets  was not lethal for the host  and essential for the parasite network .
these enzymes are, thus, predicted to be perfectly selective with respect to the plasmodium falciparum network.
intriguingly,  <dig> drug targets were identified to be dispensable in both models.
when the simulations included the experimental in vitro conditions that validated the drug targets, 9/ <dig> enzymes turned out to be essential.
this situation was defined as conditional essentiality, as the enzyme becomes essential when some substrates are not available in the medium.
the remaining  <dig> glycolytic enzymes were, instead, predicted to be non-essential.
this could be due to off-target effects, to extra-metabolic functions or to possible assembly of multi-enzymatic complexes.
homologous drug targets essential in both networks
the gene-deletion approach predicted that  <dig> enzymes are essential in both networks , thus indicating a possible metabolic hepatic impairment caused by the inhibition of homologous enzymes.
while this enzymatic set is already experimentally tested, a literature search was done to find any evidence of human cellular toxicity.
it was predicted that only acyl-coa syntethase may be a selective target for antimalarial treatment .
the essentiality of this enzyme is experimentally demonstrated in human lymphoblast-like cells
<cit> .
the fitness approach predicted that thymidylate synthase was equally detrimental for both models .
this enzyme is a possible therapeutic drug target that is efficient against a wide spectrum of human tumors
<cit>  but one main drawback is the possibility of its enzymatic over-expression that may confer drug resistance.
orotidine-5-phosphate decarboxylase and orotate phosphoribosyltransferase form a multienzymatic complex, but for this analysis the two enzymatic activities were assessed separately.
nevertheless, the results obtained with the fitness approach indicated the same degrees of biomass impairment.
the cellular toxicity caused by the inhibition of orotidine-5-phosphate decarboxylase was demonstrated in human leukemia cell lines
<cit> , while orotate phosphoribosyltransferase is an antitumoral target for human gastric carcinoma cells
<cit> .
equally to the effects caused by these two enzymes, also aspartate carbamoyltransferase was predicted to inhibit the same biomass components .
the essentiality of last enzyme is demonstrated in human hepatocytes
<cit> .
similarly to the cited enzymes, dihydroorotase can also impair the synthesis of the same biomass components.
its essentiality is demonstrated in ccrf-cem leukemic cells
<cit> .
the reduced fitness approach correctly predicted that the enzymatic inhibition of acetyl-coa carboxylase causes an importing of plasma triglycerides and this phenomenon has been experimentally demonstrated in vitro <cit> .
acetyl-coa carboxylase is the rate-limiting step of the fatty acid anabolism and it is essential for human breast cancer cells
<cit> .
carbamoyl-phosphate synthase was predicted to be more detrimental for the hepatocyte than acetyl-coa carboxylase.
this enzyme catalyzes the formation of carbamoyl phosphate from carbon dioxide and ammonia  or glutamine .
here, it was not discriminated between the ammonia-donors  because the inhibition of one reaction was able to be fully compensated by the other.
the essentiality of carbamoyl phosphate synthetase  was demonstrated in mouse liver
<cit> .
the last enzyme of this set was glycerol-3-phosphate acyltransferase, that is essential for human hepatocyte cultures
<cit> .
the gene deletions of this antimalarial drug target set were confirmed by the aforementioned experimental data.
moreover, the reduced fitness approach correctly predicted the specific case that was triggered by the inhibition of acetyl-coa carboxylase: while in the reference state the triglycerides are part of the maintenance function, thus they are exported into the blood, under the perturbation there was an inversion of the boundary flux and they were instead imported.
the behavior of the predicted fitness functions, that were simulated for this enzymatic set, are depicted in figure
<dig>
reduced fitness rank of essential drug targets
for the  <dig> essential enzymes, we applied the reduced fitness concept to assess in a more subtle way their impact on the two metabolic networks .
to validate the outcome of the reduced fitness rank, three enzymes were shortlisted from table
1: acyl-coa synthetase ; aspartate carbamoyltransferase ; glycerol-3-phosphate acyltransferase .
the impairment of acyl-coa synthetase in hepatonet <dig> caused a perturbation in the mitochondrial synthesis of cardiolipin , while in plasmonet the inhibition severely destroyed the production of sphingomyelin .
hepatonet <dig> mitochondrial cardiolipin was produced by the condensation of glycerol-3-phosphate and cdp-diacylglycerol, that was obtained by mitochondrial phosphatidate.
this latter metabolite was synthesized from acyl-coa mitochondrial pool .
cytosolic acyl-coa syntethase was responsible for the formation of these activated fatty acids, thus an enzymatic impairment can affect the cardiolipin synthesis.
this is experimentally demonstrated in human tumoral cells
<cit> .
acyl-coa synthetase inhibition impaired plasmonet sphingomyelin production: the main precursors of sphingomyelin are serine and palmitoyl-coa, that was produced in the cytosol by the enzyme.
