CA2814784A1 - Soluble physiological chitosan formulations combined with platelet-rich plasma (prp) for tissue repair - Google Patents

Abstract

The present disclosure relates to an activated polymer composition for use in repairing tissue of a patient comprising platelet-rich plasma (PRP), a chitosan solution, a salt such as NaCI or glycerol phosphate, and an activator such as at least one of CaCI2 and a mixture of thrombin/CaCI2.

Description

SOLUBLE PHYSIOLOGICAL CHITOSAN FORMULATIONS COMBINED
WITH PLATELET-RICH PLASMA (PRP) FOR TISSUE REPAIR
TECHNICAL FIELD
[0001] The present invention relates to soluble physiological chitosan formulations combined with platelet-rich plasma (PRP) for tissue repair, which includes both thrombin and/or CaCl2 as clot activator and different mixing methods.
BACKGROUND ART

[0002] Chitosan is a linear polysaccharide composed of 13-(1-4)-linked D-glucosamine (deacetylated unit) and N-acetyl-D-glucosamine (acetylated unit), which primarily results from the alkaline deacetylation of chitin. Chitosan can exist in many structural conformations, depending on a variety of factors that include the degree of hydration, the electrolyte environment and the complexity of original chitin mixture. Chitosan and its amino-substituted derivatives are bioerodible, biocompatible and biodegradable cationic polymers that have been advanced for a wide variety of applications, including tissue engineering, drug and gene delivery, pharmaceutical formulation, scaffolds for cell growth and cell encapsulation, wound healing and surface hemostasis.

[0003] A well known property of chitosan is its solubility at acidic pH (<6) and insolubility at neutral pH, making its use in solution with living cells and tissues problematic. Various publications (Chenite, international patent application publication No. WO 99/07416; Chenite et al., 2000, Biomater., 21: 2155-2161;
Chenite et al., 2001, Carbohyd. Polym., 46: 39-47) describe that admixing a polyol-phosphate dibasic salt, i.e. glycerol-phosphate (GP), to an aqueous solution of chitosan can increase the pH of the solution while avoiding precipitation of the polymer. In the presence of these particular salts, chitosan solutions of substantial concentration (0.5-3%) and high molecular weight (>
several hundred kDa) remain liquid, at low or room temperature, for a long period of time with physiologically acceptable neutral pH region between 6.8 and 7.2. These chitosan-glycerol phosphate solutions which can gel upon mild heating (for example from 4 to 37 C), are biocompatible, biodegradable and adhesive to human tissues, provide for new opportunities in the delivery of sensitive therapeutics.

[0004]
Chitosan's properties allow it to rapidly clot blood, and have recently gained approval in the USA for use in bandages and other hemostatic agents.
The first step in the early wound healing process is hemostasis due to blood coagulation. One approach to improve healing is to stabilize the blood clot by dispersing a soluble biocompatible polymer throughout uncoagulated fresh blood, the polymer acting as a scaffold throughout the clot to maintain its volume and to increase clot adhesion to tissues at the lesion site (Iliescu et al., 2007, Microsc. Res. Tech., 71: 236-247). Chitosan-GP solutions are non-toxic and bioresorbable, in addition to permitting coagulation and impeding clot retraction. They are mixed with autologous blood to form viscous chitosan-GP/blood mixtures that solidified in about 10 minutes in part due to the thrombogenicity of chitosan (Hoemann et al., 2007, Osteoarthritis & Cartilage, 15: 78-89).

[0005]
Platelet-rich plasma (PRP) is a blood-derived product that concentrates a high number of platelets in a small volume of plasma. It has a substantial role in tissue regeneration and wound healing. In some applications, platelets have been used directly without being formulated. In other applications, a platelet gel (also known as a platelet clot) has been used that was prepared from PRP. The term "platelet gel" was introduced to describe the gelatin-like malleable product that results when thrombin and calcium are added to PRP. The addition of thrombin and calcium induces the cleaving fibrinogen to form fibrin which polymerizes, producing a glue-like gel. Platelets trapped in the gel are activated and release bioactive molecules. In most studies and clinical applications for tissue repair, a thrombin/calcium chloride solution was used to activate platelets to make PRP form a platelet gel. For example: PRP was clotted by adding a 10% thrombin solution (v/v, 1000 U/ml in 100 mM CaCl2) to yield a final thrombin concentration of 100 U/ml (Akeda et al., 2006, Osteoarthritis and Cartilage, 14: 1272-1280); 200 pl of PRP was treated with pl of sterile bovine thrombin prepared by mixing 25 pl of the enzyme (1000 U/ml) in 10 ml of CaCl2 under sterile conditions to obtain a clot (Ranly et al., 2007, J. Bone Joint Surg. Am., 89: 139-147). PRP has also been activated just before application with 10% calcium chloride solution and 5000 units of bovine thrombin to form a gel (You et al., 2007, Oral Surg. Med. Oral Oral Pathol.
Oral Radiol. Endo., 103: e8-e12).

[0006] In a few studies and clinical applications, only calcium was used to activate platelets to make PRP form a platelet gel (clot). For example: 10%
CaCl2 solution was added into PRP to activate platelets and the platelet gel formed after 10 to 15 minutes (Casati et al., 2007, Int. J. Oral Maxillofac.
Surg., 36: 132-136). Calcium chloride solutions with different concentration (5%, 10%, 25%, and 50%) have also been used alone to induce platelet activation, revealing that CaCl2 alone was suitable for triggering PRP activation, and that 5% calcium chloride solution was the most effective concentration in activating PRP to clot (Fedrico Luengo Gimeno et al., 2006, Thrombosis Journal, 4:18-25). PRP clots were also prepared by adding 0.5 ml of 10% calcium chloride to tubes and mixing with PRP. The mixture was then clotted with bone graft material graft (Human Freeze Dried Demineralized Cortical Bone) (Mendonca et al., 2006, Int. J. Oral Maxillofac. Surg., 35: 88-91). International patent application publication No. WO 96/23039 describes a novel type of hemostatic adhesive agents. These agents were prepared from PRP concentrate in combination with physiologically acceptable biocompatible polymers, which included alginates, poly-L-amino acids (poly-L lysine, poly-L-histidine and poly-a-D-glutamic acid), chitosan and chitin. In the presence of calcium ions, the combination of plasma concentrate with the polymers formed adhesives which had very strong adhesive properties and very rapid onset of these adhesive properties.

[0007] There is still a need for an improved polymer formulation with an improved solubility at physiological pH and ionic strength that can be mixed with PRP to form a hybrid polymer/PRP implant. There is a specific need for a hybrid polymer/PRP implant with good mechanical properties that can be obtained by a simple preparation method.

SUMMARY

[0008] In accordance with the present disclosure, there is now provided a clot activating polymer composition for use in repairing tissue of a patient comprising platelet-rich plasma (PRP), a chitosan, a salt and a clot activator.

[0009]
According to a first aspect, the present application provides a clot-activated polymer composition comprising platelet-rich plasma (PRP), a chitosan, a salt and a clot activator. In an embodiment, the salt may be an organic or inorganic salt. In an embodiment, the inorganic salt is sodium salt, chloride salt, potassium salt, calcium salt, magnesium salt, phosphate salt, sulfate salt and/or carboxylate salt. In another embodiment, the inorganic salt is at least one of NaCI, KCI, CsCI, CaCl2, CsF, KCIO4 NaNO3 and/or CaSO4. In another embodiment, the organic salt is glycerol-phosphate (such as 8GP). In a further embodiment, the clot activator is a CaCl2 solution (having, for example, a concentration equal to or higher than about 1.0 A w/w and equal to or lower than about 25% w/w or equal to or higher than about 1.3 % w/w and equal to or lower than about 3%) that can be optionally combined with thrombin. In still another embodiment, the polymer can prepared by combining said PRP to a chitosan solution comprising said chitosan and said salt at a volume ratio of equal to or lower than about 3:1 or about 2:1 v/v. In still another embodiment, the polymer can prepared by combining said PRP to a chitosan solution comprising said chitosan and said salt at a volume ratio equal to or lower than 4:1 and equal to or lower than 1:1. In an embodiment, the polymer composition has a pH equal to or higher than about 6.2 and equal to or lower than about 6.8.
In still another embodiment, the polymer is prepared with a solution of said chitosan having an osmolality equal to or higher than about 250 mOsm/kg and equal to or lower than about 600 mOsm/kg or an osmolality equal to or higher than about 342 mOsm/kg and equal to or lower than about 361 mOsm/kg. In an embodiment, the polymer is prepared with a solution of said chitosan having a chitosan concentration of equal to or higher than about 1.0% w/w and equal to or lower than about 10% w/w or a chitosan concentration is equal to or higher than about 1.62% w/w and equal to and lower than about 2% w/w. In another embodiment, the chitosan has a degree of deacetylation (DDA) equal to or higher than about 20% and equal to or lower than about 100% (such as, for example, about 76% or about 81%). In another embodiment, the chitosan has a number average molecular weight (Mn) equal to or higher than about 1 kDa and equal to or lower than about 10 MDa (such as, for example, about 232 kDa or about 298 kDa). In still another embodiment, the polymer further comprises a mineral acid or an organic acid, including, but not limited to hydrochloric acid, acetic acid, nitric acid, phosphoric acid, sulfuric acid, boric acid hydrofluoric acid and/or hydrobromic acid.

[0010]
According to a second aspect, the present application provides a clot-activated polymer composition prepared by combining platelet-rich plasma (PRP), a chitosan solution, a salt solution and a clot activator solution. In this polymer composition, the concentration of chitosan in said chitosan solution is equal to or higher than about 1.0% w/w and equal to or lower than about 10%
w/w, and the volume ratio between the PRP and the chitosan solution is between about 4:1 to about 1:1. In an embodiment, the polymer composition can also be obtained by combining a mineral acid or an organic acid (such as, for example, mineral acid is hydrochloric acid, acetic acid, nitric acid, phosphoric acid, sulfuric acid, boric acid hydrofluoric acid and/or hydrobromic acid). In a further embodiment, the salt solution comprises an inorganic salt, including, but not limited to sodium salt, chloride salt, potassium salt, calcium salt, magnesium salt, phosphate salt, sulfate salt and/or carboxylate salt (such as, for example, NaCI, KCI, CsCI, CaCl2, CsF, KCI04, NaNO3 and/or CaSO4). In another embodiment, the salt solution comprises an organic salt, such as, for example, glycerol-phosphate (or 13GP). In still another embodiment, the clot activator solution comprises thrombin at a concentration from about 100U/m1 to about 1000 U/ml diluted in a 10% w/w of a CaCl2 solution. In another embodiment, the clot activator is a CaCl2 solution optionally combined with thrombin. In another embodiment, the volume ratio between a first solution comprising the PRP, the chitosan solution and the salt and a second solution comprising the clot activator is equal to or lower than about 10:1,or about 9:1. In another embodiment, the concentration of CaCl2 in the CaCl2 solution is equal to or higher than about 1.0 % w/w and equal to or lower than about 25% w/w or equal to or higher than about 1.3 % w/w and equal to or lower than about 3%
w/w. In still another embodiment, the volume ratio of between the PRP and the chitosan solution is equal to or lower than about 3:1, about 2:1. In still another embodiment, the polymer composition has a pH equal to or higher than about 6.2 and equal to or lower than about 6.8. In a further embodiment, the chitosan solution has an osmolality equal to or higher than about 250 mOsm/kg and equal to or lower about 600 mOsm/kg or equal to or higher than about 342 mOsm/kg and equal to or lower than about 361 mOsm/kg. In still another embodiment, the concentration of chitosan in said chitosan solution is equal to or higher than about 1.62% w/w and equal to or lower than about 2% w/w. In still another embodiment, the chitosan of said chitosan solution has a degree of deacetylation (DDA) equal to or higher than about 20% and equal to or lower than about 100% (such as, for example, about 76% or about 81%). In still a further embodiment, the chitosan of the chitosan solution has a number average molecular weight (Mn) equal to or higher than about 1 kDa and equal to or lower than about 10 MDa (such as, for example, about 232 kDa or about 298 kDa).

[0011] In a third aspect, the present application provides a method for repairing a tissue of a patient, said method comprising the step of introducing into said tissue a clot-activated polymer composition as defined herein such that the composition adheres to the tissue and promotes cell proliferation for repairing the tissue. In an embodiment, the tissue is cartilage, meniscus, ligament, tendon, bone, skin, cornea, periodontal tissues, maxillofacial tissues, temporomandibular tissues, abscesses, resected tumors and/or ulcers.

[0012] In a fourth aspect, the present application provides use of a clot-activated polymer composition as defined herein for repairing a tissue of a subject, wherein the polymer composition adheres to the tissue and promotes cell proliferation as well as the use of a clot-activated polymer composition as defined herein in the manufacture of a medicament for repairing a tissue of a subject, wherein the polymer composition adheres to the tissue and promotes cell proliferation. In an embodiment, the tissue is cartilage, meniscus, ligament, tendon, bone, skin, cornea, periodontal tissues, maxillofacial tissues, temporomandibular tissues, abscesses, resected tumors and/or ulcers.

