What Is EBO2 (EBOO) Therapy? Procedure, Evidence, Cost, and Safety

EBO2 (also called EBOO) stands for extracorporeal blood oxygenation and ozonation. Blood is drawn continuously, passed through a filter and a gas-exchange device where it meets an oxygen and ozone mixture, and returned to the patient [1]. An Italian group described the technique in the early 2000s as a way to deliver a more controlled ozone dose to a larger volume of blood than major autohemotherapy reaches [1]. One US clinic describes 2 to 5 liters of blood passing through the circuit in a 60 to 75 minute visit [2]. In the United States it is sold as an elective wellness procedure, paid for out of pocket, by clinics that describe themselves as offering functional and preventative care [2].

What EBO2 is

EBO2 is a blood-circuit procedure, not an injection or a drug infusion. A clinic that offers it describes the sequence as removing a quantity of the patient’s blood, mixing it with an oxygen and ozone blend, and returning it to the body [3]. What distinguishes EBO2 from earlier methods is that the loop runs continuously and combines extracorporeal filtration with gas exchange across a membrane [1]. Each session uses a single-use sterile circuit, filter and tubing set [2].

One Beverly Hills clinic describes running 2 to 5 liters of blood through the circuit over a 60 to 75 minute visit, with a licensed clinician present for the whole session [2]. Another, in West Palm Beach, describes a session as intake and safety clearance, then oxygenation, ozonation and filtration under the supervision of trained medical staff [4].

The volume of blood treated is the clearest difference from older ozone methods, and one clinic puts it front and center at 2 to 5 liters [2]. It is also the figure that a San Diego clinic offering the procedure calls a marketing gimmick, on the grounds that ozone dosing is measured in micrograms per milliliter and not in liters of blood processed [3]. Clinics do not agree on how a session should be dosed or how many sessions a course should contain. One states plainly that no published dosing standard for EBOO exists, so the number of sessions is set by the supervising clinician [2].

EBO2 vs EBOO: two names, one procedure

EBOO is the original abbreviation, used in the peer-reviewed literature since 2000 [5]. EBO2 is a later stylization of the same phrase, with the 2 doing the work of the second O. One clinic states the equivalence directly, describing EBOO as short for extracorporeal blood oxygenation and ozonation and noting that it is sometimes written EBO2 [4].

Two caveats are worth carrying into a consultation. First, some clinics attach a proprietary name: one West Palm Beach practice markets its version as “EBOOST” and describes it as EBOO delivered on a machine the clinic built itself [4]. Second, at least one clinic uses the two abbreviations to mean different things, reserving EBO2 for EBOO combined with a light-therapy device and pricing the two separately [3]. Another adds full-spectrum ultraviolet exposure to every session and calls the combination an O3UV protocol [2]. The name on the price list does not reliably tell you what is in the circuit, so ask which components a given clinic includes.

What happens during a session

Clinics describe a broadly similar sequence. Screening comes first: one clinic starts with an office consultation and basic safety labs, and says it can sometimes waive repeat testing if CBC, CMP and G6PD results from the past three months are available [3]. Another runs an intake and screening that includes a G6PD test before any first session, and says candidacy is settled before the patient pays for the procedure [2].

Blood is then routed into the circuit. It passes over a hemofilter: one clinic states that EBOO uses the same dialyzer filters as dialysis, arranged differently and without the dialysate fluid that dialysis relies on [3]. The oxygen and ozone mixture meets the blood across the membrane of a gas exchanger [1]. The exchanger the technique’s developers built was designed for minimal foreign-surface contact and a negligible priming volume, and was bench-tested on a buffered saline solution containing potassium iodide, not on blood or in patients [6]. A collection container is where any middle molecules that cross the membrane would be collected, which the same clinic presents as a theoretical possibility rather than a measured one [3].

