Efficacy and Safety of Alpha1-Proteinase Inhibitor (Human), Modified Process (Alpha-1 MP) in Subjects With Pulmonary Emphysema Due to Alpha1 Antitrypsin Deficiency (AATD)

Inclusion Criteria:

- Have a documented total alpha1-PI serum level < 11 µM.

- Have a diagnosis of congenital AATD with an allelic combination of ZZ, SZ, Z(null),
(null)(null), S(null), or "at-risk" alleles.

- At the Screening (Week -3) Visit, have a post-bronchodilator forced expiratory volume
in 1 second (FEV1) ≥ 30% and < 80% of predicted and FEV1/forced vital capacity (FVC) <
70% (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage II or III).

- Have a carbon monoxide diffusing capacity (DLCO) ≤ 60% of predicted (corrected for
HgB) within the past 2 years OR evidence of pulmonary emphysema on CT scan within the
past 2 years per the Investigator's judgment.

- Have clinical evidence of pulmonary emphysema per the Investigator's judgment.

Exclusion Criteria:

- Has received alpha1-PI augmentation therapy for more than 1 month within the six
months prior to the Screening Visit.

- Has received alpha1-PI augmentation therapy within one month of the Screening Visit.

- Has had a chronic obstructive pulmonary disease (COPD) exacerbation within the 5 weeks
prior to the Screening Visit or during the Screening Phase.

- Unable to physically (e.g., unable to fit inside the CT scanner) or mentally (e.g.,
claustrophobic) undergo a CT scan.

- History of lung or liver transplant.

- Any lung surgery during the past 2 years (excluding lung biopsy).

- On the waiting list for lung surgery, including lung transplant.

- Smoking during the past 12 months or a positive urine cotinine test at screening that
is due to smoking. Maybe on Nicotine replacement, including vapor cigarettes.

- History of anaphylaxis or severe systemic response to any plasma-derived alpha1-PI
preparation or other blood product(s).

- Use of systemic steroids above a stable dose equivalent to 5 mg/day prednisone (i.e.,
10 mg every 2 days) within the 5 weeks prior to the Screening Visit (inhaled steroids
are not considered systemic steroids) or during the Screening Phase.

- Use of systemic or aerosolized antibiotics for a COPD exacerbation within the 5 weeks
prior to the Screening Visit or during the Screening Phase.

- Known selective or severe Immunoglobulin A (IgA) deficiency.