Initial recognition of microbes, as they enter the body, is based on germ line-encoded pattern recognition receptors that selectively bind to essential components of pathogens. This allows the body to respond immediately to the microbial invasion before the development of active immunity. The signal-transducing receptors that trigger the acute inflammatory cascade have been elusive until very recently. On the basis of their genetic similarity to the Toll signaling pathway in Drosophila, mammalian Toll-like receptors (TLRs) have been identified. By now, nine transmembrane proteins in the TLR family have been described. Mammalian TLR4 is the signal-transducing receptor activated by the bacterial lipopolysaccharide. The activation of TLR4 leads to DNA binding of the transcription factor NF-kappaB, resulting in activation of the inflammatory cascade. Activation of other TLRs is likely to have similar consequences. TLR2 mediates the host response to Gram-positive bacteria and yeast. TLR1 and TLR6 may participate in the activation of macrophages by Gram-positive bacteria, whereas TLR9 appears to respond to a specific sequence of bacterial DNA. The TLRs that control the onset of an acute inflammatory response are critical antecedents for the development of adaptive acquired immunity. Genetic and developmental variation in the expression of microbial pattern recognition receptors may affect the individual's predisposition to infections in childhood and may contribute to susceptibility to severe neonatal inflammatory diseases, allergies, and autoimmune diseases.