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Childhood-onset white matter diseases including multiple sclerosis and monogenetic leukoencephalopathies, are characterized by neuroinflammatory tissue damage. Here, we propose that CD8+ T cell phenotypes within lesions serve as critical immune checkpoints for tissue damage and regeneration. Our objective is to define CD8+ T cell-driven disease and regenerative pathways by utilizing a combination of multifluorescent immunohistochemistry, spatial transcriptomics and multimodal MR imaging in patients ...