[0013] In a fifth aspect, the present application provides a method of preparing a clot-activated polymer composition for repairing tissue in a subject.
Broadly, the method comprises dissolving from 1.0% w/w to 10.0 /0 w/w of chitosan in HCI to provide a chitosan-HCI mixture, adding a NaCI solution or glycerol phosphate to the chitosan-HCI mixture to provide a chitosan-HCI-salt mixture, admixing platelet-rich plasma (PRP) to the chitosan-HCI-salt mixture at a volume ratio between about 4:1 and about 1:1 to provide a PRP/chitosan-HCI-salt mixture; and adding a clot activator to the PRP/chitosan-HCI-salt mixture at a volume ratio of between about 5:1 to about 10:1. In an embodiment, the clot activator is a CaCl2 solution optionally combined with thrombin. In another embodiment, in step a), wherein the chitosan is dissolved in HCI by heating at a temperature of about 60 C for about 2 hours. In still another embodiment, the chitosan is provided in a solution of about 1.62% w/w. In yet another embodiment, the chitosan has a degree of deacetylation (DDA) of about 76% or of about 81%. In yet another embodiment, the chitosan has a number average molecular weight (Mr) of about 232 kDa or of about 298 kDa. In yet a further embodiment, the hydrochloric acid is provided as a 38 mM solution or as a 71 mM solution. In an embodiment, the NaCI is provided as a 150 mM solution or as a 160 mM solution. In an embodiment, the 3-glycerol phosphate is provided as a 2.15 % w/w solution. In another embodiment, the concentration of CaCl2 in the CaCl2 solution is equal to or higher than about 1.0 % w/w and equal to or lower than about 25 % w/w. In yet another embodiment, the thrombin is provided as a solution of about 100 U/ml to about 1000 U/ml diluted with 10%
w/w of the CaCl2 solution. In still another embodiment, the clot activator is layered on top of the PRP/chitosan-HCI-salt mixture. In still another embodiment, the clot activator is gently mixed by inversion with the PRP/chitosan-HCI-salt mixture.

[0014]
Accordingly, it is provided a clot-activated polymer composition comprising platelet-rich plasma (PRP), a chitosan solution, a salt and a clot activator.

[0015] In an embodiment, the salt is an organic or inorganic salt. The inorganic salt can be sodium salt, chloride salt, potassium salt, calcium salt, magnesium salt, phosphate salt, sulfate salt or carboxylate salt.
Alternatively, the salt is at least one of NaCI. KCI, CsCI, CaCl2, CsF, KCIO4 NaNO3 or CaSO4.

Furthermore, the organic salt can be glycerol-phosphate.

[0016] In another embodiment, the activator is at least one of a CaCl2 solution or a mixture of thrombin/CaCl2.

[0017] In a further embodiment, the mix ratio of PRP/chitosan-salt and activator is at most 10:1, or at most 9:1 of a volume ratio.

[0018] In an additional embodiment, the concentration of the CaCl2 activator is between 1.0 % w/w to 25% w/w, alternatively between 1.3 % w/w to 3% w/w.

[0019] In another embodiment, the mix ratio of PRP:chitosan is from 4:1 to 1:1 v/v, alternatively 3:1, or 2:1 v/v.

[0020] In an additional embodiment, the composition has a pH between 6.2 and 6.8.

[0021] In another embodiment, the chitosan solution has an osmolality between 250 mOsm/kg and 600 mOsm/kg, alternatively between 342 mOsm/kg and 361 mOsm/kg.

[0022] In a further embodiment, the concentration of chitosan in the chitosan solution is between about 1.0% w/w to 10% w/w more particularly between about 1.62% w/w to 2% w/w.

[0023] In another embodiment, the chitosan of said chitosan solution has a degree of deacetylation (DDA) between 20% to 100%, more particularly of 76%
or 81%.

[0024] In another embodiment, the chitosan of the chitosan solution has a number average molecular weight (Mn) ranging from 1 kDa to 10 MDa, more particularly of 232 kDa or 298 kDa.

[0025] In a further embodiment, the composition described herein further comprises a mineral acid or an organic acid, such as for example hydrochloric acid, acetic acid, nitric acid, phosphoric acid, sulfuric acid, boric acid hydrofluoric acid or hydrobromic acid.

[0026] It is also provided herein a clot-activated polymer composition prepared by combining platelet-rich plasma (PRP), a chitosan solution, a salt and an activator; wherein the concentration of chitosan in the chitosan solution is between about 1.0% w/w to 10% w/w; and the PRP: chitosan ratio being 4:1 to 1:1 v/v.

[0027] In an embodiment, the activator is thrombin from 100U/m1 to 1000 U/ml diluted with 10% w/w of CaCl2.

[0028] It is also provided a method for repairing a tissue of a patient, the method comprising the step of introducing into the tissue a polymer composition as defined in herein such that the composition adheres to the tissue and promotes cell proliferation for repairing the tissue.

[0029] In an embodiment, the tissue can be cartilage, meniscus, ligament, tendon, bone, skin, cornea, periodontal tissues, maxillofacial tissues, temporomandibular tissues, abscesses, resected tumors and/or ulcers.

[0030] It is also provided herein the use of a polymer composition as defined herein for repairing a tissue of a subject, and/or in the manufacture of a medicament for repairing a tissue of a subject, wherein the polymer composition adheres to the tissue and promotes cell proliferation.

[0031] It is additionally provided herein a method of preparing a polymer composition for repairing tissue in a subject, the method comprising the step of dissolving from 1.0% w/w to 10.0% w/w of chitosan in NCI; adding a NaCI
solution or glycerol phosphate to the chitosan-HCI mixture; admixing platelet-rich plasma (PRP) to the chitosan-HCI-NaCI or chitosan-HCl-GP mixture in a ratio between 4:1 and 1:1 v/v; and adding an activator to the PRP/chitosan-HCI-NaCI or glycerol phosphate mixture in a ratio of at most from 5:1 to 10:1 v/v.

[0032] In an embodiment, the chitosan is dissolved in HCI by heating at 60 C
for about 2 hours.

[0033] In another embodiment, the composition comprises 1.62% w/w of chitosan with a degree of deacetylation (DDA) of 76% or 81% with a number average molecular weight (Mn) of 232 kDa or 298 kDa, 38 mM or 71 mM of hydrochloric acid, and 150 mM or 160 mM of NaCI, or 2.15 % w/w of 3-glycerol phosphate.

[0034] In a further embodiment, the activator is layered on top of the PRP/
chitosan-HCI-NaCI or chitosan-HCl-pGP mixture.

[0035] In another embodiment, the activator is gently mixed by inversion with the PRP/ chitosan-HCI-NaCI or chitosan-HCl-f3GP mixture.
BRIEF DESCRIPTION OF THE DRAWINGS

[0036] Reference will now be made to the accompanying drawings.

[0037] Fig. 1 is a histogram reflecting the coagulation time of PRP/chitosan clots-1 (PRP/chitosan-HCI-NaCI pH 6.6) prepared with thrombin/CaC12 activator by different mixing methods. Mixing method 1 was gentle inversion, mixing method 2 was drawing into a syringe without inversion and mixing method 3 was layering.

[0038] Fig. 2 is a histogram reflecting the coagulation time of PRP/chitosan clots-2 (PRP/chitosan-HCI-í3GP pH 6.6) prepared with thrombin/CaC12 activator by different mixing methods. Mixing method 1 was gentle inversion, mixing method 2 was drawing into a syringe without inversion and mixing method 3 was layering.

[0039] Fig. 3 is a histogram reflecting the mechanical strength of PRP/chitosan clots (PRP/chitosan-HCI-NaCI pH 6.6 or PRP/chitosan-HCI-pGP
pH 6.6) prepared with thrombin/CaCl2 activator by different mixing methods.
Mixing method 1 was gentle inversion, mixing method 2 was drawing into a syringe without inversion and mixing method 3 was layering.

[0040] Fig. 4 corresponds to photographic representations of PRP/chitosan clots in the glass tubes (A, C, E, G, I, K) and after removal from the tubes (B, D, F, H, J, L) wherein the sample numbers are: 1-1 (with NaCI, mixing method 1);
1-2 (with NaCI, mixing method 2); 1-3 (with NaCI, mixing method 3); 2-1 (with I3GP, mixing method 1); 2-2 (with I3GP, mixing method 2); 2-3 (with I3GP, mixing method 3).

[0041] Fig. 5 corresponds to photographic representations of runniness tests of non-activated PRP/chitosan mixtures to evaluate handling properties at different times after mixing (A: 30 seconds; B: 1 min.; C: 2 min.; D: 3 min.;
E: 5 min.; and F: 10 min.); wherein the sample numbers are from left to right: 1-1 (with NaCI, mix ratio: 3:1); 1-2 (with NaCI, mix ratio: 2:1); 2-1 (with I3GP, mix ratio: 3:1); 2-2 (with I3GP, mix ratio: 2:1); Control (pure PRP).

[0042] Fig. 6 is a histogram reflecting the coagulation time of non-activated PRP/chitosan mixtures (PRP/chitosan-HCI-NaCI pH 6.6 or PRP/chitosan-HCI-8GP pH 6.6) with different mix ratios.

[0043] Fig. 7 corresponds to photographic representations of non-activated PRP/chitosan clots with different mix ratios in the glass tubes (A, D, G, J), after removal from the tubes (B, E, H, K) and after mechanical strength test (C, F, I, L) wherein the sample numbers are: 1-1 (with NaCI, mix ratio 3:1); 1-2 (with NaCI, mix ratio 2:1); 2-1 (with I3GP, mix ratio 3:1); 2-2 (with I3GP, mix ratio 2:1).

[0044] Fig. 8 is a histogram reflecting the mechanical strength of non-activated PRP/chitosan clots wherein the sample numbers are: 1-1 (with NaCI, mix ratio: 3:1); 1-2 (with NaCI, mix ratio: 2:1); 2-1 (with I3GP, mix ratio:
3:1); 2-2 (with I3GP, mix ratio: 2:1).

[0045] Fig. 9 is a histogram reflecting the coagulation time of PRP/chitosan-HCI-NaCI pH 6.6 mixtures with different chitosan and CaCl2 concentrations and at different mix ratios wherein the sample numbers are: 1-1 (1.3% CaCl2, mix ratio 3:1, 1.62% chitosan); 1-2 (1.3% CaCl2, mix ratio 3:1, 2% chitosan); 1-3 (1.3% CaCl2, mix ratio 2:1, 1.62% chitosan); 1-4 (1.3% CaCl2, mix ratio 2:1, 2%
chitosan); 2-1 (3% CaCl2, mix ratio 3:1, 1.62% chitosan); 2-2 (3% CaCl2, mix ratio 3:1, 2% chitosan); 2-3 (3% CaCl2, mix ratio 2:1, 1.62% chitosan); 2-4 (3%
CaCl2, mix ratio 2:1, 2% chitosan).

[0046] Fig. 10 is a histogram reflecting the mechanical strength of PRP/chitosan-HCI-NaCI pH 6.6 clots with different chitosan and CaCl2 concentrations and at different mix ratios wherein the sample numbers are: 1-1 (1.3% CaCl2, mix ratio 3:1, 1.62% chitosan); 1-2 (1.3% CaCl2, mix ratio 3:1, 2%
chitosan); 1-3 (1.3% CaCl2, mix ratio 2:1, 1.62% chitosan); 1-4 (1.3% CaCl2, mix ratio 2:1, 2% chitosan); 2-1 (3% CaCl2, mix ratio 3:1, 1.62% chitosan); 2-2 (3%
CaCl2, mix ratio 3:1, 2% chitosan); 2-3 (3% CaCl2, mix ratio 2:1, 1.62%
chitosan); 2-4 (3% CaCl2, mix ratio 2:1, 2% chitosan).

[0047] Fig. 11 is a histogram reflecting coagulation time of PRP/chitosan-HCI-NaCI pH 6.6 or PRP/chitosan-HCI-13GP pH 6.6 clots activated by gentle inversion with CaCl2 (all clots are at 1.62% chitosan, mix ratio 3:1) wherein the sample numbers are: clot-1 (CH0100702B: Mn 232 kDa, 81% DDA); clot-2 (CH0050602A: Mn 298kDa, 76% DDA); control (pure PRP).

[0048] Fig. 12 is a histogram reflecting the mechanical strength of PRP/chitosan-HCI-NaCI pH 6.6 or PRP/chitosan-HCI-13GP pH 6.6 clots activated by gentle inversion with CaCl2 (all clots are at 1.62% chitosan, mix ratio 3:1) wherein the sample numbers are: clot-1 (CH0100702B: Mn 232 kDa, 81% DDA); clot-2 (CH0050602A: Mn 298 kDa, 76% DDA); control (pure PRP).