Timing and monitoring vary by clinic. The Beverly Hills clinic quotes a 60 to 75 minute visit covering filtration, ozonation and ultraviolet exposure, with continuous clinician monitoring throughout [2]. Appointments run longer than the circulation time once intake, line placement and recovery are added. Clinics also differ on what the fee covers, with some bundling consultation, screening labs or a post-session IV and others billing each separately [2].

How it differs from MAH and 10-pass ozone

Major autohemotherapy, or MAH, is the older and far more common method. One clinic defines a pass as drawing a quantity of blood, infusing it with a measured concentration of ozone gas, and reinfusing it, with about 14,000 micrograms of ozone per pass and 7 to 10 minutes per pass [2]. It puts a standard MAH pass at roughly 200 mL, a fraction of what an EBOO session handles and in a fraction of the time [2]. 10-pass ozone repeats that cycle about ten times in one sitting, and the same clinic requires a G6PD test before a patient goes beyond three passes [2].

EBO2 replaces the batch with a continuous loop and adds the filter. The developers’ argument for it is dose control: a steady exchange across a membrane delivers a more measured dose to more blood than repeated batches do [1]. One US group measured ozone uptake during continuous countercurrent flow across a dialysis membrane and reported at least three times the uptake of other blood-ozone methods, describing it as the first quantitative comparison of its kind [7]. That measurement carries real limits: it came from the practitioners who use the method, PubMed lists no study-design type for it, and it reports no patient outcomes [7].

Price tracks intensity. At one clinic a 10-pass session is $599 and a standard single-pass MAH session starts at $250, against $799 for EBOO [2].

The proposed mechanism, and how much of it is established

The mechanistic case for ozone therapy was built largely by Velio Bocci. He argued that ozone is intrinsically toxic as an inhaled gas, yet produces a cascade of ozone-derived compounds when it dissolves in blood at judicious, physician-controlled doses, which he connected to effects in infections, vasculopathies and orthopedic conditions [8]. A later review stated the same idea as a paradox: prolonged inhalation damages the lungs, while a single precisely calibrated dose dissolved in blood outside the body triggers antioxidant and biochemical responses in blood cells and endothelium that the authors describe as useful in selected diseases without toxicity [9]. Both are narrative reviews by long-time proponents, with no systematic search and no new controlled data [8][9].

The proposed pathway runs through oxidative stress, where a brief oxidative stimulus is said to provoke a protective antioxidant response [9]. Where that idea has been tested directly in blood ozonation, the result has not been consistent. A controlled, single-blind crossover study of 12 hemodialysis patients compared nine sessions of ozonated autohemotherapy with nine sham oxygen-only sessions and found no significant change in plasma C-reactive protein or interleukin-6 [10]. Twelve patients and two markers cannot rule out other biological effects. The null result still stands as the recorded outcome of the study built to detect one [10]. Dose direction is not settled either: in 80 patients randomized to different ozone concentrations for lumbar disc herniation, a medium concentration reduced inflammatory markers while the highest concentration raised them [11].

The marketing framing is a separate question from the mechanism. Clinics commonly present EBO2 as a way to “detox” or clean the blood, and the filter is what makes that framing plausible to a reader. What the filter is documented to do is narrower. A clinic that offers the procedure states that middle molecules such as beta-2 microglobulin, urea, uric acid, cytokines and homocysteine could in theory cross the membrane, that this is inferred from dialysis and has not been measured in EBOO, and that no validated research published in the US has shown what the collection canister actually contains [3]. The same page calls “ozone dialysis” a misleading label, because dialysis removes solutes osmotically using large volumes of dialysate that EBOO does not use, and it warns readers to be wary of clinics claiming to filter plastics, biofilms, metals, viruses and bacteria [3]. The one published attempt to measure anything removed is a single-patient case report, covered below [12].

What the peer-reviewed evidence shows

Studies of EBOO itself

We located six indexed publications that describe EBOO itself, and five of them come from the group that developed it. They are listed with their study type, size and limitations in our research summaries.

