The differentiated state of mature cells of adult organisms is achieved and maintained through the epigenetic regulation of gene expression, which consists of several mechanisms including DNA methylation. The advent of induced pluripotent stem cell technology enabled the conversion of adult cells into any other cell type passing through a stable pluripotency state. However, indefinite pluripotency is unphysiological, inherently labile, and makes cells prone to culture-induced alterations. The direct conversion of one cell type to another without an intermediate pluripotent stage is also possible but, at present, requires the viral transfection of appropriate transcription factors, limiting its therapeutic potential. The aim of this study was to investigate whether it is possible to achieve the direct conversion of an adult cell by exposing it to a demethylating agent immediately followed by differentiating culture conditions. Adult human skin fibroblasts were exposed for 18 h to the DNA methyltransferase inhibitor 5-azacytidine, followed by a three-step protocol for the induction of endocrine pancreatic differentiation that lasted 36 d. At the end of this treatment, 35 ± 8.9% fibroblasts became pancreatic converted cells that acquired an epithelial morphology, produced insulin, and then released the hormone in response to a physiological glucose challenge in vitro. Furthermore, pancreatic converted cells were able to protect recipient mice against streptozotocin-induced diabetes, restoring a physiological response to glucose tolerance tests. This work shows that it is possible to convert adult fibroblasts into insulin-secreting cells, avoiding both a stable pluripotent stage and any transgenic modification.pancreatic beta cell | cell plasticity R egenerative medicine requires new cells that can be delivered to patients for repairing and renovating degenerated or damaged tissues (1). When such cells are not readily available, two main strategies have been developed to obtain them: directed differentiation, by which pluripotent cells, exposed to specific cell culture conditions designed to mimic natural events, assume a specific cell fate, and transdifferentiation, also referred to as reprogramming, which enables a fully differentiated cell type to be converted into another without going through an undifferentiated pluripotent stage (2).Induced pluripotent stem cell (iPSC) technology showed that the stability of a mature phenotype can be overcome when transforming a somatic cell of any patient in an unlimited source of autologous pluripotent cells. The elimination of the immune rejection risk provided by iPSCs immediately boosted the clinical potential of directed differentiation (3). However, the requirement of permanent integration of viral vectors into the host genome to generate iPSCs poses a severe limit to their current therapeutic use (1). This has stimulated the development of several protocols for a virus-free iPSC derivation, but at present, these approaches are generally more technically demanding and l...