1. Proteinase inhibitors have been studied in whole serum by using a kinetic method that avoids potentially damaging protein separation procedures.

2. The α2-macroglobulin of an individual can be allocated unambiguously into one of seven categories according to the binding of trypsin to inhibitor in two kinetically apparent binding modes (β- and α-modes).

3. The distribution of α2-macroglobulin β:α ratios in a healthy adult population is defined, and shown to be independent of sex and age.

4. The distribution of β: α ratios in a group of patients with cryptogenic fibrosing alveolitis was found to be significantly different (P < 0.005) from the normal distribution.

5. Changes in the β: α ratio were noted in five of six patients with cryptogenic fibrosing alveolitis after treatment, but on no occasion when two healthy subjects were assessed a total of nine times.

6. The molecular interpretation and the possible importance of altered proteinase inhibition in inflammation and fibrosis are discussed.

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