The family of serine proteinase inhibitors (serpins) is a class of proteins that can adopt multiple conformations and exist in various physical forms, some of which are known to be pathogenic. 1,2 Serpins can exist as native (active), cleaved (inactive), latent (inactive, but not cleaved), complexed with target enzyme, and polymerized forms, and it has been suggested that these conformers have not only diverse functional properties at the cellular level and different elimination rates, but also may exhibit new physiological functions. 3,4 ␣ 1 -Antitrypsin (AAT) is the prototypic member of the serpin family and primarily inhibits neutrophil elastase and proteinase 3. 5 AAT is an acute-phase protein, predominantly synthesized by the liver, the concentration of which during the acute-phase processes rises by three-to fourfold that of normal (1.34 mg/mL). 1 It follows that levels of AAT-elastase complexes also increase, a conclusion supported by the observation that, e.g., in acute leukemia patients, AATelastase complex levels are found to be more than 10 times higher than normal. 6 Formation of a stable, covalent complex between AAT and its target enzyme is associated with cleavage of the serpinreactive center loop, generating a 4-kd carboxyl-terminal fragment of 36 residues. This peptide remains non-covalently bound to the cleaved AAT in complex with enzymes and also to the core of cleaved AAT, dissociated from the complex. 3 The peptide can be separated from the cleaved AAT under denaturing conditions in vitro. Joslin et al. showed that proteolytically cleaved AAT binds to receptors on HepG2 cells and that binding is mediated by the same domain within the carboxyl-terminal fragment of AAT as for AAT-enzyme complexes. 7 Results from their studies using AAT-elastase complexes and purified fragments of AAT confirmed that a domain within the 4-kd carboxyl-terminal fragment of AAT is necessary for binding to these serpin-enzyme complex (SEC) receptor(s), and that such a domain is available for receptor binding only when AAT forms a complex with serine proteinase or when it is proteolytically modified. Recently, it was demonstrated that cellular internalization and degradation of antithrombin-thrombin, AAT-elastase, AAT-trypsin, urokinasetype plasminogen activator-plasminogen activator inhibitor-1, and some other SECs, but not native or cleaved forms of serpins, is mediated by the low-density lipoprotein receptorrelated protein 8 and very-low-density lipoprotein receptor. 9 Identification that protease-serpin complexes are recognized by endocytosis receptors of the low-density lipoprotein (LDL) receptor family suggests that those receptors play a role in both lipoprotein metabolism and proteinase regulation during the inflammatory response. In our previous work, we showed that proteolytically cleaved AAT increases LDL binding and uptake by up to 70% in a concentration-and time-dependent manner in HepG2 cells, suggesting a possible Abbreviations: AAT, ␣ 1 -antitrypsin; SEC, serpin-enzyme complex; LDL, low-density lipopr...