Immunoadsorption in ME/CFS and Long COVID: Benefits and Limits
Immunoadsorption (IA) is emerging as a promising experimental therapy for postviral conditions, including ME/CFS and long COVID. But despite headlines about “detox,” IA has a highly specific function: it removes certain antibodies—not environmental toxins or other byproducts many patients worry about.
In this post, we’ll explain how IA works, what the latest studies show, who might benefit, and where the real—and the mistaken—expectations lie.
What Is Immunoadsorption Therapy for ME/CFS and Long COVID?
Immunoadsorption is an extracorporeal treatment: blood is circulated out of the body and passed through a column designed to bind specific proteins—mainly immunoglobulins like IgG—as well as immune complexes. Unlike plasma exchange, which removes a broad range of plasma proteins nonselectively, IA is much more targeted (Scheibenbogen et al., 2018). Think of it as precision immunoglobulin filtering.
Why Is IA Being Studied for ME/CFS and Long COVID?
A growing number of patients with ME/CFS or post-COVID syndrome test positive for autoantibodies that target β2-adrenergic and muscarinic (M3/M4) receptors—proteins that help regulate blood vessel tone, heart rate, and digestion. These autoantibodies may play a key role in common symptoms like fatigue, orthostatic intolerance, and brain fog (Sotzny et al., 2022). Since IA can specifically lower these antibodies, researchers are investigating its potential to relieve symptoms.
Evidence So Far: Immunoadsorption for ME/CFS and Long COVID
2018 pilot study (n = 10): Participants with ME/CFS underwent IA treatment. Seven of them reported rapid symptom improvements that lasted several months. The researchers observed significant decreases in β2-adrenergic receptor autoantibodies (Scheibenbogen et al., 2018).
2024 prospective cohort (20 post-COVID ME/CFS patients): After five IA sessions, IgG and β2-receptor autoantibodies dropped by around 78%. Seventy percent of patients experienced meaningful improvements in physical functioning that persisted up to six months (Stein et al., 2024).
Randomized controlled trials (ongoing): Two major studies—IA-PACS-CFS (double-blinded, placebo-controlled) and IAMPOCO (single-blind, crossover)—are recruiting now. These trials aim to provide stronger evidence about IA’s effectiveness (Preßler et al., 2024; Stortz et al., 2025). Both studies take place in Germany.
While these early results are encouraging, IA is still under investigation. It has not yet been approved for ME/CFS or long COVID, and we need controlled trial outcomes before concluding.
Does Immunoadsorption Reduce Antibodies to Chronic Viruses?
One important point about immunoadsorption is that it is not virus-specific. Most devices remove IgG broadly, meaning that antibodies to common latent viruses—like Epstein–Barr virus (EBV), human herpesvirus-6 (HHV-6), or cytomegalovirus (CMV)—are reduced alongside the targeted autoantibodies (Scheibenbogen 2018; Stein 2024).
Why does this matter? Many people with ME/CFS and long COVID have immune systems that show signs of frequent activation against these chronic or latent viruses. It’s possible that part of the benefit seen with IA could come from temporarily lowering this viral immune “background noise,” not just the autoantibodies directed at adrenergic or muscarinic receptors.
This is still speculative—studies so far have focused on receptor autoantibodies, and no trials have directly linked symptom improvement to lowering anti-viral IgG. But for clinicians and researchers, it’s a reminder that IA changes the broader antibody landscape, not just one target.
Who Could Benefit From Immunoadsorption in ME/CFS and Long COVID?
So far, the most promising results come from patients who:
Have post-infectious ME/CFS or long-COVID syndrome;
Show elevated levels of β2-adrenergic or muscarinic autoantibodies;
Experience autonomic dysfunction or characteristic immune patterns.
Whether IA would benefit other clinical presentations—like those without detectable autoantibodies—is still unknown.
What Immunoadsorption Removes—and What It Doesn’t in ME/CFS and Long COVID
What IA can remove:
Immunoglobulins (IgG, IgM, IgA, etc.);
Free light chains and immune complexes;
Specific autoantibodies, depending on column design
What IA cannot remove:
Microplastics/nanoplastics: These are solid particles found in blood; IA columns do not filter particulate matter. There is no known method to remove these as of yet.
PFAS (“forever chemicals”): Small, protein-bound molecules—not the targets of IA—and seem to be best removed by traditional dialysis (Huang et al., 2023).
Mycotoxins: no specific IA columns exist to capture them.