the parasite shows a high activity of fatty acid anabolism, thus the enzyme is important for plasmodial growth
<cit> .
during the intra-erythrocytic stage, the parasite synthesizes new sphingolipids which are necessary for the formation of the tubovesicular network
<cit> .
the formation of this membrane structure connects the parasitic vacuole with the host membrane during invasion.
a possible activation of sphingomyelinase, that degrades sphingomyelin pools, provokes the plasmodial death.
this suggests that a certain amount of sphingolipids is essential for plasmodium falciparum.
the second enzyme is aspartate carbamoyltransferase whose inhibition caused an impairment of udp-glucose production in hepatonet <dig>  and mrna in plasmonet .
it is reported that inhibitors of aspartate carbamoyltransferase cause a 10% reduction of the utp intracellular pools in hepatoma cell culture
<cit> .
the last enzyme is glycerol-3-phosphate acyltrans- ferase, that caused dramatic effects in the hepatocyte metabolism, hindering the production of phosphatidylethanolamine , phosphatidylinositol , phosphatidylcholine , cardiolipin  and triglycerides .
phosphatidate is a common precursor of these metabolites and is formed in the human in the linear chain from 1-acyl-glycerol-3-phosphate, a product of glycerol-3-phosphate acyltransferase.
a specific inhibitor of this enzyme  causes in obese rats the reduction of triglycerides and phosphatidylcholine
<cit>  and this was also confirmed by our analysis.
the in silico inhibition of the enzyme impaired the production of phosphatidylcholine  in plasmonet.
the plasmodial gene sequence that encodes glycerol-3-phosphate acyltransferase is expressed in double yeast mutants and biochemically characterized
<cit> .
the authors suggested that it is likely that glycerol-3-phosphate acyltransferase is essential for a growing plasmodium falciparum, that requires high amount of phospholipids for membrane synthesis.
this hypothesis is sustained by another work, whose biochemical analyses show that parasites in trophozoite and schizont stages have an high acyltransferase activity
<cit> .
although it was not possible to assess the quantitative aspect of the selectivity score with experimental evidence, there was a good agreement among the obtained results and the literature.
homologous drug targets predicted non-essential in both networks
twelve drug targets showed up to be non-essential in both networks , although their essentiality is experimentally validated for the parasite.
in  <dig> cases the conflicting outcomes could be sorted out with literature-based assessment of the in vitro medium compositions and restriction of indicated inbound fluxes .
the remaining discrepancies may be due to possible molecular interactions that were not considered in the network reconstruction, e.g.
off-target effects.
for example, velanker and coworkers find that plasmodial glycolytic enzymes associate with membranes and cytoskeleton components and drain their substrates near to the invasion machineries, making contact with host microtubules
<cit> .
the authors also suggest that the inhibition of the glycolysis is achieved with enzymatic inhibitors or, alternatively, with the disruption of the cytoskeleton assembly.
it is then likely that plasmodial glycolytic enzymes form a multi-enzymatic complex that is associated to the cytoskeleton.
this hypothesis is also supposed by an old theoretical work, that suggests that the glycolytic enzymes are not ”evenly distributed throughout the cytosol”, but are likely localized in restricted regions
<cit> .
it is also likely that these cytoskeleton-associated enzymes have an important role during host invasion and, thus, their inhibitors may cause off-target effects.
in this set, gene deletions predicted that  <dig> glycolytic enzymes were dispensable.
these were aldolase, hexokinase and triose-phosphate isomerase.
parasitic aldolase, for example, binds ama <dig> effector to initiate host invasion
<cit> .
furthermore, the parasite relies on the glycolysis for its own atp production, that is invested for growth, replication, motility and invasion.
hexokinase is found to be essential for the intra-erythrocytic stage of the protozoan
<cit> .
on the other hand, it was predicted that hexokinase in intra-hepatic stage was dispensable for the achievement of the biomass reactions.
then, to simulate the effects of the upper glycolytic branch disruption, a double knock-out of hexokinase and glucose-6-phosphate isomerase was simulated.
in this case, the impaired biomass components were phosphatidylinositols.
this impairment and its consequences were in agreement with experimental assays, where the inhibition of hexokinase provokes the total disruption of the synthesis of glycophosphatidylinositols
<cit> .
it is then likely that hexokinase and glucose-6-phosphate isomerase belong to the same multienzymatic complex that was proposed by huebscher
<cit> .
the last enzyme of this little set is triose-phosphate isomerase, that is expressed on the membrane of infected erythrocytes where it triggers antibody selection and prolonged hemolytic anemia
<cit> .
because of its specific extra-metabolic functions , it is very likely that this enzyme is connected to off-target effects.
among the enzymes that are conditionally essential, ornithine decarboxylase was found to be essential under the restriction of polyamines  and under the block of agmatinase.
this enzyme synthesizes the first polyamine: putrescine.
