This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: General pathology, Subject name: Pathology
Endotoxin shock is intiated by - 
Select and explain. 
A. endothelial injury, B. Peripheral vasodilation, C. Increased vascular permeability, D. Cytokines action
D: Cytokines action
Answer: D: Cytokines action 
Explanation: Cells of the innate immune system express receptors (e.g., Toll-like receptors ) that recognize a host of microbe-derived substances containing so-called pathogen-associated molecular patterns (PAMPs). Activation of pathogen recognition receptors by PAMPs triggers the innate immune responses that drive sepsis. Upon activation, the inflammatory cells produce TNF and IL-1 (and other cytokines), plus cytokine-like mediators such as high-mobility group box 1 (HMGB1). Reactive oxygen species and lipid mediators such as prostaglandins and plateletactivating factor (PAF) also are elaborated (Chapter 2). These effector molecules activate endothelial cells, resulting in expression of adhesion molecules. ( Robbins Basic Pathology, 9 th edition, page 95 )