[0049] Fig. 13 corresponds to photographic representations of PRP/chitosan clots activated by gentle inversion with CaCl2 (all clots are at 1.62%
chitosan, mix ratio 3:1) in the glass tubes (A, D, G, J, M), after removal from the tubes (B, E, H, K, N) and after mechanical strength test (C, F, I, L, 0) wherein the sample numbers are: 1-1 (with NaCI; Mn 232 kDa, 81% DDA); 1-2 (with r3GP; Mn 232 kDa, 81% DDA); 2-1 (with NaCI; Mn 298 kDa, 76% DDA); 2-2 (with 13GP; Mn 298 kDa, 76% DDA); control (pure PRP).

[0050] Fig. 14 is a histogram reflecting liquid expressed by PRP/chitosan clots activated by gentle inversion with CaCl2 (all clots are at 1.62%
chitosan, mix ratio 3:1) wherein the sample numbers are: Clot-1 (CH0100702B: Mn 232 kDa, 81% DDA); Clot-2 (CH0050602A: Mn 298 kDa, 76% DDA); control (pure PRP).

DETAILED DESCRIPTION

[0051] Is now provided and disclosed herein a novel formulation of PRP/chitosan mixtures activated by a clot activator (such as CaCl2 and/or thrombin). Such formulations are useful for the facilitating tissue repair.

[0052] The clot-activated polymer compositions described herein are capable of allowing the formation of a platelet gel or clot. The other components of the polymer composition (such as chitosan, the salt and optionally the acid) allow the PRP to be activated with conventional methods using a clot activator (such as CaCl2 and/or thrombin) to form a platelet gel (or platelet clot). The clot-activated polymer compositions described herein are capable of allowing the formation of a paste-like or gel. For example, and as shown below, the PRP
included in the composition does enable the formation of a chitosan-based gel.

[0053] The clot-activated polymer compositions described herein comprise a PRP, a chitosan, a salt and a clot activator. In an embodiment, the clot-activated compositions described herein solely contain plasma rich in platelets as blood-derived products. In another embodiment, the PRP is autologous with respect to the recipient of the compositions, i.e. the PRP is obtained from the same individual who is going to receive the clot-activated polymer composition.
However, the PRP can also be allogeneic to the recipient, i.e. obtained from an individual that is immunologically distinct from the recipient of the clot-activated polymer composition but where the individual and the recipient are from the same species. In this embodiment, the PRP should be preferably matched (in part or in total) with at least one or several platelet antigens. In another embodiment, the PRP can also be xenogeneic to the recipient, i.e. obtained from an individual that is immunologically distinct from the recipient of the clot-activated polymer composition and where the individual and the recipient are not from the same species. In still a further embodiment, the PRP can be derived from a human source.

[0054] As used herein, the clot activator is an agent capable of inducing clotting of PRP and the formation of a platelet gel from a native PRP. Such clot

55 activators include, but are not limited to a CaCl2 solution and a combination of CaCl2 and thrombin.
[0055] In an embodiment, the clot-activated polymer consists essentially of a PRP, a chitosan, a salt and a clot activator. In this specific embodiment, other active agents which are participating to the formation of the gel or clot are not included. However, other components such as an acid (to facilitate the dissolution of the chitosan), preservatives or medicines can be included.

[0056] As defined herein as method 1, thrombin with the concentration of 1000 U/ml (thrombin was dissolved in 10% w/w CaCl2 solution) was used to activate the PRP/chitosan mixtures, and the mix ratio of PRP/chitosan mixture to thrombin/CaCl2 solution is 9:1 at volume ratio.

[0057] Another aspect identified as mixing method 1, is the formation of PRP/chitosan mixtures, where thrombin/CaCl2 was mixed into PRP/chitosan by times gentle inversion of the mixing tube containing stainless steel beads and then drawn into a syringe for placement in glass tubes for preparing clot (implant).

[0058] Still another aspect is to provide a novel method identified as mixing method 2 of formation of PRP/chitosan mixtures, where thrombin/CaCl2 was added to the PRP/chitosan without inversion and directly drawn into a syringe for placement in glass tubes for preparing clot (implant).

[0059] Still another aspect of the invention is to provide a novel formation of PRP/chitosan mixtures, which is prepared by mixing method 3 where the PRP/chitosan mixture was placed in glass tubes and then thrombin/CaCl2 solution, was layered on top of the PRP/chitosan in the tube for preparing clot (implant).

[0060] The mixing method 3 was the best mixing method for the thrombin/CaCl2 activator, resulting in the best clot properties, coagulating in a suitable time, no clot retraction, good mechanical properties and good homogeneity.

[0061] Still another aspect is to provide a novel formation of PRP/chitosan mixtures, which is prepared by syringe mixing method where the PRP/chitosan mixtures was mixed with the activator (thrombin/CaCl2 solution: 1000U/mL in 10`)/0(w/w) CaCl2 of initial) by using double syringe system, then transferred into glass tubes for preparing clot (implant).

[0062] Still another aspect is to provide a novel formation of thrombin free PRP/chitosan mixtures, which is prepared by just using CaCl2 solution with different concentration (from 1.0% w/w to 25% w/w) as activator and mixing method 3 where the PRP/chitosan mixture was placed in glass tubes and then just CaCl2 solution was layered on top of the PRP/chitosan for preparing clot (implant).

[0063] Still another aspect of the invention is to provide a novel formulation of thrombin free PRP/chitosan mixtures, which is prepared by just using CaCl2 solution with different concentration (from 1.0% w/w to 25% w/w) as activator, where CaCl2 was mixed into PRP/chitosan by 5 times gentle inversion of the mixing tube containing stainless steel beads and then drawn into a syringe for placement in glass tubes for preparing clot (implant).

[0064] Still another aspect is to provide a novel formation of thrombin free PRP/chitosan mixtures, which is prepared by just using CaCl2 solution with lower concentration (1.0% w/w to 5% w/w) as activator, and using chitosan solution with different concentrations (1.0% w/w to 10.0% w/w) mixed with PRP
at different mix ratios (PRP:chitosan is from 4:1 to 1:1 at volume ratio).

[0065] It is thus disclosed herein a novel formulation and/or method of preparing PRP/chitosan mixtures with thrombin, where the PRP/chitosan mixture was placed in glass tubes and then thrombin/CaCl2 solution was layered on top of the PRP/chitosan in the tube for preparing implant (shown in Example 1 from human blood). Platelet rich plasma (PRP) was isolated from freshly drawn citrate anticoagulated whole blood with two-step centrifugation (1300 rpm for 10 minutes and then 2000 rpm for 10 minutes). Chitosan (1.62%
w/w)-HCI (38 mM)-NaCI (160 mM) solution at pH of 6.54 and osmolality of 361 mOsm/kg, and chitosan (1.62% w/w)-HCI (71 mM)-8GP (2.15% w/w) solution at pH of 6.65 and osmolality of 342 mOsm/kg were mixed with PRP. 900 1,11 of platelet-rich plasma (PRP) was pipetted into cryotubes containing 300 .1 of a chitosan solution and three 0.39g stainless steel balls, mixed by hand for 10 seconds (shaken and reversed about 50 times vigorously). The mix ratio of PRP
to chitosan was 3:1 at volume ratio.

[0066] 300 jil was transferred into 3 glass tubes at 37 C by using 1 ml syringe. Immediately 30 I thrombin solution (1000U/m1) diluted with sterile 10%
(w/w) calcium chloride solution (mix ratio of PRP/chitosan to thrombin/CaCl2 is to 1) was added on the surface of PRP/chitosan mixture of each glass tube for preparing 3 clots (implants). Coagulation time test results showed PRP/chitosan-HCI-NaCI mixtures coagulated within 6 minutes and PRP/chitosan-HCI-13GP mixture formed clot within 8 minutes in the glass tube (see Table 2, Figs. 1 and 2). For both of them, almost no liquid was expressed and the clot didn't retract.

[0067] The PRP/chitosan clots made by this mixing method/activator combination were firm and elastic, the mechanical strength of the clots were ++++ (Table 3, Figs. 3 and 4). The homogeneity of the clots (Table 4) was better than the homogeneity of clots made by mixing method 2 (1 sample was " ", 1 was "2) and better than the homogeneity of clots made by mixing method 1 (both were "-"). Mixing method 3 resulted in the best clot properties, coagulated in a suitable time, with no clot retraction, good mechanical properties and good homogeneity. Similar results were also obtained from rabbit blood.

[0068] The current description also provides a novel formation of thrombin free PRP/chitosan mixtures (shown in Example 3), prepared by just using CaCl2 solution with lower concentration (1.3% w/w and 3% w/w) as activator, and using chitosan solution with different concentrations (1.62% w/w and 2% w/w) mixed with PRP at different mix ratios (PRP:chitosan ratio is 3:1 or 2:1).
Platelet rich plasma (PRP) was isolated from freshly drawn citrate anticoagulated whole blood with two-step centrifugation (1300 rpm for 10 minutes and then 2000 rpm for 10 minutes). Chitosan (1.62% w/w)-HCI (38 mM)-NaCI (160 mM) solution at pH of 6.56 and osmolality of 344 mOsm/kg, and chitosan (2.0% w/w)-HCI (50 mM)-NaCI (150 mM) solution at pH of 6.49 and osmolality of 324 mOsm/kg were used to mix with PRP. To prepare the PRP/chitosan mixture at mix ratio of 3:1(v/v), 0.9 mL of platelet-rich plasma (PRP) was pipetted into the cryotubes containing 300 pL 1.62% w/w chitosan (or 2.0% w/w chitosan) solution and three 0.39g stainless steel balls, mixed by hand for 10 seconds (shaken and reversed about 50 times vigorously). 300 1AL was transferred into 3 glass tubes at 37 C by using 1 ml syringe. Immediately 60 pl 1.3% (w/w) calcium chloride solution (or 3% w/w CaCl2 solution) was instilled very carefully and slowly on the surface of PRP/chitosan mixture of each glass tube for preparing 3 clots (the mix ratio of PRP/chitosan to CaCl2 solution was 5 to 1 at volume ratio).

[0069] To prepare the PRP/chitosan mixture at mix ratio of 2:1 (v/v), all the procedures described above were repeated by pipetting 0.8 mL of PRP into 400 pl chitosan solution. Coagulation time test results (Table 10 and Fig. 9) showed that all the mixtures coagulated within 8 minutes. For the same mix ratio, more concentrated chitosan solutions needed less time to clot (2.0% vs 1.62%). For the same chitosan concentration, PRP mixed with more chitosan solution needed less time to clot (mix ratio of 2:1< mix ratio of 3:1). At the same chitosan concentration and mix ratio, the mixtures activated with 3% CaCl2 solution coagulated slightly faster than the mixtures activated with 1.3% CaCl2 solution (coagulation time was shorter for 3 of 4 samples). Mechanical strength results showed (see Table 11, Fig. 10) that all eight clots didn't retract significantly, but the clots prepared with 2% chitosan appeared to express less liquid than the clots prepared with 1.62% chitosan. Although the mechanical strength scores were identical for all samples, the mechanical strength of the clots prepared with 2% chitosan appeared slightly better (after crushing, 2 of 4 samples showed just a hole in the center of clots, 1 of 4 samples was broken into two connected fragments and 1 of 4 samples was broken into two fragments) than the clots prepared with 1.62% chitosan (after crushing, 4 of 4 samples were broken into two connected fragments).

[0070] The homogeneity evaluation results (Table 12) demonstrated that the homogeneity of all eight clots was satisfactory (all of them were above ).
The homogeneity of clots prepared with 1.3% CaCl2 solution (3 of 4 samples were +, 1 of 4 was between and +) was better than the homogeneity of the clots prepared with 3% CaCl2 solution (1 of 4 sample was +, 3 of 4 samples were between and +).

[0071] In summary, PRP/chitosan-HCI-NaCI clots with good properties can be prepared by mixing PRP with 2.0% or 1.62% w/w chitosan solutions at both mix ratios of 2:1 or 3:1 v/v, and activating with 1.3% or 3% w/w CaCl2 solutions.
The PRP/chitosan-HCI-NaCI mixtures prepared with 2.0% chitosan solution at mix ratio of 2:1 (v/v), using 3% w/w CaCl2 solution as activator, resulted in the best clot properties, clotting in a suitable time, with no clot retraction, good mechanical properties and good homogeneity. The use of a higher concentration (2%) and greater mix ratio of chitosan solution to PRP resulted in more attractive handling properties since these mixtures were more paste-like and more viscous and thus easier to apply in cartilage defects and to other sites that are challenging for delivery.