The first human report, in 2000, described an author self-testing the device and noting that lipomas disappeared after six treatments, followed by use in a patient with Madelung disease and in several patients with atherosclerotic vasculopathy, with reported clinical benefit and no observed side effects [5]. It was an uncontrolled preliminary series, with self-experimentation and no precisely reported total sample size [5]. A 2002 case report described one dialysis patient with necrotizing fasciitis who improved after EBOO, with no control patient and no long-term follow-up reported [13]. A 2005 narrative review restated the rationale without new controlled outcome data [1]. A 2007 paper tested a new gas exchange device on the bench in saline rather than blood or patients [6].

The one controlled trial randomized 28 patients with peripheral artery disease to EBOO or intravenous prostacyclin. EBOO produced significantly greater regression of ischemic skin lesions and better pain and well-being scores, with no significant difference between groups in measured arterial circulation [14]. It is a single Italian center, 28 patients, and the available abstract does not describe blinding of outcome assessment or the randomization method [14].

The most recent entry is a 2025 case report in an 88-year-old woman with chronic iron-deficiency anemia. Across two series of EBOO treatments, urinary toxin-to-creatinine ratios fell by an average of 64.8% for mycotoxins, 25.7% for heavy metals and 55.1% for other environmental toxins; nickel did not fall, and hemoglobin was largely unchanged [12]. It is one patient, with no control for ongoing environmental exposure between measurements, so it cannot establish cause [12].

Evidence for ozone therapy more broadly

Most of the ozone research in this set studies injected or topical ozone for a local problem, which is a different intervention from running blood through a circuit.

A Cochrane review pooled three randomized trials of ozone for diabetic foot ulcers, 212 participants in total. One trial found greater ulcer-area reduction and shorter hospitalization than antibiotics; pooling the other two found no significant difference from usual care in healing, adverse events or amputation rate. All three were at high or unclear risk of bias, and the reviewers concluded that they could not draw firm conclusions about effectiveness [15]. A later review of 12 randomized trials in chronic wounds found faster wound-area improvement and a lower amputation rate for diabetic foot ulcers, while complete healing rates and hospital stay did not differ, and judged the evidence for other wound types uncertain [16].

In joints, a level-I meta-analysis of 424 patients found intra-articular ozone gave pain scores statistically similar to hyaluronic acid at 4 to 6 months, with no placebo arm and no longer-term comparison [17]. For low back pain from herniated disc, a systematic review of 8 observational studies and a meta-analysis of 4 randomized trials reported positive pain outcomes and low morbidity from percutaneous ozone injection, graded level II-1 to II-3, with the authors noting that no placebo-controlled trial was found [18]. The largest trial of systemic blood ozonation in this set is not an EBOO study: 140 patients with dry age-related macular degeneration received 27 sessions of major ozonated autohemotherapy over 12 months and retained visual acuity compared with multivitamin controls, though PubMed does not tag the paper as a randomized controlled trial, masking of assessors is not described, and a co-author is a leading proponent of ozone therapy [19].

What is missing

No large independent randomized trial of EBO2 has been published for any condition. The largest randomized EBOO comparison enrolled 28 patients at the developers’ own center [14], and every other EBOO-specific publication is a case report, a narrative review or a bench test [5][13][1][6][12]. One clinic states that there is no published dosing standard for EBOO to compare protocols against [2], and another that no validated research published in the United States has established what the filter removes [3]. No adverse-event registry exists either, so safety estimates borrow from studies of other ozone methods.

Regulatory status in the US and abroad

Ozone therapy is not FDA-approved to treat any condition. The governing regulation, 21 CFR 801.415, describes ozone as “a toxic gas with no known useful medical application” in specific, adjunctive or preventive therapy, and states that an effective germicidal concentration would exceed what people and animals can safely tolerate [20]. The same section states that a device generating ozone is considered adulterated or misbranded if it is used or intended for use in any medical condition for which there is no proof of safety and effectiveness, and caps ozone released into occupied indoor air at 0.05 parts per million by volume [20]. It also records that inhaled ozone irritates mucous membranes and can cause pulmonary edema whose onset is usually delayed for hours, and that olfactory fatigue makes smell an unreliable warning [20].

