Background Alcohol impairs pulmonary innate immune function and is associated with an increased risk of tuberculosis (TB). Toll‐like receptor 2 (TLR2) is a pattern recognition receptor on alveolar macrophages that recognizes Mycobacterium tuberculosis (Mtb). The expression of TLR2 depends, in part, on granulocyte‐macrophage colony‐stimulating factor (GM‐CSF) signaling. Given our prior work demonstrating the suppression of GM‐CSF signaling following chronic alcohol ingestion, we hypothesized that alcohol impairs TLR2 expression via the suppression of GM‐CSF and thereby reduces the ability of the macrophage to recognize and phagocytose Mtb. Methods Primary alveolar macrophages were isolated from control‐fed and alcohol‐fed rats. Prior to cell isolation, some alcohol‐fed rats were treated with intranasal GM‐CSF and then endotracheally inoculated with an attenuated strain of Mtb. Primary macrophages were then isolated and immunofluorescence was used to determine phagocytic efficiency and TLR2 expression in the presence and absence of GM‐CSF treatment and phagocytic efficiency in the presence and absence of TLR2 neutralization. Results TLR2 expression and phagocytosis of Mtb were significantly lower in the alveolar macrophages of alcohol‐fed rats than control‐fed rats. In parallel, blocking TLR2 signaling recapitulated this decreased phagocytosis of Mtb. In contrast, intranasal GM‐CSF treatment restored TLR2 expression and Mtb phagocytosis in the alveolar macrophages of alcohol‐fed rats to levels comparable to those of control‐fed rats. Conclusions Chronic alcohol ingestion reduces TLR2 protein expression and phagocytosis of Mtb, likely due to impaired GM‐CSF signaling. GM‐CSF restores membrane‐bound TLR2 expression and phagocytic function.

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