Thiamine pyrophosphokinase transfers a pyrophosphate group from a nucleoside triphosphate, such as ATP, to the hydroxyl group of thiamine to produce thiamine pyrophosphate. Deficiencies in thiamine can result in the development of the neurological disorder Wernicke-Korsakoff Syndrome as well as the potentially fatal cardiovascular disease wet beriberi. Pyrithiamine is an inhibitor of thiamine metabolism that induces neurological symptoms similar to that of Wernicke-Korsakoff Syndrome in animals. However, the mechanism by which pyrithiamine interferes with cellular thiamine phosphoester homeostasis is not entirely clear. We used kinetic assays coupled with mass spectrometry of the reaction products and x-ray crystallography of an equilibrium reaction mixture of thiamine pyrophosphokinase, pyrithiamine, and Mg 2؉ /ATP to elucidate the mechanism by which pyrithiamine inhibits the enzymatic production of thiamine pyrophosphate. Three lines of evidence support the ability of thiamine pyrophosphokinase to form pyrithiamine pyrophosphate. First, a coupled enzyme assay clearly demonstrated the ability of thiamine pyrophosphokinase to produce AMP when pyrithiamine was used as substrate. Second, an analysis of the reaction mixture by mass spectrometry directly identified pyrithiamine pyrophosphate in the reaction mixture. Last, the structure of thiamine pyrophosphokinase crystallized from an equilibrium substrate/product mixture shows clear electron density for pyrithiamine pyrophosphate bound in the enzyme active site. This structure also provides the first clear picture of the binding pocket for the nucleoside triphosphate and permits the first detailed understanding of the catalytic requirements for catalysis in this enzyme.Thiamine pyrophosphokinase (TPK, 2 EC 2.7.6.2) catalyzes the transfer of a pyrophosphate group from ATP to thiamine to form thiamine pyrophosphate (TPP). TPK is a member of the pyrophosphotransferase family that also includes 6-hydroxy-methyl-7,8-dihydropterin pyrophosphokinase (HPPK), phosphoribosylpyrophosphate synthase, nucleotide pyrophosphokinase, and GTP pyrophosphokinase.The product of the reaction, TPP, plays a central role in cellular energy generation and functions as a tightly bound cofactor for the reactions catalyzed by pyruvate dehydrogenase, ␣-ketoglutarate dehydrogenase, branched chain ␣-keto acid dehydrogenase, and 2-hydroxyphytanoyl-CoA lyase. In addition, TPP is also required for transketolase activity in the pentose phosphate pathway. This pathway is the sole source of ribose for nucleotide synthesis and the major source of NADPH for reductive biosynthesis. Therefore, the production of TPP catalyzed by TPK is critical for both catabolic and anabolic cellular processes.