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Recent studies demonstrated that HELLP syndrome falls within the spectrum of secondary microangiopathy due to abnormal complement activation. However, to date, the link between angiogenic imbalance, endothelial dysfunction, and complement activation remains unclear. Building upon current understanding of complement regulation, this paper proposes a novel pathophysiological approach, suggesting a new understanding of HELLP syndrome and preeclampsia, including the undebatable role of sFlt\u20101\/PlGF and the knowledge of maternal systemic endothelial and renal diseases. We hypothesize that endothelial glycocalyx may be the missing link between angiogenic factors, inflammatory regulation, and endothelial maternal lesions. Targeting the glycocalyx\u2010endothelium axis may enable novel therapeutic strategies that delay delivery and reduce maternal\u2010neonatal morbidity in preeclampsia and HELLP syndrome.<\/jats:p>","DOI":"10.1002\/cph4.70032","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T09:30:58Z","timestamp":1754040658000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Endothelial Glycocalyx: The Missing Link Between Angiogenic Imbalance in Preeclampsia and Systemic Inflammation in <scp>HELLP<\/scp> Syndrome"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4805-2083","authenticated-orcid":false,"given":"Anthony","family":"Atallah","sequence":"first","affiliation":[{"name":"Department of Maternal\u2010Fetal Medicine Hospices Civils de Lyon, H\u00f4pital Femme M\u00e8re Enfant, Groupement Hospitalier Est  Bron France"},{"name":"Claude Bernard University 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