Human alpha(1)-antitrypsin-deficient variants may aggregate in the liver, with subsequent deficiency in the plasma, which can lead to emphysema. The structural and functional characteristics of 10 dysfunctional alpha(1)-antitrypsin variants (R39C, S53F, V55P, 192N, G115S, N158K, E264V, A336T, P3695, and P369L) were analyzed in detail. Most of theta were unstable, as compared to the wild-type molecule, and many of the variants folded into an intermediate form. When five thermostable mutations (T68A, A70G, M3741, S381A, and K387R) were introduced into dysfunctional alpha(1)-antitrypsin variants, the stabilities and inhibitory activities of most of the variants were restored to levels comparable to those of the wild-type molecule. However, the extremely unstable S53F variant was not stabilized sufficiently by these mutations SO as to exhibit function. N158K variant, which carries a mutation in the region critical for the reactive site loop insertion into beta-sheet A, exhibited a reduced level of inhibitory activity, despite conformational stabilization. These results show that aberrant folding caused by conformational destabilization due to mutations can be compensated for by increasing the overall stability of the alpha(1)-antitrypsin molecule, with exception of a mutation in the highly localized region critical for functional execution. (c) 2006 Elsevier Inc. All rights reserved.