[0072] The current invention also provides another novel formation of thrombin free PRP/chitosan mixtures (shown in Example 4), prepared by adding 3% w/w CaCl2 solution to PRP/chitosan mixture and mixing it gently by inverting the tube 5 times in 5 seconds, and then transferring in glass tubes with a syringe to prepare the clot (implant). Platelet rich plasma (PRP) was isolated from freshly drawn citrate anticoagulated whole blood with two-step centrifugation (1300 rpm for 10 minutes and then 2000 rpm for 10 minutes).
PRP was mixed with chitosan solution with different molecular weight (CH0100702B- Mn 232 kDa, 81% DDA and CH0050602A- Mn 298 kDa, 76%
DDA) and similar physiological pH and osmolality at mix ratio of 3:1. To prepare the PRP/chitosan mixture: 0.9 mL of platelet-rich plasma (PRP) was pipetted into the cryotubes containing 300 pL 1.62% w/w chitosan solution and three 0.39g stainless steel balls, mixed by hand for 10 seconds (shaken and reversed about 50 times vigorously). 240 pL 3% w/w CaCl2 solution was added to PRP/chitosan mixture and mixed gently by inverting the tube 5 times in 5 seconds. About 300 pL of mixture was then transferred into three glass tubes for preparing 3 clots.

[0073] Results showed that all the mixtures prepared with chitosan CH0100702B (Mn 232 kDa, 81% DDA) coagulated within 8 minutes. The coagulation time of PRP/chitosan-HCI-NaCI clots was near equal to the coagulation time of PRP/chitosan-HCI-13GP clots (average was 7.3 minutes versus 7 minutes respectively) (Table 15 and Fig. 11). All the mixtures prepared with chitosan CH0050602A (Mn 298 kDa, 76% DDA) coagulated within 8 minutes. The coagulation time of PRP/chitosan-HCI-NaCI clots was near equal to the coagulation time of PRP/chitosan-HCI-13GP clots (average was 7 minutes versus 8 minutes respectively) (Table 16 and Fig. 11).

[0074] The mechanical strength test results showed that all the clots prepared by gentle inversion following CaCl2 activation were firm and elastic, the mechanical strength of all the clots was "++++". There was no significant difference in mechanical strength between PRP/chitosan-HCI-NaCI clots and PRP/chitosan-HCIA3GP clots. There was no significant difference in mechanical strength among the clots prepared with the different chitosans as well (Table and Fig. 12). After 60 minutes, none of the clots expressed any liquid and retracted, the clots were perfectly intact. Meanwhile, the PRP clot without chitosan expressed a lot of liquid (82.9%) and retracted significantly (Table 17, Fig. 13 and Fig. 14).

[0075] In conclusion, gentle inversion of the cryotube after adding the CaCl2 activator does not seem to interrupt the coagulation process and affect coagulation time. The PRP/chitosan clots prepared by the gentle inversion mixing method express no liquid, do not retract, have good mechanical strength and clot in suitable time. The gentle inversion method is easier to translate to clinical application.

[0076] The compositions described herein can be used to improve the repair and to regenerate cartilaginous tissues and other tissues including without limitation meniscus, ligament, tendon, bone, skin, cornea, periodontal tissues, abscesses, resected tumors, and ulcers.

[0077] There is also contemplated herein the use of the polymer compositions described herein that can be placed or injected into a body site where the mixture aids the repair, regeneration, reconstruction or bulking of tissues. Repaired tissues include for example without limitation cartilage, meniscus, ligament, tendon, bone, skin, cornea, periodontal tissues, abscesses, resected tumors, and ulcers. The tissue that can be repaired or regenerated is for example without limitation cartilage, meniscus, ligament, tendon, bone, skin, cornea, periodontal tissue, abscesses, resected tumors, or ulcers. In some cases, the site of introduction in the body may be surgically prepared to remove abnormal tissues. Such procedure can be done by piercing, abrading or drilling into adjacent tissue regions or vascularized regions to create channels for the polymer composition to migrate into the site requiring repair.

[0078] The present disclosure will be more readily understood by referring to the following examples which are given to illustrate embodiments rather than to limit its scope.

Formulation and characterization of PRP/chitosan clots activated by thrombin and prepared with different mixing methods (Human blood) 1- Preparation of chitosan (1.62% w/w)-HCI (38 mM)-NaCI (160 mM) solution;
without NaOH, pH: 6.6; total volume: 10.0 ml

[0079] 0.180 g of chitosan (Mn 232 kDa, 81% DDA) was weighed in a 20 ml beaker, H2Odd was added to the beaker, until the weight of chitosan + H20=
9.34g. A magnetic stir bar was inserted into the beaker; the solution stirred for about 10 minutes in order to hydrate the chitosan powder as much as possible.
0.38 ml of HCI 1 N (Sigma, Product N 318949) was added to the solution under moderate stirring. The beaker was covered with parafilmTM, and the solution heated to about 60 C for 2 hours, stirred overnight until completely dissolved.

0.32 ml of 5N NaC1 (Sigma, Product N S-9888) solution was added into the beaker and well mixed. The pH of the chitosan solution was physiological at 6.5 and the osmolality was also physiological 361 mOsm/kg (Table 1).
2- Preparation of chitosan (1.62% w/w)-HCI (71 mM)-PGP (2.15% w/w) solution, pH: 6.6, total volume: 9.0 ml

[0080] 0.162 g of chitosan (Mn 232kDa, 81%DDA) was weighed in a 20m1 beaker, H20 dd added to the beaker, until the weight of chitosan + H20= 6.65g.

A magnetic stir bar was added into the beaker; the solution stirred for about minutes in order to hydrate the chitosan powder as much as possible. 0.55 ml of HCI 1 N (Sigma, Product N 318949) was added to the solution under moderate stirring. The beaker was covered with parafilmTM and stirred overnight until completely dissolved. 1.8 ml of 10.75% w/w f3GP (Sigma, Product N G9891) in 50 mM HCI was added into the beaker and well mixed (mix ratio of chitosan solution/f3GP solution is 4:1). The pH of the chitosan solution was physiological at 6.7 and the osmolality was also physiological, at 342 mOsm/kg (Table 1).
Table 1 Composition and properties of chitosan solutions.
C CC C pH
Osmolality Solution chltosan HCI NaCI I3GP Precipitation (Yow/w) (mM) (mM) (Tow/w) (Measured) (mOsm/kg) 1. Chitosan-HCI-1.62 38 160 no no 6.54 361 NaCI pH 6.6 2. Chitosan-HCI-13GP pH 6.6 1.62 71 no 2.15 no 6.65 342 3- Drawing blood

[0081] About 40 cc whole blood was extracted from a donor with informed consent using blood-taking IRB protocol. First, - 2 ml of blood was collected in a Vacutainer tube containing EDTA (Fisher, BD, Product N 02-683-99A) to obtain CBC (complete blood count) and platelet counts. Second, - 35m1 of blood was collected in 4 Vacutainer tubes containing ACD (VWR, BD, Product N VT4606) to prepare platelet-rich plasma (PRP). Each Vacutainer tube can contain up to 8.5 ml blood.
4- Isolating PRP from anti-coagulated whole blood

[0082] The ACD-Vacutainer tubes containing whole blood were centrifuged in the ACE E-Z PRPTM centrifuge at 1300 rpm for 10 minutes at room temperature in order to separate the erythrocytes from the plasma and buffy coat containing leukocytes and platelets. The supernatant fractions containing plasma and the buffy coat were removed using a 2 1/2 inch (18 gauge) blunt needle (ACE, Product N 09-002-69) attached to a 10 ml syringe (Fisher, BD, Product N 309604). The straw colored liquid was drawn into the syringe until the needle reached into the first 1-2 mm of the layer of red blood cells. The first 1-2 mm of erythrocytes was taken to ensure that the entire buffy coat (i.e., white blood cell fraction) was collected. The plasma and buffy coat fractions were expressed from the syringe into new Vacutainer tubes (washed and depyrogenized) containing no anti-coagulant. The plasma and buffy coat were further centrifuged at 2000 rpm for 10 minutes at room temperature in order to separate platelet-rich plasma (PRP) from platelet poor plasma (PPP). The Vacutainer tubes were transferred to a Vacutainer holder and the caps removed. The yellow supernatant (PPP) fractions were removed using the same 2 1/2 inch blunt needle (18 gauge) and a new 10 ml syringe. A small volume of yellow supernatant (PPP) was left in the Vacutainer tubes, leaving approximately 1.5 ml of PRP containing some PPP in the bottom fraction of the Vacutainer tubes. The top PPP fractions were expressed from the syringe into a sterile Falcon tube. The 1.5 ml of PRP in the bottom fraction of the Vacutainer tubes was gently mixed by drawing and expressing the liquid 3 times using the 3 inch blunt needle (18 gauge, ACE, Product N 09-002-70) attached to a 10 ml syringe. The PRP fraction was stored at room temperature until further use. About 6.0 ml PRP was harvested from about 35 ml ACD blood collected from the donor.

5- Preparing the thrombin coagulation solutions

[0083] To prepare the 10% (w/w) calcium chloride solution, 1.99 g of CaCl2.2H20 (Sigma, Product N C7902-500G) was weighed in a 50 ml beaker, H2Odd added to the beaker, until the weight of CaCl2.2H20 + H20 = 15g. A
magnetic stir bar was inserted into the beaker, and the solution was stirred until completely dissolved. The thrombin solution (1000U/m1) was prepared by diluting the thrombin powder with the 10% (w/w) calcium chloride solution. For this particular experiment, an entire vial (1000 U, Sigma, Product N T7009-1KU) of thrombin was diluted with 1.0 ml of 10% (w/w) calcium chloride solution.
The thrombin solution was stored on ice until use.
6- Preparing chitosan/PRP clots and measuring the coagulation time and mechanical strength of the clots

[0084] To prepare the chitosan-HCI-NaCI (pH 6.6)/PRP clots coagulated with thrombin/calcium chloride (1000 U/ml), 9001.11 of platelet-rich plasma (PRP) was pipetted into cryotubes containing 300 pl chitosan solution and three 0.39g stainless steel balls, mixed by hand for 10 seconds (shaken and reversed about 50 times vigorously). One of the following 3 mixing procedure was then used.

[0085] Mixing method #1- inversed 5 times then drawn into syringe: 133 I
thrombin solution (1000U/m1) diluted with sterile 10% (w/w) calcium chloride solution was immediately added to the PRP/chitosan mixture and mixed well by inversion for 5 seconds (inverting the tube 5 times gently). To prepare the clots, 300 I were transferred into 3 glass tubes at 37 C with a 1 ml syringe. Three clots were prepared: 1 clot was used to test coagulation time and fixed immediately after it coagulated, 1 clot was used to test coagulation time and fixed after 60 minutes, and 1 clot was used to test coagulation time and mechanical strength.

[0086] Mixing method #2- no inversion, just drawn into syringe: 133 1 thrombin solution (1000U/m1) diluted with sterile 10% (w/w) calcium chloride solution was added on the surface of PRP/chitosan mixture. The mixture was immediately drawn into a 1 ml syringe and 300 I transferred into 3 glass tubes at 37 C. Three clots were prepared: 1 clot was used to test coagulation time and fixed immediately after it coagulated, 1 clot was used to test coagulation time and fixed after 60 minutes, and 1 clot was used to test coagulation time and mechanical strength.

[0087] Mixing method #3- layered on top: 300 I of PRP/chitosan mixture was transferred into 3 glass tubes at 37 C with a 1 ml syringe. 33 I thrombin solution (1000U/m1) diluted with sterile 10% (w/w) calcium chloride solution was immediately added on the surface of PRP/chitosan mixture of each glass tube to prepare 3 clots: 1 clot was used to test coagulation time and fixed immediately after it coagulated, 1 clot was used to test coagulation time and fixed after 60 minutes, and 1 clot was used to test coagulation time and mechanical strength.

[0088] To prepare the PRP/chitosan-HCI-13GP (pH 6.6) clots coagulated with thrombin/calcium chloride (1000 U/ml), 900 I of platelet-rich plasma (PRP) was pipetted into cryotubes containing 300 pl chitosan solution and three 0.39g stainless steel balls, mixed by hand for 10 seconds (shaked and reversed about 50 times violently). Then the above 3 mixing procedures were repeated.

[0089]
Coagulation was determined by visualization of the clot at 37 C. The glass tubes were taken from the hot plate vertically every minute, the tube slowly tilted, the blood mixture visualized on the bottom of tube. If the mixture was immobile and formed a clot, then it was coagulated; if the mixture was still mobile at the bottom of the tube, it had not coagulated yet. Mechanical strength was tested by putting the clot on the centre of the palm, the clot pressed with a finger until crushed; the resistance observed to compression, liquid expression and crushed appearance were monitored. The mechanical strength was scored with the 4 "+" system: "+" represents clot was easily broken and crushed appearance was multiple fragments (more than 5 fragments); "-F+" represents clot was relatively firm and crushed appearance was multiple fragments (3-5 fragments); "+++" represents clot was firm and elastic, crushed appearance was 2-3 fragments; "++++" represents clot was firm and elastic, crushed appearance was 2 fragments (sometimes still connected) or there was just a hole in the center of the clot.

