Cell health assays measure various cellular processes to provide insight into how and why cells proliferate or die. These are primary tools to assess the cytotoxicity of drug candidates or other compounds, analyze cellular parameters in various diseases including cancer, and study basic cellular processes.
The selection of a specific cell health assay depends on the parameters that need to be measured, the required sensitivity, the throughput, and the model system. Three main classes of cell health assays can be distinguished:
- viability assays that detect the number of living cells
- cytotoxicity assays that detect the number of dead cells
- apoptosis assays that evaluate the mechanism of cell death
Depending on the required sensitivity, the throughput, and the model system, various assay formats, signal detection techniques, and devices can be used, including:
- Fluorescence, luminescence, or colorimetric assays compatible with multi-mode microplate readers
- Stain-free or fluorescence intensity microscopy imaging for cell counting
- Cell labeling with specific live/dead cell dyes and apoptotic markers for flow cytometry
Cell viability
Cell viability assays measure the relative number of live cells in cell populations, in response to a drug or other perturbation, by involving different experimental techniques depending on the required sensitivity, the throughput, and the model system. Viability assays can be multiplexed with toxicity and cell death assays to provide additional information regarding the relative number of dead cells and type of cell death. We offer assays suited for a broad range of applications that are based on bioluminescent, fluorometric, or colorimetric readouts. Endpoint assays provide sensitive, high-throughput formats, whereas real-time, live-cell assays repeatedly monitor over time and generate multiple data points from a single assay.

The essential cell viability assays are summarised in the table below:
CellTiter-Glo™ | CellTiter-Fluor | RealTime-Glo™ MT | Calcein AM | XTT | |
Working principle | Highly sensitive firefly luciferase substrate that reacts with ATP to generate a luminescent signal. | Peptide substrate (Gly-Phe-AFC) enters intact cells, where it is cleaved by the live-cell protease activity to generate a fluorescent signal proportional to the number of living cells. | The assay measures the reducing potential of viable cells, and is ATP-independent, providing an orthogonal method for viability or cytotoxicity determination. | Calcein AM is a lipophilic compound that readily enters cells through the plasma membrane, where it is hydrolyzed by esterases in the cytoplasm to release the polar, green-fluorescent calcein dye. | Reduction of a yellow tetrazolium salt called XTT (2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide). |
What is detected | ATP | protease activity | reductases activity | cytoplasmic esterases acitivity | mitochondrial dehydrogenases activity |
Signal type | luminescence | fluorescence | luminescence | fluorescence | colorimetric |
Platform | plate reader | plate reader / fluorescence microscopy | plate reader | fluorescence microscopy / flow cytometry | plate reader |
Sensitivity | 4/4 | 3/4 | 4/4 | 4/4 | 3/4 |
Throughput | high | high | high | medium | low |
Is cell lysis required ? | yes | no | no | no | no |
End-point / real time | end-point | real-time | real-time | end-point | end-point |
Multiplexing | yes | yes | yes | yes | yes |
Model system | adherent and suspension cell cultures |
In addition to the above most commonly used assays we also offer alternative approaches to suit specific experimental needs, contact us for more info.
Example output:


Cell toxicity
One of the main events that occur after cell death is the loss of membrane integrity, which allows chemicals or proteins to freely enter or exit the cell. Taking advantage of this phenomenon, we are able to evaluate the cytotoxicity of a given compound either by determining the exact number of dead cells stained with cell-impermeant fluorescent dyes or indirectly, by measuring the activity of enzymes that leak into the extracellular medium after cell membrane damage.
Membrane integrity dyes are cell-impermeant and only able to enter cells with a compromised plasma membrane. We use the nucleic acid-binding dyes (eg. DRAQ7, PI, 7-AAD, EthD-1, SYTOX) which are nonfluorescent in aqueous media but exhibit increased fluorescence upon binding to double-stranded DNA (dsDNA) or RNA. They allow for the fast and accurate evaluation of cytotoxicity and for multiplex experiments with other fluorescent dyes.

