Alpha-2 Macroglobulin is a serine proteases inhibitor, which inhibits coagulation by inactivating thrombin and Kallikrein, it inhibits fibrinolysis by inactivating plasmin and involved in transport. Alpha-2-Macroglobulin is a large plasma protein, which is produced by the liver, it’s composed of 4 identical subunits bound together by -S-S- bonds. A2M is able to inactivate many kinds of proteinases (including serine-, cysteine-, aspartic- and metalloproteinases). A2M has a 35 amino acid 'bait' region in its structure. Proteinases bind and cleave the “bait” region become bound to A2M. Macrophage receptors recognize the proteinase-A2M complex and clear it from the system. A2M binds to and removes MMP-2 and MMP-9 (active forms of the gelatinase) from the circulation using scavenger receptors on the phagocytes. The levels of Alpha-2-macroglobulin are increased in nephrotic syndrome which is a condition where the kidneys start to leak out some of the smaller blood proteins. Due to its large size, A2-macroglobulin is retained in the bloodstream. Increased production of all proteins causes A2-macroglobulin concentration to increase. Chronic renal failure might lead to amyloid by alpha-2-macroglobulin. A2M is raised in cirrhosis, pregnancy and diabetes.