The misfolding of serpins is linked to several genetic disorders including emphysema, thrombosis, and dementia. During folding, inhibitory serpins are kinetically trapped in a metastable state in which a stretch of residues near the C terminus of the molecule are exposed to solvent as a flexible loop (the reactive center loop). When they inhibit target proteases, serpins transition to a stable state in which the reactive center loop forms part of a six-stranded β-sheet. Here, we use hydrogen-deuterium exchange mass spectrometry to monitor region-specific folding of the canonical serpin human α 1 -antitrypsin (α 1 -AT). We find large differences in the folding kinetics of different regions. A key region in the metastable → stable transition, β-strand 5A, shows a lag phase of nearly 350 s. In contrast, the "B-C barrel" region shows no lag phase and the incorporation of the C-terminal residues into β-sheets B and C is largely complete before the center of β-sheet A begins to fold. We propose this as the mechanism for trapping α 1 -AT in a metastable form. Additionally, this separation of timescales in the folding of different regions suggests a mechanism by which α 1 -AT avoids polymerization during folding.hydrogen exchange | misfolding disease | protein folding T he misfolding and polymerization of serpins is linked to a number of inherited diseases including liver cirrhosis, emphysema, and dementia (1). In the most common serpin-linked disease, α 1 -antitrypsin deficiency, α 1 -antitrypsin (α 1 -AT) is trapped in a misfolded polymerization prone state during processing in the endoplasmic reticulum. Accumulation of polymers ultimately leads to apoptosis. Unlike in amyloid diseases, however, it is not thought that serpins undergo a compete change in their secondary and tertiary structures upon polymerization. Instead, serpin misfolding is thought to be related to their unusual inhibitory mechanism.The lowest free energy structure of α 1 -AT is shown in Fig. 1B. However, the structure shown in Fig. 1A is the structure that α 1 -AT spontaneously adopts during folding. Alpha-1 antitrypsin, like other inhibitory serpins, is trapped in a metastable state (2). The α 1 -AT fold consists of three β-sheets (A, B, and C) and nine α-helices (A-I). In the metastable form, residues 345-360 are exposed to solvent and comprise the reactive center loop (RCL) that is cleaved by target proteases, whereas in the stable form, these same residues form the fourth strand of β-sheet A. Cleavage by target proteases triggers a conformational change in which the N-terminal portion of the RCL spontaneously inserts into β-sheet A, carrying the bound protease (covalently linked as an acylenzyme intermediate) along with it.Evidence suggests that serpin polymerization is an intermolecular version of the above-described intramolecular process. The two most prominent models for serpin polymerization propose that polymers are formed either through the insertion of the RCL of one serpin into the A β-sheet of another, or through a domain swap mechani...