Enzyme leakage-based cytotoxicity assays detect extracellular glucose-6-phosphate dehydrogenase (G6PD), lactate dehydrogenase (LDH) or adenylate kinase (AK) released from damaged cells. Released enzymes activity can be quantified by a coupled enzymatic reaction in which provided substrates (lactate and NAD+, NADP+ or ADP) are converted to NADH, NADPH or ATP which further can be measured using different assay chemistries. The generated color, fluorescent or luminescent signal is proportional to the amount of ezyme present in analysed sample. There is no need for cell lysis so repeated samples of supernatant can be taken from wells over time without disrupting the cells themselves. This allows for kinetic analysis of cell death and multiplexing with other tests.
The essential cell toxicity assays are summarised in the table below:
LDH-Glo™ | CyQUANT™ LDH | CellTox™ | |
Working principle | LDH released from cells with damaged membrane is used for coupled reactions resulting in luciferin generation which is then converted by luciferase with luminescent signal emission. | LDH released from cells with damaged membrane is used for coupled reactions resulting in reduction of tetrazolium salts to insoluble formazan detected by colorimetry. | CellTox™ dye enters only cells with damaged cellular membrane. It gains fluorescent properties after complex formation with DNA. |
What is detected | LDH released from cells | LDH released from cells | Impaired membrane integrity (exposed DNA) |
Signal type | Luminescence | Colorimetric | Fluorescence |
Platform | Plate reader | Plate reader | Plate reader / fluorescence microscopy |
Sensitivity | 4/4 | 2/4 | 3/4 |
Throughput | Medium | Low | Medium |
Is cell lysis required? | no | no | no |
End-point / real time | Real-time | Real-time | Real-time |
Multiplexing | yes | yes | yes |
Model system | adherent and suspension cell cultures |
In addition to the above most commonly used assays we also offer alternative approaches to suit specific experimental needs, see more info.
Example output:

Cell death
Cell-death assays are crucial tools for drug discovery and development, providing insights into the mechanisms of programmed cell death and drug-induced cell death. By using these assays, researchers can assess the efficacy and safety of potential drug candidates, optimize drug dosages, and identify potential adverse effects.

There are several types of cell death, including apoptosis, necrosis, and autophagy. Discriminating between these different types of cell death is crucial for understanding their mechanisms and identifying potential therapeutic targets. Apoptosis is a programmed cell death pathway that is tightly regulated and involves caspase activation, while necrosis is an uncontrolled cell death pathway that is stimulated by external factors. Autophagy is a process of cellular recycling that can lead to cell death when its levels are excessive.
Understanding the type of cell death induced by a drug candidate is important for drug candidate profiling because different types of cell death have different mechanisms and implications for drug efficacy and safety.
The commonly used cell death assays are summarised in the table below:
RealTime-Glo™ Annexin V | CaspGLOW™ | DeadEnd™ TUNEL | CYTO-ID® | |
Working principle | Assay utilizes Annexin V-luciferase fusion protein that binds to phosphatidil serine exposed during early apoptosis. Additionally it detects membrane damage by DNA-binding fluorescent dye. | Assay utilizes specific caspase-3 inhibitor conjugated with FITC, which binds irreversibly allowing specific detection of apoptotic cells. | TUNEL detects DNA fragmentation by incorporation of fluorescein-12-dUTP at 3´-OH DNA ends by Terminal Deoxynucleotidyl Transferase. | Assay utilizes cationic amphiphilic tracer (CAT) that selectively enters pre-autophagosomes, autophagosomes, and autolysosomes. |
What is detected | phosphatidyl serine exposure and membrane integrity | caspase-3 activation | DNA fragmentation | autophagic vacuoles |
Signal type | luminescence + fluorescence | fluorescence | fluorescence | fluorescence |
Platform | plate reader | plate reader / fluorescence microscopy / flow cytometry | fluorescence microscopy / flow cytometry | fluorescence microscopy / flow cytometry |
Sensitivity | 4/4 | 4/4 | 3/4 | 3/4 |
Throughput | high | high | high | medium |
Is cell lysis required ? | no | no | no | no |
End-point / real time | Real time | End-point | End-point | End-point |
Multiplexing | yes | no | yes | yes |
Model system | adherent and suspension cell cultures |
In addition to the above assays we also offer alternative approaches to suit specific experimental needs, see more info.
Example output:

