Superactive phosphoribosylpyrophosphate (PRPP) synthetases were characterized in fibroblasts and erythrocytes from 5 unrelated men with gout and/or hyperuricemia and uric acid overproduction. The kinetic basis of enzyme superactivity in all patients was increased maximal reaction velocity. Affinities of the enzyimes for substrates and activators and responsiveness to inhibitors were normal, and levels of immunoreactive enzyme in patient and control fibroblast and erythrocyte extracts were comparable. Enzymes purified to homogeneity from 2 patients confirmed the presence of isolated catalytic defects. Altered physical properties of certain of the superactive enzymes suggesteld the presence of several distinctive structural defects among the aberrant forms. Fibroblasts from each affected patient showed increased PRPP concentration :and generation, as well as accelerated rates of all PRPP-requiring purine nucleotide synthetic pathways. Thew findings support the concept that enzyme superactivity results in uric acid overproduction as a consequence of increased rates of PRPP and purine nucleotide synthesis. Cultured cells from female relatives of 2 patients showed evidence for the heterozygous carrier state, as measured both by enzyme activities and by rates of PRPP and purine synthesis. The clinical phenotype in 4 patients was limited to early adult-onset gout and its consequences, whereas the fifth patient expressed a familial constellation of hyperuricemia, sensorineural deafness, ataxia, and renal insufficiency. The severity of the derangements in PRPP synthetase and in PRPP and purine synthesis in cells from the 5 patients, however, was comparable. The neurologic accompaniments of enzyme superactivity found in 1 family described here, and in 2 others described previously, thus may not necessarily be consequences of primary defects in PRPP synthetase.Superactivity of phosphoribosylpyrophosphate (PRPP) synthetase, the enzyme which catalyzes the synthesis of the purine regulatory substrate, PRPP, from adenosine triphosphate (ATP) and ribose-5-P (I), has been associated with gout in nearly one dozen families (2-1 1). A causal relationship between excesses of enzyme activity, inherited as an X chromosome-linked trait (12-14), and increased rates of purine nucleotide and uric acid production has been established from detailed studies of affected members of some of these families (4)(5)(6)8,(14)(15)(16)(17). Erythrocytes and fibroblasts from these individuals show increased concentrations and rates of generation of 8,[15][16][17], and increased rates of purine nucleotide synthesis de novo are demonstrable both in vivo (8,16,(18)(19)(20) and in cultured fibroblasts from these patients (3)(4)(5)8,16,17). These findings indicate that excessive purine nucleotide production and uric acid excre-