in plasmonet, a secondary bypass through agmatinase  made this enzyme dispensable.
agmatinase was identified in plasmodium berghei and hypothesized in plasmodium falciparum but never characterized here, so this bypass may not be present.
here, a double enzymatic knock-down was simulated and both enzymes resulted to be essential for plasmonet.
recently, it has been reported that a full perturbation of ornithine decarboxylase triggers sophisticated compensatory mechanisms on the transcriptome, proteome and metabolome of the parasite
<cit> .
it is then likely that the enzyme is per se essential for the parasite and that the “rescue” mechanism is a evolutionary survival strategy.
the literature indicates that the same enzyme is dispensable for the human host, suggesting a similar underlying conserved mechanism of regulation
<cit> .
in the set of conditional essential enzymes, phosphoethanolamine methyltransferase was found to become essential under depletion of external choline and phosphatidylcholine.
this enzyme had a replenishing function in the phospholipid synthetic pathway, transferring  <dig> methyl groups on the ethanolamine to form the choline head .
in plasmodium berghei it has two different substrates, ethanolamine phosphate and phosphatidylethanolamine
<cit> .
in plasmonet only the first reaction was included  and it was not active since phosphatidylcholine and choline were available in the simulated medium.
this bypass is important only if choline is missing in the external environment, so to assess its essentiality the choline/phosphatidylcholine transporters were blocked and the missing reaction was added in plasmonet.
under these conditions the enzyme was essential.
the last enzyme that was detected as dispensable is nadh dehydrogenase.
its metabolic functions can be fulfilled alternatively by complex bc <dig>  inhibitors of nadh dehydrogenase  target the mitochondrial electron transport chain but also affect complex bc <dig> <cit> .
thus, a double knockout of nadh dehydrogenase/complex bc1was applied, whose outcome indicated that the synergistic activity of both enzymes was essential for the parasite.
CONCLUSIONS
to increase the selectivity of an anti-pathogenic drug that could target also host enzymes, a conventional way is to exploit structural differences between homologous proteins.
on the other hand, network-based modeling methods are alternative and complementary strategies to assess enzymatic inhibitions.
in fact, genome-scale networks can detect enzymes that are likely to be essential and selective.
ideally, these approaches identify potential drug targets that are specific to the parasite.
while this idea may be impressive in its simplicity, the amount of parasite-specific enzymes can be restricted.
in fact, out of the merged list of  <dig> “gold standards” only  <dig> enzymes are specific to plasmodium falciparum metabolism.
it should also be considered that plasmodium falciparum, when exposed to drug-induced selective pressure, develops drug-resistance
<cit> .
in this context, it would be nice to have more predictive methods and this was the rationale behind this research.
the question this work aimed to address was the assessment of the selectivity of antimalarial drug targets with fba-based methods.
a human hepatocyte metabolic network was chosen to represent the host metabolism since the liver is the first human infection site for malaria parasites
<cit> .
furthermore, the liver possesses the most versatile metabolism among human cells.
in fact, it is likely that drug targets, that compromise the metabolism of any human cell, should also be identifiable in the hepatocyte.
furthermore, it is the preferred organ to investigate the drug-induced metabolic impairments, whose consequences may be not detectable in preclinical and clinical trials
<cit> .
to apply fba-based methods, the main requirement is the availability of curated genome-scale metabolic networks.
furthermore, to achieve a realistic flux distribution, each model should be simulated with a literature-based set of metabolic objectives.
this set allows the simulation of an anabolic physiological state of the metabolic model, in similar way to the biomass objective function
<cit> .
the applied metabolic objective sets were assembled, approximated and rescaled from a multitude of different sources.
the relative concentration share of each biomass component was taken as an estimate of its production rate.
a physiological assembly of the metabolic objectives was necessary to describe realistically the consequences of the inhibitions of chosen antimalarial drug targets.
overall, this work predicted that a large drug target set was non-essential for the hepatocyte model  and that  <dig> enzymes were instead essential for both models.
for the first set gene deletions were simulated, while for the second set the concept of reduced fitness was applied.
this last method can analyze more in detail the drug-induced impairments and their consequences on the network performance.
gene-deletion simulations are a mean to assess the importance of a given biochemical reaction for the functionality of the network.
this type of simulations are comparable to experimental gene-excision methods: the enzyme sequence is a priori disrupted and the resulting metabolic consequences are then investigated.
on the other hand, it is rare that an administrated drug can achieve 100% enzymatic inhibition.
to simulate this last scenario, the concept of reduced fitness was applied.
in this case,  <dig> enzymes, that gene deletions predicted to be essential in both models, were studied in the context of reduced fitness.
this method allows to compare the relative enzymatic essentiality and to understand which model is more sensitive to a chosen enzymatic restriction.
unfortunately, the predicted selectivity score could not be validated with the available pharmacological data  for infected and non-infected hepatocyte cultures.
