The COVID-19 pandemic, which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a public health emergency with high mortality and disability rates. Given its high mortality rate, there is a serious need for possible effective medications to eliminate the virus, limit the severity, and improve the prognosis (Altay et al., 2020). The management of COVID-19 has continued to rely on drugs repurposed based on their pharmacological effects, including antiviral, antibiotic, anti-inflammatory, and or immunomodulatory, along with availability of numerous vaccines against SARS-CoV-2 in past few months (Fan et al., 2020). Repurposing of drugs has gained enormous attention over identifying novel drug candidates, due to known safety, potency, and multi-targeted pharmacological action as an immunomodulatory, anti-inflammatory, and antimicrobial agent. Studies report that after fever, cough is one of the major symptoms in about 76% patients and sputum production in 28% patients along with 55 and 44% of patients showing dyspnea and myalgia, respectively (Huang et al., 2020). In a study determined the prevalence of asymptomatic cases of COVID-19 and characterized the symptoms of patients with mild COVID-19 report that of the 213 individuals with COVID-19, 19.2% were asymptomatic until admission (Kim et al., 2020). Among the remaining patients with mild COVID-19, cough (40.1%) was the most common symptom followed by hyposmia (39.5%) and sputum (39.5%). In individuals with hyposmia, 90% had accompanying symptoms such as hypogeusia, nasal congestion or rhinorrhoea (Kim et al., 2020). Sputum or productive cough seem a significant symptom in asymptomatic as well as symptomatic (Kim et al., 2020). Cough was observed most common symptom followed by hyposmia and sputum, while fever (>37.5°C) was only observed in 11.6% (Kim et al., 2020). Another study reported that nasal congestion (62%) was the most common symptom in individuals with mild COVID-19 (Chang et al., 2020). The role of mucolytic and bronchodilator administration and tracheal suctioning have been observed beneficial in airway hygiene by reducing the mortality rate of COVID-19 (Farooqi et al., 2020). Therefore, the role of mucolytics, in particular, has been suggested to protect the body from respiratory pathogens ascribed to their expectorant action, and are considered important as an adjuvant in the management of COVID-19 (Esam, 2020). In the purview of the pharmacological basis of therapeutics, we hypothesize that a proteolytic drug of natural origin, serratiopeptidase (SEPD), also known as Serratia E-15 protease or serralysin, serratiaprotease and serrapeptase (Bhagat et al., 2013). SEPD (EC number 3.4.24.40), a serine protease super is derived from the non-pathogenic enterobacteria, which exists in the intestine of the silkworm and facilitates disruption of the cocoon to free the silk moth (Maeda and Morihara, 1995). The forms used in pharmaceutical preparations are isolated from Serratia marcescens or Serratia sp. E 15 based on fermentation or the recombinant production using Escherichia coli (Srivastava et al., 2019). Enzyme drugs are reputed in therapeutics due to their strong target binding and specificity and catalytic behavior to change many target molecules into the desired effectors (Reshma, 2019). Proteolytic enzymes can be useful in the treatment of nosocomial, viral, and resistant infections, especially in pediatric and geriatric age groups due to its relative safety, less tolerance and resistance and its synergic effects (UmaMaheswari et al., 2016). Several proteolytic enzymes act in an orchestrated manner to control and coordinate the entry of virus, replication and diffusion in the host cells. Thus, the proteolytic enzymes could be important in interfering with virus machinery in the host cells and suggested useful in COVID-19 (Gioia et al., 2020). Recently, SEPD has been suggested to be considered in integrative management of COVID-19 (Holloway et al., 2020). One of the case report suggested the role of immunostimulants and proteolytic including SEPD in the treatment of COVID-19 (Kobakova et al., 2020). Our proposition is to repurpose a drug that possesses not only mucolytic property but also potent anti-inflammatory, and antimicrobial properties with a long history of safe clinical use. Herein, we present the possibilities of repurposing SEPD, a mucolytic that could be advantageous over others