Distinguished Professor and Chairman , Department of Pathology and Laboratory Medicine
Education & Training
- University of Chicago, 1965
- University of Chicago
- Postgraduate Training
- University of Chicago, Anatomic and Clinical Pathology
- Board Certification
- Anatomic and Clinical Pathology
Areas of Interests
- Clinical Interests
- Clinical pathology, Immunology, Autopsy Pathology
- Research Interest
- Immunopathology, Pathogenesis of tuberculosis
Pathogenesis 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.
Exploring New Ways to Deliver Value to Healthcare Organizations: Algorithmic Testing, Data Integration, and Diagnostic E-consult Service. Ann Clin Lab Sci 45: 239-247.
As the USA Health Care System undergoes transformation and transitions to value-based models it is critical for laboratory medicine/clinical pathology physicians to explore opportunities and find new ways to deliver value, become an integral part of the healthcare team. This is also essential for ensuring financial health and stability of the profession when the payment paradigm changes from fee-for-service to fee-for-performance. About 5 years ago we started searching for ways to achieve this goal. Among other approaches, the search included addressing the laboratory work-ups for specialists’ referrals in the HarrisHealth System, a major safety net health care organization serving mostly indigent and underserved population of Harris County, TX. We present here our experience in improving the efficiency of laboratory testing for the referral process and in building a prototype of a diagnostic e-consult service using rheumatologic diseases as a starting point. The service incorporates algorithmic testing, integration of clinical, laboratory and imaging data, issuing structured comprehensive consultation reports, incorporating all the relevant information, and maintaining personal contacts and an e-line of communications with the primary providers and referral center personnel. Ongoing survey of providers affords testimony of service value in terms of facilitating their work and increasing productivity. Analysis of the cost effectiveness and of other value indicators is currently underway. We also discuss our pioneering experience in building pathology residents and fellows training in integrated diagnostic consulting service.
1967-1969 Staff Associate, L.I., NIAID, NIH, Bethesda, Maryland
1975-1980 Research Career Development Award, NIH CAOO032
1970-1980 Instructor, Asst. and Assoc. Professor of Pathology, University of Chicago
1973- Board Certification – Clinical and Anatomic Pathology
1980-1997 Emory University, Atlanta, GA
Professor of Pathology, School of Medicine
Director of Diagnostic Immunology Laboratories
Director of Ph.D. Program in Experimental Path., Graduate School of Arts and Sciences
1997- to present- University of Texas Medical School, Houston, TX
Distringuished Professor of Pathology and Laboratory Medicine
Chairman. Dept. of Pathology and Laboratory Medicine
Awards and Other Professional Activities:
2015 – Gold Headed Cane Award from the Association of Clinical Scientists
2015 – Harlan J Spujt Award for sustained and distinguished scholarly achievement in pathology
by the Houston Society of Clinical Pathologists
2014 – Presidents Award of The Texas Society of Pathologists
2010 – George T. Caldwell Distinguished Service Award, Texas Society of Pathologists
2003 – Philip Levine Award for outstanding research by the American Society for Clinical Pathology
1987 – Diploma of Honor in recognition of Outstanding Contributions to Clinical Science awarded by The Association of Clinical Scientists
1988 – Commissioners’ Medal awarded by the American Society of Clinical Pathologists for Outstanding Service as Chairman of the Council on Immunopathology
1989 – Sunderman Award to The Clinical Scientist of the Year awarded by The Association of Clinical Scientists, during the 40th anniversary meeting of the society.
1986 -1991 Member, Tuberculosis Panel, U.S.-Japan Cooperative Medical Science Program
1998 – 1998 Member of Special Study Section for Malaria, NIAID, NIH
1999 NIH Special Study Section Reviewer, “Bioengineering Partnerships”
1999 Chairman, Special Emphasis Panel, AIDS and related research NIAID-NIH
1999 – 2011, Member VACC Special Study Section on Vaccines, NIH