our work had clearly some limitations, that were due to lacking pharmacological data on antimalarials and approximations of the metabolic objectives.
then, genome-scale metabolic networks do not usually integrate regulatory feed-back loops and, thus, they may be not feasible to predict consequences of enzyme inhibition that are triggered by negative regulation.
as mentioned above for the case of thymidylate synthase, enzymatic drug-induced inhibition may cause enzymatic over-expression and this aspect can not be exhaustively predicted with the methods that are here applied.
despite the applied approximations and the missing data, the obtained results were in agreement with the available literature.
thus, this framework may be useful to detect putative selective drug targets, that gene-deletion simulations may discard.
further analyses on the selectivity of antimalarial targets  are therefore required to validate the predicted selectivity score.
rna interference, for example, allows to tune the degree of inhibition, avoiding off-target effects due to unspecific protein binding
<cit> .
alternatively, enzyme impairments by covalent inhibitor assay
<cit>  could provide the experimental mirror of the computed fitness function.
in this last case, drug binding constant and cytotoxic index for each inhibitor will be useful to assess the ”pure” network effects that were here predicted.
in fact, cytotoxic index alone is not informative in this respect, as it can not discriminate among strong network effects under weak drug binding and weak network effects under strong drug binding.
finally, the last important aspect to consider is the choice of the strain of plasmodium falciparum, as drug resistance and sensitivity may largely vary among different strains.
this is the rationale why anti-pathogenic drug discovery is now focusing on drug combinations, that are effective against a wide spectrum of pathogenic strains in low doses
<cit> .

 an ideal drug should tackle the disease-causing processes in the most selective way, i.e. with no harm for the healthy cells. to our knowledge, such a perfectly selective drug does not exist. in fact, administrated chemicals can trigger at least secondary consequences in the organism or in host cells. in case of anti-parasitic drugs, side-effects on the metabolism of host cells may arise from the binding to homologous proteins that share a long evolutionary history with the parasite. to minimize such side-effects, analyses on the performance of multiple networks and the consequences of enzymatic homologous inhibitions may be useful. ideally, this analysis should be based on detailed mechanistic models of the metabolic networks of the parasite and the host cell pathways. however, all the kinetic information needed for the creation of such models is rarely available. therefore, alternative modeling frameworks, such as monte carlo simulations and flux balance analysis, have been developed for the simulation of the cellular metabolism. these methods allow the simulation of genome-scale networks, do not require kinetic enzymatic knowledge and are suited to test the outcome of gene deletions. genome-scale metabolic models of pathogens are extensively exploited to predict putative drug targets with fba frameworks. furthermore, recent network-based analyses integrate host and pathogen models to describe more accurately the metabolic interactions and to improve the search of putative drug targets. for example, the topology of automatically inferred networks of plasmodium falciparum and its human host are studied to identify essential enzymes. the metabolic network of mycobacterium tubercolosis is integrated with a human alveolar macrophage to describe three degrees of infection. similarly, a metabolic model of plasmodium falciparum is embedded in a red blood cell model to simulate its intra-erythrocytic developmental stage. furthermore, the selectivity of enzymatic drug targets is already extensively predicted with large-scale metabolic networks of human cancer cells. thus, it is reasonable to assess the selectivity of enzymatic drug targets in host-pathogen metabolic interactions with genome-scale networks. the aim of this study was the prediction of selective enzymatic inhibitions with genome-scale networks of plasmodium falciparum and the human hepatocyte. although the intra-erythrocytic plasmodial phase is still extensively investigated, the intra-hepatic phase of development is the first infection site and, thus, a promising stage of treatment. to predict feasible metabolic phenotypes, for each model a set of metabolic objectives was assembled with extensive literature search. this set described the cellular composition that is specific to the modeled cell type. then, computational methods were applied to predict the selectivity of antimalarials in absolute and in relative sense. to predict the enzymatic inhibitions in absolute terms, in silico gene deletions of homologous enzymes were performed. alternatively, the concept of reduced fitness was applied to homologous essential enzymes to assess inhibitions in relative terms. while in silico gene deletions predicted scenarios where the enzyme is fully disrupted, the second approach better described the possibility of residual enzymatic activity. the latter is more appropriate for the administration of enzymatic inhibitors that only gradually reduce the enzyme activity. the set of experimental antimalarial targets, that were tested in this work, were a merged and pruned list of published “gold standards”. the merged list contained enzymes, out of which were selected. these enzymes are known to be essential for plasmodium falciparum metabolic homeostasis and growth. to test the selectivity of these enzymes, in silico gene deletions of the enzymatic set were simulated. twenty-four enzymes were found to be essential only for the parasite and did not compromise the host metabolic performance. twelve enzymes were essential for both models and were investigated with the concept of reduced fitness, to identify which network could be more sensitive to an enzymatic impairment. then, the fitness-based selectivity score predicted that enzymes out of this last set were more sensitive for the host, as their in silico perturbations had a larger impact on the achievement of host metabolic objectives. 