Fig. 1: Aging-related decline in intestinal P-gp transport function results in an augmented exposure to substrate drugs and heightened safety concerns.

A Comparison of drug exposure in older vs younger adults based on a systematic review of pharmacokinetic data for P-gp substrate drugs (n = 14/digoxin, n = 8/fexofenadine, n = 18/dabigatran, and n = 2/edoxaban). B Comparison of exposure variation in older vs younger adults based on systematic review of pharmacokinetic data for P-gp substrate drugs (n = 9/group). C Sensitivity analysis based on the influence of P-gp abundance in jejunum and ileum on dabigatran exposure. D Comparison of pharmacokinetic profiles of dabigatran in the population across different age groups under identical dosing regimen (110 mg QD and 150 mg QD) based on PBPK model (n = 1000). E Analysis of ABCB1 single gene expression distribution in intestinal epithelial cells across different age groups (n = 1024/20–30 group, n = 2896/45–65 group, and n = 5732/65–70 group). F Pseudotime analysis of human intestinal epithelial cells (n = 9652). G Pseudotime analysis of human intestinal epithelial cells by different age groups (n = 1024/20–30 group, n = 2896/45–65 group, and n = 5732/ 65–70 group). H An overview of the scientific hypotheses of this study. Created in BioRender. Pmx, F. (2025) https://BioRender.com/1tz487n. Data are presented as mean ± SD. Statistical analyses were conducted using a two-tailed unpaired t-test in (B) and Mann–Whitney U-test in (E). Exact P values are reported in the figures.