The metastability of the native fold makes serpin (serine protease inhibitor) proteins prone to pathological conformational change, often by insertion of an extra β-strand into the central β-sheet A. How this insertion is made possible is a hitherto unresolved question. By the use of advanced hydrogen/deuterium-exchange mass spectrometry (HDX-MS) it is shown that the serpin plasminogen activator inhibitor 1 (PAI-1) transiently unfolds under native condition, on a second-to-minute time scale. The unfolding regions comprise β-strand 5A as well as the underlying hydrophobic core, including β-strand 6B and parts of helices A, B, and C. Based thereon, a mechanism is proposed by which PAI-1 makes transitions through progressively more unfolded states along the reaction coordinate to the inactive, so-called latent form. Our results highlight the profound utility of HDX-MS in detecting sparsely populated, transiently unfolded protein states. [ABSTRACT FROM AUTHOR]