[0090]
Coagulation time (Table 2, Figs. 1 and 2) results showed that all PRP/chitosan mixtures coagulated within 10 minutes (from a couple of seconds to 10 minutes). For mixing method 1 where thrombin was mixed into PRP/chitosan by 5 times gentle inversion of the mixing tube containing stainless steel beads and then taken into a syringe for placement in glass tubes:
coagulation occurred when the mixture was transferred by syringe and it was difficult to transfer the PRP/chitosan mixture into glass tubes (Table 2, Figs. 1 and 2). A lot of liquid was expressed (++++, clots started to express liquid at 4 minutes after coagulation). The clots retracted significantly resulting in a shrunken clot immersed in serum. The PRP/chitosan clots made by this method were firm and elastic, the mechanical strength was +++ (Table 3, Figs. 3 and 4).
These results suggest that bead mixing after thrombin/CaCl2 activation results in clot retraction and a relative weak clot compared to the other two mixing methods.

[0091] For mixing method 2 where thrombin was added to the PRP/chitosan without inversion and directly drawn into the syringe for placement in glass tubes, coagulation occurred immediately after placement in glass tubes (less than 10 seconds; see Table 2, Figs. 1 and 2). Some liquid was expressed (++, clots started to express liquid at 30 minutes for clot 1 and at 35 minutes for clot 2 after preparing clots). The clots retracted significantly. The PRP/chitosan clots made by this method were firm and elastic, the mechanical strength was ++++
(Table 3, Figs. 3 and 4). These result suggest that clots made by this mixing method have improved mechanical properties (++++) but still retract.

[0092] For mixing method 3 where the PRP/chitosan mixture was placed in glass tubes and then thrombin was layered on top of the PRP chitosan in the tube, coagulation occurred at 6-8 minutes in the glass tube. PRP/chitosan-HCI-NaCI mixture coagulated after 6 minutes and PRP/chitosan-HCl-13GP mixture formed clot after 8 minutes in the glass tube (Table 2, Figs. 1 and 2). Almost no liquid was expressed and the clots didn't retract. The PRP/chitosan clots made by this mixing method were firm and elastic, the mechanical strength was ++++
(Table 3, Figs 3 and 4). These results confirm that mixing method 3 results in the best clot properties, with no retraction following activation by thrombin/CaC12.
Table 2 Coagulation time of PRP/chitosan mixtures.
Mixture Sample number Coagulation time Mean Comments (Min) value (Min) PRP/ Mixing method 1 (After 1 --- All the samples coagulate chitosa adding thrombin, invert 2 -- within 10 minutes.
Transfer into n-HCI- the cryotube 5 times in 3 -- glass tubes was difficult NaCI 5 seconds, then following mixing method 1 pH 6.6 transfer into glass since the mixture collated (clot1) tubes) instantaneously; clots also Mixing method 2 (Add 1 <10 coagulated too quickly with thrombin solution on Seconds mixing method 2. The clot the surface of 2 <10 retracted a lot and expressed a PRP/chitosan mixture, Seconds lot of liquid (++++) after then directly transfer 3 <10 coagulation with mixing into glass tubes) Seconds method 1; some liquid was Mixing method 3 1 6 6 expressed (++) and clots (Transfer PRP/chitosan 2 6 retracted a little with mixing mixture into glass tubes, 3 6 method 2; the clots didn't then add thrombin retract and expressed little solution on the mixture liquid (+) with mixing method 3.
surface) Results showed that mixing PRP/ Mixing method 1 (After 1 method 3 was the best choice chitosa adding thrombin, invert 2 -- to prepare PRP/chitosan clost n-HCI- the cryotube 5 times in 3 -- following thrombin/CaCl2 13GP 5 seconds, then activation (Suitable coagulation pH 6.6 transfer into glass time, good clot shape and (clot2) tubes) good mechanical strength).
Mixing method 2 (Add 1 <10 thrombin solution on Seconds the surface of 2 <10 PRP/chitosan mixture, Seconds then directly transfer 3 <10 into glass tubes) Seconds Mixing method 3 1 8 8 (Transfer PRP/chitosan 2 8 mixture into glass 3 8 tubes, then add thrombin solution on the mixture surface) -" means the mixture coagulated during transfer and can be estimated as Table 3 Mechanical strength test of PRP/chitosan clots.
Sample Resistance to Liquid expressed Crushed compression appearance Chitosan-HCI-NaCI(pH 6.6) Firm and elastic A lot of liquid expressed 2-3 fragments) /PRP clot1-1 (1000U/m1) +++ ++++
Chitosan-HCI-NaCI(pH 6.6) / Firm and elastic Some liquid expressed Break into 2 PRP clot1-2 (1000U/m1) ++++ ++ fragments but still connected Chitosan-HCI- NaCI (pH 6.6)/ Firm and elastic Little liquid expressed Break into 2 PRP clot1-3 (1000U/m1) ++++ + fragments Chitosan-HCI- 13GP (pH 6.6) / Firm and elastic A lot of liquid expressed 2-3 fragments) PRP clot2-1 (1000U/m1) +++ ++++
Chitosan-HCI- r3GP (pH 6.6) / Firm and elastic Some liquid expressed Break into 2-3 PRP clot2-2 (1000U/m1) ++++ ++ fragments but still connected Chitosan-HCI- 13GP (pH 6.6) / Firm and elastic Almost no liquid Break into 2 PRP clot2-3 (1000U/m1) ++++ expressed fragments but still + connected 7- Histological treatment and homogeneity evaluation of PRP/chitosan clots

[0093] Fixed clots were sectioned in 2 parts. One part was paraffin embedded, stained with Safranin 0/Fast Green and observed by optical microscopy. All the photos were taken from the PRP/chitosan clot samples fixed 60 minutes after the clots were prepared, two photos taken with the 5x and 40x objectives from different regions of each sample were used for homogeneity evaluation. Each specimen was observed under microscopy with special emphasis on: presence of bubbles or cracks; presence and distribution of precipitates of chitosan described as: large aggregates or small aggregates;
chitosan distribution and whether or not they are homogeneously dispersed across the section; erythrocyte morphology in term of discoid, shrunken, swollen or chaining.

[0094] The homogeneity (average value) of clot 2 (2 of 3 samples were " ") made by mixing PRP with chitosan-HCI-13GP (pH 6.6) was slightly better than clot 1 made by mixing PRP with chitosan-HCI-NaCI (pH 6.6) (1 of 3 samples was " "). The homogeneity of the clots prepared with mixing method 3 was better (2 of 2 samples were " ") than the homogeneity of clots prepared with mixing method 2 (1 sample was " ", 1 sample was "2) or mixing method 1 (both samples were "-"). There were a lot of bubbles in the clots prepared with mixing method 1 and less bubbles in clots prepared with mixing method 2 and mixing method 3. These results showed that mixing method 1 is not ideal to prepare homogenous PRP/chitosan clots with thrombin/CaCl2 activation, the best mixing method was mixing method 3 (Table 4).
Table 4 Homogeneity of PRP/chitosan clots.
Clot-1 sample (with NaCI) Homogeneity Clot-2 sample (with 13GP) Homogeneity of clot-1 of clot-2 PRP1-1 (mixing method 1) - PRP2-1 (mixing method 1) -PRP1-2 (mixing method 2) - PRP2-2 (mixing method 2) +
PRP1-3 (mixing method 3) + PRP2-3 (mixing method 3) +

Runniness test and coagulation time test for PRP/chitosan mixtures without any activators (no thrombin or calcium) by using different mix ratios 1- Preparation of chitosan (1.62% w/w)-HCI (38 mM)-NaCI (160 mM) solution,-without NaOH, pH: 6.6,- total volume.- 10.0 ml

[0095] The chitosan-HCI-NaCI solution was prepared with chitosan Mn 232 kDa, 81% DDA as described hereinabove. The pH of the chitosan solution was physiological at 6.6 and the osmolality was also physiological (359 mOsm/kg;
Table 5).
2- Preparation of chitosan (1.62% w/w)-HCI (71 mM)-PGP (2.15%) solution, pH:
6.6, total volume: 9.0 ml

[0096] The chitosan-HCI-13GP solution was prepared with chitosan Mr, 232 kDa, 81% DDA as described hereinabove. The pH of the chitosan solution was physiological at 6.6 and the osmolality was also physiological (352 mOsm/kg;
Table 5).

Table 5 Composition and properties of chitosan solutions.
Solution No and Cchltosan CHCI CNaCI Cl3GP pH
Osmolality type.
(Yow/w) (mM) (mM) (Vow/w) Precipitation (Measured) (mOsm/kg) 1. Chitosan-HCI-NaCI pH 6.6 1.62 38 160 no no 6.57 359 2. Chitosan-HCI-8GP pH 6.6 1.62 71 no 2.15 no 6.63 352 3- Drawing blood

[0097] Blood was extracted from rabbits using sterile technique, started by injecting 0.3 cc/kg Hypnorm IM to the rabbits (for example 0.9 cc for a 3 kg rabbit). First, for each rabbit, - 2 ml of blood was collected in a Vacutainere tube containing EDTA (Fisher, BD, Product N 02-683-99A) to obtain CBC
(complete blood count) and platelet count. Second, for each rabbit, - 26m1 of blood was collected in 3 Vacutainer tubes containing ACD (VWR, BD, Product N VT4606) to prepare anti-coagulate whole blood and PRP. Each Vacutainere tube can contain up to 8.5m1 blood. Two rabbit were used in this experiment.
4- Isolating PRP from anti-coagulated whole blood

[0098] PRP was isolated from rabbit whole blood by differential centrifugation as described hereinabove. About 4.5 ml PRP can be harvested from the ACD blood collected from each rabbit.
5- Experiment part 1: Runniness test of PRP/chitosan mixture

[0099] To prepare the PRP/chitosan-HCI-NaCI (pH 6.6) (mix ratios 3:1v/v), 0.9 ml of platelet-rich plasma (PRP) was pipetted into cryotubes containing pl chitosan-HCI-NaCI (pH 6.6) solution and three 0.39g stainless steel balls, mixed by hand for 10 seconds (the tube shaken and reversed about 50 times vigorously). To prepare the PRP/chitosan-HCI-NaCI (pH 6.6) mixture (mix ratio 2:1 v/v), 0.8 ml of platelet-rich plasma (PRP) was pipetted into cryotubes containing 400 pl chitosan-HCI-NaCI (pH 6.6) solution and three 0.39g stainless steel balls, mixed by hand for 10 seconds (the tube shaken and reversed about 50 times vigorously). To prepare the PRP/chitosan-HCI-f3GP (pH 6.6) mixture (mix ratio: 3:1 and 2:1 v/v), all procedures described hereinabove were repeated by mixing PRP with chitosan-HCI-13GP (pH 6.6) solution.

[00100] For the runniness test, a total of 5 samples were tested: Samples 1 and 2 were PRP/chitosan-HCI-NaCI (pH 6.6) mixtures at mix ratio 3:1 and 2:1 v/v; Samples 3 and 4 were PRP/chitosan-HCI-f3GP (pH 6.6) mixtures at mix ratio 3:1 and 2:1 v/v, Samples 5 was PRP without chitosan as a control. A
clean plastic board was tilted on the bench top in an angle of about 45 . About 0.5 ml mixture from each sample was pipetted, then three drops of each sample were placed carefully onto the surface of the board (the distance between each sample was about 2 cm), the runniness of the mixtures was observed and photos taken at 30 seconds, 1 minute, 2 minutes, 3 minutes, 5 minutes and 10 minutes.

[00101] The runniness test results (Fig. 5) showed that pure PRP
demonstrated very liquid properties by flowing almost throughout the plastic board in 1 minute, the running distance of different samples were different, and the running distance didn't change significantly from 30 seconds to 10 minutes.
For the same mix ratio, the running distance of PRP/chitosan-NaCI was much shorter than PRP/chitosan-r3GP, possibly because the chitosan solution with NaCI was more viscous than chitosan solution with I3GP and the chitosan solution with NaCI coagulates faster than the chitosan solution with 13GP. For the same chitosan solution, the running distance of mix ratio 3:1 v/v was much longer than mix ratio 2:1 v/v. These results suggest that the use of higher chitosan concentrations (2%) and greater ratio of chitosan solution to PRP
resulted in more attractive handling properties since these mixtures were more paste-like and more viscous and thus easier to apply in cartilage defects and to other sites that are challenging for delivery.
6- Experiment part 2: preparing PRP/chitosan clots and measuring the coagulation time and mechanical strength of the clots

[00102] To prepare the PRP/chitosan-HCI-NaCI (pH6.6) and PRP/chitosan-HCI-f3GP (pH 6.6) mixtures (mix ratios 3:1 and 2:1 v/v), the same preparation procedures described hereinabove were followed. For each mixture, 300 I was transferred into 3 glass tubes at 37 C with a 1 ml syringe to prepare three clots:
1 clot was used to test coagulation time and fixed immediately after it coagulated, 1 clot was used to test coagulation time and fixed after 60 minutes, 1 clot was used to test coagulation time mechanical strength after 60 minutes.

