Nerve growth factor (NGF) is generated from a precursor, proNGF, that is proteolytically processed. NGF preferentially binds a trophic tyrosine kinase receptor, TrkA, while proNGF binds a neurotrophin receptor (NTR), p75NTR , that can have neurotoxic activity. Previously, we along with others showed that the soluble protein ␣ 2 -macroglobulin (␣ 2 M) is neurotoxic. Toxicity is due in part to ␣ 2 M binding to NGF and inhibiting trophic activity, presumably by preventing NGF binding to TrkA. However, the mechanisms remained unclear. Here, we show ex vivo and in vivo three mechanisms for ␣ 2 M neurotoxicity. First, unexpectedly the ␣ 2 M-NGF complexes do bind TrkA receptors but do not induce TrkA dimerization or activation, resulting in deficient trophic support. Second, ␣ 2 M makes stable complexes with proNGF, conveying resistance to proteolysis that results in more proNGF and less NGF. Third, ␣ 2 M-proNGF complexes bind p75 NTR and are more potent agonists than free proNGF, inducing tumor necrosis factor alpha (TNF-␣) production. Hence, ␣ 2 M regulates proNGF/p75 NTR positively and mature NGF/TrkA negatively, causing neuronal death ex vivo. These three mechanisms are operative in vivo, and ␣ 2 M causes neurodegeneration in a p75 NTR -and proNGF-dependent manner. ␣ 2 M could be exploited as a therapeutic target, or as a modifier of neurotrophin signals.S oluble hormones and growth factors (GF) are first produced as precursors that are processed by proteolytic cleavage to mature forms (1). Precursors and mature growth factors often mediate distinct signals. One example is the family of growth factors called neurotrophins that includes nerve growth factor (NGF). A precursor proNGF binds with high affinity to a neurotrophin receptor (NTR), p75 NTR (2, 3), an interaction generally considered to be neurotoxic. proNGF induces tumor necrosis factor alpha (TNF-␣) production by p75 NTR -expressing activated glia (4-6) and directly causes death in p75 NTR -expressing neurons (7-9). proNGF is proteolytically cleaved to produce mature NGF (2). Mature NGF binds with high affinity to a receptor tyrosine kinase called TrkA, an interaction that is neuroprotective. Mature NGF also binds to p75 NTR , and TrkA and p75 NTR crossregulate ligand affinity and signal transduction positively or negatively (10-12).The balance of neurotrophic versus neurotoxic signals depends on many factors, including receptor density and stoichiometry, the cell type and environment, and the proteolytic processing that influences the ratio of proNGF to mature NGF ligands. Thus, we hypothesized that additional mechanisms might exist to tightly regulate these heterogeneous and sometimes opposing signals.Proteins called growth factor binding proteins (BPs) regulate the proteolytic processing, half-life or stability, extracellular matrix interactions, and receptor binding specificity of growth factors. For example, insulin-like growth factors (IGFs) are bound by several IGF BPs, each regulating a distinct feature of IGF functions (13). A protein present in se...