During infections, pathogens bind to toll-like receptor (TLR)4 and CD14 receptors and induce cytokine release, leading to inflammation. Here, we investigated TLR4 and CD14 expression on peripheral blood leukocytes (PBLs) and their roles in lipopolysaccharide (LPS)-induced cytokine and chemokine release. Full-term and preterm neonates and adults were studied. PBLs were pretreated with anti-TLR4 -and anti-CD14 -blocking antibodies and stimulated with LPS. Cytokine and chemokine levels were measured in supernatants. TLR4, CD14 expression, and LPS-induced CXCL8 release were higher in neonates, possibly contributing to aberrant inflammation. TLR4 blockade resulted in approximately 3-fold greater suppression of LPS-induced CXCL8 release in preterm neonates (38%) than in adults (14%). CD14 blockade (ϳ80%) in neonates induced approximately 3-fold greater inhibition of CXCL8 release, compared with anti-TLR4 (ϳ30%). Anti-TLR4 partly (50 -60%) inhibited IL-10 and TNF-␣, whereas anti-CD14 completely suppressed their release. Our findings reveal that neonates depend more on TLR4 for CXCL8 release. Furthermore, neonatal LPS-induced CXCL8 release, apart from TLR4/CD14-mediated signaling, is regulated by LPS interactions with other TLRs and/or immune receptors. IL-10 and TNF-␣ release depends on LPS binding not only to CD14/TLR4 but also to CD14 associated with another TLR. Our findings reveal the contribution of TLR4 and CD14 in neonatal cytokine and chemokine release and could aid in design of antagonists to prevent harmful inflammation. (Pediatr Res 66: 179-184, 2009) N eonates are highly susceptible to Gram-negative bacteria that induce high morbidity and mortality. The principal pathogenic agent involved in neonatal sepsis induced by Gramnegative bacteria is endotoxin lipopolysaccharide (LPS), an essential component of their surface. Defense against pathogens is offered by immune cells, such as granulocytes, monocytes, and dendritic cells (DCs), which express pattern-recognition receptors (PRRs) that recognize specific structures present on microorganisms, termed pathogen-associated molecular patterns (PAMPs) (1). Binding of PAMPs to PRRs triggers antimicrobial responses to combat the infection (1,2).LPS is one of the best characterized PAMPs that binds to the CD14/toll-like receptor (TLR)4/MD2 complex of PRRs and activates intracellular signaling (3). CD14 binds to LPS but lacks an intracellular component and is, thus, incapable of signaling. MD2 is a molecule necessary for LPS recognition by TLR4, which also cannot mediate signaling. TLR4, upon LPS binding, leads to intracellular activation of mitogenactivated protein kinase and nuclear factor-B that mediate the transcription of proinflammatory cytokine and chemokine genes (4). TLR4 signaling also activates DCs that subsequently present pathogenic peptides to T lymphocytes and, thus, stimulate T-cell-mediated immunity (5).The specific roles of TLR4 and CD14 in LPS-induced inflammatory responses by neonatal leukocytes remain not clearly defined. Studies in neona...