In such lesions, similar to other members of the TNF receptor superfamily like 4-1BB, sOX40 may act as an antagonist to membrane-bound receptors and induce signaling in OX40L+ cells to produce cytokines, which in turn drive specific T helper (Th)-cell differentiation and suppress the generation of adaptive Tregs to participate in HAM/TSP pathogenesis. Here, TNFSF4 is linked to tropical spastic paraparesis.