Synthesis and characterization of thermosensitive 2-hydroxypropyl-trimethylammonium chitin and its antibacterial sponge for noncompressible hemostasis and tissue regeneration.

Noncompressible hemorrhage is a leading cause of preventable death in battlefield/civilian trauma. The development of novel injectable and biodegradable hemostatic sponges, with rapid shape recovery and excellent antibacterial activity that can control hemorrhage in noncompressible bleeding sites and promote in situ tissue regeneration is still urgently needed. In this study, thermo/pH sensitive 2-hydroxypropyl-trimethylammonium chitins (QCHs) with low degree of quaternization substitution (DS: 0.07-0.23) and high degree of acetylation (DA: 0.91-0.94) were synthesized homogeneously for the first time. Their chemical compositions including DS and DA were characterized accurately by proton NMR for the first time. High strength QCH based sponges with good water/blood absorbency, rapid shape recovery and good antibacterial activity were prepared without using any crosslinkers but only due to their thermosensitive property, since they are soluble at low temperature but insoluble at high temperature. Compared with commercial products, the QCH sponges with cationic groups had the stronger pro-coagulant ability, better hemostatic effect in normal/heparinized liver perforation and femoral artery models in rats and porcine subclavian arteriovenous resection model. Moreover, the porous structure and biodegradability of the QCH sponges could promote in situ tissue regeneration. Overall, the QCH sponges show great clinical translational potential for noncompressible hemorrhage and tissue regeneration.