1. Introduction
Nowadays, studying cell biology requires multiple procedures, chemicals, and imaging equipment for retrieving essential information on cell biology and biochemistry. Imaging methods range from complexity and cost depending on their ability to recover specific data [
1,
2]. For example, light microscopy is widely used. Still, it only shows a low-resolution 2D perspective of cells and microorganisms. On the other hand, electron microscopies (i.e., scanning electron microscopy, SEM) render a more detailed view of the cell morphology [
3,
4]. However, this technique requires sample fixation and a conductive cover for imaging and is not suitable for analyzing living cells [
3].
Furthermore, confocal microscopy allows the distinction of cell organelles through fluorescent marker staining [
1]. However, fluorescent molecules can cause a certain degree of phototoxicity, photobleaching, and intervention in cell mechanisms due to fluorescent markers aggregation, not to mention their high-cost [
5,
6]. New developments in imaging techniques are required in biological sciences to access precious information without requiring complicated sample preparation procedures or reagents that can alter different ranges of cell biology [
7].
Techniques such as holotomography (HT) rely on the interaction of light with different media within cells. HT (also known as Optical Diffraction Tomography, ODT) is a versatile alternative for cell imaging that overcomes the disadvantages that the techniques mentioned above have [
3]. HT pieces of equipment make use of refractive index (RI) for cell investigation at fast analysis rates [
3], including the possibility of adopting other techniques such as fluorescence for more precise identification of the molecular composition present in the cells [
7,
8]. Besides the visualization of cells in 3D, HT microscopy analysis allow the measurement of data like dry mass, sphericity, lipid content, protein content, and organelle identification [
9]. HT microscopy and AFM are complementary techniques since the first focuses on internal visualizing cell characteristics, whereas the second conducts high-resolution surface analysis.
Atomic force microscopy can be an accompanying technique to study cell morphology and mechanical properties [
10]. Recent AFM microscopes have had significant modifications and advancements for their use in biological research [
11]. Nowadays, AFM performs diverse analyses such as topographical imaging of cells, bacteria, and fungi, measurement of the mechanical and functional properties, recognition of molecules in organisms' structures, manipulation of cells, and imaging of dynamic biological processes [
11,
12]. Combining data generated by HT (3D and internal view of cells) and AFM (high-resolution surface analysis, mechanical properties) is essential for developing fields like cell pathology, cancer research, microbiology, nanotoxicology, and many others. Thus, this review briefly describes these techniques and recent works related to cancer, microbiology, and nanotoxicology using AFM and HT.
2. Holotomography Principle
The principles of holotomography are based on the developments achieved in quantitative phase microscopy, where multiple imaging techniques such as microscopy, holography, and light scattering are combined. A more detailed review of the physical principles of microscopy of the quantitative phase has already been carried out by Park et al., 2018 [
13]. In this way, this work will focus on the fundamental aspects of the equipment's operation and its most recent applications in areas such as cancer research, microbiology ,and nanotoxicology.
In the last years, optical microscopy surpassed the diffraction limit of light, resulting in super-resolution fluorescence microscopy. Because of the super-resolution of this technique, some authors call it nanoscopy. The use of fluorescence nanoscopy (FN) helped researchers discover the structural details of subdiffraction cellular architectures [
14]. Furthermore, by multi-batch labeling, researchers can monitor the dynamic changes of cells and exogenous agents due to their interaction. Super-resolution imaging has become a non-invasive method for nanoparticle biodistribution assessment with applications for understanding and optimizing nanomedicine performance [
15,
16]. Nowadays, FN provides a graphic description of the complex interactions of nanomaterials and cells, helping researchers with a more rational design of nanomaterials for biomedical applications. However, Confocal fluorescence microscopy has limitations for application in living cells. Within the protocol of this technique, there is the need to use fluorescent markers, which results in cell damage [[
5,
6].
Recently, HT has emerged as a powerful label-free three-dimensional (3D) technique for imaging cell components without requiring cell staining and label-free NPs inside cells [
17].Modern HT microscopes offer advantages like no label requirements, low phototoxicity, quick analysis, acquisition of quantitative data such as refractive index, dry mass, and protein content [
18], which in most samples, the protein concentration is linearly proportional with RI values [
19,
20]. HT analysis permits the distinction of organelles without the necessity of fluorescent markers. Analysis of the expression of biomolecules present in organisms still requires labels if the organisms do not possess fluorescent nature.
Figure 1 illustrates the main features of HT microscopy.
Measuring the differences in the RI of cell components in living organisms to construct a 3D image of the cell is a complex task due to the light refraction in media with different refractive indexes, causing multiple light scattering effects. As a laser passes through a cell, the soft wavefront acquires distortion or phase information that can be converted into intensity [
1], a feature that can be further measured and converted into qualitative data. For a 3D view of the cell, the microscope acquires multiple 2D holograms at various angles for image reconstruction [
1]. HT microscopy reconstructs the phase difference image of cells and provides the 3D RI and volume information of living and fixed cells. Because the RI value is proportional to molecular density is used for imaging cells (whole cells or intracellular organelles) and determining the molecular density of each organelle. For example, some applications of ODT include the classification of leukocytes, sperms, and red blood cells. It is also a valuable tool for investigating pathological characteristics of diverse cells [
2]. It is also a powerful technique to monitor cell changes after exposure to different agents (chemicals, microorganisms, nanomaterials); for example, a recent study reports observing the morphological changes during apoptosis of C6 rat glial cells after exposure to methamphetamine hydrochloride [
3]. This microscopy technique is complementary due to limitations on molecular-related information and the uncertainties of the structural reliability of organelles expressed only by RI.
As previously stated, many organelles possess different ranges of RI, permitting their identification by HT. However, digital organelle staining requires selecting a range of RI so that knowing the refractive index values of various organelles is necessary for correct identification and digital coloring [
4].
Table 1 presents a brief list of typical cell organelles and their RI values based on the literature. As can be noticed from
Figure 2, which includes the refractive indexes of cell organelles, many share RI values, so care must be taken when processing data to avoid confusing elements that can have similar RI values. HT microscopy limitations rely upon low molecular specificity due to shared RI values among several proteins [
1].
Nowadays, HT microscopes are commercially available. HT microscopes differ in design, although modern equipment uses low energy wavelength for measurements, reducing its phototoxicity [
9,
10].
Figure 3a illustrates a basic structure of an HT microscope. A low-energy laser splits into two beams, one serves as a reference pattern, and the second interacts with the sample. The interference between the two beams is then used to construct a hologram [
11]. The construction of a 3D hologram requires multiple analyses at different angles. Depending on the equipment, one can find different approaches to obtain multiple points of view in the samples (by using a moving mirror that deflects the laser in several spots to construct the image or by using a digital micromirror device) [
12,
13].
Figure 3b shows a cell undergoing sequential angle scanning by HTM. HTM generates a refractive index (RI) distribution by putting together the RI range of images acquired from 201 sequential angles scanned from two-dimensional holograms [
14].
As an emerging technique, HT microscopy (also known as quantitative phase imaging, QPI) faces numerous challenges to becoming a routine technique for biomedical research. For example, there is the unavailability of a standard protocol to improve image acquisition [
15] , a lack of accuracy in 3D RI image reconstruction, limitations for imaging thick biological specimens [
16,
17] , and the need for standardized 3D QPI metrology. Researchers in the field; work on developing techniques to differentiate specific organelles in a cell and to distinguish single cells from neighboring cells. Modern HT equipment includes software for 3D image processing; however, its algorithm can not discriminate precisely among the different cell organelles. Currently, researchers explore diverse strategies to provide a robust and general method to precisely and accurately segment cells during 3D reconstruction. Among these strategies are; computational models (machine learning techniques) [
18,
19], the use of non-toxic RI matching media (iodixanol) [
17], noise suppression techniques [
20], and the standardization of image assessment metrics [
21].
Thanks to holotomography, many cells and organisms can be analyzed in great detail in record time due to its ease of preparation compared to techniques that need staining, which can take hours to prepare. Besides, the HT microscope can be operated under different conditions a characteristic that allows for the analysis of living cells (adherent or suspended), or living cells interacting with exogeneous agents (
Figure 4). Manipulation of the HT microscope is simpler than other electronic microscopes and its price is lower. HT microscopy offers numerous advantages to advance live cell imaging: a) high resolution (nanoscale), b) label-free, c) real-time, d) quantitative phase imaging, e) fluorescence.
Figure 4 shows examples of HT images of different kind of cells or organisms.