The agency has applied this to EBOO equipment directly. On 7 July 2025 the FDA’s Center for Biologics Evaluation and Research sent a warning letter to O3UV, LLC of Grand Ledge, Michigan, covering two autohemotherapy devices, Champion Full Spectrum and EBOO Full Spectrum UV, sold to practitioners across the United States and intended for conditions including autoimmune, cardiovascular and respiratory disease [21]. The letter found the devices adulterated because no premarket approval application was in effect and misbranded because no 510(k) notification had been submitted, and listed unique device identifier, registration and listing failures alongside eight quality-system findings including no design controls, no complaint procedure and no corrective-action procedure [21]. The same letter records that the EBOO kits were built around purchased polyethersulfone hemodialyzer filters from a supplier the firm had not evaluated [21].

Outside the US the picture is different, though not because the evidence is different. The available account of European regulation comes from the field’s own advocacy body rather than from a neutral registry, so read it as an interested party’s summary: AEPROMO, the Spanish association of medical professionals in ozone therapy, reports that five EU member states have regulated the practice in some form, namely Greece from 1991, Italy in three of its 20 regions, Spain in 15 of 17 autonomous communities for private practice, Portugal since 2013, and Germany under a general freedom-of-therapy principle, where statutory health insurance stopped reimbursing ozone therapy on 11 December 2020 while private insurers may still do so [22]. We found no independent regulatory source covering the same ground. Permission to practice a therapy is in any case a separate question from evidence that it works.

Safety, side effects, and who should not do it

Published safety data for EBO2 specifically are thin, because the EBOO literature is six papers with a combined sample in the dozens. What exists comes from ozone autohemotherapy and from case reports.

On the reassuring side, a randomized trial of 118 patients adding ozonated autohemotherapy to drug therapy for insomnia and myofascial pain reported no adverse complications in either group, though safety was judged by complications that happened to be observed rather than by systematic monitoring [23]. The chronic-wound review found no adverse events attributed to ozone across its 12 included trials [16].

On the other side, a 2017 case report describes a 54-year-old woman with hypertension, diabetes and chronic kidney disease who developed hyperkalemia during ozone autohemotherapy that progressed to sinus arrest; the arrhythmia resolved after ozone therapy was stopped and the potassium was treated [24]. One case cannot establish the mechanism, and the link rests on the sequence of events [24]. Dose is not neutral either: the disc-herniation trial found the highest ozone concentration raised inflammatory markers rather than lowering them [11].

The screening gate clinics use in practice is a G6PD test. People with glucose-6-phosphate dehydrogenase deficiency have less protection against oxidative damage to red cells, and oxidative treatments can trigger hemolysis in them, which is why one clinic runs the test before a first EBOO session and before any patient goes beyond three ozone passes [2]. Another looks for CBC, CMP and G6PD results from the past three months and offers ozone therapy only to established patients who have completed a medical assessment [3]. Beyond that, EBO2 carries the ordinary hazards of intravenous access and of any extracorporeal circuit, which is why clinics use a single-use sterile circuit, filter and tubing set for each session [2]. Anyone with kidney disease, an arrhythmia or an electrolyte problem has reason to raise the case report above with their own physician before booking.

What it costs and why insurance does not cover it

Three US clinic pages checked on 17 September 2026 list the following. The Beverly Hills clinic charges $799 for a single session and $699 per session in a four-session package totaling $2,796 [2]. The West Palm Beach clinic charges $830 [4]. The San Diego clinic charges $1,050 for EBOO and $1,250 for EBO2 with light therapy, with consultation and labs quoted separately [3].