Coagulation of the clot was determined by visualization of the clot at 37 C as described hereinabove. Mechanical strength was tested as described hereinabove.

[00103] Coagulation test results (Table 6 and Fig. 6) showed that PRP/chitosan mixtures with NaCI coagulated within 5 minutes (5 minutes for mix ratio 3:1 vs 3 minutes for mix ratio 2:1). PRP/chitosan mixtures with I3GP

coagulated after 45 minutes (51 minutes for mix ratio 3:1 vs 45 minutes for mix ratio 2:1). For both mix ratios (3:1 and 2:1), the mixtures with NaCI (clot1) coagulated much faster than the mixture with 13GP (clot2). Clots prepared with a mix ratio 2:1 coagulated slightly faster than clots prepared with a mix ratio 3:1, suggesting that increasing chitosan concentration accelerated the coagulation or created a more viscous solution.

[00104] With regard to the mechanical strength of clots (Table 7, Figs. 7 and 8), the two clots with NaCI were not firm and were easily broken. Following crushing, the clots were flattened, the mechanical strength of the clots were close to "+" (between 0 and +). The two clots with 13GP) were gel-like mixtures.
After they were poured out of the tubes, they looked like viscous mud (very fragile), and the mechanical strengths of the clots were "0". The mechanical strengths of PRP clots prepared without activation by thrombin and CaCl2 (just mix PRP with chitosan) was much weaker than the PRP clots with thrombin and CaCl2 in vitro (See Table 3 for the mechanical properties with thrombin and Table 11 for mechanical properties with CaCl2).

Table 6 Coagulation time of PRP/chitosan mixtures.
Mixture Mixing ratio Coagulation Mean Comments and sample time (Min) value number (Min) PRP/ 3:1 1 5 5 For clot1 (with NaCI), both mix ratios chitosan- 2 5 (3:1 and 2:1) coagulated within 5 HCI-NaCI 3 5 minutes (5 min for 3:1 and 3 min for pH 6.6 2:1 1 3 3 2:1);
after 60 minutes, the clot didn't (clot1) 2 3 retract and didn't express serum. For 3 3 clot2 (with r3GP), both mix ratios (3:1 PRP/ 3:1 1 51 51 and 2:1) coagulated after 45 minutes chitosan- 2 51 (51 min for 3:1 and 45 min for 2:1), HCI- f3GP 3 51 and formed gel-like clots (fragi)e);
pH 6.6 2:1 1 45 45 after 60 minutes, the clot didn't retract (clot2) 2 45 and didn't express serum. The 3 45 coagulation times of mix ratio 2:1 were less than the coagulation time of mix ratio 3:1 in mixtures with NaCI
and I3GP.
Table 7 Mechanical strength test of PRP/chitosan clots prepared without any activators (no thrombin, no calcium).
Sample Resistance to Liquid expressed Crushed compression appearance PRP/Chitosan-HCI-NaCI Easily broken Almost no liquid expressed (pH 6.6) clot1-1 (3:1) Close to "+"
Flattened PRP/Chitosan-HCI-NaCI Easily broken Almost no liquid expressed (pH 6.6) clot1-2 (2:1) Close to "+"
Flattened PRP/Chitosan-HCl-13GP Viscous mud Almost no liquid expressed (pH6.6) clot2-1 (3:1) Close to "0"
Flattened PRP/Chitosan-HCI-13GP Viscous mud Almost no liquid expressed (pH 6.6) clot2-1 (2:1) Close to "0"
Flattened 7- Histological treatment and homogeneity evaluation of PRP/chitosan clots

[00105] Histological treatment and homogeneity evaluation was performed as described hereinabove.

[00106] The histology results (Table 8) showed that the PRP/chitosan clots prepared with NaCI were homogenous, both mix ratios were "+". The homogeneity of the PRP/chitosan clots prepared with 6GP was poor, both mix ratios were "-". There was more chitosan observed in the clots prepared with a mix ratio of 2:1 v/v than the clots prepared with a mix ratio of 3:1 v/v.
Table 8 Homogeneity of PRP/chitosan clots prepared with NaCI or 6GP at mix ratios 3:1 or 2:1.
Clot-1 samples Homogeneity of Clot-2 samples Homogeneity of (with NaCI) clot-1 (with 8GP) clot-2 PRP 1-1-2-60 (3:1) + PRP 2-1-2-60 (3:1) -PRP 1-2-2-60 (2:1) + PRP 2-2-2-60 (2:1) -Preparation of PRP/chitosan clots by using 1.62% and 2.0% chitosan solutions at mix ratios of 2:1 and 3:1 and with a small volume of CaCl2 solution as activator 1- Preparation of chitosan (1.62% w1w)-HCI (38 mM)-NaCI (160 mM) solution,.
without NaOH, pH.. 6.6; total volume: 10.0 ml

[00107] The chitosan-HCI-NaCI solution was prepared with chitosan Mn 232 kDa, 81% DDA as described hereinabove. The pH of the chitosan solution was physiological at 6.6 and the osmolality was also physiological (344 mOsm/kg;
Table 9).
2- Preparation of chitosan (2.0% w/w)-HCI (50 mM)-NaCI (150 mM) solution,.
pH: 6.5; total volume: 10.0 ml

[00108] 0.222 g of chitosan (Mn 232 kDa, 81% DDA) was weighed in a 20 ml beaker, H2Odd added to the beaker, until the weight of chitosan + H20= 9.20g.
A magnetic stir bar was inserted into the beaker; the solution stirred for about minutes in order to hydrate the chitosan powder as much as possible. 0.50 ml of HCI 1 N (Sigma, Product N 318949) was added to the solution under moderate stirring. The beaker was covered with parafilmTM, and the solution heated to about 60 C for 4 hours, stirred overnight until completely dissolved.
0.30 ml of 5N NaCI (Sigma, Product N S-9888) solution was added into the beaker and well mixed. The pH of the chitosan solution was physiological at 6.5 and the osmolality was also physiological (324 mOsm/kg; Table 9).
Table 9 Composition and properties of chitosan solutions Solution No Cchltosan CHCI CNaCI Cr1GP pH
Osmolality and type. (%w/w) (mM) (mM) (%w/w) Precipitation (Measured) (mOsm/kg) 1.Chitosan-HCI-NaCI pH 6.6 1.62 38 160 no no 6.56 344 2.Chitosan-HCI-NaCI pH 6.5 2.0 50 150 no no 6.49 324

[00109] Two different chitosan solutions (with NaCI, 1.62% and 2.0%) with similar physiological osmolality were successfully prepared. Chitosan solution with higher concentration (2.0%) was much more viscous than chitosan solution 2 with lower concentration (1.62%) by visualization.
3- Drawing blood

[00110] Blood was extracted from rabbits using sterile technique as described previously. Two rabbits were used in this experiment.
4- Isolating PRP from anti-coagulated whole blood

[00111] PRP was isolated from rabbit whole blood by differential centrifugation as described previously. About 4.5 ml PRP can be harvested from the ACD blood collected from each rabbit and about 9.0 ml PRP was harvested in this experiment.
5- Preparing CaCl2 activator solutions

[00112] To prepare the 1.3% (w/w) and 3% (w/w) CaCl2 solution, respectively 0.26 g and 0.60 g of CaCl2.2H20 (Sigma, Product N C7902-500G) were weighed and deposited in two different 50 ml beakers, H2Odd was added into these beakers, until the weight of CaCl2.2H20 + H20 = 15g. A magnetic stir bar was inserted into the beakers and stirred until completely dissolved.

6- Preparing PRP/chitosan clots and measuring the coagulation time and mechanical strength of the clots

[00113] PRP/chitosan-HCI-NaCI mixtures were prepared at mix ratio 3:1 v/v:
0.9 mL of platelet-rich plasma (PRP) was pipetted into cryotubes containing pl 1.62% chitosan-HCI-NaCI (pH 6.6) solution and three 0.39g stainless steel balls, mixed by hand for 10 seconds (the tube was shaken and reversed about 50 times vigorously). 300 ill was transferred into 3 glass tubes at 37 C with a 1 ml syringe. Immediately 60 pL 1.3% (w/w) calcium chloride solution was instilled very carefully and slowly on the surface of PRP/chitosan mixture of each glass tube to prepare 3 clots: 1 clot was used to test coagulation time and fixed immediately after it coagulated, 1 clot was used to test coagulation time and fixed after 60 minutes, 1 clot was used to test coagulation time and mechanical strength after 60 minutes. All procedures which are described hereinabove were repeated with 2.0% chitosan-HCI-NaCI (pH 6.5) solution instead of using 1.62 %

chitosan solution.

[00114] PRP/chitosan-HCI-NaCI mixtures were prepared at mix ratio 2:1 v/v:
0.8 ml of platelet-rich plasma (PRP) was pipetted into the cryotubes containing 400 pl 1.62% chitosan-HCI-NaCI (pH 6.6) solution and three 0.39g stainless steel balls, mixed by hand for 10 seconds (the tube was shaken and reversed about 50 times vigorously). 300 p,1 was transferred into 3 glass tubes at 37 C

with a 1 ml syringe. Immediately 60 pL 1.3% (w/w) calcium chloride solution was instilled very carefully and slowly on the surface of PRP/chitosan mixture of each glass tube to prepare 3 clots: 1 clot was used to test coagulation time and fixed immediately after it coagulated, 1 clot was used to test coagulation time and fixed after 60 minutes, 1 clot was used was used to test and mechanical strength after 60 minutes. All procedures which described hereinabove were repeated with a 2.0% chitosan-HCI-NaCI (pH 6.5) solution.

[00115] The PRP/chitosan mixtures were also activated with a 3% w/w CaCl2 solution. All procedures described hereinabove were repeated with a 3% w/w CaCl2 solution instead of a 1.3% w/w CaCl2 solution.

[00116] Coagulation of the clot was determined by visualization of the clot at 37 C as described hereinabove. Mechanical strength was tested as described hereinabove. The coagulation test results (see Table 10 and Fig. 9) showed that all the mixtures coagulated within 8 minutes. For the mixtures activated by 1.3 CaCl2, PRP mixed with 1.62% chitosan at mix ratio 3:1 coagulated at 8 minutes, PRP mixed with 2.0% chitosan at mix ratio 3:1 coagulated at 6 minutes, PRP mixed with 1.62% chitosan at mix ratio 2:1 coagulated at 7 minutes, PRP mixed with 2.0% chitosan at mix ratio 2:1 coagulated at 5 minutes. For the mixtures activated by 3 % CaCl2, PRP mixed with 1.62%
chitosan at mix ratio 3:1 coagulated at 8 minutes, PRP mixed with 2.0%
chitosan at mix ratio 3:1 coagulated at 5 minutes, PRP mixed with 1.62%
chitosan at mix ratio 2:1 coagulated at 5 minutes, PRP mixed with 2.0%
chitosan at mix ratio of 2:1 coagulated at 3 minutes. For the same mix ratio, a more concentrated chitosan solution needed less time to clot (2.0% w/w <
1.62% w/w). For the same chitosan concentration, PRP mixed with more chitosan solution needed less time to clot (mix ratio of 2:1 v/v < mix ratio of 3:1 v/v). PRP/chitosan mixtures activated with 3% CaCl2 solution coagulated slightly faster than the mixtures activated with 1.3% w/w CaCl2 solution (3 of 4 samples coagulated faster with 3% w/w CaCl2).

Table 10 Coagulation time of PRP/chitosan mixtures Mixture Chitosan Coagulation Mean Comments concentration and mix time (Min) value ratios of PRP to (Min) chitosan PRP/ 1.62% and 3:1 1 8 8 All the mixtures activated by chitosan- (clot1-1) 2 8 1.3 %
CaCl2coagulated HCI-NaCI 3 8 within 8 minutes; for same (clot1: 2.0% and 3:1 1 6 6 mix ratio, more concentrated adding (clot1-2) 2 6 chitosan solution needed 1.3% 3 6 shorter time to form a clot CaCl2 1.62% and 2:1 1 7 7 (2.0%<1.62%). For same solution (clot1-3) 2 7 chitosan solution, PRP mixed as 3 7 with more chitosan solution activator) 2.0% and 2: 2 5 1 1 5 5 need shorter time to form a (clot1-4) clot (mix ratio of 2:1< mix 3 5 ratio of 3:1).
PRP/ 1.62% and 3:1 1 8 8 All the mixtures activated by 3 chitosan- (clot2-1) 2 8 %
CaCl2coagulated within 8 HCI-NaCI 3 8 minutes; for same mix ratio, (clot2: 2.0% and 3:1 1 5 5 more concentrated chitosan adding (clot2-2) 2 5 solution needed shorter time 3% CaCl2 3 5 to form a clot (2.0%<1.62%).
solution 1.62% and 2:1 1 5 5 For same chitosan solution, as (clot2-3) 2 5 PRP mixed with more chitosan activator) 3 5 solution need shorter time to 2.0% and 2:1 1 3 3 form a clot (mix ratio of 2:1<
(clot2-4) 2 3 mix ratio of 3:1).