0lethal with block of the alternative reaction q ec.. 1to activate the enzyme in the reference state, the import of dihydroorotate should be blocked. 2lethal with block of thetrahydrofolate recharging. block of r q r r r r 3triacylglycerol is imported, instead to be exported, to compensate the inhibition consequences. 4lethal with external depletion of glycerol, -diacyl glycerol, sn glycerol phosphate, phosphatidylcholine, phosphatidylserine, phosphatidylethanolamine. 5lethal with external depletion of adenosine, adenine, hypoxanthine, inosine. 6acceptors of the respiratory electron chain are ubiquinone and cytochrome c, lethal if also complex iii is blocked. 7lethal with external depletion of spermidine. 8lethal with external depletion of phosphatidylcholine. 9lethal with external depletion of 5’-methylthioinosine, xanthine, hypoxanthine, inosine. 10lethal with external depletion of spermidine. 11off-target effects due to the enzymatic role during host invasion. 12lethal with external depletion of guanine and guanosine. 13lethal with external depletion of putrescine, spermidine and blocked agmatinase, in plasmodium bergheii but not yet charaterized in plasmodium flaciparum). 14topologically not essential, synthetically lethal with inhibition of glucose 6p isomerase. 15lethal with external depletion of phosphatidylcholine and choline. 16off-target effects due to cytoskeleton association of the enzyme. 17rf score = selectivity score predicted with the concept of reduced fitness. x = essential enzyme; o=non essential enzyme; ∙=conditional essential enzyme. hn = hepatonet1; pn=plasmonet; rf50=reduced fitness at 50% of enzyme inhibition.  the gene-deletion approach divided the set of drug targets in three groups: enzymes that are essential in both networks, enzymes that are essential only in plasmonet and enzymes that are dispensable in both networks. the largest set of experimental drug targets was not lethal for the host and essential for the parasite network. these enzymes are, thus, predicted to be perfectly selective with respect to the plasmodium falciparum network. intriguingly, drug targets were identified to be dispensable in both models. when the simulations included the experimental in vitro conditions that validated the drug targets, 9/ enzymes turned out to be essential. this situation was defined as conditional essentiality, as the enzyme becomes essential when some substrates are not available in the medium. the remaining glycolytic enzymes were, instead, predicted to be non-essential. this could be due to off-target effects, to extra-metabolic functions or to possible assembly of multi-enzymatic complexes. homologous drug targets essential in both networks the gene-deletion approach predicted that enzymes are essential in both networks, thus indicating a possible metabolic hepatic impairment caused by the inhibition of homologous enzymes. while this enzymatic set is already experimentally tested, a literature search was done to find any evidence of human cellular toxicity. it was predicted that only acyl-coa syntethase may be a selective target for antimalarial treatment. the essentiality of this enzyme is experimentally demonstrated in human lymphoblast-like cells. the fitness approach predicted that thymidylate synthase was equally detrimental for both models. this enzyme is a possible therapeutic drug target that is efficient against a wide spectrum of human tumors but one main drawback is the possibility of its enzymatic over-expression that may confer drug resistance. orotidine-5-phosphate decarboxylase and orotate phosphoribosyltransferase form a multienzymatic complex, but for this analysis the two enzymatic activities were assessed separately. nevertheless, the results obtained with the fitness approach indicated the same degrees of biomass impairment. the cellular toxicity caused by the inhibition of orotidine-5-phosphate decarboxylase was demonstrated in human leukemia cell lines, while orotate phosphoribosyltransferase is an antitumoral target for human gastric carcinoma cells. equally to the effects caused by these two enzymes, also aspartate carbamoyltransferase was predicted to inhibit the same biomass components. the essentiality of last enzyme is demonstrated in human hepatocytes. similarly to the cited enzymes, dihydroorotase can also impair the synthesis of the same biomass components. its essentiality is demonstrated in ccrf-cem leukemic cells. the reduced fitness approach correctly predicted that the enzymatic inhibition of acetyl-coa carboxylase causes an importing of plasma triglycerides and this phenomenon has been experimentally demonstrated in vitro. acetyl-coa carboxylase is the rate-limiting step of the fatty acid anabolism and it is essential for human breast cancer cells. carbamoyl-phosphate synthase was predicted to be more detrimental for the hepatocyte than acetyl-coa carboxylase. this enzyme catalyzes the formation of carbamoyl phosphate from carbon dioxide and ammonia or glutamine. here, it was not discriminated between the ammonia-donors because the inhibition of one reaction was able to be fully compensated by the other. the essentiality of carbamoyl phosphate synthetase was demonstrated in mouse liver. the last enzyme of this set was glycerol-3-phosphate acyltransferase, that is essential for human hepatocyte cultures. the gene deletions of this antimalarial drug target set were confirmed by the aforementioned experimental data. moreover, the reduced fitness approach correctly