LPS (endotoxin): Requires hemoperfusion cartridges like polymyxin-B, not IA devices (Cutuli et al., 2016). This is usually reserved for severe LPS exposure during septic shock, not the subclinical exposures seen in postviral illness.
Spike protein – IA does not remove viral proteins like SARS-CoV-2 spike protein. A different technique, H.E.L.P. apheresis, has been proposed to bind and remove spike fragments along with fibrinogen, cytokines, and other pro-inflammatory factors (Jaeger et al., 2022). While intriguing, this approach is investigational and distinct from IA. It does not remove antibodies.
Is Immunoadsorption Safe and Available for ME/CFS and Long COVID?
IA is usually administered in 5 sessions over 1 week, sometimes followed by intravenous immunoglobulin (IVIG). Most patients tolerate it well, though there are occasional side effects: hypotension, vascular access issues, and temporary symptom flares (Scheibenbogen et al., 2018; Stein et al., 2024). As one can imagine, therapy could be a bit intense to experience.
Right now, IA remains investigational for ME/CFS and long COVID and is generally accessible only in specialized centers or via clinical trials.
Final Thoughts on Immunoadsorption for ME/CFS and Long COVID
Immunoadsorption holds promise for a subset of ME/CFS and long-COVID patients—particularly those with autoantibodies against adrenergic or muscarinic receptors. Early findings are encouraging, but randomized controlled trials are crucial to validate efficacy and safety.
Importantly, IA is not a “do-it-all detox.” It does not clear PFAS, microplastics, mycotoxins, or other environmental toxins—not unless specially designed adsorption columns are developed. So far, this has not been an area of research interest for postviral patients.
As research evolves, IA may find a place in targeted, antibody-mediated treatment strategies for ME/CFS and long COVID. It’s also likely that this therapy will need to be combined with other approaches that address additional aspects of postviral pathology, such as mitochondrial dysfunction and neuroinflammation.
References
Cutuli SL, Artigas A, Fumagalli R, et al. Polymyxin-B hemoperfusion in septic patients: analysis of a multicenter registry. Ann Intensive Care. 2016;6(1):77. doi:10.1186/s13613-016-0178-9
Jaeger BR, Arron HE, Kalka-Moll WM, Seidel D. The potential of heparin-induced extracorporeal LDL/fibrinogen precipitation (H.E.L.P.)-apheresis for patients with severe acute or chronic COVID-19. Front Cardiovasc Med. 2022;9:1007636. Published 2022 Oct 11. doi:10.3389/fcvm.2022.1007636
Preßler H, Machule ML, Ufer F, et al. IA-PACS-CFS: a double-blinded, randomized, sham-controlled, exploratory trial of immunoadsorption in patients with chronic fatigue syndrome (CFS) including patients with post-acute COVID-19 CFS (PACS-CFS). Trials. 2024;25(1):172. Published 2024 Mar 7.
Stortz M, Klimpke P, Kommer A, et al. Immunoadsorption study Mainz in adults with post-COVID syndrome (IAMPOCO)-a single-blinded sham-controlled crossover trial to evaluate the effect of immunoadsorption on post-COVID syndrome. Trials. 2025;26(1):119. Published 2025 Apr 3
Sotzny F, Filgueiras IS, Kedor C, et al. Dysregulated autoantibodies targeting vaso- and immunoregulatory receptors in Post COVID Syndrome correlate with symptom severity. Front Immunol. 2022;13:981532. Published 2022 Sep 27. doi:10.3389/fimmu.2022.981532
Huang JK, Chuang YS, Wu PH, et al. Decreased levels of perfluoroalkyl substances in patients receiving hemodialysis treatment. Sci Total Environ. 2023;896:165184. doi:10.1016/j.scitotenv.2023.165184
Scheibenbogen C, Loebel M, Freitag H, et al. Immunoadsorption to remove ß2 adrenergic receptor antibodies in Chronic Fatigue Syndrome CFS/ME. PLoS One. 2018;13(3):e0193672. Published 2018 Mar 15. doi:10.1371/journal.pone.0193672
Stein E, Heindrich C, Wittke K, et al. Efficacy of repeated immunoadsorption in patients with post-COVID myalgic encephalomyelitis/chronic fatigue syndrome and elevated β2-adrenergic receptor autoantibodies: a prospective cohort study. Lancet Reg Health Eur. 2024;49:101161. Published 2024 Dec 12. doi:10.1016/j.lanepe.2024.101161