Clinics’ own claims about the national range are wider than that sample and disagree with each other. One puts the usual advertised single-session price at $1,000 to $1,500, with packages bringing the effective price to roughly $900 to $1,200 [2]. Another cites $1,200 to $2,500 and prices its own session well below the band it quotes [4]. A typical course is described as three to six sessions spaced one to two weeks apart, which is what package pricing is built around [2]. Our cost guide tracks these figures with check dates.

Insurance does not reimburse EBO2, and the reason is the regulatory status rather than the price. Because no ozone therapy is FDA-approved for any diagnosis, insurers and Medicare treat it as elective, and HSA or FSA funds are typically ineligible without a letter of medical necessity that the plan administrator accepts [2]. One clinic states that it bills no insurance at all and takes payment at the time of service [2].

Who offers it and how to evaluate a clinic

EBO2 is offered in the US mainly by functional medicine and longevity practices [4], usually alongside IV vitamin therapy, peptides, hormones and other ozone methods [4][2]. Our clinic directory lists the US practices we have catalogued.

A few questions separate careful practices from the rest, and the sharpest ones come from clinics themselves. Ask whether a G6PD test is part of screening and whether it happens before the first session [2]. Ask who is in the room for the full hour and what their license is [2][4]. Ask exactly what the quoted fee covers, since consultation, labs and add-on IVs are billed separately at some clinics and bundled at others [2][3]. Ask what the clinic claims the filter removes, and whether it has published laboratory data supporting that claim; the San Diego practice makes that test explicit and warns against clinics claiming to filter plastics, biofilms, metals, viruses or bacteria without publishing the data [3].

Treat two specific pitches as warning signs. A clinic that performs the procedure calls the claim that a set number of sessions will filter all of your blood a marketing gimmick, and says dosing is measured in micrograms per milliliter [3]. The same clinic calls the label “ozone dialysis” misleading, because no dialysate is used [3]. And since one clinic states that no published dosing standard for EBOO exists [2], a clinic presenting its own protocol as the established one is overstating what is known.

History: from Bocci’s group to today’s clinics

EBOO began as hospital research. Nicola Di Paolo, Velio Bocci and colleagues reported the first human use of their apparatus in 2000, including an author’s self-experiment [5]. By 2002 they described it as already in routine use at their hospital when they published the necrotizing fasciitis case [13]. The 2005 controlled trial in peripheral artery disease and the 2005 review set out the clinical rationale that clinics still cite [14][1], and a 2007 bench study tested a purpose-built gas exchange device [6]. Bocci’s broader case for medical ozone ran in parallel through reviews in 2004 and 2009 [8][9].

The academic thread then thinned. The next notable contributions came from practitioners: a 2023 ozone-uptake measurement reported by the clinicians who use the method [7] and a 2025 single-patient case report [12]. The commercial side moved on a different track. By the time of the FDA’s 2023 inspection, one manufacturer was distributing EBOO and related equipment to physicians and nurses throughout the United States and marketing it for autoimmune, cardiovascular and respiratory conditions, which is what brought the 2025 warning letter [21]. That distance, between a technique with six indexed papers and equipment sold to practitioners nationwide, is the central fact about EBO2 today.

Bottom line

EBO2 (EBOO) is a real procedure with a coherent rationale and a very small evidence base. We located six indexed publications describing it [5][13][1][14][6][12], five of them from the Italian group that developed it, and the largest randomized comparison enrolled 28 patients at that group’s own center [14]. Ozone therapy is not FDA-approved for any condition, and 21 CFR 801.415 describes ozone as “a toxic gas with no known useful medical application” in specific, adjunctive or preventive therapy [20]; in July 2025 the FDA told a US manufacturer of EBOO equipment that its devices were adulterated and misbranded [21]. Three clinics checked in September 2026 charge $799 to $1,250 per session out of pocket [2][4][3]; two of them screen with a G6PD test before treating [2][3], and those same two disagree with each other about dosing and about what the filter does [2][3]. Anyone considering it should read the claims a clinic makes against what its own peers say is documented, and take the question to a physician who knows their history.