predicted the specific case that was triggered by the inhibition of acetyl-coa carboxylase: while in the reference state the triglycerides are part of the maintenance function, thus they are exported into the blood, under the perturbation there was an inversion of the boundary flux and they were instead imported. the behavior of the predicted fitness functions, that were simulated for this enzymatic set, are depicted in figure reduced fitness rank of essential drug targets for the essential enzymes, we applied the reduced fitness concept to assess in a more subtle way their impact on the two metabolic networks. to validate the outcome of the reduced fitness rank, three enzymes were shortlisted from table 1: acyl-coa synthetase; aspartate carbamoyltransferase; glycerol-3-phosphate acyltransferase. the impairment of acyl-coa synthetase in hepatonet caused a perturbation in the mitochondrial synthesis of cardiolipin, while in plasmonet the inhibition severely destroyed the production of sphingomyelin. hepatonet mitochondrial cardiolipin was produced by the condensation of glycerol-3-phosphate and cdp-diacylglycerol, that was obtained by mitochondrial phosphatidate. this latter metabolite was synthesized from acyl-coa mitochondrial pool. cytosolic acyl-coa syntethase was responsible for the formation of these activated fatty acids, thus an enzymatic impairment can affect the cardiolipin synthesis. this is experimentally demonstrated in human tumoral cells. acyl-coa synthetase inhibition impaired plasmonet sphingomyelin production: the main precursors of sphingomyelin are serine and palmitoyl-coa, that was produced in the cytosol by the enzyme. the parasite shows a high activity of fatty acid anabolism, thus the enzyme is important for plasmodial growth. during the intra-erythrocytic stage, the parasite synthesizes new sphingolipids which are necessary for the formation of the tubovesicular network. the formation of this membrane structure connects the parasitic vacuole with the host membrane during invasion. a possible activation of sphingomyelinase, that degrades sphingomyelin pools, provokes the plasmodial death. this suggests that a certain amount of sphingolipids is essential for plasmodium falciparum. the second enzyme is aspartate carbamoyltransferase whose inhibition caused an impairment of udp-glucose production in hepatonet and mrna in plasmonet. it is reported that inhibitors of aspartate carbamoyltransferase cause a 10% reduction of the utp intracellular pools in hepatoma cell culture. the last enzyme is glycerol-3-phosphate acyltrans- ferase, that caused dramatic effects in the hepatocyte metabolism, hindering the production of phosphatidylethanolamine, phosphatidylinositol, phosphatidylcholine, cardiolipin and triglycerides. phosphatidate is a common precursor of these metabolites and is formed in the human in the linear chain from 1-acyl-glycerol-3-phosphate, a product of glycerol-3-phosphate acyltransferase. a specific inhibitor of this enzyme causes in obese rats the reduction of triglycerides and phosphatidylcholine and this was also confirmed by our analysis. the in silico inhibition of the enzyme impaired the production of phosphatidylcholine in plasmonet. the plasmodial gene sequence that encodes glycerol-3-phosphate acyltransferase is expressed in double yeast mutants and biochemically characterized. the authors suggested that it is likely that glycerol-3-phosphate acyltransferase is essential for a growing plasmodium falciparum, that requires high amount of phospholipids for membrane synthesis. this hypothesis is sustained by another work, whose biochemical analyses show that parasites in trophozoite and schizont stages have an high acyltransferase activity. although it was not possible to assess the quantitative aspect of the selectivity score with experimental evidence, there was a good agreement among the obtained results and the literature. homologous drug targets predicted non-essential in both networks twelve drug targets showed up to be non-essential in both networks, although their essentiality is experimentally validated for the parasite. in cases the conflicting outcomes could be sorted out with literature-based assessment of the in vitro medium compositions and restriction of indicated inbound fluxes. the remaining discrepancies may be due to possible molecular interactions that were not considered in the network reconstruction, e.g. off-target effects. for example, velanker and coworkers find that plasmodial glycolytic enzymes associate with membranes and cytoskeleton components and drain their substrates near to the invasion machineries, making contact with host microtubules. the authors also suggest that the inhibition of the glycolysis is achieved with enzymatic inhibitors or, alternatively, with the disruption of the cytoskeleton assembly. it is then likely that plasmodial glycolytic enzymes form a multi-enzymatic complex that is associated to the cytoskeleton. this hypothesis is also supposed by an old theoretical work, that suggests that the glycolytic enzymes are not ”evenly distributed throughout the cytosol”, but are likely localized in restricted regions. it is also likely that these cytoskeleton-associated enzymes have an important role during host invasion and, thus, their inhibitors may cause off-target effects. in this set, gene deletions predicted that glycolytic enzymes were dispensable. these were aldolase, hexokinase and triose-phosphate isomerase. parasitic aldolase, for example, binds ama effector to initiate host invasion. furthermore, the parasite relies on the glycolysis for its own atp production, that is invested for growth, replication, motility and invasion. hexokinase is found to be essential for the intra-erythrocytic stage of the protozoan. on the other hand, it was predicted that hexokinase in intra-hepatic stage was dispensable for the achievement of the biomass reactions. then, to