The versatility of HTM allows the combination of the microscope with other analytical techniques to increase the capabilities of this technique. A recent study by Ryu et al., 2021, reports on combining a microfluidic device and HT microscopy for red blood cell histopathological analysis. The microfluidic device was attached to the HT microscope to obtain biochemical (hemoglobin content) and morphological properties (corpuscular volume) [
22].It is also possible to couple the HT microscope with mass spectrometry for a more precise location and identification of organelles' composition. Using live single-cell mass spectrometry coupled to HT microscopy renders an improved 3D spatial resolution (X-Y-axis 0.18 µm and Z-axis 0.33 µm) and more accurate quantitative cell analysis [
23].As previously stated aquiring molecular specificity by HTM is still a challenge. A late study reports the construction of a computational mid-infrared photothermal microscope, which is able to obtain infrared spectra and bond-selective 3D refractive index maps [
24].
As an emerging technique, HT still faces challenges for reproducibility with data generated across research groups. To alleviate this problem, researchers must establish standard protocols for sample preparation and libraries with data regarding the RI values of organelles within different cell lines. Moreover, recent studies discuss that cell fixation can alter the refractive index of cells and cellular compartments, reducing the accuracy and reproducibility of HT morphology analysis [
25]. Despite the current practical limitations of the HT technique, as outlined above, the growth ability of HT depends on the user´s needs and technological advances. In this regard, the latest HT microscopes are suitable for analyzing organoids or tick specimens [
26]. We want to remark that HT microscopy is a versatile technique to image and analyze the dynamics of biological events because of its label-free and quantitative imaging capabilities. Among optical cell nanoscopy techniques, the advantages of HT are its non-invasive nature, simplicity, and fast acquisition times. HT renders images with high precision and high resolution (differences in the refractive index within the cell give the contrast for imaging different organelles). HT provides a 4D examination of living cells under varying conditions (external stimuli or exogeneous agents –drugs, toxins, nanomaterials-) [
27,
28].
3. Atomic Force Microscopy Principle and Imaging Modes
AFM has become one of the most versatile techniques for analyzing samples with many surface characteristics. Its main principle relies on deflecting a cantilever caused by the interacting forces between a tip attached to it and the sample. In most AFM, a laser is reflected on the cantilever surface to detect the cantilever deflections and know its position along the z-axis [
29], as shown in
Figure 5.
AFM has multiple image modes that adapt to different characteristics of the sample and allow obtaining diverse types of information based on the properties of the specimen and the AFM mode of operation [
30]. In the beginning, AFM was not attractive to conduct research in the biological field due to the complex nature of the technique (setup, alignment, and adjustment of system parameters were cumbersome). Also, there were the limitations of the low Spatio-temporal resolution, mode of operation, and small scan area of the AFM types of equipment. The first commercial AFM microscopes operated under contact mode. Under these operation conditions, it becomes difficult the analysis of heterogeneous surfaces or soft samples. Numerous technological advances allow the implementation of different types of interaction of the AFM probe with the analytes, broadening the applications of this technique.
Modern AFM types of equipment operate under different modes offering researchers multiple possibilities for analysis. As previously mentioned, the contact mode was the pioneering form of operation in AFM however, this way of interaction between the probe and the sample is not ideal in biomedical research. We refer the reader to a review by [
31] that exhaustively describes the breakthrough discoveries that position AFM as a valuable tool for life sciences and bio-medical research. Applications of AFM in the biomedical field increased with the development of tapping mode since the analysis of soft samples using intermitted contact (tapping mode) minimizes sample deformation. There are numerous examples of AFM application in the tapping mode to study microorganisms, tissues, or cells [
32,
33,
34,
35]. There are also examples of AFM sudies regarding the interaction of antimicrobial agents and microorganisms [
36].
Our research group is interested in establishing AFM as a routine technique to study the bio-interactions of nanomaterials with different cell lines and microorganisms [
36,
37,
38,
39]. Our results demonstrate the high resolution of AFM to elucidate the morphology and morphology changes of cells (or microorganisms) due to the interaction with nanomaterials. However, since AFM is a microscopy technique for high-resolution surface images, the AFM data does not demonstrate the entry of NMs in cells (or microorganisms).
Figure 6 depicts AFM images of cells or microorganisms before and after treatment with NMs.
Figure 6A (A549 cells control group) and
Figure 6A1 (A549 cells treated with Au NMs) illustrate the changes in the morphology of the cells resulting from cell-NMs interaction.