Table 11 Mechanical strength test of PRP/chitosan clots.
Sample Resistance to Liquid Crushed compression expressed appearance Chitosan-HCI-NaCl/PRP clot1- Firm and elastic ++ 2 fragments but 1 (1.62%, 3:1, 1.3% CaCl2) ++++ still connected Chitosan-HCI-NaCl/PRP clot1- Firm and elastic + 2 fragments 2 (2.0%, 3:1, 1.3% CaCl2) ++++
Chitosan-HCI-NaCl/PRP clot1- Firm and elastic ++ 2 fragments but 3 (1.62%, 2:1, 1.3% CaCl2) ++++ still connected Chitosan-HCI-NaCl/PRP clot1- Firm and elastic ++ 2 fragments but 4 (2.0%, 2:1, 1.3% CaCl2) ++++ still connected Chitosan-HCI-NaCl/PRP clot2- Firm and elastic ++ 2 fragments but 1 (1.62%, 3:1, 3% CaCl2) ++++ still connected Chitosan-HCI-NaCl/PRP clot2- Firm and elastic +
Hole in center 2 (2.0%, 3:1, 3% CaCl2) ++++
Chitosan-HCI-NaCl/PRP clot2- Firm and elastic ++ 2 fragments but 3 (1.62%, 2:1, 3% CaCl2) ++++ still connected Chitosan-HCI-NaCl/PRP clot2- Firm and elastic +
Hole in center 4 (2.0%, 2:1, 3% CaCl2) ++++

[00117] When the mechanical strength of clots was tested after 60 minutes, it was found that all eight clots were firm and elastic. For clot1-1 (1.62%, 3:1 and 1.3% CaCl2 solution), some liquid exuded (scored as ++), the clot didn't retract significantly, the mechanical strength was "++++", after crushing, the clot broke in two connected fragments. For clot1-2 (2.0%, 3:1 and 1.3% CaCl2 solution), almost no liquid exuded (scored as +), the clot didn't retract, the mechanical strength was "++++", after crushing, the clot broke in two fragments. For clot1-3 (1.62%, 2:1 and 1.3% CaCl2 solution), some liquid exuded (scored as ++), the clot didn't retract significantly, the mechanical strength was "++++", after crushing, the clot broke in two connected fragments. For clot1-4 (2.0%, 2:1 and 1.3% CaCl2 solution), some liquid exuded (scored as ++), the clot didn't retract significantly, the mechanical strength was "++++", after crushing, the clot broke in two connected fragments. For clot2-1 (1.62%, 3:1 and 3% CaCl2 solution), some liquid exuded (scored as ++), the clot didn't retract significantly, the mechanical strength was "++++", after crushing, the clot broke in two connected fragments. For clot2-2 (2.0%, 3:1 and 3% CaCl2 solution), a little liquid exuded (scored as +), the clot didn't retract significantly, the mechanical strength was "++++", after crushing, the clot had just a hole in centre. For clot2-3 (1.62%, 2:1 and 3% CaCl2 solution), some liquid exuded (scored as ++), the clot didn't retract significantly, the mechanical strength was "++++", after crushing, the clot broke in two connected fragments. For clot2-4 (2.0%, 2:1 and 3% CaCl2 solution), almost no liquid exuded (scored as +), the clot didn't retract, the mechanical strength was "++++", after crushing, the clot had just a hole in center (Table 11, Fig. 10).

[00118] In this experiment (Table 11 and Fig. 10), all eight clots didn't retract significantly, but from the amount of liquid expressed and the photos of clots before crushing, the retraction of clots with 2% w/w chitosan was less than the clots with 1.62% w/w chitosan. Although the mechanical strength test showed identical scored for all clots, it appeared that the mechanical strength of clots prepared with 2% w/w chitosan was slightly better (after crushing, 2 of 4 samples had just a hole in the center of clots, 1 of 4 sample was broken into two connected fragments and 1 of 4 samples was broke into two fragments) than the clots prepared with 1.62% w/w chitosan (after crushing, 4 of 4 samples were broken into two connected fragments.
7- Histological treatment and homogeneity evaluation of PRP/chitosan clots

[00119] Histological treatment and homogeneity evaluation was performed as described hereinabove.

[00120] The histological evaluation results (Table 12) showed that the homogeneity of all eight clots was satisfactory (none of them was -, all were above ). For clot1-1 (1.62%, 3:1, 1.3% CaCl2), homogeneity was +; for clot1-2 (2.0%, 3:1, 1.3% CaCl2), homogeneity was +; for clot1-3 (1.62%, 2:1, 1.3%
CaCl2), homogeneity was +; for clot1-4 (2.0%, 2:1, 1.3% CaCl2), omogeneity was + (between and +); For clot2-1 (1.62%, 3:1, 3% CaCl2), homogeneity of clot + (between and +); for clot2-2 (2.0%, 3:1, 3% CaCl2), homogeneity was +

(between and +); for clot2-3 (1.62%, 2:1, 3% CaCl2), homogeneity of clot +
(between and +); for clot2-4 (2.0%, 2:1, 3% CaCl2), homogeneity was +.

[00121] The homogeneity of clots prepared with 1.3% w/w CaCl2 solution (3 of 4 samples were +, 1 of 4 samples was between and +) was better than the clots prepared with 3% w/w CaCl2 solution (1 of 4 were samples was +, 3 of 4 samples were between and +).
Table 12 Homogeneity of PRP/chitosan clots Clot samples (with NaCI) Homogeneity of clot PRP 1-1-60 (1.62%, 3:1, 1.3% CaCl2) PRP 1-2-60 (2.0%, 3:1, 1.3% CaCl2) PRP 1-3-60 (1.62%, 2:1, 1.3% CaCl2) PRP 1-4-60 (2.0%, 2:1, 1.3% CaCl2) + (between and +) PRP 2-1-60 (1.62%, 3:1, 3% CaCl2) + (between and +) PRP 2-2-60 (2.0%, 3:1, 3% CaCl2) + (between and +) PRP 2-3-60 (1.62%, 2:1, 3% CaCl2) + (between and +) PRP 2-4-60 (2.0%, 2:1, 3% CaCl2) Formulation and characterization of PRP/chitosan clots prepared with chitosan solutions of different molecular weight (Rabbit blood) and an inversion mixing method 1- Preparation of chitosan (1.62% w/w)-HCI (38 mM)-NaCI (160 mM) solution;
without NaOH, pH: 6.6; total volume: 10.0 ml

[00122] The chitosan-HCI-NaCI solutions were prepared with chitosan Mn 232 kDa, 81% DDA or with chitosan Mn 298 kDa, 76% DDA as described hereinabove. The pH of the chitosan solutions were physiological at 6.6 and 6.5 and the osmolality was also physiological (332 and 330 mOsm/kg; Table 13).
2- Preparation of chitosan (1.62% w/w)-HCI (71 mM)-f3GP (2.15%) solution, pH:
6.6, total volume: 9.0 ml (Respectively using chitosan CHI 00702B, CH0050602A)

[00123] The chitosan-HCl-GP solutions were prepared with chitosan Mn 232kDa, 81%DDA or with chitosan Mn 298 kDa, 76% DDA as described hereinabove. The pH of the chitosan solutions were physiological at 6.7 and the osmolality was also physiological (341 and 339 mOsm/kg; Table 13).
Table 13 Composition and properties of chitosan solutions.
Solution No and Cchitosan CHCI CNaCI Cl3GP pH
Osomolarity type. (Vow/w) (mM) (mM) (Vow/w) Precipitation (Measured) (mOsm) 1-1.Chitosan-HCI-NaCI
pH6.6(CH0100702B) 1.62 38 160 no no 6.61 332 1-2.Chitosan-HCI-pH6.6(CH0100702B) 1.62 71 No 2.15 no __ 6.67 341 2-1.Chitosan-HCI-NaCI
pH6.6(CH0050602A) 1.62 38 160 no no 6.52 330 2-2.Chitosan-HCI-BGP
pH6.6(CH0050602A) 1.62 71 No 2.15 no 6.65 339 3- Drawing blood

[00124] Blood was extracted from rabbits using sterile technique, as described hereinabove. One rabbit was used in this experiment.
4- Isolating PRP from anti-coagulated whole blood

[00125] PRP was isolated from rabbit whole blood by differential centrifugation as described hereinabove. About 4.5 ml PRP was harvested from the ACD blood collected the rabbit.
5- Experiment part 1: Formulation and characterization of PRP/1.62% chitosan clots (with NaCI and I3GP)

[00126] PRP/chitosan-HCI-NaCI mixtures were prepared at mix ratio 3:1 v/v:
0.9 mL of platelet-rich plasma (PRP) was pipetted into cryotubes containing pl 1.62% w/w chitosan-HCI-NaCI (pH 6.6) solution and three 0.39g stainless steel balls, mixed by hand for 10 seconds (the tube was shaken and reversed about 50 times vigorously). 240 pL 3% w/w CaCl2 solution was added to the PRP/chitosan mixture and mixed gently by inverting the tube 5 times in 5 seconds. 300 pL of each mixture was transferred into three glass tubes to prepare 3 clots: 1 clot was used to test coagulation time and fixed immediately after it coagulated, 1 clot was used to test coagulation time and fixed after minutes, 1 clot was used to test coagulation time and mechanical strength after 60 minutes. All the procedures described hereinabove were repeated by mixing PRP with 1.62% w/w chitosan-HCl-GP (pH6.6) solution instead of 1.62% w/w chitosan-HCI-NaCI (pH6.6) solution. All procedures which are described hereinabove were performed with the 2 different chitosans: chitosan CH0100702B (Mn 232 kDa, 81% DDA) and chitosan CH0050602A (Mn 298 kDa, 76% DDA).

[00127] Coagulation of the clot was determined by visualization of the clot at 37 C as described hereinabove. Mechanical strength was tested as described hereinabove.

[00128] Results showed that all the mixtures prepared with chitosan CH0100702B (Mn 232 kDa, 81% DDA) coagulated within 8 minutes. The coagulation time of PRP/chitosan-HCI-NaCI clots was near equal to the coagulation time of PRP/chitosan-HCI-13GP clots (average was 7.3 minutes versus 7 minutes respectively) (Table 14 and Fig. 11). Results showed that all the mixtures prepared with chitosan CH0050602A (Mn 298 kDa, 76% DDA) coagulated within 8 minutes. The coagulation time of PRP/chitosan-HCI-NaCI
clots was near equal to the coagulation time of PRP/chitosan-HCI-13GP clots (average was 7 minutes versus 8 minutes respectively) (Table 14 and Fig. 11).
Table 14 Coagulation time of PRP/chitosan clots prepared by inversion with CH0100702B and CH0050602A chitosans.
Mixture Concentration Coagulation Mean Comments of chitosan time (Min) value solution and (Min) mix ratio PRP/ Chitosan- 1.62% 1 8 7.3 All the mixtures HCI-NaCI and 3:1 2 7 coagulated within 8 CH0100702B (clot1-1) 3 7 minutes (from 7 minutes to 8 minutes).
PRP/ Chitosan- 1.62% 1 7 7 All the mixtures HCI-13GP and 3:1 2 7 coagulated at 7 minutes).
CH0100702B (clot1-2) 3 7 PRP/ Chitosan- 1.62% 1 7 7 All the mixtures HCI-NaCI and 3:1 2 7 coagulated at 7 minutes.
CH0050602A (clot2-1) 3 7 PRP/ Chitosan- 1.62% 1 8 8 All the mixtures HCI- I3GP and 3:1 2 8 coagulated at 8 minutes.
CH0050602A (clot2-2) 3 8 PRP without Without 1 16 15.3 All the mixtures chitosan chitosan 2 15 coagulated within 16 (clot-C) 3 15 minutes (from 15 minutes to 16 minutes).
6-Mechanical strength test and Liquid expression

[00129] All the clots prepared by inversion were firm and elastic, the mechanical strength of all the clots was "++++". There was no significant difference in mechanical strength between PRP/chitosan-HCI-NaCI clots and PRP/chitosan-HCI- clots. There was no significant difference in mechanical strength among the clots prepared with the different chitosans as well (Table and Fig. 12). After 60 minutes, the PRP/chitosan clots prepared by inversion with CH0100702B and CH0050602A, both with NaCI or f3GP, didn't express any liquid and retract (Table 15, Figs. 13&14), the clots were perfectly intact.
Meanwhile, the PRP clot without chitosan expressed a lot of liquid (82.9%) and retracted significantly (Table 15, Fig. 13&14).
Table 15 Mechanical strength test of PRP/chitosan clots prepared by inversion.
Sample Resistance to Weight Weight Weight Liquid Crushed Level of compression of the of tube of expressed =
appearance hemolysis tube + clot + Tube + (B-C)/(B-A) X
(A) serum clot (C) 100 (B) PRP/1.62 /0 ++++ 7.47g 7.86g 7.86g 0 2 fragments Chitosan-HCI- but still NaCI (pH6.6) connected clot1-1 (3:1, CH0100702B) PRP/1.62% ++++ 7.46g 7.84g 7.84g 0 2 fragments Chitosan-HCI- but still i3GP (pH6.6) connected clot1-2 (3:1, CH0100702B) PRP/1.62% ++++ 7.53g 7.92g 7.92g 0 Hole in Chitosan-HCI- center NaCI (pH6.6) clot2-1 (3:1, CH0050602A) PRP/1.62 /0 ++++ 7.48g 7.86g 7.86g 0 2 fragments Chitosan-HCI- but still I3GP (pH6.6) connected clot2-2 (3:1, CH0050602A) Pure PRP clot- ++++ 7.38g 7.73g 7.44g 82.9 2 fragments C (without but still chitosan) connected 8- Histological treatment and homogeneity evaluation of PRP/chitosan clots

[00130] Histological treatment and homogeneity evaluation was performed as described hereinabove.