simulate the effects of the upper glycolytic branch disruption, a double knock-out of hexokinase and glucose-6-phosphate isomerase was simulated. in this case, the impaired biomass components were phosphatidylinositols. this impairment and its consequences were in agreement with experimental assays, where the inhibition of hexokinase provokes the total disruption of the synthesis of glycophosphatidylinositols. it is then likely that hexokinase and glucose-6-phosphate isomerase belong to the same multienzymatic complex that was proposed by huebscher. the last enzyme of this little set is triose-phosphate isomerase, that is expressed on the membrane of infected erythrocytes where it triggers antibody selection and prolonged hemolytic anemia. because of its specific extra-metabolic functions, it is very likely that this enzyme is connected to off-target effects. among the enzymes that are conditionally essential, ornithine decarboxylase was found to be essential under the restriction of polyamines and under the block of agmatinase. this enzyme synthesizes the first polyamine: putrescine. in plasmonet, a secondary bypass through agmatinase made this enzyme dispensable. agmatinase was identified in plasmodium berghei and hypothesized in plasmodium falciparum but never characterized here, so this bypass may not be present. here, a double enzymatic knock-down was simulated and both enzymes resulted to be essential for plasmonet. recently, it has been reported that a full perturbation of ornithine decarboxylase triggers sophisticated compensatory mechanisms on the transcriptome, proteome and metabolome of the parasite. it is then likely that the enzyme is per se essential for the parasite and that the “rescue” mechanism is a evolutionary survival strategy. the literature indicates that the same enzyme is dispensable for the human host, suggesting a similar underlying conserved mechanism of regulation. in the set of conditional essential enzymes, phosphoethanolamine methyltransferase was found to become essential under depletion of external choline and phosphatidylcholine. this enzyme had a replenishing function in the phospholipid synthetic pathway, transferring methyl groups on the ethanolamine to form the choline head. in plasmodium berghei it has two different substrates, ethanolamine phosphate and phosphatidylethanolamine. in plasmonet only the first reaction was included and it was not active since phosphatidylcholine and choline were available in the simulated medium. this bypass is important only if choline is missing in the external environment, so to assess its essentiality the choline/phosphatidylcholine transporters were blocked and the missing reaction was added in plasmonet. under these conditions the enzyme was essential. the last enzyme that was detected as dispensable is nadh dehydrogenase. its metabolic functions can be fulfilled alternatively by complex bc inhibitors of nadh dehydrogenase target the mitochondrial electron transport chain but also affect complex bc. thus, a double knockout of nadh dehydrogenase/complex bc1was applied, whose outcome indicated that the synergistic activity of both enzymes was essential for the parasite.  to increase the selectivity of an anti-pathogenic drug that could target also host enzymes, a conventional way is to exploit structural differences between homologous proteins. on the other hand, network-based modeling methods are alternative and complementary strategies to assess enzymatic inhibitions. in fact, genome-scale networks can detect enzymes that are likely to be essential and selective. ideally, these approaches identify potential drug targets that are specific to the parasite. while this idea may be impressive in its simplicity, the amount of parasite-specific enzymes can be restricted. in fact, out of the merged list of “gold standards” only enzymes are specific to plasmodium falciparum metabolism. it should also be considered that plasmodium falciparum, when exposed to drug-induced selective pressure, develops drug-resistance. in this context, it would be nice to have more predictive methods and this was the rationale behind this research. the question this work aimed to address was the assessment of the selectivity of antimalarial drug targets with fba-based methods. a human hepatocyte metabolic network was chosen to represent the host metabolism since the liver is the first human infection site for malaria parasites. furthermore, the liver possesses the most versatile metabolism among human cells. in fact, it is likely that drug targets, that compromise the metabolism of any human cell, should also be identifiable in the hepatocyte. furthermore, it is the preferred organ to investigate the drug-induced metabolic impairments, whose consequences may be not detectable in preclinical and clinical trials. to apply fba-based methods, the main requirement is the availability of curated genome-scale metabolic networks. furthermore, to achieve a realistic flux distribution, each model should be simulated with a literature-based set of metabolic objectives. this set allows the simulation of an anabolic physiological state of the metabolic model, in similar way to the biomass objective function. the applied metabolic objective sets were assembled, approximated and rescaled from a multitude of different sources. the relative concentration share of each biomass component was taken as an estimate of its production rate. a physiological assembly of the metabolic objectives was necessary to describe realistically the consequences of the inhibitions of chosen antimalarial drug targets. overall, this work predicted that a large drug target set was non-essential for the hepatocyte model and that enzymes were instead essential for both models. for the first set gene deletions were simulated, while for the second set the concept of reduced fitness was applied. this last method can analyze more in detail