in COVID-19 treatment due to its wide range of therapeutic effects, including anti-inflammatory, antimicrobial, atheroprotective, antithrombotic, and fibrinolytic properties. Based on these properties, we opined that these properties may provide better therapeutic benefits in limiting the severity and progression of the disease, by reducing the risks of respiratory complications and related death. Serratiopeptidase as A Mucolytic Drug Can Be Useful in COVID-19 In individuals with COVID-19, sputum production, nasal congestion and cough are reported one of the common symptoms after fever (Chang et al., 2020; Huang et al., 2020; Kim et al., 2020). As cough is a major symptom of SARS-CoV-2 infection, the caseinolytic and mucolytic actions of SEPD on the sputum believed to be beneficial. Recently, one of the mucolytic drugs, bromhexine, has been suggested to be repurposed for the possible treatment of COVID-19 (Maggio and Corsini, 2020). Mucolytics either enhance bronchial mucus secretion or reduce mucus viscosity and further facilitate its removal by coughing. The mucus secreted by the goblet cells is an adhesive viscoelastic gel containing high molecular weight mucous glycoproteins and water. The airway mucus is well-known as the first line of airway defense against pathogens, including coronaviruses. The hypersecretion of the airways mucus in a defensive response to the pathogens are believed to cause airway obstruction that leads to respiratory distress (Lu et al., 2021). The mucus in airways traps and keep the microorganisms by a coordinated process of mucociliary clearance which involves release of mucus from the secretory cells controlling the transportation and viscoelasticity by motile cilia on multiciliated cells (Janssen et al., 2016). Mucus accumulation and increase in sputum viscoelasticity reduce mucociliary and cough clearance, thus retaining the sputum and obstructing the airways that enhance inflammation, infection, and progressive lung diseases by neutrophil infiltration (Maggio and Corsini, 2020). SEPD is shown to enhance mucociliary transportability (Maheshwari et al., 2006) and mucociliary clearance by decreasing neutrophils and modulating sputum viscoelasticity in patients with airway diseases (Nakamura et al., 2003). In addition to the mucolytic property, SEPD through oral administration in allergic conditions decreases the viscosity of the nasal mucus by improving rheological properties; thus, it plays a role in mucociliary clearance (Majima et al., 1988; Majima et al., 1990). SEPD has been found bioavailable in the nasal or tracheobronchial mucus, and it exerts proteolytic action even after oral intake (Majima et al., 1988; Majima et al., 1990). Recently, the role of mucins glycoproteins, the structural components of mucus and its interaction with microorganisms particularly SARS-CoV-2 and its pathophysiological and therapeutic relevance has been presented to enhance mucosal defense and control respiratory infections (Chatterjee et al., 2020). The elevated levels of mucin has been reported in the airway mucus of critical ill COVID-19 patients (Lu et al., 2021). The higher levels of mucins are reported in the COVID-19 patients bronchoalveolar lavage fluid (BALF) and lungs of preclinical models of SARS-CoV-2 (Liu et al., 2020). Liu et al. (2020) suggested that during SARS-CoV-2 infection, the rise in the IFN-β and -γ leads higher expression of mucins in alveolar epithelial cells. The mucins stick with the blood-gas barrier and accumulated alveolar mucus affects the blood-gas barrier thereby impeding the gaseous exchange of O2 and CO2 and causing hypoxia, a key factor that initiates COVID-19-induced mortality. Following progression in the diseases, increase in barrier thickness, along with raised inflammatory exudates causes impediment in exchange of O2 and CO2 that leads to the critical illness and complications (Liu et al., 2020). Additionally, SEPD has shown useful in chronic respiratory diseases (Nakamura et al., 2003), chronic sinusitis (Majima et al., 1988), ear, nose and throat disorders (Mazzone et al., 1990), secretory otitis media (Bellussi et al., 1984) and chronic airway disease with troubled expectoration (Nagaoka et al., 1979). Based on the role of SEPD on mucociliary clearance, relieving cough and promoting airway hygiene, it may be useful in delaying pulmonary complications and improving quality of life in COVID-19.