Background: Neutrophil dysfunction in alcoholic hepatitis is associated with endotoxemia and an increased incidence of infection, but the mechanism is unclear. We aimed to investigate the role of Toll-like-receptors (TLR)2, 4 and 9 in mediating neutrophil dysfunction in alcoholic hepatitis. Methods: Neutrophils from healthy volunteers were incubated with alcoholic hepatitis patients` plasma (n=12) with/without TLR2, 4 or 9 antagonists and with/without human albumin. TLR2, 4 and 9 expression, neutrophil oxidative burst, phagocytosis and CXCR1+2 expression were measured by FACS analysis. Results: Patients' plasma increased oxidative burst, decreased CXCR1+2 expression and decreased phagocytosis of normal neutrophils in association with increased expression of TLR2, 4 and 9 and depletion of ATP. Inhibition of TLR2, 4 and 9 prevented the increase in oxidative burst and the decrease in CXCR1 and CXCR2 expression but did not prevent phagocytic dysfunction. Incubation with albumin completely prevented the patient plasma induced neutrophil dysfunction. Conclusion: Increased expression of TLR2, 4 and 9 is associated with neutrophil dysfunction, endotoxaemia and energy depletion. TLR2, 4 and 9 inhibition does not improve phagocytosis, indicating that TLR over-expression may be the result and not the cause of neutrophil activation. Albumin, an endotoxin scavenger, prevents the deleterious effect of patients' plasma on neutrophil phagocytosis, resting burst and TLR expression.