[00131] The PRP/chitosan clots prepared by inversion with (3GP were more homogenous (1 of 2 samples was "+" and one was " between and +) than the PRP/chitosan clots prepared by inversion with NaCI (both samples were "2) (Table 16).
Table 16 Homogeneity of PRP/chitosan clots prepared by inversion Clot samples (with Homogeneity of Clot samples (with Homogeneity of NaCI) clots (with NaCI) 13GP) clots (with I3GP) (CH0100702B) (CH0100702B) PRP 2-1 PRP 2-2 (between and +) (CH0050602A) (CH0050602A) PRP-C (without N/A N/A
chitosan)

[00132] While the invention has been described in connection with specific embodiments thereof, it will be understood that it is capable of further modifications and this application is intended to cover any variations, uses, or adaptations of the invention following, in general, the principles of the invention and including such departures from the present disclosure as come within known or customary practice within the art to which the invention pertains and as may be applied to the essential features hereinbefore set forth, and as follows in the scope of the appended claims.

Claims (73)

WHAT IS CLAIMED IS:

1- A clot-activated polymer composition comprising platelet-rich plasma (PRP), a chitosan, a salt and a clot activator.

2- The clot-activated polymer composition of claim 1, wherein the salt is an organic or inorganic salt.

3- The clot-activated polymer composition of claim 2, wherein the inorganic salt is sodium salt, chloride salt, potassium salt, calcium salt, magnesium salt, phosphate salt, sulfate salt or carboxylate salt.

4- The clot-activated polymer composition of claim 2, wherein the inorganic salt is at least one of NaCl, KCl, CsCl, CaCl2, CsF, KClO4 NaNO3 or CaSO4.

5- The clot-activated polymer composition of claim 2, wherein the organic salt is glycerol-phosphate.

6- The clot-activated polymer composition of any one of claims 1-5, wherein said clot activator is a CaCl2 solution.

7- The clot-activated polymer of claim 6, wherein said CaCl2 solution further comprises thrombin.

8- The clot-activated polymer composition of any one of claims 1-7, wherein the polymer is prepared by combining said PRP to a chitosan solution comprising said chitosan and said salt at a volume ratio of about 4:1.

9- The clot-activated polymer composition of claim 8, wherein the volume ratio is about 3:1.

10- The clot-activated polymer composition of claim 8, wherein the volume ratio is about 2:1.

11- The clot-activated polymer composition of claim 8, wherein the volume ratio is about 1:1.

12- The clot-activated polymer composition of claim 8, wherein the volume ratio is from about 4:1 to about 1:1.

13- The clot-activated polymer composition of claim 6, wherein the concentration of CaCl2 in said CaCl2 solution is between about 1.0 % w/w to about 25% w/w.

14- The clot-activated polymer composition of claim 6, wherein the concentration of CaCl2 in said CaCl2 solution is between about 1.3 % w/w to about 3% w/w.

15- The clot-activated polymer composition of any one of claims 1-14, wherein the polymer composition has a pH between about 6.2 and about 6.8.

16- The clot-activated polymer composition of any one of claims 1-15, wherein the polymer is prepared with a solution of said chitosan having an osmolality between about 250 mOsm/kg and about 600 mOsm/kg.

17- The clot-activated polymer composition of claim 16, wherein the osmolality between about 342 mOsm/kg and about 361 mOsm/kg.

18- The clot-activated polymer composition of any one of claims 1-17, wherein the polymer is prepared with a solution of said having a chitosan concentration of between about 1.0% w/w to about 10% w/w.

19- The clot-activated polymer composition of claim 18, wherein the chitosan concentration is between about 1.62% w/w to about 2% w/w.

20- The clot-activated polymer composition of any one of claims 1-17, wherein the chitosan has a degree of deacetylation (DDA) between about 20% to about 100%.

21- The clot-activated polymer composition of claim 20, wherein the DDA is 76% or 81%.

22- The clot-activated polymer composition of any one of claims 1-21, wherein the chitosan has a number average molecular weight (M n) ranging from about 1 kDa to about 10 MDa.

23- The clot-activated polymer composition of claim 22, wherein the M n is about 232 kDa or about 298 kDa.

24- The clot-activated polymer composition of any one of claims 1-23, further comprising a mineral acid or an organic acid.

25- The clot-activated polymer composition of claim 24, wherein the mineral acid is hydrochloric acid, acetic acid, nitric acid, phosphoric acid, sulfuric acid, boric acid hydrofluoric acid or hydrobromic acid.

26- A clot-activated polymer composition prepared by combining platelet-rich plasma (PRP), a chitosan solution, a salt solution and a clot activator solution, wherein:
.cndot. the concentration of chitosan in said chitosan solution is between about 1.0% w/w to 10% w/w; and .cndot. the volume ratio between the PRP and the chitosan solution is between about 4:1 to about 1:1.

27- The clot-activated polymer composition of claim 26, further comprising combining a mineral acid or an organic acid.

28- The clot-activated polymer composition of claim 26 or 27, wherein the salt solution comprises an inorganic salt.

29- The clot-activated polymer composition of claim 28, wherein the inorganic salt is sodium salt, chloride salt, potassium salt, calcium salt, magnesium salt, phosphate salt, sulfate salt or carboxylate salt.

30- The clot-activated polymer composition of claim 28, wherein the inorganic salt is NaCl, KCl, CsCl, CaCl2, CsF, KClO4, NaNO3 or CaSO4.

31- The clot-activated polymer composition of claim 26 or 27, wherein the salt solution comprises an organic salt.

32- The clot-activated polymer composition of claim 31, wherein the organic salt is glycerol-phosphate.

33- The clot-activated polymer composition of any one of claims 26-32, wherein the clot activator solution comprising thrombin at a concentration from about 100U/ml to about 1000 U/ml diluted in a 10% w/w of a CaCl2 solution.

34- The clot-activated polymer composition of any one of claims 26-32, wherein the clot activator is a CaCl2 solution.

35- The clot-activated polymer composition of claim 34, wherein the CaCl2 solution further comprises thrombin.

36- The clot-activated polymer composition of any one of claims 26-35, wherein the volume ratio between a first solution comprising the PRP, the chitosan solution and the salt and a second solution comprising the clot activator is about 10:1.

37- The clot-activated polymer composition of any one of claims 26-35, wherein the volume ratio between a first solution comprising the PRP, the chitosan solution and the salt and a second solution comprising the clot activator is about 9:1.

38- The clot-activated polymer composition of claim 34, wherein the concentration of CaCl2 in the CaCl2 solution is between about 1.0 % w/w to about 25% w/w.

39- The clot-activated polymer composition of claim 34, wherein the concentration of CaCl2 in the CaCl2 solution is between about 1.3 % w/w to about 3% w/w.

40- The clot-activated polymer composition of any one of claims 26-39, wherein the volume ratio of between the PRP and the chitosan solution is about 3:1.

41- The clot-activated polymer composition of any one of claims 26-39, wherein the volume ratio of between the PRP and the chitosan solution is about 2:1.

42- The clot-activated polymer composition of any one of claims 26-40, wherein the polymer composition has a pH between about 6.2 and about 6.8.

43- The clot-activated polymer composition of any one of claims 26-42, wherein the chitosan solution has an osmolality between about 250 mOsm/kg and about 600 mOsm/kg.

44- The clot-activated polymer composition of claim 43, wherein the chitosan solution has an osmolality between about 342 mOsm/kg and about 361 mOsm/kg.

45- The clot-activated polymer composition of any one of claims 26-44, wherein the concentration of chitosan in said chitosan solution is between about 1.62% w/w to about 2% w/w.

46- The clot-activated polymer composition of any one of claims 26-45, wherein the chitosan of said chitosan solution has a degree of deacetylation (DDA) between about 20% to about 100%.

47- The clot-activated polymer composition of claim 46, wherein the DDA is about 76%.

48- The clot-activated polymer composition of claim 46, wherein the DDA is about 81%.

49- The clot-activated polymer composition of any one of claims 26-48, wherein the chitosan of the chitosan solution has a number average molecular weight (M n) ranging from about 1 kDa to about 10 MDa.

50- The clot-activated polymer composition of claim 49, wherein the M n is about 232 kDa or about 298 kDa.

51- The clot-activated polymer composition of claim 27, wherein the mineral acid is hydrochloric acid, acetic acid, nitric acid, phosphoric acid, sulfuric acid, boric acid hydrofluoric acid or hydrobromic acid.

52- A method for repairing a tissue of a patient, said method comprising the step of introducing into said tissue a clot-activated polymer composition as defined in any one of claims 1-51 such that the composition adheres to the tissue and promotes cell proliferation for repairing the tissue.

53- The method of claim 52, wherein said tissue is selected from the group consisting of cartilage, meniscus, ligament, tendon, bone, skin, cornea, periodontal tissues, maxillofacial tissues, temporomandibular tissues, abscesses, resected tumors and ulcers.

54- Use of a clot-activated polymer composition as defined in any one of claims 1-51 for repairing a tissue of a subject, wherein the polymer composition adheres to the tissue and promotes cell proliferation.

55- Use of a clot-activated polymer composition as defined in any one of claims 1-51 in the manufacture of a medicament for repairing a tissue of a subject, wherein the polymer composition adheres to the tissue and promotes cell proliferation.

56- The use of claim 54 or 55, wherein said tissue is selected from the group consisting of cartilage, meniscus, ligament, tendon, bone, skin, cornea, periodontal tissues, maxillofacial tissues, temporomandibular tissues, abscesses, resected tumors and ulcers.

57- A method of preparing a clot-activated polymer composition for repairing tissue in a subject, said method comprising the steps of:
a) dissolving from 1.0% w/w to 10.0% w/w of chitosan in HCl to provide a chitosan-HCl mixture;
b) adding a NaCl solution or glycerol phosphate to the chitosan-HCl mixture to provide a chitosan-HCl-salt mixture;
c) admixing platelet-rich plasma (PRP) to the chitosan-HCl-salt mixture at a volume ratio between about 4:1 and about 1:1 to provide a PRP/chitosan-HCl-salt mixture; and d) adding a clot activator to the PRP/chitosan-HCl-salt mixture at a volume ratio of between about 5:1 to about 10:1.

58- The method of claim 57, wherein the clot activator is a CaCl2 solution.

59- The method of claim 58, wherein the CaCl2 solution also comprises thrombin.

60- The method of any one of claims 57-59, wherein, in step a), wherein the chitosan is dissolved in HCl by heating at a temperature of about 60°C
for about 2 hours.

61- The method of any one of claims 57-60, wherein the chitosan solution has a chitosan concentration of about 1.62% w/w.

62- The method of any one of claims 57-61, wherein the chitosan solution comprises chitosan having a degree of deacetylation (DDA) of about 76%.

63- The method of claim 62, wherein the DDA is about 81%.

64- The method of any one or claims 57-63, wherein the chitosan solution comprises a chitosan having a number average molecular weight (M n) of about 232 kDa.

65- The method of claim 64, wherein the M n is of about 298 kDa.

66- The method of any one of claims 57-64, wherein the concentration of the hydrochloric acid in the chitosan-HCl-salt solution is about 38 mM.

67- The method of any one of claims 57-64, wherein the concentration of the hydrochloric acid in the chitosan-HCl-salt solution is about 71 mM.

68- The method of any one of claims 57-67, wherein the concentration of NaCl in the chitosan-HCl-salt solution is about 150 mM.

69- The method of any one of claims 57-67, wherein the concentration of NaCl in the chitosan-HCl-salt solution is about 160 mM.

70- The method of claim 58, wherein the concentration of CaCl2 in the CaCl2 solution is between about 1.0 % w/w to about 25 % w/w.

71- The method of claim 59, wherein the thrombin is provided as a solution of about 100 U/ml to about 1000 U/ml diluted with 10% w/w of the CaCl2 solution.

72- The method of any one of claims 57-71, wherein the clot activator is layered on top of the PRP/chitosan-HCl-salt mixture.

73- The method of any one of claims 57-71, wherein the clot activator is gently mixed by inversion with the PRP/chitosan-HCl-salt mixture.