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.