To elucidate the effects of carboxymethyl chitosan (CMCTS) on the proliferation, differentiation and cytokine secretion of peripheral blood mononuclear cells (PBMCs), leukomonocytes were separated and cultured. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assays, acridine orange/ethidium bromide staining, flow cytometry and enzyme-linked immuno sorbent assay was used to evaluate different concentrations of CMCTS A (molecular weight (MW = 50 000) and CMCTS B (MW = 500 000) in the proliferation, apoptosis, differentiation and cytokine secretion of PBMCs. The results demonstrated that CMCTS A and CMCTS B at concentrations of 500 and 100 mu g ml(-1), respectively, significantly enhanced the proliferation of PBMCs. Both CMCTS A and CMCTS B inhibited the apoptosis of PBMCs, and the optimal inhibitory concentration was 500 mu g ml(-1). Furthermore, the inhibitory efficacy of CMCTS A was higher than that of CMCTS B. CMCTS A induced the differentiation of PBMCs with CD4 antibody at concentrations of 500 and 100 mu g ml(-1). Furthermore, the differentiation of PBMCs with CD3-CD56 antibodies was induced by both CMCTS A and CMCTS B. Both CMCTS A and CMCTS B at concentrations of 500 mu g ml(-1) induced interleukin (IL)-2 secretion, with CMCTS A having a more marked effect than that of CMCTS B. CMCTS A at a concentration of 500 mu g ml(-1) induced interferon (IFN)-gamma secretion. In conclusion, CMCTS with a low MW (50 000) and at a concentration of 500 mu g ml(-1) positively regulated the proliferation, differentiation and IFN-gamma and IL-2 secretion of the PBMCs in vitro. Polymer Journal (2013) 45, 226-232; doi:10.1038/pj.2012.118; published online 11 July 2012