Figure 6B and
Figure 6B1 show the damage exerted by CuFe
2O
4 NMs in Staphylococcus Aureus. White arrows indicate the presence of NMs in the bacterial cells.
Figure 6C and
Figure 6C1 show the effects of the interaction of ZnO-Al
3+ NMs and SHSY-5Y cells. The control group (
Figure 6C) presents a typical morphology and connections with neighboring cells; on the contrary, treated cells (
Figure 6C1) exhibit changes in the morphology and damaged neighboring cell connections (white arrows).
In the past decade, the AFM has emerged as a powerful tool for acquiring structural and mechanical properties of biological samples at the atomic level [
40]. Nowadays, it is possible to use different strategies (tip shape, tip functionalization, tip-sample interaction) to apply and measure a broad range of forces (within the cell, chemical, biological, or electrostatic interactions) from pico to nano Newtons; these measurements provide invaluable insights into how molecular recognition or biomolecular interactions contribute to the regulation of biological systems [
41]. Besides, coated cantilevers (conductive or magnetic coating) are suitable to measure electrostatic or magnetic forces and image electrical (local surface capacitance, local conductance, surface charge distribution) or magnetic (magnetic domains) properties of the sample .
With the advent of tapping mode, AFM became a dynamic tool to acquire the structural (micro or nanoscale) details and mechanical properties of cells or biomolecules (
Figure 7). Numerous developments aid the complexity of AFM biological applications; for example, by modification of the AFM tip, it is possible to measure different surface properties, such as adhesion forces, friction, viscoelastic properties, mechanical properties (Young modulus) or electrostatic and magnetic properties (
Figure 7B). It is also possible to attach the tip to a microelectrode (conductive tips) to combine tapping mode with a different scanning probe microscopy (SPM) technique to study at once distinct surface properties (i.e., structural and electrochemical imaging) (
Figure 7C). Using this hybrid technique allow researchers to relate topography with conductivity maps, reveal the presence of specific molecules on the cell's surface, or monitor its metabolic rate. The combination of scanning electrochemical microscopy (SECM) with AFM in tapping mode (SECM-AFM) allows the investigation of the activity of numerous molecules. Furthermore, AFM microscopy provides endles possibilities for tip functionalization (molecules, viruses, cells) to react selectively with a target molecule (receptor) to investigate specific biomolecular interactions.
Despite the numerous advantages of AFM imaging, acquisition time was an obstacle to study biochemical or conformational changes of biomolecules in real-time. HS-AFM notably increases the image acquisition speed becoming suitable for studying biological processes in real-time and analyzing the dynamics of cellular processes [
42]. One limitation of HS-AFM is the scanning area; however, during the last decade, the advances in electronics, cantilever and piezoelectric scanner design, allow to extend the available scan range (in air and in liquids). A recent study, remarks the importance on the innovations of modern AFM equipments, that operate at high speed, are stable in liquids, with large field of view and image with high spatial and temporal resolution. These characteristisc allow for imaging at high-speed under physiological environments to investigate and record the activity (dynamics) of different biomolecules (i.e., mithocondrial DNA replication) or live cells in real-time and at the single-molecule or single-cell level [
43].
The possibility of AFM imaging in liquids allows the study of living cells under different conditions. The capability of AFM to image and interact with the surfaces of living cells or tissues under physiological conditions gives researchers endless possibilities to develop new methodologies for more realistic and accurate biomedical applications [
44]. Initially, researchers used a liquid cell for AFM imaging in a confined physiological environment. Unfortunately, the volume of the liquid cell is an obstacle for many AFM biological applications since many biomolecules become diluted [
45]. Later, by combining microfluidics technology and redesigning cantilever and cell liquid chambers, Fluid AFM imaging improved considerably.
The fabrication of hollow cantilevers, whose design is application-dependent, made possible the fluid force-controlled manipulation of single cells (Fluidic Force Microscopy -FluidFM-). Numerous biological processes can be investigated at the single-cell level using FluidFM [
46]. For example, cell adhesion is essential for several functions of microbial (biofilm formation, survival, pathogenesis) and mammalian (embryonic development, tissue morphogenesis, inflammation) cells. FluidFM enables the quantification of living cell adhesion forces in a physiological environment. Recent reviews highlight the biological applications of the FluidFM technique.
Traditional AFM cannot discriminate the materials composition of the sampled surface unless several properties like elasticity, electronic and magnetic properties are studied [
47]. With the coupling of infrared spectroscopy, AFM opened doors for specific molecular analysis along the surface. When irradiated with light, the sample suffers thermal expansion that the tip can measure, relating the tip response with the excitation wavelength IR patterns can be obtained for acquiring chemical structural information [
47].