the drug-induced impairments and their consequences on the network performance. gene-deletion simulations are a mean to assess the importance of a given biochemical reaction for the functionality of the network. this type of simulations are comparable to experimental gene-excision methods: the enzyme sequence is a priori disrupted and the resulting metabolic consequences are then investigated. on the other hand, it is rare that an administrated drug can achieve 100% enzymatic inhibition. to simulate this last scenario, the concept of reduced fitness was applied. in this case, enzymes, that gene deletions predicted to be essential in both models, were studied in the context of reduced fitness. this method allows to compare the relative enzymatic essentiality and to understand which model is more sensitive to a chosen enzymatic restriction. unfortunately, the predicted selectivity score could not be validated with the available pharmacological data for infected and non-infected hepatocyte cultures. our work had clearly some limitations, that were due to lacking pharmacological data on antimalarials and approximations of the metabolic objectives. then, genome-scale metabolic networks do not usually integrate regulatory feed-back loops and, thus, they may be not feasible to predict consequences of enzyme inhibition that are triggered by negative regulation. as mentioned above for the case of thymidylate synthase, enzymatic drug-induced inhibition may cause enzymatic over-expression and this aspect can not be exhaustively predicted with the methods that are here applied. despite the applied approximations and the missing data, the obtained results were in agreement with the available literature. thus, this framework may be useful to detect putative selective drug targets, that gene-deletion simulations may discard. further analyses on the selectivity of antimalarial targets are therefore required to validate the predicted selectivity score. rna interference, for example, allows to tune the degree of inhibition, avoiding off-target effects due to unspecific protein binding. alternatively, enzyme impairments by covalent inhibitor assay could provide the experimental mirror of the computed fitness function. in this last case, drug binding constant and cytotoxic index for each inhibitor will be useful to assess the ”pure” network effects that were here predicted. in fact, cytotoxic index alone is not informative in this respect, as it can not discriminate among strong network effects under weak drug binding and weak network effects under strong drug binding. finally, the last important aspect to consider is the choice of the strain of plasmodium falciparum, as drug resistance and sensitivity may largely vary among different strains. this is the rationale why anti-pathogenic drug discovery is now focusing on drug combinations, that are effective against a wide spectrum of pathogenic strains in low doses. 
metabolic network-based analyses may help to identify those parasite’s essential enzymes whose homologous counterparts in the human host cells are either absent, non-essential or relatively less essential. the search for new drug targets for antibiotics against plasmodium falciparum, a major cause of human deaths, is a pressing scientific issue, as multiple resistance strains spread rapidly. using the well-curated metabolic networks plasmonet of the parasite plasmodium falciparum and hepatonet of the human hepatocyte, the selectivity of experimental antimalarial drug targets was analyzed. applying in silico gene deletions, of these drug targets were found to be perfectly selective, in that they were essential for the parasite but non-essential for the human cell. from the perspective of a host-pathogen metabolic interaction, an estimation of the drug targets-induced consequences can be beneficial for the development of a selective anti-parasitic drug. plasmodium falciparumhuman hepatocytedrug targetsdrug selectivitygenome-scale networksreduced fitnessflux balance analysis genome-scale models can be useful to depict and quantify the effects of enzymatic inhibitions on the impaired production of biomass components. the selectivity of a subset of enzymes, that were essential in both models, was evaluated with the reduced fitness concept.
 the search for new drug targets for antibiotics against plasmodium falciparum, a major cause of human deaths, is a pressing scientific issue, as multiple resistance strains spread rapidly. metabolic network-based analyses may help to identify those parasite’s essential enzymes whose homologous counterparts in the human host cells are either absent, non-essential or relatively less essential.  using the well-curated metabolic networks plasmonet of the parasite plasmodium falciparum and hepatonet of the human hepatocyte, the selectivity of experimental antimalarial drug targets was analyzed. applying in silico gene deletions, of these drug targets were found to be perfectly selective, in that they were essential for the parasite but non-essential for the human cell. the selectivity of a subset of enzymes, that were essential in both models, was evaluated with the reduced fitness concept. it was, then, possible to quantify the reduction in functional fitness of the two networks under the progressive inhibition of the same enzymatic activity. overall, this in silico analysis provided a selectivity ranking that was in line with numerous in vivo and in vitro observations.  genome-scale models can be useful to depict and quantify the effects of enzymatic inhibitions on the impaired production of biomass components. from the perspective of a host-pathogen metabolic interaction, an estimation of the drug targets-induced consequences can be beneficial for the development of a selective anti-parasitic drug. plasmodium falciparumhuman hepatocytedrug targetsdrug selectivitygenome-scale networksreduced fitnessflux balance analysis 