The serpin plasminogen activator inhibitor-1 (PAI-1) is a specific inhibitor of plasminogen activators and a potential therapeutic target in cancer and cardiovascular diseases. Accordingly, formation of a basis for development of specific PAI-1-inactivating agents is of great interest. One possible inactivation mode for PAI-1 is conversion to the inactive, so-called latent state. We have now screened a phage-displayed peptide library with PAI-1 as bait and isolated a 31-residue cysteine-rich peptide that will be referred to as paionin-4. A recombinant protein consisting of paionin-4 fused to domains 1 and 2 of the phage coat protein g3p caused a 2-to 3-fold increase in the rate of spontaneous inactivation of PAI-1. Paionin-4-D1D2 bound PAI-1 with a K D in the high nanomolar range. Using several biochemical and biophysical methods, we demonstrate that paionin-4-D1D2-stimulated inactivation consists of an acceleration of conversion to the latent state. As demonstrated by site-directed mutagenesis and competition with other PAI-1 ligands, the binding site for paionin-4 was localized in the loop between ␣-helix D and -strand 2A. We also demonstrate that a latency-inducing monoclonal antibody has an overlapping, but not identical binding site, and accelerates latency transition by another mechanism. Our results show that paionin-4 inactivates PAI-1 by a mechanism clearly different from other peptides, small organochemical compounds, or antibodies, whether they cause inactivation by stimulating latency transition or by other mechanisms, and that the loop between ␣-helix D and -strand 2A can be a target for PAI-1 inactivation by different types of compounds.Plasminogen activator inhibitor type-1 (PAI-1) is a fast and specific inhibitor of the urokinase-type plasminogen activator (uPA) and the tissue-type plasminogen activator. PAI-1 is therefore an important regulator of the physiological and pathophysiological functions of plasminogen activation. A high level of PAI-1 in blood is associated with an increased risk of thrombotic events (for review, see Vaughan, 1998). PAI-1 is therefore a potential target for antithrombotic therapy. A high level of PAI-1 in tumors is associated with a poor prognosis, and several studies have suggested that PAI-1 is contributory to tumor invasion and metastasis (for review, see Andreasen et al., 1997Andreasen et al., , 2000Durand et al., 2004;Andreasen, 2007). PAI-1 is therefore a potential target for anticancer therapy.PAI-1 belongs to the serpins, a protein family of which the best characterized members are known to be inhibitors of serine proteases. Serpins are globular proteins consisting of three -sheets (A, B, and C) and nine ␣-helices (A-I). Of crucial importance for the inhibitory mechanism of serpins is the surface-exposed reactive center loop (RCL), tethered between -strands 1C and 5A. The active site of the protease attacks the P1-P1Ј bond in the RCL as a substrate, but at the enzyme-acyl intermediate stage, where the active site serine of the protease and the P1 r...