Metabolic dysfunctionāassociated steatohepatitis (MASH) is a leading cause of chronic liver disease with few therapeutic options. To narrow the translational gap in the development of pharmacological MASH treatments, a 3D liver modelĀ from primary human hepatocytes and nonāparenchymal cells derived from patients with histologically confirmed MASH was established. The model closely mirrors diseaseārelevant endpoints, such as steatosis, inflammation and fibrosis, and multiāomics analyses show excellent alignment with biopsy data from 306 MASH patients and 77 controls. By combining highācontent imaging with scalable biochemical assays and chemogenomic screening, multiple novel targets with antiāsteatotic, antiāinflammatory, and antiāfibrotic effects are identified. Among these, activation of the muscarinic M1 receptor (CHRM1) and inhibition of the TRPM8 cation channel result in strong antiāfibrotic effects, which are confirmed using orthogonal genetic assays. Strikingly, using biosensors based on bioluminescence resonance energy transfer, a functional interaction along a novel MASH signaling axis in which CHRM1 inhibits TRPM8 via Gq/11 and phospholipase Cāmediated depletion of phosphatidylinositol 4,5ābisphosphate can be demonstrated. Combined, this study presents the first patientāderived 3D MASH model, identifies a novel signaling module with antiāfibrotic effects, and highlights the potential of organotypic culture systems for phenotypeābased chemogenomic drug target identification at scale.