AFM-IR nano spectroscopy is a sensitive technique that allows direct visualization of the drug loading of single biomolecule carriers, aiding in optimizing the protocol of biomolecule drug loading. Hanke et al. successfully applied AFM-IR to investigate the loading of DNA origami nanostructures with the photosensitizer methylene blue. AFM-IR finds application to study molecular changes in living bacteria .A recent review describes the application of AFM-Ir for drug delivery systems (polymer-based, lipid-contained, and metal-based) characterization. For more information regarding the recent technological AFM-IR developmente, the reader is reffered to [
48].
AFM is nowadays a robust and multifunctional technique for manipulating and detecting bio-interactions at nanometer resolution. However, as previously discussed (AFM-IR), AFM cannot provide information regarding chemical composition or internal structures. To solve these limitations, AFM can be combined with other microscopy techniques. For example, super-resolution optical microscopy can simultaneously identify several cell components (or exogenous agents) and visualize inside the cell. Advanced AFM equipment for life sciences combines optical and AMF techniques to avoid the inherent limitations of single microscopy techniques. Utilizing correlative data facilitates understanding the complex relationship between structure, composition, and function by picturing functional information in the contact of structural and compositional details in biological research [
49]. For more information on the advances in correlative AFM and optical microscopy, we refer the reader to[
50,
51,
52].
Different AFM types of equipment exist nowadays commercially. Of utmost importance is that these pieces of equipment are user-friendly since they can operate under automated conditions (setup, alignment, and re-adjustment of system parameters). Furthermore, these microscopes offer a high Spatio-temporal resolution, large scan area, and fast scanning of corrugated samples becoming, very attractive for biomedical applications. AFM is not just an imaging technique; it also allows the determination of the analytes' different nano-mechanical properties (stiffness, elasticity, dissipation, viscoelastic properties, hardness, among others). Latest generation microscopes can also operate under numerous conditions (temperature, air, in fluids). Data analysis is simple, accurate, and versatile (it is even possible to overlay AFM data with data generated with another advanced optical microscopy). For example, the combination of confocal microscopy and AFM indentation allowed the study of cell mechanics in 3D environments, demonstrating the change in the mechanical properties of metastatic cancer cells during invasion into collagen I matrices [
53].
5. Conclusions and Prospects.
This review highlights the versatility of AFM and HT microscopy as valuable tools in biomedical research that provide real-time, label-free, and high-resolution images of living cells under different conditions. AFM and HT can generate data not just on the morphology of the cells but also on mechanical, magnetic, electrochemical properties, or dry mass composition. Recent studies remark on the advantages of using these techniques in biomedical-related fields. AFM microscopy offers plenty of alternatives for the multiparametric and multifunctional characterization of biological systems with improved performance: fast scanning, fast force spectroscopy analysis, sub-piconewton force precision, thermal stability, ultra-low noise, and user-friendly for researchers at all levels of experience. The integration of AFM with another microscopy (inverted optical microscope) or spectroscopy techniques (Raman, IR) produces correlated measurements that offer a more comprehensive understanding (dynamics, structural, mechanical, chemical, and functional heterogeneity) of complex biological systems. Latest developments allow coupling AFM microscope to a picobalance to monitor time-dependent mass measurements in physiological conditions. Modern complex AFM systems ( AFM-picobalance-inverted optical microscope) compute data to link cell mass dynamics to cell morphology and growth with application in the study of a vast number of cellular processes: Cell mass or volume regulation, cell migration, cell nutrition, cell division, cell cycle progression, fat cell storage, viral infection-related mechanisms, and new therapies for cancer, among others. HT microscopy imaging is appropriate for distinguishing neoplastic changes with sub-cell determination in vivo as a non-invasive technique (without the requirement for biopsy). HT microscopy is a simple and robust strategy for the diagnosis, monitoring, and elucidation of the mechanisms of disease development. It is also suitable for research studies in cytotoxicity (phenotypic screening of living cells, cell responses to drug interaction, dose-dependent cell death), and cell metabolism. AFM and HT microscopy as standard strategies in biological or biomedical research enables researchers to obtain more precise information about cells, organelles, and their interactions with exogenous agents. This knowledge is crucial to addressing challenging burdens in biomedical research and drug discovery.