NOD-like receptors are cytosolic proteins that contain a central nucleotide-binding oligomerization domain (NACHT), an N-terminal effector-binding domain and C-terminal leucine-rich repeats (LRRs). NOD-like receptors have been implicated as ancient cellular sentinels mediating protective immune responses against intracellular pathogens. Recent studies have described the genetic association of polymorphisms in NOD-like receptor genes with complex chronic inflammatory barrier diseases, such as Crohn's disease and asthma and with rare auto-inflammatory syndromes including familial cold urticaria, Muckle-Wells syndrome and Blau syndrome. Whereas genetic variability in NLRs may have been an important element to provide plasticity to antigen recognition and host defense in the past, recent changes in the lifestyle of industrialized societies (e.g. hygiene ("cold-chain-hypothesis"), nutrition, or antibiotics) may have turned ancient genetic variability into disease-causing mutations. The review focuses on NLR function in the molecular pathophysiology of human inflammatory disorders.