The present invention relates to modified serpins for use in the treatment of
bradykinin-mediated diseases. The modified
serine protease inhibitors (serpins) have mutations in one or more of the P4, P3, P2, P1 and P1′ residues of their
reactive center loop, which mutations increase the
serpin's inhibition of
plasma kallikrein (PK) as compared to the corresponding unmodified
serpin. The mutations in the modified serpins of the invention further ensure that serpins display substantially no inhibition of at least
thrombin and activated
protein C. A modified
serpin of the invention further preferably shows increased inhibition of at least one of an active form of
Factor XII (FXII) and
plasmin as compared to the corresponding unmodified serpin, and, preferably, the serpin inhibits at least one of an active form of FXII and PK stronger than they are inhibited by C1
esterase inhibitor. Preferably the modified serpin is a modified α1-antitrypsin. The invention further pertains to
nucleic acid molecule encoding the modified serpins of the invention, e.g. a
gene therapy vector, and to pharmaceutical compositions comprising the modified serpins of the invention or such
gene therapy vectors.