University of Chicago, 1965
University of Chicago
Postgraduate Training
University of Chicago, Anatomic and Clinical Pathology
Board Certification
Anatomic and Clinical Pathology

Areas of Interest

Clinical Interests

Clinical pathology, Immunology, Autopsy Pathology

Research Interests

Immunopathology, Pathogenesis of tuberculosisPathogenesis of Tuberculosis.

Development of vaccines and host directed therapies for post-primary tuberculosis (TB) is impeded by a flawed paradigm that granulomas are the key lesion of both primary and post-primary TB. As a result, investigators have neither reliable targets nor biomarkers. This paradigm derives from animal studies in the late 20th century. We have rediscovered, confirmed and extended the paradigm that obstructive lobular pneumonia, not granulomas, is the precursor lesion of post-primary TB (1-7). This lesion is seldom seen because it is asymptomatic. It develops in people with sufficient immunity to heal all granulomas. Alveolar macrophages in the least active part of the lung become infected and small bronchioles become obstructed. The lesions spread for months via bronchi before rapidly undergoing necrosis to produce clinical disease. Our recognition of the precursor lesion of post-primary TB and development of an animal model provide both a target and biomarkers for development of host directed therapy. Such therapies involving immune checkpoints are being intensively studied for cancer. We use methods and results of studies with cancer in coordinated studies of human and mouse TB to define the microenvironment of developing post primary TB and evaluate agents for host directed therapy of TB.

1. Hunter, R. 2015. Tuberculosis as a three-act play: A new paradigm for the pathogenesis of pulmonary tuberculosis. . Submitted.

2. Hunter, R. L., J. K. Actor, S. Hwang, V. Karev, and C. Jagannath. 2014. Pathogenesis of Post Primary Tuberculosis: Immunity and Hypersensitivity in the Development of Cavities. Ann Clin Lab Sci 44: 365-387.

3. Hunter, R. L. 2011. On the pathogenesis of post primary tuberculosis: the role of bronchial obstruction in the pathogenesis of cavities. Tuberculosis (Edinb) 91 Suppl 1: S6-10.

4. Hunter, R. L. 2011. Pathology of post primary tuberculosis of the lung: an illustrated critical review. Tuberculosis (Edinb) 91: 497-509.

5. Hunter, R. L., C. Jagannath, and J. K. Actor. 2007. Pathology of postprimary tuberculosis in humans and mice: contradiction of long-held beliefs. Tuberculosis (Edinb) 87: 267-278.

6. Hunter, R. L., M. Olsen, C. Jagannath, and J. K. Actor. 2006. Trehalose 6,6′-dimycolate and lipid in the pathogenesis of caseating granulomas of tuberculosis in mice. Am J Pathol 168: 1249-1261.

7. Welsh, K. J., S. A. Risin, J. K. Actor, and R. L. Hunter. 2011. Immunopathology of Postprimary Tuberculosis: Increased T-Regulatory Cells and DEC-205-Positive Foamy Macrophages in Cavitary Lesions. Clinical and Developmental Immunology 2011: 1-9.