We have studied families C and A in which superactivity of PRPP synthetase (E.C. 2.7.6.1) is associated with gout and uric acid overproduction in affected hemizygous males. PRPP synthetase catalyzes synthesis of PRPP, a regulatory substrate in purine synthesis de novo. Activities of the enzyme in erythrocyte and fibroblast extracts from the male index cases, T.C. and R.A., were nearly threefold greater than normal at each Pi concentration tested. PRPP synthetase superactivity was accompanied by increased intracellular PRPP concentration and generation in erythrocytes and fibroblasts from these patients, and enhanced rates of PRPP-dependent purine synthesis reactions, including purine synthesis de novo, were demonstrable in their fibroblasts. These findings suggested that increased intracellular synthesis dut to enzyme superactivity underlay purine nucleotide and uric acid overproduction in these patients. Similar studies in cells from the sister of T.C. and the mother of R.A. showed increased values that were, however, intermediate between normal values and those of the affected males, indicating that these women are heterozygous carriers of the traits for enzyme superactivity. The enzymatic basis for increased PRPP synthetase activity in both families was investigated. Immunochemical studies in dialyzed erythrocyte lysates and highly purified erythrocyte enzyme preparations provided evidence for increased enzyme activity per molecule of immunoreactive enzyme. In addition, purified T.C. and R.A. PRPP synthetases showed 3.1- and 2.8-fold greater enzyme specific activities, respectively, than comparably purified normal enzymes. Kinetic constants of purified T.C. and R.A. PRPP synthetases for substrates, activators, and inhibitors were indistinguishable from normal, and increased maximal reaction velocity alone appeared to account for enzyme superactivity. Despite an apparently similar kinetic mechanism for superactivity, the diminished electrophoretic mobility of T.C. PRPP synthetase and increased thermal lability of R.A. PRPP synthetase suggested distinct structural alterations leading to enzyme superactivity in families C and A.