AbstractKupffer cells (KC) and gut‐derived bacterial endotoxin have been implicated in the aetiology of alcoholic liver disease. Usingin vivomicroscopic methods, we have shown that ethanol ingestion in mice causes a dose dependent increase in leucocyte adhesion and endothelial cell swelling in hepatic sinusoids. Activation of KC is elicited at low doses while depression occurs at high doses and with chronic exposure. The responses are exacerbated in the presence of endotoxaemia or sepsis and are not seen in endotoxin‐resistant animals, implicating a role for endotoxin in the ethanol‐induced inflammatory response. In addition, the responses are abolished with anti‐TNFαsuggesting that TNFαis a primary mediator of these events. Nitric oxide (NO) initially appears to play an important role in these events by stabilizing the TNFα‐mediated hepatic microvascular inflammatory response to acute ethanol ingestion, thereby helping to protect the liver from ischaemia and leucocyte induced oxidative injury. Finally, an ongoing clinical study has confirmed a mild systemic endotoxaemia in patients hospitalized for alcoholic liver disease. All of these results support important roles for endotoxin, cytokines, nitric oxide and sinusoidal lining cells in the pathophysiology of liver injury resulting from ethanol alone or in combination wi