The next five years will be critical for the field. With several biotech startups focusing on serpin conformational modulators, we anticipate:
| Drug Class | Mechanism | Example | | :--- | :--- | :--- | | Direct Protease Inhibitor | Blocks enzyme active site | Sivelestat (neutrophil elastase inhibitor) | | | Enhances endogenous serpin function | Experimental compounds | | AACT Replacement Therapy | Infuses synthetic AACT (no activator) | Not yet clinically available | | Gene Therapy for AACT | Increases AACT gene expression | Viral vectors (preclinical) | aact activator
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